Polio Wars (8 page)

Parents and family members publicized her dramatic results, praising their efficacy and her moral character. In the
North Queensland Register
one father described his son whom “medical men [had] pronounced a permanent cripple.” Kenny had taken photographs of the boy's withered limb and had the leg measured by a physician supervising her work. When Cilento examined the child after 4 months of Kenny treatment, he admitted to the father that the boy's progress was remarkable.
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This public support gave her work political momentum. With the approval of the state government Kenny opened an outpatient clinic on George Street, Brisbane, in June 1935.
⁴⁴
A few months later, perhaps pressured by medical critics, the government set up a Royal Commission to study her work. Initially Kenny said she was delighted by this action. The commission's members were all well-known physicians, including Anneas McDonnell, Kenny's mentor from Toowoomba, and it was chaired by orthopedist Charles Thelander, a cousin of hers.
⁴⁵

The Queensland Commission's 1938 report took up 37 pages in the
Medical Journal of Australia
and was summarized in the
British Medical Journal
and
JAMA
.
⁴⁶
Like most Australian physicians the commission members did not approve of Kenny's methods or her ideas. They drew on a critical review of Kenny and Guinane's 1937 textbook by Sydney surgeon Lennox Teece who warned about the dangers of overstretching and deformity if immobilization were rejected and doubted that any paralyzed muscles had been “reactivated” by her methods.
⁴⁷
The Queensland commission declared that immobilization was “
essential”
in polio care and any abandonment was a “
grievous error
and fraught with great danger.”
⁴⁸
Like Teece the commission also dismissed Kenny's work with children with cerebral palsy. Given special facilities and time, the commission argued, most “spastic” children did “improve with age apart from any treatment whatever.”
⁴⁹
Admirers of her work, the commission explained, had been blinded by Kenny's “strong personality” and “her own conviction of technical competence” rather than the actual efficacy of her methods.
⁵⁰
“Doctors' Sharp ‘No:' Find Kenny System A Failure” announced the
Sydney Sun
. The article concluded that a properly trained physical therapist could have obtained similar results given the same opportunity for concentrated attention.
⁵¹
More harshly the
Australasian
pointed out that many “cripples” had “wasted their time and public money on a repetition of treatment—modified in some cases for the worse.”
⁵²

By the time the Queensland commission was finishing its report, however, Kenny had already left Australia. In 1937 she traveled to London where she convinced health officials to allow her to introduce her methods in the Queen Mary's Hospital in Carshalton, Surrey, a children's convalescent hospital run by the London County Council. She was in charge of 3 wards, caring for around 20 patients with polio and 8 with cerebral palsy, and her work was supervised by a group of orthopedic specialists. Later she commented on the specialists' disdain, but in this period she felt hopeful that the surgeons, perhaps inspired by the hospital's enthusiastic nurses and physical therapists, were taking her work seriously.
⁵³
In late 1937 she returned from England to care for her ailing mother
and was engulfed by more polio outbreaks. She trained nurses and worked at a children's rehabilitation hospital in Hampton, a Melbourne suburb.
⁵⁴
Increasingly confident, Kenny responded to reporters' queries mischievously, reminding them about the patients being treated at Queen Mary's in England where “her ideas” were having “scientific and public investigation.” She denied that she had ever promised a “100 percent cure” or that her patients were improved as a result of her “personality,” retorting “I thought that with intelligent men, the age of witchcraft and ‘hooey' had gone. Loyalty to me is inspired by [the] improved condition of my patients.”
⁵⁵
In a technique she would later use many times she showed before-and-after photographs of her patients to counter the commission's claims that some had shown “no appreciable recovery.”
⁵⁶
A few of Kenny's adult patients wrote to local newspapers praising her “invaluable work” and the Queensland government that had given them access to it.
⁵⁷
In the
Brisbane Courier-Mail
one former patient made much of Kenny's ethical veracity: “if she knows she cannot help the patient she immediately says so.” This former patient also questioned the commission's qualifications, suggesting “instead of a commission of medical men, why not a commission of patients or their parents?”
⁵⁸
But in a statement repeated by critics for the rest of Kenny's life, Sydney orthopedist Max Hertz proclaimed that “the treatment has features that are new and features that are good, but where they are good they are not new and where they are new they are not good.”
⁵⁹

