Polio Wars (34 page)

Gill had retired from the University of Pennsylvania in 1942 after over 2 decades as chair of the department of orthopedic surgery. He continued his private practice and when Alfred Shands left for the army, Gill replaced him as director of the Alfred DuPont Institute, a hospital for disabled children in Wilmington, Delaware. He tried in vain to draw a line between necessary clinical improvement and slavish following of Kenny's work. At a meeting of the Philadelphia chapter of the American Physiotherapy Association, divisions deepened after Rutherford John, a prominent surgeon on the board of directors of the Philadelphia Society for Crippled Children and an associate professor of orthopedic surgery at the University of Pennsylvania, called the Kenny method “very rational” and
Gill retorted that John was “either stupid or willfully misrepresenting the truth.”
¹⁶⁷
Gill was appalled to see an advertisement for Kenny and Pohl's new textbook whose publishers had “the unblushing audacity” to declare that “orthodoxy has erred both in recognition as well as in the interpretation of the physical findings in this disease” and that Kenny's concept and treatment were “now generally accepted and approved by the medical professional everywhere.” He was also annoyed that 3 recent publications on Kenny had all proclaimed that Kenny's work would be “the basis for the future treatment of infantile paralysis” and that her “original” and “revolutionary” concept was “fundamentally different from that hitherto prevailing.”
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Kenny's method, in Gill's view, had become famous not through scientific research but “as the result of publicity designed for the public.” Under the influence of this publicity parents were demanding that their child be treated by the Kenny method; “in other words, the doctor is being told by the layman how he should treat a specific disease.” With an implicit jab at the NFIP Gill warned that allowing “methods of propaganda” to “outrun scientific research and clinical observations and rational analysis” was dangerous both for physicians as well as the public for it would lead physicians to be “swept away from their positions of scientific observation and rational criticisms” and they might subsequently “feel some inward embarrassment and humiliation.”
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Gill again took up the argument that little in Kenny's work was new. Many of her “concepts of principles and methods of treatment” were the same as those published by Robert Lovett and many other physicians in proceeding years and ignored “our common fund of knowledge concerning the nature and the pathology in infantile paralysis.” Proud of orthopedic treatment and its results, Gill believed “if any of us treat a child from the beginning of the disease and throughout the following months and deformities develop, we know that we are not following orthodox principles of treatment.” Nor did Gill believe that Kenny's results had been fairly compared to patients treated by standard methods. In any case, a control study of polio would never be possible for even during the same epidemic patients had varying symptoms and there was an “uncertain prognosis in any individual case.” When the wide publicity around the Kenny movement had “run its course,” he concluded, the final result “whatever it may be, will depend not upon the statements now made by Miss Kenny and her followers, but upon scientific observation and reasoning.”
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In 1944, not long after his comments were published in the
Journal of Bone and Joint Surgery
, Gill replaced Ober as president of the American Orthopedic Association, a symbol of anti-Kenny orthopedic leadership.

As Gill recognized, Kenny's work had become central in NFIP publicity, featured in the NFIP's 1942 annual report and the NFIP pamphlet
The Kenny Method of Treatment
. The
National Foundation News
, a monthly newsletter sent to all NFIP chapters, began urging local and state officials to send one or more persons to be trained in the Kenny method, explaining that “it is a wise and legitimate expenditure of funds for the Chapter.” The
News
carefully listed not only the Institute but 5 other centers that offered “Kenny Method Courses.”
¹⁷¹
While pleased with these signs of philanthropic support Kenny remained dissatisfied. She was not convinced that the NFIP had fully revised its support of previous medical practice. It continued, for example, to distribute other pamphlets whose content contradicted her understanding of the disease.
Doctor, What Can I Do?
, she complained to O'Connor, referred to “damaging” treatment and “describes the symptoms of a disease which I have proved does not exist.” Both
Splints: Their Distribution and Use
and
The Use of the Respirator in Poliomyelitis
referred to “devices … for a disease that does not exist.”
¹⁷²

