Polio Wars (58 page)

Kenny had no patience with obscuration. In sorrow and anger she agreed that the AMA report did not represent Compere's own opinion for “you are too honest, I hope, to be a double-dealer.” But she was “surprised to think you signed your name to it,” especially as it “accused me of perjury,” which was “poor thanks to give to one who came from afar to give to you the greatest gift you and your people have yet received with regard to this disease and many others.” Compere should be well aware that the committee had not “made a close study of this work for two years” but instead had wasted time “visiting other Centers where a crude, mongrelized treatment is given.” As for her claim that orthopedists resented losing surgical patients, “an Orthopedic Surgeon from Kansas City informed me that the average work of the Orthopedic Surgeon was 40 per cent the after-effects of infantile paralysis. Whether it is correct or not I do not know.”
¹¹⁰
She did not comment on the ethical implications of her statement, which had angered Compere, but defended herself from what she saw as accusations of fraud and deception. This was not a letter that could be answered in any calm way and Compere did not try. Instead he quietly moved away from his prominent stance as a Kenny ally and began to rebuild allegiances with his specialist peers. “My interest in any particular method for the treatment of infantile paralysis, has been over-estimated,” Compere told a man seeking his support for an invention to standardize heating hot packs a few months later; “I have used hot packs, as recommended by Miss Kenny, but have found them far less curative than Miss Kenny herself.”
¹¹¹
Compere continued as the chair of the orthopedics department of Northwestern's medical school until 1949 and in the 1950s edited a well-known volume on orthopedics and traumatic surgery, but—perhaps as the price he paid for supporting Kenny in the early 1940s—he was never elected to a senior position in any national orthopedic society.
¹¹²

By comparison Robert Funsten and Charles Frankel, his junior associate at the University of Virginia, remained important orthopedic authorities, speaking frequently about the dangers of Kenny's version of polio care. At the Southern Medical Association in 1945, for example, they warned that a “rigid” use of the Kenny method, which they had tried in 1943, had been “expensive, illogical and unsatisfactory.” Perhaps Kenny had “stimulated a great deal of investigative work,” but much research had now “disproven
many of her statements and claims.” They also condemned her “bitter determination … to force her theories upon the medical profession and the public regardless of pathological data.”
¹¹³

In July 1944, Marvin Kline, as head of the Institute's board of directors, wrote to O'Connor to apply for a 3-year $840,000 grant. In what was clearly another move in the polio wars Kline said boldly that this large NFIP grant would be used to continue funding the Institute's technician teaching programs in the Kenny method—“the only treatment based on sound physical medicine”—and to establish a clinical research center at the Institute to be “devoted to clinical investigation of the disease of infantile paralysis and the application of the Kenny principles to other neuro-muscular diseases” including arthritis, cerebral palsy, and postoperative care.
¹¹⁴
Gudakunst asked Diehl to find out more about this request. Diehl checked but found that neither Knapp nor the current coordinator of the Kenny courses at the medical school knew “anything about it.”
¹¹⁵

The NFIP wanted to handle this grant application as carefully as possible. The decision to turn the Institute into a center for clinical research would represent a major shift in power relations between the NFIP and Kenny's supporters. The NFIP, further, had consistently argued that the Institute was an inappropriate site for polio research. Twelve months earlier Kline and 2 city aldermen had traveled to New York to discuss the Institute's budget and had promised O'Connor “that the purpose of the Kenny Institute was for the teaching of the Kenny method” and that NFIP funding for the Institute was to be handled between Diehl and O'Connor.
¹¹⁶
But now a group of Institute officials was acting without having consulted Diehl or even most of the physicians in its own facility.

It was here that John Pohl, superintendent of the Kenny Institute, made a decisive move away from other Institute physicians. He had written the grant application in consultation with Kline and other members of the Institute's board, and he recognized that calling the Institute a potential research site was a defining step. Krusen at the Mayo Clinic and Lewin in Chicago may have been able to express their support of Kenny while holding onto the respect of their specialist peers, but Pohl was working in the eye of the storm without a senior teaching position at the medical school.
¹¹⁷
His polio work had rapidly become an inseparable part of Kenny's sphere.

