Polio Wars (32 page)

Before Stimson's AMA speech appeared in
JAMA
in 1942 he and his medical staff at the Willard Parker hospital had published a study comparing 33 patients who had the “accepted” treatment with 28 treated by the Kenny method. They concluded that for patients with spasm Kenny's method should be the “treatment of choice.”
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Now Stimson argued not just for a change in therapy but in theory as well. Kenny's work along with “recent studies of many medical research workers and clinicians” should lead physicians to rethink polio's pathology and physiology. While currently many theories were available to explain the causes of spasm, spasm itself was constantly present in acute polio and could be aggravated by forced immobilization with the use of casts and splints. Stimson defined and then used Kenny's terms
incoordination
and
alienation
to try to establish them as part of the ordinary medical vocabulary.
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Despite this confirmation of Kenny's concepts, Stimson (or perhaps
JAMA
editor Fishbein) placed quotation marks around the term
alienation
; the other 2 terms were left free of textual doubt.

Stimson's
JAMA
article reinforced a general sense among American physicians that Kenny's method was effective, especially for polio's acute stage, and that Kenny herself was reliable. Although Stimson was convinced that her ideas were original and worthy of scientific investigation, not everyone agreed. Her training—as a nurse she presumably knew nothing of tissue culture or dissected bodies—and her gender made her sound like a technical innovator who had gone too far in talking about science and theory. How much should physicians use her new terms and her ideas? Were her ideas just lucky guesses, based in ignorance or perhaps clinical acumen, or were they based on a distinctive scientific understanding of the body? If what she argued made scientific sense must previous scientific explanations be rejected? Had standard polio therapies been based on poor science?

In Canada observers of Kenny's work took on the question of credibility. Drawing on their experience during and after a serious epidemic in Manitoba in 1941, physicians at Winnipeg's Children's Hospital argued that not only was Kenny's work effective but it made scientific sense. Their arguments combined the evidence of their eyes and hands
with a new understanding of the body based on Kenny's theories. Kenny had “revolutionized our ideas on the symptomatology and treatment of acute anterior poliomyelitis” said orthopedist Alfred Deacon. During her visit to Winnipeg the medical staff “could feel the spasm she demonstrated and see the effects they were producing” and had been especially impressed—indeed “astounded”—by Kenny's ability to show that some patients deemed paralyzed could indeed move “merely by restoring the patient's mental awareness of those muscles, and thus correcting their alienation.” These results convinced the staff that her methods made sense physiologically and that “in most cases … the flaccid muscles are indeed alienated from their brain control.” The outcome of the new therapies was equally dramatic, for they produced “better results than any method we have hitherto used.”
¹²⁵
These impressive clinical results were also mentioned by the hospital's administrator who, however, warned his board of trustees that the 1941
Reader's Digest
story had been “painted in too brilliant colors,” leaving the impression “that the method of treatment returns paralyzed muscles entirely to normal” with patients “returned to complete robust muscular health.”
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“We cannot use the known pathology of the disease to justify a refusal to re-examine the clinical picture of this disease,” Children's Hospital director Bruce Chown declared boldly in the
Canadian Public Health Journal
. Writing as a pathologist and a pediatrician, Chown cited recent work by Johns Hopkins virologists Howard Howe and David Bodian whose critique of the standard classification of polio, Chown argued, could explain the diverse “symptoms and signs” of temporary paralysis that Kenny called mental alienation. Speaking as a clinician, a researcher, and an administrator well aware of the routine of caring for patients during and after an epidemic, Chown was convinced that “the whole disease is in need of reassessment.” “Some have found the stimulus unpleasant,” he warned, “but reaction is taking place.”
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Even more important was physiological research by University of Rochester orthopedist Plato Schwartz that established the existence of spasm through electronic analysis of muscles. In work funded by the NFIP Schwartz used the oscillograph he had developed in his Gait Laboratory to try to measure spasm. Schwartz and his colleague Harry Bouman took more than 500 records from 7 patients with acute polio and compared them to records of normal subjects and to patients without polio but with other kinds of “spastic” paralysis. Their research identified what they called “spasticity” (spasm) in patients with polio, although whether this was responsible for muscle weakening “cannot be answered at this time.” They also found evidence of “spasticity” in the muscles of patients with polio “where no clinical evidence of muscle weakening can be found” as well as in weakened muscles, suggesting both that spasm did exist but also that it could not necessarily be identified by clinical observation alone. Their
JAMA
article included 4 illustrations of “oscillographic records of muscle action currents” that showed “definite evidence of muscle spasm.”
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These 4 images seemed more serious and scientific than photographs of patients sitting up or walking.

