Polio Wars (53 page)

On experiences of polio, including at Warm Springs, see Richard L. Bruno
The Polio Paradox: Understanding and Treating ‘Post-Polio Syndrome' and Chronic Fatigue
(New York: Warner Books, 2002); Lynne M. Dunphy “ ‘The Steel Cocoon:' Tales of the Nurses and Patients of the Iron Lung, 1929–1955”
Nursing History Review
(2001) 9: 3–34; Amy L. Fairchild “The Polio Narratives: Dialogues with FDR”
Bulletin of the History of Medicine
(2001) 75: 488–534; Hugh G. Gallagher,
Black Bird Fly Away: Disabled in an Able-Bodied World
(Arlington, VA: Vandamere Press, 1998); Hugh Gregory Gallagher
FDR's Splendid Deception
(New York: Dodd, Mead, 1985); Tony Gould
A Summer Plague: Polio and Its Survivors
(New Haven: Yale University Press, 1995); Robert F. Hall
Through the Storm: A Polio Story
(St. Cloud, Minnesota: North Star Press, 1990); Daniel Holland “Franklin D. Roosevelt's Shangri-La: Foreshadowing the Independent Living Movement in Warm Springs, Georgia, 1926–1945”
Disability & Society
(2006) 21: 513–535;Davis W. Houck and Amos Kiewe
FDR's Body Politics: The Rhetoric of Disability
(College Station: Texas A & M University Press, 2003); Leonard Kriegel Flying Solo:
Reimagining Manhood, Courage, and Loss
(Landham, NY: Ballantine: 1998); Theo Lippman, Jr.
The Squire of Warm Springs: F.D.R. in Georgia 1924–1945
(Chicago: Playboy Press, 1977); Janice Flood Nichols
Twin Voices: A Memoir of Polio, the Forgotten Killer
(Bloomington, IN: iUniverse, Inc., 2007); Naomi Rogers “Polio Chronicles: Warm Springs and Disability Politics in the 1930s”
Asclepio: Revista de Historia de la Medicine y de la Ciencia
(2009) 61: 143–174; Naomi Rogers “Silence Has Its Own Stories: Elizabeth Kenny, Polio and the Culture of Medicine”
Social History of Medicine
(2008) 21: 145–161; Edmund J. Sass with George Gottfried and Anthony Sorem eds.
Polio's Legacy: An Oral History
(Lanham, MD: University Press of America, 1996); Marc Shell
Polio and Its Aftermath: The Paralysis of Culture
(Cambridge: Harvard University Press, 2005); Susan Shreve
Warm Springs: Traces
of a Childhood at FDR's Polio Haven
(New York: Houghton Mifflin, 2007); Julie Silver and Daniel Wilson
Polio Voices: An Oral History from the American Polio Epidemics and Worldwide Eradication Efforts
(New York: Praeger, 2007); Turnley Walker
Roosevelt and the Warm Springs Story
(New York: A. A. Wyn, 1953); William Foote Whyte
Participant Observer: An Autobiography
(Ithaca: ILR Press, 1994); Daniel J. Wilson “Braces, Wheelchairs, and Iron Lungs: The Paralyzed Body and the Machinery of Rehabilitation in the Polio Epidemics”
Journal of Medical Humanities
(Fall 2005) 26: 173–190; Daniel J. Wilson
Living with Polio: The Epidemic and Its Survivors
(Chicago: University of Chicago Press, 2005); Regina Woods
Tales from Inside the Iron Lung (and How I Got Out of It)
(Philadelphia: University of Pennsylvania Press, 1994); Heather Green Wooten
The Polio Years in Texas: Battling a Terrifying Unknown
(College Station: Texas A&M University Press, 2009).

1943 HAD BEEN
a bad year for polio, and 1944 was worse. With a total of 19,272 reported cases, it was the second-largest epidemic year yet recorded in U.S. history. Impossible to predict or prevent, polio epidemics followed Americans as they moved around the country seeking jobs in the wake of wartime industries, especially in the mid-Atlantic region and the South.

