Polio Wars (7 page)

In the early twentieth century polio outbreaks were a new phenomenon. Away from the city, rural patients frequently depended on idiosyncratic methods practiced by a doctor, nurse, or family member. In urban institutions there was an effort to standardize polio care. Patients with paralysis were first isolated in separate wards until their fever subsided and they were deemed noncontagious. As polio's early symptoms were frequently confused with other diseases such as tubercular meningitis some physicians recommended a spinal tap. Even after the polio virus was identified in 1909 it was not visible in an ordinary microscope, so analyzing spinal fluid was more often a search to rule out other possible infections. Polio paralysis was believed to be caused by nerve cells damaged by an inflammation of the central nervous system, so doctors recommended strict bed rest and immobilization. Especially for children who were restless casts were used to restrain movement. Patients were immobilized sometimes for many months in what was seen as “physiological rest.” Children's limbs became flabby (flaccid) and wasted, and, with casts that restricted growth, both bones and muscles tended to atrophy. Patents were offered massage, baths, exercises, and sometimes electrical treatment to try to regain muscle strength but usually in gloomy institutions with limited nursing staff and a sense of prognostic pessimism. After 18 months of treatment patients were considered unlikely to improve and were fitted for braces and/or crutches, and told to anticipate tendon transfers and other orthopedic interventions involving hospitalization after a year or so.

Until the late 1930s Kenny saw mainly patients who had had this kind of polio care, sometimes years earlier. She took the casts, stomach corsets, and other apparatus off her patients and encouraged them to move their long-neglected stiff muscles. She used a variety of rehabilitative methods, including hot- and cold-water sprays, muscle exercises, and an unusual technique she called “manual vibration” in which her arm vibrated as she tried to stimulate a patient's unused muscles and thereby, she believed, reconnect the muscle to its corresponding neuron. Unlike most physical therapy recipients, her patients played an active role in their rehabilitation, learning to understand the function of individual muscles. Kenny began to wonder whether her methods might be even more effective applied to patients in polio's acute early stages. She also came to believe that the standard polio therapies were not only unhelpful but actually harmful.

