Polio Wars (21 page)

Convinced that the Kenny method described in Cole and Knapp's
JAMA
article was an important step toward improving polio therapy, a number of physicians, nurses, and physical therapists wanted to see the nurse and her work for themselves. In August 1941, during the worst polio epidemic Manitoba had then experienced, Canadian pathologist Bruce Chown, who had become director of the Winnipeg Children's Hospital while its regular administrator was in the armed forces, invited Kenny to visit the hospital and demonstrate her work.
¹¹³
A few weeks earlier Chown had visited polio clinics in the United States including an unscheduled trip to Minneapolis. While “the time obviously was too short … to learn Nurse Kenny's methods in detail,” he told his hospital's trustees, he had been impressed by what he had seen and felt “very strongly that, if possible, we should send a member of the Physiotherapy Department … to spend three to six months under Nurse Kenny studying her methods in detail.”
¹¹⁴

In a dramatic move, reported in the Minneapolis newspapers, Kenny and Mary flew to Winnipeg. At the Children's Hospital Kenny “went from one bedside to another and called attention to the errors that had been made by the orthodox procedure.” “Fortunately,” she noted, the “orthodox procedure had not been adhered to strictly” and patients were
not immobilized “to the same extent as in many other institutions.”
¹¹⁵
Kenny's identification of previously unnoticed symptoms caught the attention of hospital staff who watched as she “showed us spasm in some of muscles of every one of our patients.”
¹¹⁶
This act of showing and then treating was dramatic and transformative. “Sister Kenny showed us some things about poliomyelitis of which we had not been aware,” Alfred Deacon, the hospital's senior orthopedic surgeon, told Don Gudakunst a few weeks later; “we had not noticed these things ourselves, nor had we seen them mentioned in [the] medical literature on poliomyelitis.” Deacon was particularly struck by Kenny's ability to demonstrate the “functional nature of flaccid paralysis”; after she named and treated the new symptoms, patients began “to use muscles they had not used for days or weeks, a few times in a few minutes.”
¹¹⁷
Here evidence of the disabled and then healed body told a memorable clinical story.

Kenny left Winnipeg after a few days, leaving Mary for 2 more weeks to oversee the work and to teach members of the hospital staff the new methods. When the Winnipeg epidemic subsided Deacon and Helen Ross, the hospital's chief physical therapist, traveled to Minneapolis to learn more.
¹¹⁸
They “came back convinced of two things,” Bruce Chown reported to the hospital's trustees, “1, that the method
is
good and 2, that we have been carrying it out essentially as Sister Kenny does except that we have been over cautious in allowing patients out of bed.” Chown also proudly told the board that he had been asked to report “on our experiences here” to the director of the national department of pensions and national health in Ottawa. “Once again,” he declared, “we are in the forefront of the attack on disease as we have been in the past.”
¹¹⁹
The doctors, nurses, and physical therapists at the Winnipeg Children's Hospital continued their clinical commitment to Kenny's work long after this early visit, and as national and international publicity around her work intensified, the hospital became known as a center for the Kenny method. When specialty committees later began to investigate her method they traveled to Winnipeg.
¹²⁰

The success of the Winnipeg trip inspired Kenny to seek out other opportunities to speak to medical groups. During the following months she addressed medical societies in Duluth, Minnesota, and in Columbus, Ohio, and was the featured speaker at the New York Hospital for Joint Diseases.
¹²¹
She also visited the Willard Parker Hospital (the city's contagious disease hospital), the Ruptured and Crippled Hospital, and New York's Orthopedic Hospital. She made sure that the NFIP's medical director Don Gudakunst accompanied her on as many of these visits as possible and listened to the praise she received.
¹²²

Travel enabled her to gather comments from new allies and to introduce her methods and ideas directly, not filtered through second-hand reports. Throughout her career she consistently made much of the credibility of personal observation. Ignoring her own resistance to showing her work during the physical therapists' visit, she reminded O'Connor that it had surely been unwise to have chosen therapists to evaluate her treatment that “they had never seen” and were “not even familiar” with. Fortunately the Kendalls' attacks could now be countered by her new American medical allies. “I was informed by the Senior Orthopedic Surgeon of a world famed clinic that my knowledge of muscle action was not equalled [sic] in any part of the world,” she told O'Connor, and, at a recent meeting in New York that Dr. Gudakunst had attended, “a foremost orthopedic surgeon” had said “that my knowledge of muscle anatomy and function was unsurpassed anywhere.”
¹²³

Kenny's base in Minneapolis was boosted by her first celebrity patient: Marjorie Lawrence, a soprano from the Metropolitan Opera who had become paralyzed while singing in Mexico a few months earlier. Lawrence was a fellow Australian. Born in a country town outside Melbourne, she had made her debut at New York's Metropolitan Opera in 1935 and delighted opera audiences when she became the first Brunnhilde to follow Richard Wagner's directions explicitly by riding a horse into the flames of Siegfried's funeral pyre in the final scene of the Ring cycle.
¹²⁴
Lawrence became Kenny's patient in September 1941 and found her both fierce and gentle, exuding “the strength of authority” combined with “a blend of warm humanity.”
¹²⁵
After a month Lawrence moved out of the hospital into a nearby apartment, where Kenny therapists could visit her, and her husband, an osteopath, could continue her treatment. Although she was not able to walk Lawrence began to retrain her voice, and in 1943 she returned to the Metropolitan Opera stage as a guest artist, singing Venus in “Tannhauser” seated on a divan. She was wheeled out to take her bows. “Diva Returns, Paralysis Beaten” announced the
New York Times
.
¹²⁶

