Polio Wars (22 page)

FIGURE 2.2
Image of a child patient in a splinted positin “frequently used … to maintain constant muscle protection” from a 1941 guide for the care of polio patients in the home. Reprinted in 1943 from Robert V. Funston and Carmelita Calderwood
Orthopedic Nursing
(St. Louis: Mosby Co., 1943),
p. 424
. Courtesy of Elsevier.

Kenny recognized that her fleeting visits to medical societies and hospitals might intrigue physicians and other professionals but that true conversion had to come from a concerted study of her work.
¹³⁷
In this era textbooks were at the heart of all medical education. Kenny noticed that 2 recent books on polio therapy mentioned her work, neither of them satisfactorily. Chicago orthopedic surgeon Philip Lewin's text
Infantile Paralysis
was “very vague about the condition of spasm” and “still presents a treatment for a soft, flabby, flaccid paralysis,” a symptom she did not believed existed. She especially disliked his publisher's advertisement in
JAMA
claiming that “the technique of my work had been fully described by Dr. Lewin in his book,” despite the fact that his reference to her work “scarcely covered a page.”
¹³⁸
She was also unhappy about the “distorted and untruthful statements” in Krusen's 1941 text
Physical Medicine
.
¹³⁹
Krusen had noted that her ideas were “almost
diametrically opposed to those of the Kendalls” and were “so revolutionary that, on first consideration, they would seem hardly to warrant careful scrutiny.” Despite her “considerable following” he felt American physicians must rely on the “essentially fair” report of 7 British orthopedists in the 1930s, which concluded that her methods were “harmless but of unproved value.”
¹⁴⁰
Neither Krusen nor Lewin, Kenny complained to the dean of Minnesota's medical school, “know anything about my work,” and both made “very sarcastic reference … to certain important principles of my method.”
¹⁴¹
Medical publishers such as W.B. Saunders saw her work as significant and, as Lewin's
JAMA
advertisement showed, even a selling point. These books made her certain that she needed her own textbook.

Kenny recognized that her textbook would have to contain evidence that, unlike her Australian 1937 text, she intended to control closely. Her
Treatment of Infantile Paralysis in the Acute Stage
was published by a local Minneapolis company in September 1941.
¹⁴²

Its 264 pages were divided into 17 chapters and 3 appendices. The prose was repetitive and disjointed with many of its chapters simply versions of lectures Kenny had given in Brisbane in the late 1930s and then in Minneapolis. The book included 61 photographs of patients as well as several images of Kenny clinics in Australia and England. The images of the patients, Kenny explained in her preface, were “photographic confirmation” of the value of her work; the images of the buildings and wards were probably included for the same reason.
¹⁴³
As the book was intended to be used as a pedagogic resource, most of its chapters were organized by body part: Chapter 9 on the neck, Chapter 10 the shoulder girdle, Chapter 11 the forearm and hand, and Chapters 13 and 14 the limbs. The remaining chapters and appendices provided an intellectual defense of her scientific contribution.

Kenny believed that this text would play a crucial role in establishing her work as a serious medical contribution as “it must be understood by all that it is impossible to teach without a book of reference.” Even more crucially, the book's detailed explanations of her work would “insure its permanency.”
¹⁴⁴
Designed for those learning to be Kenny technicians, it was filled with descriptions of detailed techniques that were distinctively different from those used in standard polio care. Kenny had long ago found that skeptical professionals, especially nurses, tended to be “impressed by the authority associated … with the printed word.”
¹⁴⁵
The book would stand in for her own voice when she left America, providing both a warning and a defense for her technicians and their medical supervisors who would otherwise “have slipped back into the wrong method if it was not recorded in the book how damaging would be this procedure.”
¹⁴⁶

Even those sympathetic to Kenny's cause were disappointed by this book. A Chicago surgeon told Gudakunst that its awkward prose meant it was “not very easily read or easily understood.”
¹⁴⁷
Still, its pictures and detailed instructions made it a useful clinical guide. Perhaps it was a bit too accessible, Cole warned Gudakunst, so “that there is great danger of this book being misused by poorly trained or irregular practitioners.” Nonetheless Cole felt “that the part of the book dealing with methods has been very excellently prepared and that a lot of the stuff in the book is good.”
¹⁴⁸
In publishing this text, Kenny had gone over the head of the NFIP to reach American medical professionals directly. When professionals and members of the public asked the NFIP for a copy Gudakunst explained that the book had been written and published “without the knowledge of the Foundation” and distributed “in spite of the Foundation.” Its poor quality, he told one physician frankly, was the reason “it is necessary that the Foundation prepare a
pamphlet of its own describing some of the main points of her technique.”
¹⁴⁹
In 1942 NFIP produced a pamphlet based on reports by Kenny's Minnesota medical supervisors.
¹⁵⁰