Kenny gained nursing experience outside the Queensland bush with the outbreak of the Great War. Although she was initially ineligible for the Nursing Service as she had not attended nursing school and had no nursing certificate, she was able to join the Australian Army's Medical Corps based on her clinical experience and a letter of reference from a respected senior professional (probably Anneas McDonnell). Despite lacking the formal education usually required for such an honor, she received her title “Sister” (the British and Australian term for senior nurse and the Army equivalent of First Lieutenant) when she worked as an army nurse on troop ships bringing wounded Australian soldiers home from the battles of Europe.
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Nursing soldiers while traveling under the threat of enemy submarines was rough and dangerous work, but it reinforced Kenny's love of adventure and willingness to take risks. She had closed her clinic before joining the army, but after the war she continued to work as a nurse, taking on individual disabled private patients and caring from them in their homes. In the 1920s, after her widowed mother Mary Moore Kenny moved to a small house in Nobby, Kenny, concerned about her mother's declining health, adopted Lucy Lily Stewart, a 9-year-old girl from Brisbane, and renamed her Mary Kenny.
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In 1926 Kenny designed a new kind of stretcher she called the Sylvia stretcher for carrying patients across rough terrain. Royalties from the stretcher along with her war pension gave her some financial stability.
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Kenny's challenge to standard polio care would probably have remained the work of a little-known rural nurse if polio had not become a growing problem in North America and Western Europe, a disease whose “very name strikes terror to the heart of parents,” as one American physician dramatically phrased it in 1930.
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Hope flared briefly during the late 1930s with the testing of a polio vaccine and a preventive nasal spray, both supported by the President's Birthday Ball Commission (the antecedent of the NFIP), but one led to 11 deaths and the other caused children to temporarily lose their sense of smell and did not prevent paralysis.
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Kenny's methods captured public and professional attention just as Australian medical journals were filled with disappointing news about these latest American polio therapies.
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By the 1930s Kenny had become a national figure, featured in newspapers and popular magazines as “a new Florence Nightingale” whose discovery of new methods of treating polio made her “as well known as Brisbane's Town Hall.”
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Formal and imposing in photographs she wore her grey hair in a bob with a string of pearls around her neck.
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The 1920s and 1930s were also a period when Queensland's government became a force for medical progress in opposition to the professional establishment. Queensland's Labor Party began to establish a nascent health and welfare system. After abolishing the state's upper house in 1922, Labor politicians began to address many of the state's health and welfare problems, expanding the state funding of hospitals and adding an additional subsidy based on profits from Queensland's Golden Casket, a government-run lottery whose revenues helped finance the state's public hospitals.
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With the new oversight of regional hospital boards the power structure of most state-funded hospitals shifted away from specialist consultants who tended to give priority to their private practices and preferred hospital directors to be young, inexperienced, and easily controlled physicians.
Now Queensland hospital directors were trained medical administrators who sought efficient and progressive hospital policies and were empowered to employ full-time, salaried medical staff.
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Prominent among Kenny's political friends was Charles Chuter, a powerful civil servant. In the 1930s despite fierce attacks from the Queensland medical elite Chuter was appointed undersecretary of the new Department of Health and Home Affairs. Like Edward (Ned) Hanlon who headed this department, Chuter was sympathetic to Kenny's complaints that doctors did not know what they were talking about when they defended standard polio care.
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In 1933 Chuter arranged for Kenny to give a special demonstration of her work at the Brisbane General Hospital.
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It was a turning point for Kenny, a moment she returned to many times—and it was a disaster. Brisbane orthopedist Harold Crawford and most of the other physicians present dismissed her as an “ignorant, uncouth bush nurse,” especially when she tried to explain how to “stimulate a dormant muscle by manual vibration” or claimed that she had cured patients who had polio and cerebral palsy. There was silence when Kenny said boldly that she did not believe in casts, splints, or immobilization; and when she pointed to a groove in the back of the neck of a 9-year-old boy as a sign of impending paralysis the audience responded with “disgusted looks and then jeering laughter.”
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As Crawford, who was head of the Queensland branch of the Australian medical association as well as president of the state's physical therapy society, pointed out, Kenny was not a trained masseur (physical therapist) and therefore was not “registered” to carry out this kind of therapy. In his view she did not seem to understand the intricacies of muscle exercises and even those of her therapies that were based on familiar methods were used “in a wrong or even harmful manner.” Indeed he feared some of the “severe and forcible” movements she advocated might fracture a limb or even “increase paralysis.”
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Under Crawford's guidance the Queensland branch of the Australian Massage Association later sought to bar her trained nurses from hospital positions on the grounds that muscle education should be the province of a formally trained physical therapist, not someone trained for a few months by an idiosyncratic bush nurse.
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Nonetheless Chuter was able to persuade Ned Hanlon to have the state government pay for a clinic to be managed by Kenny.
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The clinic, in which Kenny had already been working, was based in a hotel's refurbished ground floor in Townsville, a port centered around northern Queensland's agricultural and mining industries, about 800 miles north of Brisbane. The government clinic opened in 1934 as a trial to see if Kenny's work was sound and could be taught to other nurses. Kenny made sure the walls were painted in a soothing blue, and that both the surroundings and her nurse-trainees were “gentle and encouraging” to ensure there were no “suggestions of future helplessness.”
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The clinic was supervised by local physicians including James Guinane, a surgeon who was the son of the hotel's owner. Although Kenny was supposed to restrict her care to 17 patients who were to be assessed by medical supervisors she refused to turn away other disabled patients who began to arrive in “all sorts of vehicles from swanky motor cars to broken-down spring carts.”
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Like other medical observers Guinane noticed that Kenny was a quick study, learning from comments by visiting physicians. Yet, also like other physicians, he found her at times “quite fanatical.”
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Still he began to prepare a textbook with her, published in 1937 as
Infantile Paralysis and Cerebral Diplegia
, its title reflecting her interest in treating patients with cerebral palsy as well as polio. The text argued that
specially trained attendants could help to restore “functional power to apparently paralysed muscles” and counter the “deleterious effect of immobilization” with every exercise “guided by the attendant, and mentally controlled by the patient.”
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Kenny's teaching skills were less easy to assess. Her relations with the Brisbane nurses sent to work with her in the Townsville clinic were at times stormy and difficult. She found it hard to teach the manual vibration technique and no longer emphasized it. The nurses disliked her use of nonstandard terminology and her tendency to alter methods depending on the improvement of the patient.
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Dissatisfied with what she saw as the nurses' resistance to her methods and limited understanding of physiology Kenny warned them that “their nursing training with its tendency to stereotype information acted as a bar to their adaptability” and that it would probably take at least a year to alter their unfortunate “fixation” of orthodox ideas about polio.
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The Queensland government chose Raphael Cilento, the state's director-general of health, as the official assessor of Kenny's Townsville clinic. A medical graduate from the University of Adelaide and with public health experience in Queensland's tropical north, Cilento shared the Labor Party's belief in a centralized health policy to expand the public's access to hospitals and clinics.
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In a series of reports to the state minister of health he came to decry both her techniques and her understanding of disability care. He became convinced that her results were “merely suggestion” and due largely to the impression of “her dominant personality upon each case.” Nor did he believe Kenny was a good teacher as her methods could not “be taught with ease to anyone.” After Kenny had left for a few months, he noted, one patient experienced “partial retrogression,” which only strengthened his case that positive results were due entirely to her personality.
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In 1935 he began to attack her claims of originality, suggesting publicly that the work of Boston physical therapist Wilhemine Wright was “very similar” to hers. Later he claimed that he had lent Kenny Wright's muscle training pamphlet, which she then returned to him with passages marked in pencil and turned into her method.
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Outraged by Cilento's suggestion that she had secretly copied another's work Kenny told local reporters that that “even if Dr. [sic] Wright's ideas were the same as hers, the question was whether he [sic] or others would have satisfactory methods of putting them into effect.”
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While she had initially admitted that her methods were not new, Cilento's remarks led her to defend her work more fiercely, including its originality.
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The Townsville clinic, she declared provocatively, aware that this public debate would reach the ears of her government sponsors, was being funded “not to test her method, but to train students in that method.”
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Although she was still careful to have physicians supervise her patients, Kenny began to claim clinical authority distinct from that of an ordinary nurse or physical therapist. She saw herself as a supervisor of nurses, teaching a new method of treatment that could “reawaken” nerve impulses that were “dormant” even when “the best standard method had failed.”
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As she explained to reporters, she sought medical advice about the scientific basis of her work and the appropriate moments for its application, not about its efficacy. “I do not want medical men to discuss whether or not my work is valuable, because I know what it will do” she said defiantly. “I want them to tell me how best this new knowledge of rapidly restoring paralysed people to health and strength can be applied where it is needed.”
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Kenny also began to believe there was a medical conspiracy against her, telling the
Women's Weekly
magazine that the “treatise” that she and Guinane had written was
“the only copy in the world” and therefore “great care had to be taken to safeguard it falling into unscrupulous hands.”
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Later she claimed that “a doctor had burnt a chart which had shown improvement in a patient at her clinic.”
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She also became more careful of her own moral reputation. She told an old friend that she was going to discharge one of her nurses who was keeping company with “a very reputable chap” because Kenny had heard that the friendship was a little too intimate and her enemies would try to ruin her with any rumors of indiscreet conduct.
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