Polio Wars (23 page)

Despite her protests, Kenny was a quick study. She began to consider writing another book with the explicit sponsorship of the NFIP and her medical supervisors. Her next textbook, as we will see, was published in 1943 with a preface from O'Connor and an afterward by Knapp, and was co-written with Pohl.

The pinnacle of Kenny's early success came on December 5, 1941, 2 days before Pearl Harbor. At the second annual meeting of the NFIP's medical advisors held in New York—to which Kenny was not invited—the Committee on Research for the Prevention and Treatment of After-Effects announced that, based on reports from Minneapolis, the Kenny method used during the early stages of polio “greatly reduced … the length of time during which pain, tenderness, and spasm are present” and prevented “contractures caused by muscle shortening during this period.” The general physical condition of her patients also seemed to be better than patients treated by other methods.
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In a dramatic policy announcement, the NFIP's medical advisors then recommended that health officials throughout the nation should promptly be given information “regarding the nature of the Kenny technique and its integration with other measures of treatment”; the NFIP should establish training programs for physicians, nurses, and physical therapists to become “fully trained in the essentials and principles of the Kenny method”; and it should produce “a concise manual providing the essential principles and details of the Kenny method and of other applications of hydropathy and physical treatment in the early stage of infantile paralysis.”
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With careful timing, Fishbein published a sympathetic editorial in
JAMA
arguing that recent physiology research had shown that immobilization might be harmful as normal groups of muscle fibers could become atrophic with the restriction of “the flow of these proprioceptive impulses.” The editorial firmly rejected the concept of alienation, arguing, as the Kendalls had done, that “no experimental evidence” supported
“the contention that single muscle units might, as a result of appropriate manipulation, be encouraged to send their nerve fibers to muscles fibers which had been rendered atrophic by anterior horn cell degeneration.” In his description of Kenny's technique Fishbein deliberately provided few details, and the details he did provide were casual and inaccurate. “If all available motor units in paretic muscles are to retain their maximum physiologic capacity,” Fishbein wrote, then “massage and freedom of movement” were “clearly indicated.”
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Neither massage nor free muscle movements were part of Kenny's work.

Here were explicit signs of clinical change and proposed policies for the inculcation of this work into medical practice. Defending this change in NFIP policy in promoting a kind of polio care that sounded so different from standard methods, O'Connor sought to downplay both Kenny and her clinical results. At the NFIP meeting's annual dinner at the Hotel Pierre, O'Connor emphasized that the Minnesota clinicians' conclusions were supported by NFIP-funded physiological research, including animal experiments from Iowa State University and the University of Toronto that suggested that restricted motion could delay muscle recovery. To placate skeptical orthopedists O'Connor referred to research by eminent Iowa orthopedist Arthur Steindler that had shown that shortening and distortion could be caused by contractions of severely paralyzed muscles that were allowed to remain in one place for too long.
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Despite these efforts to incorporate Kenny's work within serious scientific research the press delighted in the story of a crusading nurse and her revolutionary method of treatment. With headlines like “Sister Kenny's Triumph,”
Time
and
Newsweek
explained that her methods, unlike standard clinical practice, stimulated rather than immobilized muscles in early cases, and that
JAMA
—“organized medicine's leading publication”—had “formally approved” her work.
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“Kenny Paralysis Treatment Approved by U.S. Medicine” agreed the
New York Times
, quoting O'Connor's statement that her methods had been proven “superior to the present orthodox methods of treatment.”
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In vain Fishbein prepared a further
JAMA
editorial that urged American physicians to remember that the conclusions of the NFIP's advisory committees were based on “reports from various experimental laboratories and clinics.” He also sought to move the work out of Kenny's hands, describing Knapp's detailed study of the Kenny method that would enable Knapp and other physicians “to continue with the teaching after Miss Kenny and her staff return to Australia.” The new method “represents an elaboration of well recognized principles in the treatment of acute paralysis” and was based on “scientific research on the physiology of the nervous system which explains the value of the technic.”
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It was, in other words, not a strange, unscientific system developed by an innovative nurse, but the practical articulation of methods that fit into mainstream medical science and were therefore worthy of funding and further study.