Efforts to ensure that the textbook was not seen to have the imprimatur of the NFIP were, however, mostly in vain. Both Gudakunst and O'Connor were convinced that the book had breached the NFIP's policy that grant recipients “refrain from writing articles for public or professional magazines, lecturing or releasing information in any way except through this Foundation.”
¹⁵¹
In his role as the head of the NFIP Committee on Information Fishbein phoned John Bruce, head of the Bruce Publishing Company, to warn him of this breach of contract.
¹⁵²
Bruce knew nothing about any contract with the Foundation, and repeated Kenny's assurance that she had “entered into no contracts and made no commitments.” His publishing company, Bruce emphasized to Fishbein, intended “to market this book [only] to the medical profession” and he believed that “nothing in the book or in Kenny's method” conflicted “in any way with ethical medical practices.” Gudakunst asked Cole to make sure that Bruce agreed “to insert a flyleaf giving a statement to the effect that the National Foundation had no responsibility for the publication nor does it sponsor the distribution of the book.”
¹⁵³
“We could of course take the necessary steps to stop the publication,” Fishbein reflected in a rare letter to O'Connor marked “Personal,” “[but] this would, I fear, do more harm than good.” Whatever Bruce claimed about marketing the book only to physicians, Fishbein could see that “it will naturally be worked over by the lay press when it published.” “I shall of course arrange to have a suitable review of the book in the Journal of the American Medical Association and sooner or latter [sic] I shall write a piece about Sister Kenny to put her in proper perspective,” he assured O'Connor. Perhaps, Fishbein added wickedly, Kenny should be allowed to speak at the NFIP meeting that December, maybe “a two minute presentation so that [the] audience can get the full flavor of her personality.”
¹⁵⁴

In a haughty defense of her book Kenny protested to Fishbein that she was under control of neither her Minnesota supervisors nor her NFIP sponsors. In one phone call Fishbein told her that although he had “advised the Foundation to allow the publication … when we review the book, we shall call attention to such misstatements of fact as appear.”
¹⁵⁵
Kenny then “minutely examined” her book and told him she “could not find the mistakes referred to.” The idea of a contract breach was nonsense, she added, as the lectures that made up the book did not deal with the results of work carried out under the NFIP grant.
¹⁵⁶
“She was very much on her high horse,” Fishbein said when he described this conversation to O'Connor, and had declared “ ‘Well, I don't care for America anyway. I merely came over here to get my book published, and I am going back to Australia as soon as I can.' I asked her if she would authorize me to use that statement to the press, and then I hung up on her.” “She is, of course, an impossible person as far as concerns any sensible conversation,” he added, “I propose to have nothing further to do with her.”
¹⁵⁷
But as Fishbein recognized, such a policy of high-minded neglect was not going to work. Privately O'Connor agreed with Fishbein's desire to have nothing further to do with Kenny but as NFIP director he had no such option. After discussing the problem of her book with Gudakunst, O'Connor decided to ignore her claim that the book established the worth of her work. He assured Fishbein that he would continue to point out to her, as he had repeatedly, that the University of Minnesota's medical school “is our grantee to evaluate her work, and we therefore look to that institution rather than to her.”
¹⁵⁸

In a move that gained her even more publicity Kenny cooperated with Lois Maddox Miller in the writing of “Sister Kenny vs. Infantile Paralysis,” the featured article in the
December 1941 issue of
Reader's Digest
. Fishbein had assured O'Connor a few months earlier that he knew Miller, “a friend of mine,” was working on an article on Kenny; “however, all of the medical articles of the Digest are submitted to me and I will have the opportunity to go over that one.”
¹⁵⁹

