Polio Wars (87 page)

While Kenny's name was avoided by most of the speakers, her ideas were not. Many of the exhibits and technical films showed aspects of her treatment and featured some of the physical therapists she had trained, and, following Kenny's lead, speakers sought to link clinical signs to pathology.
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Both spasm and pain were now recognized symptoms, although some presenters argued that spasm was rare, and others argued that its presence did not indicate a new pathology.
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Virologist David Bodian of Johns Hopkins agreed that an “important component of muscle weakness in the acute stage may be a partial and temporary loss of function of some motor units.” He believed that “the origin of muscle pain in poliomyelitis also requires further exploration” and referred vaguely to “the re-routing of neuron-chain discharge pathways from interrupted primary paths to secondary alternative paths.”
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Fritz Buchthal, a physiologist from Copenhagen, noted that “the occurrence of ‘spasm' ” had been “the subject of intensive discussions and controversies,” although in his research spasm rarely occurred unless “passive therapies” were employed too vigorously.
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During the discussion following Buchthal's paper, Lewis Pollock, a Chicago neurologist, declared dramatically that 11 neurologists assigned to Chicago's city hospitals had conducted around 9,000 examinations of individual muscles and could not find a single instance of spasm.
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Oxford orthopedist W. Ritchie Russell, the author of a textbook on polio which Kenny had read in the 1930s, said firmly that patients must have “physiologic rest” for any “so-called spasm” could be a muscle's “response to stretch if nothing else, and perhaps a defense against pain.”
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While the cause of pain in polio, commemorators admitted, was still obscure, most continued to argue that the pathology of polio was without doubt based on affected nerve cells. Stanford pediatrician Harold Faber was sure that the polio virus was “strictly neurotropic.”
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Bodian—a neurobiologist and not a clinician—was one of the few who wondered out loud about “the possibility … that a peripheral disease may exist in the absence of central infection.”
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Kenny did not pay much attention to this kind of debate. She was upset when someone asked a question about the cause of spinal deformities, which members of the panel on stage could not answer. Some of her physician allies asked her to explain this symptom, but when this request was sent to the session's moderator Robert Bennett he did not recognize her as an appropriate respondent.
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Kenny did respond dramatically after a session in which Herbert Seddon, a respected British orthopedist, criticized her method by name. Seddon may not have noticed that the
American participants were avoiding Kenny's name, or he may not have cared. Speaking as a specialist still reeling from the reorganization of the British health system and without the backing of a major polio philanthropy, he called on physicians to seek more economical treatments, arguing that the public “should get value for money.” He was one of the few participants to discuss the cost of medical care openly. “Everyone agrees that the Kenny treatment is expensive,” he said, quoting an estimate from Nicholas Ransohoff that Kenny treatment was around 5 times as expensive as orthodox care. According to the views of “dispassionate critics,” Seddon declared, this expenditure was not justified. He was unsparing in his attacks on his own colleagues as well. “It is not sufficient to dismiss Miss Kenny's work as an expensive nine days' wonder; we must ask ourselves whether our own methods of treatment are altogether rational. Maybe we are, in fact, wasting money in prolonging treatment beyond the point when it is of the slightest use to the patient.” He also noted what he called “curious inconsistencies” in current polio practice, urging his peers to “abandon the notion that denervated muscle is in a peculiarly delicate state [for] … it does not degenerate; it atrophies.”
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Physicians, Seddon argued during the discussion of his paper, needed better studies of recovery based on “carefully controlled clinical experiment[s].”
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While he was uncomfortable with Ransohoff's promotion of curare, he did praise Ransohoff's arguments in favor of early ambulation compared to the “slavish enforcement of bed-rest that most of us had practised [sic].”
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Kenny then demanded a news conference with Seddon and Ransohoff. She had contested Seddon's views before, assuring her Australian critics that his claim in 1947 that spasm was rare in his own patients was because “Professor Seddon is viewing the disease from the orthodox point of view.”
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Now she and “a corps of assistants began feeding statements into a mimeograph machine and within a few hours she had a batch of handout[s] for other members of the press.” Seddon and Ransohoff attended this press conference as did Fishbein. Wearing a royal purple dress and large garden-party hat, Kenny challenged Seddon's calculations and his critique. Kenny treatment at both the Minneapolis Institute and at the Jersey City center, she argued, cost between $9.12 and $12.50 a patient daily, while Ransohoff had previously told her that in his hospital such care cost $17 a day. In any case, the comparison was inappropriate, for it was comparing good care to poor care and therefore any discussion “was a waste of time.” As for the “dispassionate critics”—who she guessed were the members of the 1944 AMA committee—she gave Seddon copies of a telegram showing their refusal to give out the names of the cities or hospitals they visited and one from Alfred Deacon noting that at the end of a 2-year period his Kenny-treated patients were “ten times better.”
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Ransohoff refused to back down, and while Seddon responded politely, he also did not yield. He thanked her publicly “for methods which you have given me that are advantageous to my patients. You got rid of braces. But I do not agree with you on everything. I have to treat the very poor. And for them, when speaking on economic grounds, I cannot recommend the Kenny treatment on account of expense.”
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Kenny technician Amy Lindsey recalled later that Seddon came back into the meeting room after the reporters had left and shook Kenny's hand saying he admired her although they didn't agree on everything.
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In contrast, Fishbein recalled that Seddon had said to him after this press conference “I think the old girl is potty.”
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Reporters were split between admiring Kenny's bravado and finding her amusing and embarrassing. NFIP publicist Roland Berg reported in an internal note that when “Miss Kenny attempted to voice her pseudo-scientific facts … the press was not at all impressed
and reported nothing of her claims.”
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But science journalist Albert Deutsch disagreed. In his article “Sister Kenny and the Foundation” he wrote that Kenny had “made a greater contribution to its treatment than any other personality of our generation” and for 30 years “had to fight the bigoted opposition of medical groups who were outraged by the notion that a nurse could teach them anything.” Deutsch castigated NFIP officials who had deliberately ignored her and “apparently have allowed personal peeves and prejudices to get in the way of scientific duty and humanitarian consideration.” Like “many great medical pioneers,” he admitted, Kenny could be difficult and placed too high a value on her work, but she had “beyond all doubt, made a most valuable contribution to the understanding and treatment of polio.” “Under no circumstances,” he cautioned, “should personal feuding be allowed to stand between children fighting off the crippling after-effects of polio and the best possible means of helping them get well.”
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In a deliberate rebuttal to the film Kenny had shown Congress 2 months earlier, University of Illinois's Division of Services for Crippled Children, funded by the NFIP, presented a new technical film called
Nursing Care of Poliomyelitis
at the international conference. It was 4 reels and in sound and color. Kenny's methods appeared throughout, without her name and once again in a modified version. Thus, the first reel,
The Acute Stage
, showed the use of footboards and hot packs (both Kenny hallmarks); the second reel,
Treatment of Spasm
, demonstrated details of administering hot packs as well as how to use baths as a substitute; the third reel dealt with the iron lung; and the fourth, on the convalescent stage, showed ways of applying splints “to prevent deformity” and various muscle tests. A
JAMA
reviewer thought the film was likely to be useful in training physicians, advanced medical students, nurses, and physical therapists, “who may not always appreciate how elaborate the procedure must be if the patient is to have the best possible care and [be] spared unnecessary suffering.”
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Humane polio care, this film suggested, could be obtained by mixing old and new methods, not by slavish adherence to a single program.