Annoyed at the inaccuracies of the first editorial, Kenny was irate that this second editorial portrayed her work as simply part of the progress of medical science. “It is impossible to merge any other existing treatment with the Kenny treatment,” she protested to O'Connor. “All other systems have been evolved for symptoms that do not exist. Dr. Gudakunst admitted this to me when I spoke to him.”
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Urging Kenny to complain to Fishbein directly, O'Connor implied that he had little influence over the AMA's journal but Kenny would have none of it. “I quite understand the Foundation has no control over the American Medical Journal,” she pointed out to him, “but I should imagine it has the power to correct the misleading statements made in connection with the Foundation's activities.”
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Kenny was right. The NFIP was able to exert influence over
JAMA
, but O'Connor refrained from doing so until Fishbein published an anonymous review of Kenny's textbook. Mealy-mouthed in its praise and sharp-tongued in its criticism, the review by Edward Lyon Compere, an eminent Chicago orthopedic surgeon, found Kenny's book full of “infinite detail” and providing a “confusing discussion of pathologic principles.” A nurse might not be expected to understand polio's complexities, he argued, but any physician “thoroughly grounded in physiology, anatomy and pathology” who had observed “the degenerative changes in the anterior horn cells … will find much in the Kenny theory that is absurd and unscientific.” Irrespective of the author's “enthusiasm” that appeared in every chapter of the book and bordered “on religious fanaticism,” Compere noted, there would continue to be patients who needed splints, those who would undoubtedly die if they were not in an iron lung, and those would never walk a step “without the aid of the braces she condemns.” Still, the medical profession owed Kenny “a debt of gratitude for having made us realize that prolonged splinting without exercise, without heat and moisture applied to the limbs, is harmful.” Compere hoped his peers would be “sufficiently liberal minded to accept the good elements of the Kenny theory without losing our balance and falling head over heels into a pit which both Galen and Hippocrates succeeded in climbing out of many centuries ago.”
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This pit,
JAMA
readers could assume, was empirical, symptomatic medical care, bereft of the rigor of male Western scientific knowledge.

Outraged, Kenny called Gudakunst twice, reversing the charges, to complain that the AMA's official journal had called her ideas “absurd and unscientific.” If the review was not retracted, she said, she would return immediately to Australia “since there was no use trying to fight the American Medical Association.” Gudakunst urged her to forget the review and go on with her work, but Kenny said she was too upset. Shifting her argument to an appeal to populism she declared that she would go on a lecture tour to appeal directly to the public for Americans had supported her more than the NFIP or the University of Minnesota.
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She also wrote to Fishbein, accusing his reviewer of not keeping “abreast with current literature” such as “the acknowledgment of the official observers of the Medical School, University of Minnesota.” It was not true that the condition of spasm was familiar to polio experts. In Kenny's experience, based on the many thousands of cases seen in different parts of the world, polio authorities had ignored “this painful and damaging condition.” Trying to be both courteous and vehement, Kenny “respectfully” suggested the reviewer “come to Minneapolis as soon as possible, and I will produce the evidence to convince him that he is altogether wrong in his concept, and how unwise it is to condemn a work he knows nothing whatever about.”
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Discovering the reviewer's identity, Kenny contacted Compere directly and urged him to come to Minnesota and see her work for himself.
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NFIP officials were becoming familiar with Kenny's threats of leaving and her demands for public recognition. But after the NFIP's December decision to promote her work Kenny could now more confidently challenge critics with evidence that its own elite medical advisors recognized her methods as a valuable improvement to former polio therapies.