Miller, a freelance science journalist, deftly drew a picture of Kenny that intrigued American readers. In 5 pages her article moved from “the lonely outlands where she served as visiting nurse, midwife, and counselor to the sparsely settled families” to a “small boy, his legs strapped in splints, his face contorted from pain” to the 8 government-supported large hospital clinics in Australia where “hundreds of nurses take the two-year postgraduate course which fits them to use the Kenny method.” These exaggerated claims—the hundreds of nurses, the formal 2-year course, and the 8 government clinics—were part of a story Kenny had developed since her return from Australia in June. Having “dedicated her life to extending her merciful work as widely as possible” Kenny (“the British give chief nurses the title of ‘Sister' ”) had looked toward the United States and discovered that “the United States has maintained the most enlightened and realistic attitude toward the problem—has tried hardest to push research into polio's mysteries, has done more in after-therapy, and, through the great National Foundation of Infantile Paralysis, supported by contributions from the entire nation, has demonstrated its determination to reach out for the best and newest at any cost.”
¹⁶⁰
Such hyperbole showed Fishbein's likely hand.

In this picture, Kenny was a “tall, gray-haired, motherly woman [who] proudly refers to herself as a ‘bush baby.' ” Miller described her age as “some 50 years”; in fact Kenny had just turned 61. Kenny's methods were contrasted with the effects of ordinary treatment during which “there is a long, grim siege of pain—anywhere between two weeks and many months.” Miller's description of the method itself was somewhat inaccurate: spasm, an important symptom “which apparently doctors had not noticed before,” was relieved by hot foments, massage, manipulation, and passive exercise.
¹⁶¹
Kenny was usually annoyed when professionals or the press talked about “massage” (she fought for and later won a
JAMA
retraction) but here she made no comment.

The spectacular results of Kenny's work were exemplified by the miraculous recovery of Kenny's American patients. Rita N. a patient with bulbar poliomyelitis had been given last rites by a priest but after 20 days of Kenny treatment she recovered fully. Her mother said “ ‘It seemed like a miracle—we had given up hope.” Joan B., who would have been placed in an iron lung, was “completely cured” in 6 weeks. The bulk of the article dealt with Kenny's effort to convince physicians: some denied the “phenomenon of spasm, or minimized its importance”; many considered her “bold refusal to use splints or braces… unwise and hazardous.” But Kenny had been victorious, proving her work was new and revolutionary.
¹⁶²

In a section that most closely showed Fishbein's editing hand, Miller tried to establish that Kenny herself, however unorthodox and shocking her methods, was not challenging the medical hierarchy. Kenny was an enthusiast, but she also knew her place. She had “devoted her life to the one crusade, demonstrating to physicians, training other nurses in her methods, spreading her influence with missionary zeal.” Yet “the nurse practicing the Kenny method does not replace the doctor, but works with him. She does not cure the disease—medical science knows no cure for it. But she does make it easier to bear, and does cut down—often completely eliminates—aftereffects.” Most of all, Kenny had “turned a deaf ear to suggestions that she would get ahead faster if she ignored the doctors. ‘This treatment can be developed only within the medical profession,' she said, and stuck to it.” Miller left ambiguous whether Kenny's contribution was simply a treatment or a new concept as well. She quoted Kenny's
Australian mentor Aeneas McDonnell, probably via Kenny herself, saying “She has knocked our theories into a cocked hat; but her treatment works, and that's all that counts.”
¹⁶³

This story had something for everyone. It provided polio survivors and their families as well as other disabled readers with hope in a scientific form. Physical therapists and nurses dissatisfied with current polio practices were intrigued about this miracle healer. Readers seeking alternatives to surgery saw Kenny's work as natural, domestic, and pain-free. Here was a sympathetic picture of a middle-aged, yet still vigorous nurse who both worked within the traditional restraints of her career and gender—a physician's helpmeet, a care-giver who touched bodies and dealt with the messy stuff of pain and disability—and yet stood outside it, challenging orthodoxy in thinking as well as practice, telling doctors what to do. Miller called Kenny motherly for she cared for children, but such a designation could also call up a picture of mothers fiercely defending their young, or perhaps the kinds of characters featured in Wild West movies where the rancher's wife knew how to use a gun to warn off marauders. This nurse, readers were assured perhaps too vehemently, was committed to orthodox medicine, its culture, and its professional hierarchy. But what if she moved away from the auspices of the respected medical school? What if her patients' families began demanding that she take control of polio care instead of their doctor? What if she felt that the NFIP was not properly supporting and promoting her work?