Both Kenny and the NFIP immediately saw the implications of this study. A photograph of Kenny with Schwartz at the University of Rochester was published in the
Rochester Times
and reprinted in the
National Foundation News
.
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In her speech as the guest of honor at the university's annual alumnae dinner Kenny described Schwartz's article as the first formal academic recognition of her work showing “scientific proof for her concept of poliomyelitis and its treatment.” Less effusively and without mentioning
Kenny's theory, Schwartz replied that he gave her “full credit for discontinuing methods of fixation or immobilization and for stressing early reeducation of muscles.”
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The NFIP's newsletter featured the study, noting that a “laboratory equipped with delicate electrical instruments” had picked up and magnified minute electrical currents of nerve impulses and then measured, recorded photographically, studied, and analyzed them, providing “the first real proof that Miss Kenny was treating a condition which actually did exist.”
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Gudakunst similarly assured professionals and parents that this study proved Kenny's work was not based on “wild theory and uncontrolled imagination” but “that Kenny has described exactly what does happen.”
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Both Stimson's and Schwartz's studies were highlighted in the 1942
Yearbook of Physical Therapy
that devoted 24 pages to studies of Kenny's work compared to 3 pages the year before.
¹³³
At the American Congress of Physical Therapy Knapp similarly praised researchers such as Schwartz and Bouman who had begun to search for the physiological cause of spasm and referred to his own research conducted with a physiologist that supported “the fundamentals of the method.” While it was true that Kenny's work was “based on radical changes in physiologic interpretations of the observed symptoms,” Knapp said, there was no disagreement with known pathology. Indeed her work had made clear how little physicians did know “about the fundamental pathologic physiology of poliomyelitis.”
¹³⁴

In “Sister Kenny Wins Her Fight,” a follow-up
Reader's Digest
story in 1942, Lois Miller declared that the NFIP's approval of Kenny was “without precedent or parallel in medical history.” Boosted by clinical results described by Stimson and physiological evidence by Schwartz at the University of Rochester, “overnight the theories and practices that had been applied to the treatment of infantile paralysis for decades became outmoded; in their place came a new treatment—opposed to the old ideas—which had in its favor only one thing: it worked!” Miller did add that it was “still too early to inquire exactly how and why the treatment achieves its remarkable results.”
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In November 1942 5 members of the orthopedic committee formed during the summer's AMA meeting came to Minneapolis. Some of them, Kenny recognized immediately, “had written most antagonistically and untruthfully” about her work. This enmity was clear when “one extremely antagonistic member of the group” using the fighting word “cure” asked Kenny “what do you call a cure for this disease?”
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Ralph Ghormley was the committee's chair, but he was not able to come to Minneapolis, so Melvin Henderson, Ghormley's Mayo colleague who was not a member of the committee, had agreed to be its acting chair. In addition, Ghormley asked each of the visiting doctors to write his impressions of the visit. Kenny showed the visitors her patients, demonstrated her methods, and lectured on her theories, with some additional lectures from Pohl. She resented this further investigation of her work and while she was eager to prove her method's efficacy she was also quick to hear quizzical comments as attacks.

