Polio Wars (24 page)

Gudakunst began to use Kenny's explanations to defend her work. One of her objections to splints, he told one skeptic, “is that the pressure of the splint on the skin serves to stimulate the reflexes and produce additional spasm,” admitting “I'm getting so I talk like Kenny.”
¹⁸⁷
When Henry Viets, an editor of the
New England Journal of Medicine
, sent him a draft of an editorial on Kenny, Gudakunst protested that “the techniques developed by Miss Kenny call for an intimate knowledge of muscle anatomy and function” and praised “the excellent end results seen in her cases” and her specialized physical therapy that treated “incoordination and alienation as well as through the proper application of heat during the stage of spasm.”
¹⁸⁸
Like Kenny, Gudakunst rejected the idea proposed in
JAMA
that Kenny's work “represents an elaboration of well recognized principles in the treatment of acute paralysis.” Her view of polio was not simply part of the progression of medical science, he assured Fishbein's
JAMA
assistant Larry Salter, for nowhere in the medical literature with which he was familiar was polio described as having symptoms that were “primarily spastic contractures of the muscles.” Previous medical teaching “very definitely has been that loss of function was due to paralysis and that there was no other damaging involvement of the nervous system,” yet Kenny “has demonstrated that actually the paralysis of this disease is a very minor contributing factor to disability” and “the inability to use ‘healthy muscles' really accounts for the disfunction creating disability.” Gudakunst realized that defensive physicians might be unable to admit the extent of Kenny's innovation. “There is a revolutionary element,” he told Salter, “hence, the unwillingness and even the inability to appreciate just what she has.”
¹⁸⁹
After reading Compere's report of his visit Gudakunst wrote to him agreeing that “there is much of good in the Kenny method” and the NFIP had “a tremendous responsibility” to acquaint “American physicians with her work.” While Gudakunst “wholeheartedly” agreed that “Miss Kenny's book is a sad mistake,” he was “in complete sympathy with your attitude and what you say—that the book does not express an opinion of the treatment itself.”
¹⁹⁰

Gudakunst also developed a new way of looking at polio patients. When he visited patients at Cleveland's contagious disease hospital a few weeks after his Minneapolis visit, he reported that they were “in very good shape, [but] they in no way compare with those treated by the Kenny method.” Indeed, Gudakunst himself was able to identify “evidence of definite spasm in the hamstrings and gastric-nemius groups in several patients,” a sign, he felt, of the patients' inadequate care.
¹⁹¹

But clinical results were one thing; scientific theory was another. Fishbein, Salter, and other AMA officials retained their skepticism that a nurse could use clinical experience alone to come up with any credible explanation for understanding the physiology or pathology of a disease. In “my personal opinion,” Salter told Gudakunst bluntly, “when she starts to discuss anyone else's opinion of her theories—in contrast to her method—she is on controversial ground and the less she says about differing opinions, and even her own
theories
on how her
method
works, the better off she will be and the happier she will make you, me and a lot of other people who are continuously dragged into her ‘fights.' ”
¹⁹²

In mocking Kenny's theories Fishbein's assistant was drawing on a familiar tradition of denigrating those outside the medical establishment who could be valued perhaps for pragmatic techniques but not for theoretical contributions to medical science. The poor quality of her textbook helped to reinforce this distinction, and even supporters such as Gudakunst and Compere began to defend her work based more on its clinical efficacy than its intellectual originality. Thus, as Gudakunst admitted to one Connecticut health official, Kenny's book “is one of the worst attempts to describe a technique that I have ever encountered. But this does not mean that Miss Kenny's work is not good. I sincerely believe that she has made a real contribution to the treatment of early poliomyelitis.”
¹⁹³

By early 1942, a year after the physical therapists' visit to Minneapolis, many things had changed. The
Reader's Digest
article had solidified Kenny's status as an exciting new figure in medicine—an exotic nurse from a distant land. She had also acquired powerful new allies. Even Gudakunst was now a proponent, willing on occasion to use the power of the NFIP. After protests by Gudakunst and a phone conversation with O'Connor, for example, Fishbein did publish a “Correction” in the mid-January issue of
JAMA
, correcting not Compere's review but his first editorial. Massage did not have any part in Kenny's procedure, the editor now admitted, and “according to her concept, the cardinal symptoms of infantile paralysis are ‘muscle spasm, muscle incoordination and muscle alienation,' ” a phrase from Kenny's letter to Fishbein.
¹⁹⁴
Here was a reference, however reluctantly, to both her clinical techniques and her ideas.