Pohl was a shy man, uncomfortable with the cocktail parties and formal dinners that Kenny adored. Yet he had increasingly linked his own career to Kenny. He admitted that she could be difficult but he began to feel that his contribution was translating her ideas for other doctors to understand.
¹¹⁸
Kenny's work with Henry Haverstock had impressed him mightily, and in 1942 this patient (H.H.) was the first of a series of 26 patients he described in a report on the Kenny method published in
JAMA
.
¹¹⁹

Kenny saw Pohl as one of her most attentive and helpful supporters. He had, she noted in early 1942, “attended every session and was present at the bedside of every acute case when examined by me and took particular care to watch all phases of the signs and symptoms and the especial treatment for each sign and symptom.”
¹²⁰
Pohl's promotion of Kenny, however, made him less reliable as an objective medical observer.
¹²¹
But he deeply believed that the worth of her work should stand above petty politics, whether among city officials,
the Institute's staff and directors, or the medical school faculty. Immediately after the AMA report he had told the local newspapers that her work was “the finest and best treatment known at the present time” and that “antiquated methods which allow children to suffer deformities from infantile paralysis should be abolished.”
¹²²
University physicians, in Pohl's view, had allied themselves with the NFIP ostensibly for scientific reasons but really because the NFIP was one of the nation's richest sources for medical research funding. It was an expression of his personal and professional faith in Kenny's work that led him to take this provocative new step of trying to expand the Institute's mission.

O'Connor decided that the opinion of a group outside the NFIP was needed to assess this new grant application and turned to the National Research Council (NRC) to advise the NFIP on whether to fund it or, more accurately, how least problematically to reject it. Founded during World War I as a scientific advisory body for the military, the NRC had taken on this function again during World War II, establishing a series of committees offering expertise on topics ranging from foot fungus to dengue fever.
¹²³

In August 1944, in response to O'Connor's request, the NRC's Division of Medical Sciences set up a special subcommittee to investigate the Institute's grant application.
¹²⁴
The coordinators of the subcommittee, George Darling, the vice-chairman of the Division, and O. H. (Perry) Pepper, head of the Division's Committee on Medicine, were careful to frame this investigation as the arbitration of what constituted an appropriate place to conduct scientific research and professional training based on national standards and the NFIP's already established policies. The new subcommittee, they reiterated, was not going to “get drawn into any of the pros and cons concerning the Kenny treatment itself.”
¹²⁵

Pepper was a senior faculty member at the University of Pennsylvania and a member of a socially prominent Philadelphia family.
¹²⁶
The rest of the NRC subcommittee consisted of 2 medical school deans (Milton Winternitz of Yale and Wilbur C. Davison of Duke), a physiologist (Philip Bard of Johns Hopkins), a virologist-epidemiologist (Thomas Francis Jr. of the University of Michigan), an orthopedist (Guy Whitman Leadbetter from George Washington's medical school), a physical medicine expert (George Morris Piersol of the University of Pennsylvania), and George Darling himself.
¹²⁷
Francis, who later coordinated the Salk vaccine trials, was the only member with research expertise in polio. Neither Piersol nor Leadbetter, the 2 clinicians interested in polio therapy, had been to Minnesota or played any part in the polio wars.

In September Darling wrote a careful letter to Kline, letting him know that the committee would be traveling to Minneapolis “to make recommendations on the suitability of the Kenny Institute as a proper place to receive large grants for research, teaching, and so forth—not to study or evaluate the Kenny Treatment, as such.” The visitors would want to see facilities and equipment and to talk with the Institute's medical staff, business administrator, and others responsible for the proposed research and training programs. They “will, of course, hope to see Sister Kenny,” but “they will not be particularly interested in patients except incidentally, nor in demonstrations of the treatment methods.”
¹²⁸
This letter, Pepper told Darling in a private note, “hit the exact note which I had hoped you would.”
¹²⁹