During the early 1940s Kenny, the National Foundation for Infantile Paralysis (NFIP) and the American Medical Association (AMA) had worked as uneasy allies. But in the mid-1940s, this alliance turned into a fierce battle over medical orthodoxy and professional self-interest. In February 1944 Kenny announced that the NFIP had refused her Kenny Institute the $150,000 it needed to expand its training program and to hire anatomists and physiologists to pursue research. She did not make clear how she or the Institute had requested this amount, but she did claim that Fishbein and O'Connor continued to treat her with skepticism and hostility. Recently Fishbein had told her to “leave the United States because other countries need my assistance.”
¹
This was the opening salvo of the polio wars between Kenny and the NFIP.

The polio wars were medical culture wars, played out in the popular and professional press with a feisty, uncontainable woman at the center. As they escalated, Kenny accused the NFIP of never having supported or respected her and of funding worthless polio treatments recommended by antagonistic physicians. Even its support of research was wrong-headed, she complained, because scientists working under NFIP grants ignored the insights of her work. By this time Kenny had behind her supporters in business, politics, and the press, along with expansive public good will. Despite a frantic effort to contain the fight the NFIP found itself on the defensive, and by 1945 it was losing allies among the wealthy, many women, and even Hollywood moguls.

The AMA's lock on power began to unravel as well, as the conservative policies of its leaders—especially Morris Fishbein—fell out of favor with policymakers, patients, and many physicians. While the AMA had been successful in lobbying to keep federal health insurance out of the 1935 Social Security Act, it suffered a major public humiliation in 1943 when the Department of Justice won an antitrust suit against the AMA and its affiliated medical society in Washington, D.C. The society, backed by the AMA, had sought to deny hospital privileges and membership to doctors associated with a prepaid health insurance plan.
²
Sensing weakness, Congress began debating new health insurance programs. Meanwhile, Fishbein became an easy target for discontent within the association. At the AMA's June 1944 annual meeting California delegates tried to oust him as general secretary and editor of
JAMA
. Their resolution was defeated 144 to 9 but each year the vote became closer. It was the beginning of the end for Fishbein, whom the
Saturday Evening Post
characterized in 1946 as “the best-known and least-liked doctor in the United States.” Grudgingly, the AMA's House of Delegates formally approved limited group medical practice and voluntary insurance plans sponsored by medical societies (later called Blue Shield).
³
In the mid-1940s, however, Fishbein still held the reins, and he continued to see Kenny as an annoyance who would be easily controlled.

The polio wars were invigorated in July 1944 when the Kenny Institute boldly applied for a large research grant from the NFIP, an application O'Connor managed to thwart by asking yet another group of experts to assess and reject the Institute as a site for clinical research. Frustrated, Kenny tried to expand her clinical practice at the Institute by accepting patients with other neuromuscular conditions such as cerebral palsy, but a combination of city and professional politics ended that effort. Kenny's claim that her work was being undermined by an “organized opposition” was taken up by a few national politicians who saw a way to attack both the AMA and President Roosevelt. And in Minneapolis the Institute's board reorganized itself into a fundraising corporation known as the Kenny Foundation. But after Roosevelt's death in April 1945 polio politics shifted into a competition between 2 polio philanthropies both trying to convince the American public of social and financial support.