Kenny had come to believe that her methods were being diluted in the various centers outside Minneapolis supported by the NFIP and that even sympathetic physicians were altering elements of her work when they returned to their home institutions. Where she had once bragged that treatment by even partly trained technicians would be an improvement on previous treatment, she now railed against deviation from any aspect of her method. Further, instead of her initial support for nurses and physical therapists who had trained at the Institute to work as teachers after receiving their certificates, by early 1943 she was no longer convinced that most of them were sufficiently trained to work as teachers. Kenny began to denigrate centers outside the Institute, using, as she often did, the words of others. Some of the physicians who had taken her class in early 1943, she reported, had gone to “other centers where the treatment is supposed to be taught” and stated “that the other centers have fallen far short of the standard at Minneapolis.”
¹⁷³
These comments contradicted efforts by the NFIP to integrate her work at diverse well-respected medical centers across the country. It also reflected her growing sense that the Institute must rank as the most important center for teaching her methods.

The argument, made frequently in medical, nursing, and physical therapy journals, that Kenny had merely drawn attention to neglected, mainstream polio therapies, frustrated Kenny. She had identified clinical signs, which she argued were crucial and which had not been previously recognized; otherwise surely a physician would have developed therapies to treat them. The more that the “attention” argument was made, the more vehemently Kenny argued that her new signs could not be added onto the standard view of polio, that the success of her methods proved that she had developed a distinctive understanding of what caused polio's paralysis. Thus, her work must
replace
standard care, not complement it.

She became convinced that only her specially trained technicians could lead the national and international effort to alter polio's clinical care. Eager to provide these technicians with opportunities to showcase their work she was delighted when the NFIP agreed to send Mary Kenny and Ethel Gardner, one of Kenny's inner circle from the Institute, to travel to Argentina during a serious polio epidemic. In early 1943 the head of Argentina's national department of health had asked for help from the NFIP and also contacted the
Reader's Digest
, which had published an article on Kenny in its Spanish edition and set up a scholarship fund for South American nurses and doctors to train at the Kenny Institute.
¹⁷⁴
In Buenos Aires an American expert at the Rockefeller Foundation's International Health Division reiterated the request for technical assistance, and, after O'Connor contacted Roosevelt, Gudakunst began working out the details.
¹⁷⁵
Sending aid of any kind to Argentina was tricky. Argentina was the only Latin American country that had not severed diplomatic relations with Germany and Italy, and its unstable government was allowing Nazi Germany to establish a spy network there.
¹⁷⁶
In a statement that combined U.S. foreign policy with its own philanthropic mission, the NFIP announced
proudly that the trip would “not only aid those stricken by infantile paralysis but will, through that manifest assistance, further implement the Good Neighbor policy.”
¹⁷⁷

Gudakunst had heard disturbing reports from Miland Knapp about the Little Rock epidemic in which patients had supposedly been discharged too early and the hot packing had been poorly organized, “partly due to lack of help and facilities and partly due to a feud between the nurse in charge of the floor and the nurses who had been sent to Minneapolis for Hot Pack training.”
¹⁷⁸
So as not to make “the same mistake that we made in Little Rock,” Gudakunst made sure that an approved physician accompanied the 2 Kenny technicians.
¹⁷⁹
His choice, Philadelphia orthopedist Rutherford John, had contacted Gudakunst in February proposing himself for the Argentina trip, for “the Army won't take me, and my foot itches to do some traveling.”
¹⁸⁰
John had already declared at a meeting of the state's chapter of the American Physiotherapy Association that he believed Kenny's work was “very rational” and that her ideas “dovetail[ed] wonderfully with our scientific knowledge of the disease.”
¹⁸¹
Gudakunst considered John “a top-notch man fairly well acquainted with the Kenny method” who had traveled in South America and therefore “knows something of the customs, and has a fair ability to converse in Spanish.”
¹⁸²
He also asked the opinions of Mayo orthopedist Melvin Henderson and Morris Fishbein, who both gave their approval.
¹⁸³