Almost all of the 5 visitors' responses showed that their previous attitudes were not changed. Henderson was pointedly neutral and in a positive tone said that the visit convinced him that “there is a good deal more to this disease than merely the involvement of
the anterior horn cells.”
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Edward Compere from Chicago, already known as a Kenny ally, was far more enthusiastic. He had begun to use Kenny's methods by early 1942 and had praised them in the
Archives of Physical Therapy
. Though “not a cure,” he wrote, they did reduce the “severity of the paralysis.”
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Compere recognized that the visit had not gone well and did not want personal animosities to derail a fair assessment of Kenny's contribution. While “it will not be easy to separate the personal equation,” he told Ghormley, “we should not judge the method, however, or the theory, on a basis of our dislike of some of the publicity which has so flooded the newspapers or because we may have had conflicts with Miss Kenny herself.”
¹³⁹
Robert Funston, chair of the Department of Orthopedic Surgery at the University of Virginia, had allowed his younger colleague to attend one of Kenny's courses a few months earlier and had sent members of his hospital staff to Minneapolis for further training.
¹⁴⁰
In a noncommittal report Funston noted that Kenny's patients had better flexibility and fewer “contractures” than other patients he had seen. As for her ideas about “the function of individual muscles,” in some “I think she is right and other[s] I do not.”
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St. Louis orthopedists Albert Key and Relton McCarroll came and left as adversaries. Key distrusted the examples of “apparently normal children” Kenny showed the committee, seeing them as very mild patients who “would have recorded normal muscles whether or not they had had the Kenny treatment.” He admitted he was intrigued by X-ray films of a patient with mild scoliosis who had worn a spinal support for 3 years and then been treated by Kenny. The more recent X-rays showed curves in the lumbar and dorsal spine that “were slightly less than were those in the earlier film” and he felt that “this case would bear study.”
¹⁴²
Both men disliked Kenny's rejection of orthopedic apparatus and her use of Kenny (short) crutches; both felt that such patients would be better off with braces “from an economic standpoint” and “that many of these patients will later choose a brace in preference to the crutches.” With no sympathy for Kenny's new definition of “deformity,” McCarroll was annoyed by Pohl's upbeat predictions of a patient whose peroneal muscles were still paralyzed after 14 months of treatment. Pohl had said that even if the muscles did not regain normal power “there would be no tendency to deformity in later years. How they can be so certain of this is impossible to see.”
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Both men also found Kenny rude and inflexible. According to Key “she made numerous dogmatic and, to my mind, obviously untrue statements and when questioned said to me on three occasions, ‘There are none so blind as those who will not see,' and turned her back. On other occasions she merely said that she was wasting her time trying to show us anything.” Her claims of having “discovered a cure” and having “revolutionized the treatment of this disease” they saw as “nonsense,” and both berated the NFIP “for fostering this publicity.”
¹⁴⁴

Kenny had hoped to sway the committee by a demonstration of mental alienation, using a trick she had developed years earlier. She asked the visitors to examine one of her patients and, as she recalled it, all “pronounced the extensors of the leg completely paralyzed. I disagreed and stepped forward. Again, as I had done in my own wild out-back of Australia thirty years before, I taught the muscle what to do, gave back to it its motor pattern, and then linked it up with the brain path. Full use of the muscle was restored in less than twenty seconds.”
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Then she declared dramatically “that muscle is normal; it was only alienated and I have restored its power.”
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Key and McCarroll were both unimpressed and perhaps also embarrassed to have been shown up.
¹⁴⁷
Nor did Kenny's efforts to have the surgeons feel the clinical signs she had identified with their own hands
succeed. McCarroll recalled that he was asked to compare a muscle in spasm with the same muscle in the opposite limb. “I very frankly could not detect any difference in the feel or the appearance of these muscles,” he reported to Ghormley. He saw no evidence that any of these muscles could return to their normal power, pointing out “they keep no detailed records on these muscles.”
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