Polio Wars (28 page)

In the 1940s clinical research was still an amorphous field. Many physicians were convinced that valuable evidence could still be gained from case studies of individual patients or small groups of patients, and offered these studies to medical journals. In fact most clinical research published in mainstream medical journals was, like Kenny's, based on a
group of patients, usually fewer than 50. Rarely were there any formal controls, other than comparisons to patients in other hospitals or other wards or under another physician's care. McCarroll and Crego's 1941 study, for example, had simply altered elements of the care provided to their own patients over a series of years, and then compared the clinical results.

But moving from potentially useful clinical observations to an assessment of therapy based on those observations raised tricky epistemological issues, especially around the definition of scientific evidence and the idea of a clinician as a researcher. Were clinicians scientists? Did they practice scientific medicine?

The search for quantifiable evidence was especially elusory for polio. Its early clinical signs before the appearance of paralysis—pain, skin sensitivity, fatigue, a stiff neck—were frequently misdiagnosed. When clinical improvements occurred, they were often assessed by the patient or the patient's family, ignoring the evidence of muscle tests such as those codified by Robert Lovett and his physical therapists in the 1910s. Even more crucial for patients was the issue of functionality, which was even less easily standardized. Still many physicians turned hopefully to physiological research for a definitive answer. During the 1940s Kenny proponents and opponents grasped at laboratory studies seeking a concrete link between clinical practice and laboratory research, but found evidence for both sides of the Kenny debate.

The taint of psychology was also in the air, a disturbing hidden factor that threatened to mislead true scientific investigation. The enthusiasm of recently graduated Kenny technicians reminded their medical supervisors of a kind of evangelism, reminiscent of overly hopeful patients rather than the neutral professional demeanor of polio experts. Further, Kenny's strict therapeutic routine—with its distinctive terms, hand grips, positioning of hot packs, and muscle exercises—disconcerted physicians seeking to integrate only parts of her method into their regular practice. “We must be careful not to become bound by a ritual of terms and procedures which physicians and laymen think of as a magic formula,” Warm Springs director Robert Bennett warned.
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The enthusiasm around Kenny's therapies reminded many physicians of the convalescent serum controversy. Made from the blood of patients who had recovered from polio, this therapy was introduced in the 1910s both to prevent paralysis and to lessen its severity.
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With no formal clinical trials, physicians began to write enthusiastic papers advocating its use after trying it “on a few cases without controls,” one physician observed. Then panicky parents began to demand its use in every case, making it “difficult or actually hazardous to conduct a properly controlled study,” and wasting “money, time, energy and blood.”
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Medical and popular faith in the serum continued into the 1940s, despite later research, including an extensive study of New York City's 1931 epidemic, showing that it did not prevent or ameliorate paralysis.
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The serum did not even make scientific sense for the polio virus was believed to travel through the body through nerve tissue and not through the blood. Nonetheless the serum continued to be produced and distributed by health departments.
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“The serum treatment of polio has very little to stand on, either theoretically or from statistical results,” Yale epidemiologist John Paul reflected, but “the public has become so aware of the fact that there is a serum for the disease that it is difficult not to administer it.”
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Kenny had for some time been dissatisfied with her position as guest instructor: not a doctor and not a nurse; a pivotal figure in training courses yet constantly negotiating with skeptical medical school faculty; a consultant at most Minnesota hospitals yet unable to control the conditions of her work. Backed by local politicians and businessmen, she began to seek out a place where she could direct her work free of the control of university officials and hospital administrators. She visited 3 city facilities: the Glen Lake tuberculosis sanatorium, the Parkview tuberculosis hospital, and Lymanhurst, a former tuberculosis rehabilitation center on Chicago Avenue, part of which was still in use for children with chronic heart disease. Only Lymanhurst, she argued, was close enough to the city hospital to provide “easy access to all visiting Doctors and the Doctors attending the monthly classes at the Continuation Center and the University.”
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The Elizabeth Kenny Institute at 1800 Chicago Avenue was formally opened in December 1942.

When Kenny learned that some local physicians were unhappy about the eviction of their patients with chronic heart disease, she scornfully told reporters that “research has been completed regarding heart ailments, while research regarding infantile paralysis barely has started,” adding (as she often did when she felt undervalued) “if it's too much trouble to move a few patients from one hospital to another … Perhaps I should go elsewhere.”
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Until this point O'Connor and the Minneapolis surgeons had seen Kenny as a visitor who would leave a new kind of clinical practice institutionalized. Kenny herself seemed to have shared this view. But with the founding of the Institute bearing her name and under her control, Kenny became firmly situated in the Twin Cities.

In an era when nurses were seen as the recipients of medical science rather than its designers, Kenny knew that her claims to new knowledge were controversial before their content was even known. But as the Institute prospered and Kenny was feted as a savior, she began to argue that her work embodied a new knowledge of polio drawn from a close reading of the body. Polio, she said, was not solely a neurological disease but also a disease of muscles and “peripheral structures.” She published 2 books in 1943: her autobiography
And They Shall Walk
coauthored with novelist Martha Ostenso and a textbook entitled
The Kenny Concept of Infantile Paralysis and Its Treatment
coauthored with orthopedist John Pohl. Both books challenged medical skepticism. In
The Kenny Concept of Infantile Paralysis
she began to argue that it was impossible to teach anyone to treat the symptoms she had identified if they did not understand her concept of the disease. Indeed, she frequently added, the prognosis for a patient treated without this new knowledge would always be far poorer than for a patient treated by professionals who fully understood the Kenny concept. Both books, of course, provided the opportunity for Kenny to settle scores and to retell stories her way.