Kenny found that she was able to win over critics of her written work with the clinical evidence of her patients. In response to her letters and phone calls, Compere traveled to Minneapolis for a day's observation and returned to Chicago, he admitted to NFIP officials, “very much more sold on her methods than I had been before.” His opinion of the book did not “represent my opinion of the treatment itself.” While he did not “understand why she achieved some of her results” and was not “prepared to accept
all of her theory” he was convinced that “her methods are definitely good.”
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Gratified that she could now count Compere among her supporters, Kenny now reminded him of his promise “to rectify the erroneous ideas you had about my work” by writing a statement that could be published in
JAMA
.
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While Compere did not write a correction, he did invite Kenny to come to Chicago to discuss her work before an audience of doctors, nurses, and physical therapists at the Wesley Memorial Hospital. Fishbein, whom Kenny invited, did not attend.
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Her lecture, Compere told her later, was a great success. He hoped she would return to give another talk and demonstration and he promised to explain “the advantages of the Kenny method” at the next meeting of the Chicago Orthopedic Society.
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A delighted Kenny thanked him, but wanted to correct a comment about Cole and Knapp's skepticism that had been made during her trip. “I asked Dr. Cole and Dr. Knapp where they disagreed with me, and they said that they do not disagree with me anywhere. They did at first but not now.”
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Perhaps Compere, having met Kenny in person, could guess that Cole and Knapp had learned not to engage in debates with their Australian visitor.

Even before Compere's visit Gudakunst had also traveled to Minnesota, a visit that led him, like Compere, to change his mind. He had been appointed the NFIP's medical director only a few months before Kenny's arrival in New York in April 1940. As Michigan's state health officer during the 1930s he had survived many stormy experiences, and his position as medical advisor to O'Connor, who was a lawyer and not a doctor, gave him ample opportunities to confront and dissuade aspiring polio innovators, and to “weed out the obviously sorry applications.”
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He had organized the visits of the 5 physical therapists to see Kenny in Minneapolis and read their mixed reports. Concerned that she was a publicity seeker and perhaps a bit crazy, he had begun to caution others not to laud her too extravagantly. When the NFIP was consulted by
Parents Magazine
about the advisability of making its annual award on behalf of children to Kenny in 1941, Gudakunst had warned that “it would be unwise to have such an award made immediately.” The award was not given to Kenny until the following year.
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When Gudakunst arrived in Minneapolis, Kenny eagerly demonstrated her work and gave a lengthy lecture during which she called on the NFIP “to correct the erroneous statements” in the first
JAMA
editorial. These mistakes, she claimed, had harmed patients by suggesting to patients and medical professionals that massage was part of her work. Further, its lack of detail had resulted in some patients having to undergo “the [unnecessary] operation of appendectomy … owing to the lack of knowledge of the true symptoms of the disease.” She quoted tributes made by “all visiting doctors to this clinic,” such as a group of Ohio orthopedists who told her “they could only look back with sorrow and regret at the mistakes made in the past.” Shrewdly, her lecture included not only a defense of her ideas but also the claim that her work returned patients to economic independence. Thus, an 18-year-old patient who had gained “a certain amount of recovery in all muscle groups” could now wash and feed herself and stand up alone, and she had won a scholarship to study commercial art.
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His visit to Minneapolis convinced Gudakunst both of the value of Kenny's work and the danger of inaccurate publicity, which was hurting both the NFIP's promotion of the new method and the fund's own reputation. He became convinced that the AMA was deliberately undermining Kenny and thereby her philanthropic sponsor. After a radio program sponsored by the AMA “gave her an extensive plug but described her work as consisting of early active exercise,” he suggested that someone from the AMA “should go to
Minneapolis to visit Miss Kenny and see what she is doing,” and that whatever
JAMA
published about Kenny “be reviewed by such an informed individual.” The ill-advised
JAMA
editorial, he added, repeating another point Kenny had made to him in Minneapolis, may even have harmed patients if physicians used “active massage in the early stage of the disease” acting “under the misconception” that they were “using at least a modification of the Kenny method.”
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To O'Connor he also wondered whether “a conference with Dr. Fishbein might not be out of order.”
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