Kenny had made much of the fact that her work at Queen Mary's Hospital was being investigated scientifically. She was thus very disappointed when a few months later the London specialists published an unenthusiastic report in the
British Medical Journal
. They admitted that none of her patients treated without splinting had developed “contractures” but nonetheless did not approve of Kenny's refusal to use splints or her claim that splinting would cause muscular impulses to “wither… [and] die beyond the hope of resuscitation.” Despite her promises she had not achieved any “permanent cure[s]” and her use of early muscle exercises though “harmless” was “of unproved value.”
⁶⁰
It was a sign that Kenny's work had reached a national medical audience that the
Medical Journal of Australia
then published a letter from Kenny protesting this report by noting that physicians at the Hampton hospital had recently “drawn attention to the evils of improper splinting,” praised her identification of the condition of muscle spasm as “a definite contribution to the treatment of poliomyelitis,” and urged “further research… both clinically and academically, into this disease.”
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Her attention to the clinical sign of muscle spasm was new. She had not mentioned it in her 1937 text, but later claimed that she had discussed it in London and the specialists had told her it was new to them.
⁶²

Prominent physicians continued to dislike Kenny and her attacks on standard polio care, and sought to defend themselves against her accusations that they neglected their patients. Thus, the
Medical Journal of Australia
paired Kenny's response with an article by Melbourne polio expert Jean Macnamara. Without denying her own advocacy of splinting, Macnamara nonetheless protested strongly against any suggestion that she did not use physical therapies or kept patients confined for a long period of time.
⁶³
Most experts agreed with Macnamara but a few remained intrigued by the idea that immobilization might be harmful. The journal's next issue contained a letter that praised Kenny for helping “to break down the pernicious form of treatment” of “overlong reliance” on rest and splints.
⁶⁴

Perhaps as a result of such confusion among experts or the power of public support Kenny's influence expanded. With the support of Billy Hughes, the federal minister of health, and a wealthy philanthropist, she had set up a clinic attached to the Royal North Shore Hospital in Sydney that was in Hughes' constituency.
⁶⁵
Now the New South Wales minister for health, citing evidence that North Shore patients had shown “improvement,” opened the state's second Kenny clinic at Newcastle Hospital.
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Most importantly, the Queensland government offered Kenny control of Ward 7 at the Brisbane General Hospital. It was highly unusual to have a nonphysician in charge of inpatients at a large city hospital. As one Brisbane physician later recalled, she “wasn't under anybody” and she reported directly to the minister of health.
⁶⁷

Kenny's success in Brisbane was partly the result of alliances with influential administrators. Abraham Fryberg, for example, who had directed Kenny's George Street clinic in 1936, continued to support her after he joined the Queensland health department.
⁶⁸
An even more powerful ally was Aubrey Pye, a prominent surgeon who directed the entire Brisbane Hospital complex. During the late 1930s Pye became the gatekeeper for every clinical demonstration she sought to make.
⁶⁹
Pediatric surgeon Felix Arden, the director of the Children's Hospital in the Brisbane Hospital complex, whose own father was in a wheelchair, was sympathetic to the difficulties faced by physically disabled people. Arden asked parents whose children were sent to the Children's Hospital if they wanted Kenny or orthodox methods of treatment. If they expressed no preference he alternated the patients fifty/fifty.
⁷⁰
Elsewhere Kenny's clinics received far less administrative support. At the North Shore hospital her outpatient clinic, housed in the basement of one of hospital buildings, was visited by neither the hospital's medical director nor the hospital residents. Other clinics suffered similar neglect. But this disregard afforded Kenny and her staff complete clinical control.
⁷¹