In February 1944 Kenny announced that because the NFIP was not willing to provide the Institute with funding, although her work in America was not done, she would have to return to Australia. At the same time, recognizing the role that research breakthroughs played in the March of Dimes publicity, she announced a new diagnostic sign, a distinctive muscle condition to help professionals begin treatment even before the first signs of paralysis appeared. The misdiagnosis of polio had continued to be a serious problem for families and health professionals, with a number of patients admitted to already overcrowded polio wards who were later diagnosed with, for example, diphtheria and meningitis.
⁴
Earlier treatment, she claimed, would improve every patient's chance of recovery, ameliorate polio's symptoms, and reduce pain “almost entirely.” This would be “the greatest contribution that has yet been given to the medical world in connection with this disease.” The sign was a peculiar rubbery sensation in the muscle that could be felt by a technician rotating a patient's joints. It indicated, Kenny said, that the muscle would soon go into spasm and would probably become paralyzed. But, she added, although many
physicians had begged her to teach them, without the support of the NFIP and the AMA she would be unable to do so. “I am loath to leave this country,” she told reporters dramatically, “but there is not much use in me staying unless I get greatly increased support.”
⁵

“Must Sister Kenny Leave?” asked the
Chicago Herald-American
, the
New York Journal-American
, and other newspapers. Fishbein quickly told the press that he had meant only that “her work needs dissemination throughout the world.”
⁶
But his antagonism to Kenny was widely known. A few weeks earlier in a
JAMA
editorial entitled “Physiologic Nonsense and Poliomyelitis,” he had quoted with relish the assessment of the eminent neuroscientist Stanley Cobb who praised “qualified investigators” like Joseph Moldaver and warned that “new and empirical methods of treatment backed by uncritical enthusiasm may produce many cures but much physiologic nonsense. The treatment may be good, but the ex post facto conclusions of the therapeutist are usually bad.”
⁷
A “therapeutist” was obviously far from a scientist.

Seeing this at first as a minor skirmish, O'Connor and his staff defended the NFIP with a few brief statements. There was no “controversy between the National Foundation and Sister Kenny,” O'Connor told reporters. “We have put [up] all money ever requested to evaluate and teach the Kenny method. Our reports and all our public statements show that.” He recognized that Kenny had expressed her dissatisfaction with continuing investigations of her work, but declared that the NFIP would “continue to evaluate the Kenny method … in the hope of finding greater values in it.”
⁸

These denials were not effective. Amplified by the Hearst newspapers and later the
Reader's Digest
, they became weapons in a nascent populist movement. Here was a woman wronged, a selfless nurse devoting her life to healing children, yet being given no respect or honor by the men of the medical profession. Americans sent letters of outrage to Kenny, Roosevelt, O'Connor, their congressmen, and their local newspapers. They formed campaigns to raise money for the Kenny Institute, and warned local and national NFIP officials that the March of Dimes would receive no further support from them if its policy did not change. Most of all, Americans debated the nature of professional authority and research priorities, and the role that gender, social status, and character played in determining who received the respect of the medical establishment and the funding of powerful philanthropies. To its great surprise the NFIP found itself forced to defend and define what constituted scientific evidence, how medical expertise was and should be determined, and the purpose of research. Inspired by Kenny's struggles, the media campaign rapidly became a wider forum for the public to express long-standing frustration with unresponsive physicians and hospitals, autocratic public officials, the dismissal of strong women, the neglect of chronic disease, and enforced medical orthodoxy.

This was a new moment in American medical politics. Although on other occasions Kenny had threatened to leave, accused the NFIP of not supporting her work, and mentioned her early diagnostic sign, the story had always faded quickly. This time it caught fire. In the fervor of this battle, Kenny succeeded in challenging the public to rethink the medical establishment's claim to a monopoly on scientific truth and medical authority, and forced a powerful philanthropy to defend its research funding policies. She made the battle personal—about respect for herself and proper care for the disabled—as well as political. Her accusations that a medical cabal was attacking her and denying proper care to patients rang true to many Americans. How did the NFIP decide who to give money to? Was it just a club of elite physicians, funding each other? The NFIP, once able to command the public's unlimited faith, now encountered every philanthropy's worst nightmare: the suspicion of
its donors. In pulling the powerful down to the level of public debate Kenny revived and expanded a medical populist movement that had previously been restricted to male entrepreneurs such as John Brinkley and female evangelists such as Aimee Semple McPherson.