As physicians began to take Kenny's work seriously they were eager to demonstrate the fair, scientific, and open-minded nature of their profession by welcoming the woman and the work. But the battle was not over. While it was obvious that Kenny's methods were becoming a central part of NFIP publicity, the question of authority over clinical care remained undecided. Kenny's textbook had been published, but despite Kenny's efforts to make the text serious and scientific, many readers saw it as the work of an overenthusiastic nurse, partly because it was poorly written and partly because it challenged the views of orthopedists who had been trained in more pessimistic, less activist therapies. Seeking to capture the cautious tone of the NFIP's medical advisors, Gudakunst began preparing an NFIP text based on the work of Cole, Knapp and Pohl.
¹⁹⁵
His pamphlet on
The Kenny Method
and the courses that the NFIP began to set up in hospitals and health science schools outside Minneapolis suggested that wiser, more experienced polio experts were in control of this clinical innovation.

As physicians, nurses, and physical therapists began to alter their practice, they struggled to decide how significant clinical observation was and should be. Kenny had claimed to be seeking scientific explanations for the new symptoms she had identified, and initially she, like her critics, saw laboratory research by physiologists and pathologists as epitomizing scientific truth, a more reliable truth than one that clinicians could hope to establish. Even clinical experts expressed caution in judging Kenny's work solely by its
clinical results. In a 3 page section on the Kenny treatment in
The 1941 Year Book of Physical Therapy
Richard Kovacs noted that although “the last word has not yet been spoken as to the most effective treatment,” this method clearly was a break “away from the present method of prolonged complete immobilization.” It might sound “revolutionary” to those who believed in “standard' treatment,” but in mild yet hopeful words Kovacs felt its results appeared “encouraging.”
¹⁹⁶
Viets' editorial in the
New England Journal of Medicine
praised her methods and, unlike the
JAMA
editorials, argued that Kenny's method “completely revolutionizes modern ideas regarding the treatment of acute poliomyelitis” by rejecting “muscle testing, splinting, avoiding of overstretching, absolute rest and many other procedures.” What his editorial did not refer to was any part of her growing articulation of a new view of polio itself.
¹⁹⁷
To their surprise when orthopedists and physical medicine specialists turned to laboratory research to compare Kenny's claims to serious studies of the impact of the polio virus on muscles they discovered there were few such studies.

As Fishbein had anticipated, Kenny's book was indeed read by ordinary Americans, and this led to growing popular demand for her work. James Gray of the
St Paul Pioneer Press
praised her “blunt, matter-of-fact and sensible” tone and her publicized decision to work within the medical establishment.
¹⁹⁸
Members of NFIP chapters began demanding more information about this method and urged the NFIP's national office to publicize it more extensively. A physician from Tacoma, Washington, who was a member of his local chapter, suggested to Gudakunst that “some of our publicity in connection with the Roosevelt Birthday Ball next month could be well devoted to a discussion of the present status of Sister Kenney's [sic] work” and urged the NFIP to offer “some official recognition of this nurse and her work.”
¹⁹⁹
The chair of the NFIP chapter in Magnum, Oklahoma, similarly told O'Connor that the
Reader's Digest
article was “the best article on the subject that I have ever read.” Reprints of it, he believed, “should be in the hands of every Committee for Infantile Paralysis in the U.S.”
²⁰⁰
During the NFIP's March of Dimes January campaign the link between polio and President Roosevelt inspired some Americans to insist that Kenny share this national attention. After reading about Kenny in the
Reader's Digest
and the
New York Times
Ann van Kavcren, a nurse working with polio patients at the Boston Children's Hospital, expressed herself “greatly shocked to learn that this treatment has been used for many years in Australia, and that we are just now hearing about it.” Kenny, she argued, should be recognized in some public way, and the appropriate moment might be the March of Dimes' upcoming celebration of the president's 60th birthday in January 1942.
²⁰¹
It was the beginning of a new moment in America's polio history with Kenny at the center.