Kenny did not read a copy of the Kendall's report on their visit until after she returned from Canada. In her 8-page reply to O'Connor she explained that their attack on her work was the result of their inability to “calmly make a comparison of the two treatments and the results.” Had they approached their task rationally and unemotionally instead of with professional defensiveness, they would have seen, just as “all previous critics” had admitted, that “deformities do occur despite the best efforts of the orthopedic surgeon … [and] that quite a degree of this deformity was corrected when all supporting apparatus is removed and Kenny treatment substituted.”
¹²⁷
Kenny also became convinced that the Kendalls were trying to turn other professionals against her. “It was rather unfortunate that Dr. Lewin had the disadvantage of several days with the Kendalls before having the opportunity of meeting myself,” she complained in a letter to Fishbein, for “the Kendalls have a wrong conception of the disease, and, I am afraid, know very little about the symptoms they are undertaking to present a treatment for and would prefer the child to suffer rather than their own professional pride.”
¹²⁸
In later years Kenny described the January 1941 visit many times. Sometimes she attacked the Kendalls' “obstinance and prejudice,” which had led them to stay away from the afternoon demonstrations; at other times she said “they were probably honest in their convictions and preferred not to see afflicted children suffer from a treatment they believed to be not only unwise and positively damaging.”
¹²⁹

When Kenny later discussed the January 1941 visit in her autobiography she made it a serious professional group: “a convention of members of the American Physiotherapy Association, delegates… from Baltimore, Chicago, Georgia Warm Springs, and many other cities.” She referred to the Kendalls as 2 “prominent physiotherapists,” and not by name but as 2 men who “especially requested that I should not be permitted to teach my treatment of the disease.” The erasure of Florence Kendall was a poignant reminder of the women physical therapists who had mocked Kenny in Australia. In ignoring the warm reception she received from local women therapists Kenny made herself the lone woman standing up against all these men. She dismissed their report as a personal and irrational attack that “appeared to be much more concerned with me personally than with my work.”
¹³⁰
She did not refer to Alice Plastridge's more positive reports on the visit, which she may not have seen, but she also did not recount the enthusiasm expressed by Plastridge and the other visiting therapists. Indeed, physical therapists were portrayed as unable to break out of their traditional mindset and recognize another woman
professional's contribution to medicine. “It was too much for me to hope that an audience habituated to one way of thinking would turn from the opinions of indisputable authorities and embrace those of a comparative stranger.”
¹³¹

Kenny recognized that she had to provide evidence to justify her provocative claim that her work led to fewer disabilities than any other polio treatment. The testimonials she had brought with her from Australia and those she was gathering from American physicians had not impressed the visiting therapists and might not sway other skeptics. While the bodies of her patients in Minneapolis remained her most powerful living testimonials, she knew that they could be dismissed as anomalies. Although she continued to resist the necessity for detailed clinical records or muscle testing, Kenny did seek to harness the power of statistics. She was especially struck by the publication of McCarroll and Crego's article in the
Journal of Bone and Joint Surgery
, which the Kendalls had vainly sought to edit before publication. In one table the St. Louis surgeons listed the number and percentage of patients who had achieved what they called “normal” recovery: 4 patients (13 percent) who had been immobilized for 1 to 4 months with no physical therapy; 9 patients (15 percent) who had received a combination of immobilization and physical therapy, which they termed the Kendall method; and 25 patients (19 percent) who had received “no treatment.”
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While she recognized that her own methods had not been used Kenny interpreted these statistics to mean that only 15 percent of children had recovered even when treated by “the best technicians” trained in methods recommended by the Kendalls'
PHS Bulletin
.
¹³³
The St. Louis article made a permanent impression on her. She read it as a published acknowledgment of orthodox failure and quoted its statistics for the rest of her life. The list of polio authorities McCarroll and Crego quoted—including Baltimore's George Bennett and Charles Irwin of Warm Springs—were leading orthodox representatives who had to be either converted or denigrated.
¹³⁴
Partly as a result of Kenny's frequent reference to it, the St. Louis study lingered in the minds of many polio experts in the early 1940s, and, to the Kendalls' distress, it was interpreted as proving the poor results of immobilization and, worse, as an accurate characterization of the Kendalls' work as epitomizing a conservative and damaging method of polio therapy.
¹³⁵

Kenny's use of these comparative statistics ignored the problems of using quantitative analysis for a disease whose sequelae could not be solidly predicted. The credit Kenny claimed for all recoveries, the Kendalls had tried to impress on their NFIP sponsors, ignored the likelihood that many of her patients had made a spontaneous recovery. When Kenny did try to make statistical comparisons between her recoveries and those treated with orthodox methods, the Kendalls remained unconvinced, pointing out that “there are no accurate statistics in this country” for the number of polio recoveries, spontaneous or not.
¹³⁶

In fact, comparing the results of polio therapies was almost impossible. Physicians frequently commented that paralysis was an unstable symptom, sometimes intractable and sometimes swiftly ameliorated. Polio was considered such a seriously disabling disease that when Kenny showed physicians her impressive results they often told her the patient had not had polio. She had to establish polio as a disease whose clinical symptoms could be safely and predictably ameliorated (although not “cured”), yet serious enough that it required intelligently designed and executed methods of care. Physicians had long been suspicious of taking efficacy as the defining factor in assessing therapy. The controlled trial was not widely used, and talk of careful scientific study usually meant descriptive observations of patients. Behind the statistics Kenny quoted were grateful
parents, pain-free children, and solicitous attendants. Happy, healthy Kenny-treated patients, compared to the familiar sights on most polio wards, made a profound impression on every observer. These became the sights and sounds of therapeutic efficacy.