Kenny's feisty style suited a newly militarized environment as American nurses embraced the war effort.
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Nurses praised Kenny as another heroic contributor to nursing progress. In May 1942 she was invited to the American Nurses Association (ANA) Biennial
Convention in Chicago, attended by an estimated 10,000 nurses and nursing students, where she was a featured speaker and was awarded an honorary membership as the “noted Australian nurse poliomyelitis worker.” The convention was filled with nurses in military uniforms, a vivid reminder, as ANA president Major Julia Stimson pointed out, that American nurses were the only female health professionals who could claim military officer status. The Biennial's message was reinforced by Chicago department stores whose windows illustrated the contributions of nurses to the war effort.
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Kenny was interviewed by the editor of the
Trained Nurse and Hospital Review
who praised her “poise, strength and enormous reserve” as well as the technical film Kenny showed at the meeting in which “a single finger would be raised in command, and the patient would make prodigious efforts to make his muscles comply.”
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This appearance boosted her credibility among American nurses. Frustrated with standard methods of polio care many nurses were eager for both greater clinical responsibility and clearer guidance. Orthopedists were responsible for prescribing splints but expected nurses to deal with daily care and to follow Robert Jones' dictum that “the value of weeks of careful handling may be undone by one careless stretching of a regenerating muscle.”
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For some leading clinicians the transformation in accepting Kenny's work was dramatic. Jessie Stevenson, a New York orthopedic nurse, was a nationally recognized polio expert whose
The Care of Poliomyelitis
(1940) was distributed by the NFIP. Intrigued by reports of Kenny's work, Stevenson spent 2 weeks in Minneapolis, and admitted, Kenny reported proudly to O'Connor, “that she had no idea that the symptoms and signs I have pointed out to her were in existence.”
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Stevenson then published a widely cited article on “The Kenny Method” in the
American Journal of Nursing
and revised her NFIP guide to include elements of Kenny's work. She accepted the basic assumptions of what she called the Kenny theory, and argued that nurses must understand how it differed from previously accepted concepts.
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Other nurses similarly praised Kenny's work as “a radical departure from the older methods” and with outstanding results quite unlike “the extreme pain and discomfort formerly experienced.”
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Yet Stevenson and her fellow orthopedic nurses maintained a careful distance from the public enthusiasm, embracing only certain elements of Kenny's work and indicating where they thought her claims went too far. In her review of Kenny's 1941 textbook in the
American Journal of Nursing
, Denver orthopedic nurse Carmelita Calderwood praised Kenny's extremely valuable methods, but criticized her refusal to accept any modification that might allow a nurse to combine “her hot pack methods and still maintain immobilization.” “The experienced orthopedic nurse feels definitely reluctant in accepting her theories
en bloc
,” Calderwood argued, “until there is more solid, scientific proof of the permanent efficacy of this method.”
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Strikingly, Kenny rarely repeated comments made by nurses. While feted as a nurse she stood apart from the profession. What was important to her was reaching the top of the American medical hierarchy. She saw nurses and physical therapists as the hands and feet of her movement: carrying the work into hospitals and inspiring their medical supervisors to change. Her vision of a Kenny technician was closer to an independent specialist nurse, not the handmaidens of Nightingale's era. Many nurses in the early 1940s similarly embraced this vision, declaring that “nurses aren't angels—and they do not like to be called angels!”
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The caution of many American nurses was not mirrored by the response of most physical therapists. The publicized image of Kenny as a rehabilitation expert brought welcome attention to professionals who dealt exclusively with disabled bodies. For the first time since the work of reconstruction aides during the Great War, physical therapy was news. In the early 1940s almost every issue of the
Physiotherapy Review
had articles on her work. While it was shocking to be told by a nurse—and a bush nurse—that trained therapists had missed symptoms of polio and that the standard rehabilitative methods they had relied on were harmful, her work offered exciting opportunities for clinical action. Her rejection of the Kendalls' work also appealed to many therapists who had quietly considered the Baltimore group too conservative; the Kendall method soon became synonymous with failed polio orthodoxy. Baltimore remained one of the country's anti-Kenny enclaves.

Together nurses and physical therapists created a new understanding of bodies disabled by polio. In a distinct break from clinical tradition, they began to worry less about deformities resulting from overstretching and more about those that could develop from lengthy splinting and inadequate exercise. Kenny's antagonism to muscle testing was also adopted by some who began to suggest that the muscle tests developed by Lovett indicated only “degrees of flaccidity.”
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Kenny's work, 2 nurses reflected in 1942, had done away “with the taboo against ‘stretching the paralyzed muscle.' ”
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To have nurses call a standard part of polio practice a “taboo” was astonishing, a signal of a new way of thinking. Here were signs of clinical change.

Kenny poured herself into teaching. Being able to show others her methods and have them understand her reasoning would help to combat accusations that enthusiasm or maybe some kind of hypnosis explained her results.

In early 1942, appointed as a guest instructor by the University of Minnesota, Kenny was teaching 18 local physical therapists and several therapists and nurses from Pittsburgh, Los Angeles, Iowa City, Indianapolis, Des Moines, and Warm Springs.
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She had already won over most of the region's physical therapists including those at the Gillette State Hospital for Crippled Children who were, a visiting physician reported, “enthusiastically in favor of Sister Kenny's treatment.”
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When the NFIP was initially reluctant to fund a formal teaching program Kenny found wealthy patrons Margaret Webber and her husband businessman Charles C. Webber who donated $4,500 to the University of Minnesota to be used as scholarships for 10 local nurses. Kenny delighted in these students, whom she called the Webber scholarship girls, and boasted that they would soon be “a valuable asset to any institution.”
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Members of this first generation of students became the core circle of senior Kenny technicians for the following decade.