By December 1948 2 main changes in polio treatment, research, and funding were in place. The first was a new organizational structure for the KF. Donald Dayton, a Minneapolis businessman whose son had been paralyzed by polio and treated by Kenny, now headed its Board, and pediatrician Edgar Huenkens directed the Institute. The second change occurred far from Minnesota with the organization of a Citizen's Polio Research League, a lay group inspired by the Congressional hearings, based in California's San Fernando Valley.

In Minnesota Huenkens, who had come to local prominence as the head of the state's polio commission during the 1946 epidemic, reorganized the Institute's medical staff, appointing Miland Knapp, who was already in charge of polio technicians at the University hospital, as head of a new physical medicine unit with authority over the Institute's technicians. Huenkens was eager to reestablish relations with the University of Minnesota and with the NFIP, but he recognized the delicate balance between maintaining Kenny's trust and working with those she considered her enemies. “I firmly believe in the value of her treatment,” he declared in the formal announcement of his new position, and “we hope to do away with the antagonism that exists between Sister Kenny and the medical profession, which has caused both to be misunderstood by the public.” Once these
misunderstandings were resolved he believed that “physicians will be able to judge the Kenny method objectively,” and he invited every doctor to the Institute “to observe for themselves the treatment and its results.”
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In a statement reported in local Minneapolis papers Kenny declared, “I quite agree with the procedures of members of the medical profession for their caution in not embracing new ideas that may from time to time be presented, including my own, until they are satisfied they are effective.”
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Huenkens had helped to craft this statement, and he boasted to Van Riper that “this is the most forward statement she has made yet and I got her to make it.” The Institute under his direction was now successful in “getting the doctors to adopt her methods and ignore her.”
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Van Riper did feel that “for the moment that the Kenny situation in Minneapolis is under control,” but he remained suspicious. Huenkens urged him to come out to the Institute, but Van Riper refused, adding he “would come out if I was sure I would not have to encounter her—the only way I can remain something of a gentleman is to avoid meeting her.”
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In California, to Huenkens's chagrin, Kenny was fully in control of the Citizens Polio Research League. It had a number of vocal women members including its president Mrs. Sonja Betts, and Rosalind Russell agreed to be its “patroness.”
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The league began planning a Sister Kenny Hospital to be affiliated with the Southern chapter of the California KF. It also circulated petitions asking Congress to create a federal research foundation to study polio, implying that only government-directed research into polio could be unbiased.
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The implications of this populist ideology were not lost on NFIP officials. In a private phone conversation, Van Riper told Huenkens that he was sure this new league was a kind of “Kenny Foundation No. 2,” reflecting Kenny's resentment at the shifting power relations at the Institute and in the KF.
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The
San Fernando Sun
became the mouthpiece of the new California movement. It began to publish provocative letters claiming that Kenny had been prevented from presenting the results of her polio research at the Congressional hearings “because of pressure from the National Foundation for Infantile Paralysis, members of Congress and/or the medical profession.” Herbert Avedon, the paper's editor, sent open letters to local politicians, the NFIP's national office, and Kenny herself arguing that “if any group, official, unofficial, charitable, social, medical or any other sort, actively works to prevent such information from being made known or even investigated, we believe the people ought to know.”
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Congressman Harry Sheppard, a Democrat representing northern Los Angeles, assured Avedon and his readers that the hearing had been courteous; the NFIP's executive director Joseph Savage wrote a careful and defensive reply; and Kenny sent an 8-page letter defending Congress and attacking the NFIP.
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Kenny's argument that her work could not achieve its best results when it was modified was reiterated in a letter the
Sun
published from a patient who had been recently discharged from the Los Angeles County General Hospital and could now “only walk a little.” Had he been given “the best treatment available,” he wondered. He had been reading about the Citizens Polio Research League and also heard a discussion on the radio. “If what they say is true, then I may be crippled for the rest of my life merely because I was not treated by the Kenny method.”
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