Although the NRC members tried to frame this investigation as an unbiased institutional review, it was impossible for any conciliatory letter to assuage the suspicions of Kenny and her supporters that yet another group of elite physicians was coming to Minnesota to disparage her work. Kenny shrewdly understood that the NRC could act independently of the NFIP. In a letter addressed to “Gentlemen” she presented herself cautiously as a
clinical innovator without emotionality or overreaching claims. She asked for several hours to present to the committee the results “of my clinical research” and also invited the group to the Ray-Bell Studios in St. Paul where she would show her “documentary film.” But then, moving from the cooperative to the brash, she added that she would like the committee to forward their “findings … with regard to this presentation” to British Medical Association branches in London, Sydney, Cape Town, Canada, and India, and to the health departments of these countries. In an unfortunate phrase that turned scientists into amanuenses rather than investigators, she noted that there was an “urgent need of a detailed description of my research in muscle anatomy and physiology and bodily mechanics.”
¹³⁰

On September 24 5 committee members began their trip to Minneapolis, arriving by train the following day. They dined that evening with 6 members of Minnesota's medical school faculty who were “most concerned with the teaching and research in the field of polio” and who represented its varied views.
¹³¹
Knapp and Cole worked closely and quite effectively with Kenny; Dean Diehl and William O'Brien, the coordinator of the university's postgraduate courses, were the mediators between the university and the Institute; John McKinley, professor of neuropsychiatry, and Maurice Visscher, professor of physiology, were firmly in the anti-Kenny camp. The group had “a very free discussion” and was later joined by Mayor Kline and Fred Fadell, the Institute's new public relations manager.
¹³²

The next morning the NRC committee went to the Institute where they met Kenny and the business manager of the Institute, some technicians and nurses, and Pohl and a recent medical graduate who was the Institute's resident physician. After lunch the visitors watched Kenny's film and then visited the city hospital's laboratories, which they considered inadequate and poorly equipped.
¹³³
Kline was the host of that night's dinner, and the guests included Kenny, Pohl, Henry Haverstock (father of Kenny's first patient and secretary of the Institute's board), and 2 of Kenny's wealthy local supporters.
¹³⁴

It was a short visit but the NRC committee met all the major players, saw the facilities at the Institute and city hospital, watched Kenny demonstrate her methods, and socialized with her proponents and antagonists. In November, after 2 months of discussion, the NRC committee finished its 21-page report and sent it to O'Connor.

The committee members identified a number of significant problems in the Institute's organization. The first was politics. They disliked the power exercised by Kline, who they believed was too closely connected with the Fadell agency, which was not only running the Institute's upcoming fundraising drive but also planning Kline's 1945 mayoral reelection campaign. Just what the public funds raised in the upcoming Institute drive would be used for seemed to be unclear, even to members of the Institute's board. In an early draft of its report, the NRC committee had warned that any NFIP funding policy of the Institute might increase “power in the hands of the political interests with obvious dangers of graft and still lowered standards.”
¹³⁵
The committee removed this comment, along with other intemperate phrases, from the final report.

The committee tried to take the idea of the Institute as a research facility seriously but it was difficult for its members to conceive of research without proper laboratory space or to imagine patient care alone as sufficient for a research program. Even the grant's proponents seemed unable to explain how laboratory evidence would be integrated with clinical observation. The committee was not impressed with the Institute's facilities or its professional structure. There were, the committee pointed out, few actively involved physicians. Knapp, neurologist Joseph Michaels, and pediatrician Alfred Stoesser, all chiefs
of staff at the city hospital and at the Institute, were “largely inactive in the Institute proper” although they did examine patients before they were admitted to the city hospital and were available on call at the Institute. The Institute's disturbingly close relationship to the local medical community outside the university also suggested inadequate professional supervision. Unlike the university's teaching hospital, which restricted patient care to physicians on the medical school faculty, the Institute, like most community hospitals, welcomed outside physicians who were allowed to “continue in professional charge” of their patients. The committee noted with disapproval that these physicians had to agree to “cooperate with Kenny procedures.” As for the Institute's full-time staff, the number of doctors was “grossly inadequate for the number of patients present,” a situation that probably explained the inadequacy of the Institute's clinical records, which detailed “chiefly Kenny treatment and its results.”
¹³⁶