In a series of lectures and clinical demonstrations at the Brisbane hospital a more confident Kenny began to articulate bolder claims. Not only did splints worsen muscle spasm, she argued, but the use of iron lungs could harm patients, even those with serious respiratory paralysis. She shocked hospital physicians by taking one child out of an iron lung and treating him with hot packs. The child did not die and learned to breathe on his own.
⁷²
Her efforts to explain how her methods worked were less successful. She argued that the conditions created by immobilization—lessened circulation, poor nutrition of the skin, increased joint stiffness—led to diminished nerve impulses. Immobilization also interfered with “the normal function of the subconscious mind” and gave patients “an adverse psychological outlook.” The principles of the “orthodox system” were, she said, the opposite of the principles of her system of treatment. If muscle spasm was unrecognized and untreated the consequences were dire. She spoke awkwardly of maintaining “maximum vitality and volitional control” through an “efficient” circulatory system that allowed a patient to maintain an uninterrupted stream of “neural impulses.” To explain why some patients found it difficult to move muscles that were no longer in pain or spasm she began to use the term “alienated” or speak of “a state of diminished awareness of the affected parts.” Convinced that he no longer had any control over paralyzed muscles, the patient lay in bed “frightened to move or [to] permit anyone to move him.”
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Other than neuroanatomist Herbert Wilkinson whose foreword in her 1937 textbook had speculated on the functioning of motor neurons and muscle fibers, Kenny found that
none of her Australian allies could explain why her methods worked.
⁷⁴
She was sure that somewhere experts would know how to explain them.

Kenny was convinced that polio care must be practiced her way. Changing the way polio care was practiced, she recognized, involved a vast array of cultural and social resources, not just a few clinics and a handful of medical allies. It also required changing how clinicians understood the pathophysiology of polio. Despite her use of unorthodox methods, Kenny's broader view of clinical change was based on a strong faith in scientific explanations to gird her clinical work and lead physicians to adopt it. Investigations by “men of science,” she hoped, would lead physicians to take seriously “the signs and symptoms… previously left unnoticed and unattended.”
⁷⁵
Aware that some nurses she had trained were returning to institutions full of antagonistic colleagues, she urged hospital officials to recognize them as specialists in the “Kenny system of treatment,” perhaps with a special certificate to help them gain appropriate status in their hospitals.
⁷⁶

In September 1939 Britain and Australia declared war on Germany and government officials paid more attention to readying troops than to domestic disease. Laudatory statements by physicians, Kenny discovered, were now “buried by war news.”
⁷⁷
After reading an admission in
JAMA
by a polio specialist that polio had no effective therapy, Kenny was sure that the United States, a country not immersed in the European conflict, needed her help.
⁷⁸
This idea was strengthened when Alan Lee, a sympathetic Brisbane surgeon, returned from a trip there and told her about the founding of the NFIP. Lee, who had spoken to Mayo Clinic orthopedist Melvin Henderson about his work with the foundation, urged Kenny to visit the Mayo Clinic.
⁷⁹
Pye, Fryberg, Wilkinson, and her other Brisbane allies helped organize her trip to America including Hanlon's approval of £300 to cover the round-trip fare and a letter of introduction to the head of the NFIP from the Premier of Queensland.
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Without a clear idea about how American medicine worked, Kenny left for the United States, believing that American physicians would be more open than their Australian and British counterparts.

Kenny knew she needed to find an arresting way to sell her ideas without sounding like a quack. Attacks on patent medicine promoters and unorthodox practitioners were part of a widely publicized policy of the American Medical Association (AMA). Inspired by the German model of medical education and reinforced by education reformer Abraham Flexner's 1910
Report
, America's physicians claimed to be social experts free of creed or partisanship. In theory, doctors in white coats were aloof from the commercialized world, although a number continued to appear in advertisements for cigarettes, patent medicines, detergents, and other products. The Great Depression had buffeted the stability of this medical culture. Many physicians who had seen themselves as independent businessmen were forced to consider other forms of work, including group practice, contract practice for a school system or a factory, or government health positions. Private practitioners retreated into their local medical societies and civic clubs, resentful of the privileges claimed by elite specialists at medical schools and teaching hospitals. Seeking a politics that would bind these groups across class and regional lines, the AMA held tightly to certain ethical guidelines defining professional
legitimacy. One principle was the restriction on selling: no respectable physician should directly advertise his services to the public or claim any special abilities or techniques that would “cure” disease. How then could an unknown nurse promote a method that contradicted mainstream practice to a professional community in which selling had such base, shoddy implications?