1.
“Paralysis Sufferers' Pleas Come in Flood”
Minneapolis Star-Journal
February 5 1941; Willis M. Kimball “City May Become National Center in Study of New Polio Treatment”
Minneapolis Star-Journal
January 30 1941.

2.
Paul
A History
, 312–317.

3.
Kenny with Ostenso
And They Shall Walk
, 211.

4.
Albert B. Sabin “Etiology of Poliomyelitis”
JAMA
(July 26 1941) 117: 267–269. On conferences funded by the NFIP in the early 1940s see Roy L. Chambliss, Jr. “A Social History of
the National Foundation of Infantile Paralysis, Inc, 1938–1948,” Master of Science in Social Service dissertation, Fordham University School of Social Service, New York, 1950, Public Relations, History, MOD, 82.

5.
John R. Paul “The Epidemiology of Poliomyelitis”
Infantile Paralysis; A Symposium Delivered at Vanderbilt University, April, 1941
(New York: National Foundation for Infantile Paralysis, 1941), 147–153; see also pathologist Ernest Goodpasture who admitted that many experts no longer saw polio as “essentially an infection of the central nervous system”; Ernest W. Goodpasture “The Pathology of Poliomyelitis”
JAMA
(July 26 1941) 117: 273–275.

6.
Annual Report: For the Year Ended May 31 1945
(New York: National Foundation for Infantile Paralysis, 1945), 17–22.

7.
Kenny with Ostenso
And They Shall Walk
, 222. See also Kenny boasting to Chuter that she had been invited to instruct physical therapists in Minnesota, Kenny to Dear Mr. Chuter, May 28 1940, Home Secretary's Office, Special Batches, Kenny Clinics, 1941–1949, A/31753, QSA.

8.
Alice Lou Plastridge “Report of Observation of Work of Sister Elizabeth Kenny in Minneapolis, Minnesota, January 1941” [read to Georgia Chapter of the American Physiotherapy Association on February 14 1941, at Warm Springs], Florence Kendall Collection, Silver Springs, Maryland, 1; Kenny to Dear Dr. Cole, September 12 1940, Public Relations, MOD-K.

9.
“Muscle Reeducation” [review of Kenny
Infantile Paralysis and Cerebral Diplegia: Methods Used for the Restoration of Function] Medical Journal of Australia
(May 8 1937) 1: 713–714; R. W. Cilento “Report on Sister E. Kenny's After-Treatment of Cases of Paralysis Following Poliomyelitis,” Ms. 44/109, Fryer Library, 13–14, 4; Cilento to The Minister, June 30 1939, [enclosed in] Cilento to Dear Dr. Cumpston, July 10 1939, Series A-1928, 802/17/Section, 3, AA-ACT.

10.
Henry Otis Kendall and Florence P. Kendall
Care During the Recovery Period in Paralytic Poliomyelitis
(Washington, DC: Government Printing Office, 1938, revised 1939, Public Health Service Bulletin No. 242); Kenny with Ostenso
And They Shall Walk
, 207–208.

11.
Carmelita Calderwood “Nursing Care in Poliomyelitis”
American Journal of Nursing
(1940) 40: 629–630.

12.
C. M. Sampson
A Practice of Physiotherapy
(St. Louis: C.V. Mosby, 1926), 20–22, 584–585; see also Harry Eaton Stewart
Physiotherapy: Theory and Clinical Application
(New York: Paul B. Hoeber, 1925).

13.
Frank H. Krusen
Physical Medicine: The Employment of Physical Agents for Diagnosis and Therapy
(Philadelphia and London: W. B. Saunders, 1941), 774.

14.
L. Caitlin Smith “Alice Lou Plastridge-Converse”
PT: Magazine of Physical Therapy
(2000) 8: 42–49.

15.
“Mildred Elson, 87, Physical Therapist”
Boston Globe
September 25 1987.

16.
“Gertrude Beard”
Physiotherapy Review
(June 1971) 51: 108.

17.
Florence P. Kendall “Sister Elizabeth Kenny Revisited”
Archives of Physical Medicine and Rehabilitation
(1998) 79: 361–365.