John and the 2 technicians arrived in March 1943 and based themselves in Buenos Aires.
¹⁸⁴
Diplomatically, John stayed at a hotel instead of the hospital where the technicians were staying. Debates among Argentinean physicians about the proper way to treat patients with polio were ferocious, so staying at a hotel helped him, he explained to Gudakunst, “not be associated with any one clique.”
¹⁸⁵
In a letter to the Secretary of State, U.S. Ambassador Norman Armour praised the “tact, patience, and persistence of Dr. John and the nurses,” which had overcome obstacles such as “bureaucratic procrastination, professional rivalries, lack of trained personnel, inadequacy of material equipment, and want of a common language.” The local press was all “unanimously and enthusiastically favorable,” and “only the extreme nationalist and Nazi-Fascist sheets have ignored the visit.”
¹⁸⁶
John, however, was uncomfortable. He was unable to convince some of the local physicians who disliked both the Kenny method and its “wide publicity by the Argentine press.”
¹⁸⁷
He also found the federal and city polio commissions at odds and described the strain to “keep in with both.” He gave a series of lectures that were well attended and widely reported by local newspapers. But the course he organized on muscle reeducation was overwhelmed by applicants, most bringing letters from physicians. Mary Kenny and Gardner told him they could not handle more than a dozen students. As a result, he told Gudakunst, “I had to be hardboiled and have probably made many enemies [although] … we are still immensely popular with the Press and the people.” He recognized that many Argentineans wanted the technicians “to stay on indefinitely and teach but my feeling is that we have done what can be done in a short time and it might be wiser to leave at the height of the enthusiasm.”
¹⁸⁸
In early May John returned to Philadelphia.

O'Connor began to hear troubling reports that the demands of wealthy families for private care were diverting Mary Kenny and Gardner from their teaching work. He told Gudakunst to explain to Kenny that the technicians must return to the United States. Gudakunst reminded her of “language problems” and “some hospital quarrels” and warned that “the political situation in the Argentine” was unstable.
¹⁸⁹
At first Kenny agreed that “with regard to Miss Gardner's and Mary's return from the Argentine, that is
a matter for the Foundation to decide. They sent them down, and I think Mr. O'Connor would know more about the inside affairs than I do. If he thinks it wiser for them to return, that is all right.”
¹⁹⁰

But she changed her mind a week or so later. “The work they are doing and the friendships they have formed through this work is [sic] doing much for the U.S.A.,” she told Gudakunst in what he admitted to O'Connor was “a rather heated conversation.”
¹⁹¹
The quarrels, she had learned, “were between the Doctor from the United States and my own technicians,” and John had threatened to “have them returned to the United States before their time was up.” In any case, neither technician wished “to leave an unfinished job.”
¹⁹²
As Kenny recollected it a few months later, Mary had asked to be allowed to stay, “as the children were so very sick and there was no one to attend to them. She also informed me that the doctors were very interested and that she was giving them lectures three times per week.” Mary also described “the tears of gratitude in the eyes of the mothers.”
¹⁹³
Kenny's obstinate stance was fueled by her sense that John had not properly valued her work. To explain how wrong Gudakunst had been to defend John, Kenny sent him a copy of a lecture John had given to local orthopedists that she characterized as “a gross misrepresentation of my work and primarily a lecture on the value of orthopedic surgery.”
¹⁹⁴
In reassuring Argentine orthopedists about the power relations inherent in adopting the Kenny method, John had said that Kenny technicians were all “trained under orthopedic surgeons and the mechanism of the treatment itself is basically orthopedic,” and that Kenny's work was a useful “adjunct to orthopedic surgery.”
¹⁹⁵
“[He] does not know how terribly sick these patients are and how much general care they need apart from orthopedic attention,” Kenny retorted, adding that “my contribution is not a treatment or adjunct to anything but a new concept of the disease and treatment for this concept.”
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