Polio Wars (89 page)

Aaron also pointed to conflicts between the NFIP's national office and its state and local chapters, almost 3,000 across the country. Too often chapters were run by lay citizens who might be excellent fundraisers but who often lacked other experience in health activities. “In the opinion of medical consultants,” Aaron reported, the national officers of the NFIP did not “hold sufficient authority over the various state and local chapters to assure conformity to high medical standards.”
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The NFIP's national office had tried in vain to set up rules about paying only for treatment carried out at a facility recognized by a state's crippled children's commission. Although the Federal Security Agency directed these commissions and set federal guidelines, state politics always played a part in influencing those institutions deemed “appropriate.” With 2,800 local chapters, O'Connor admitted to one potential donor, the NFIP “cannot expect perfection” in following national policy.
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Indeed, the KF was able to highlight and exploit idiosyncrasies of individual NFIP chapters. KF officers claimed that the NFIP did not pay for Kenny treatment, but that was only partly true. NFIP chapters usually paid for all polio treatment—whether “Kenny” or not—as long as it was approved by a physician. There were many anecdotes about bigoted local NFIP officials who pressured families to go to a doctor who did not use Kenny's methods: in Buffalo, a family was told by a local official that he would pay their unpaid balance only if they agreed to have a particular doctor examine their son; another family quoted an official who told the parents “how much good the March of Dimes was doing and that the Sister Kenny group was no good at all.”
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Making the distinction between care provided by Kenny technicians and general hospital care the KF argued that while the NFIP paid for hospitalization, it did not fund Kenny treatment of any patient. No
patients with polio at the Jersey City clinic, according to the KF, had ever had their bill paid by the NFIP. As a result, the KF claimed, the new foundation was forced to divert funds earmarked for training Kenny technicians and research to absorb these hospitalization costs.
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Other incidents demonstrated that chapters were interpreting NFIP propaganda for their own purposes. A woman from Manhattan Beach, California, spent 5 months as a patient in the Minneapolis Institute, but California NFIP officials refused to pay any part of the Institute's bill, telling her family “they didn't have any money to spend on ‘experimental treatment.' ”
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In Minneapolis the delicate balance between the Institute and the local NFIP chapter was constantly upset by national policies. In early 1949 the head of the Minneapolis chapter was taken aback to learn that the national office had informed Kline that it would no longer pay for patient care at the Institute. This ill-advised policy was, Minneapolis officials protested, clearly the result of not having consulted local officials. Altering this policy “would rupture the harmonious relationship” between the Institute and the NFIP and “would prejudice all Minnesotans against the National Foundation.” Many local officials might then have to resign from the NFIP and its March of Dimes January campaign “would fall flat.”
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So tricky were public relations around this issue that University of Minnesota president J. L. Morrill expressed his regret and embarrassment at having to decline the opportunity to serve as a formal sponsor of the NFIP's state drive. If he did this, he explained to an NFIP official, “it would be very difficult for me thereafter to decline similar service and connection with the Kenny campaign,” which for personal and professional reasons he would prefer not to do.
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Attacks on the NFIP were also voiced by the Citizen's League, working with the newly invigorated California KF chapters.
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State politicians responded to this public pressure. California's Republican Governor Earl Warren served as the honorary chair of the KF's Northern chapter and proclaimed state Sister Kenny days, as did the mayor of San Francisco for that city. Judge Georgia Bullock, who had been appointed to the state's high court by a Republican governor in the 1930s, urged full support of the KF campaign.
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According to Sonja Betts, head of the Citizen's League, NFIP officials “have blocked Sister Kenny at every turn, and with their money and power are exercising every strategy to prevent her from getting in on the West Coast.” Betts planned to seek the aid of both Republican and Democratic California politicians for a Congressional resolution to increase funding to the Public Health Service and to earmark part of those funds to fight polio. “The National Foundation is strong and powerful, but it is time the people took the matter into their own hands and fight to get the Kenny treatment here if we are ever going to get any relief from the ravages of polio,” Betts told reporters dramatically.
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Unlike the thriving center in Jersey City and the growing nucleus of supporters in California, the Kenny clinic in Centralia, Illinois, proved a disappointment. The clinic's first administrator resigned in early 1948, and, although the clinic's medical board appointed a successor, the Minneapolis KF board refused to approve him. The KF board claimed it was still waiting to receive formal approval of the clinic from the state's crippled children's division. The state agency hesitated to approve sending patients to the clinic,
arguing that the clinic needed more permanent specialists, specifically a pediatrician and an orthopedist.
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John Lucian Matthews, a labor leader on the Centralia clinic's board of directors, urged both Kenny and Kline to back the clinic's board in its efforts to maintain high standards. “Labor like the physicians in this area,” Matthews told Kenny, “have a warm spot in their hearts for you.”
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Although Matthews and other directors urged her to visit the clinic, Kenny initially refused, saying that Kline would visit and assuring her supporters that she had “every confidence in his ability to meet the wishes of the medical profession [and to]…solve any difficulties which may have arisen.”
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As the calls for help from Centralia continued, Kenny finally acted. She contacted Illinois Governor Dwight Green, warning that if the situation were not cleared up “it will be my painful duty to recall my Staff from the Centralia Clinic and place them in other Centers and in other States that are so eagerly awaiting the service now being given to the State of Illinois.” The “repeated stumbling blocks” around the formal certification of the clinic by the state's crippled children's division had prevented the clinic from receiving the funds “donated for purposes of caring for the children afflicted by the disease,” funds that were in the NFIP “coffers.”
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In August, 2 months after the 1948 Congressional hearings, Green arranged a meeting at his campaign headquarters attended by Kenny, the mayor of Centralia, clinic officials, and the director of the State Division of Services for Crippled Children. Green was in the midst of his campaign for his third term as Illinois's Republican governor, and he may have hoped the meeting would distract voters from the uproar over the mining accident in Centralia the year before in which 111 miners had died, one of the nation's worst mining disasters.
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Before the meeting Kenny travelled to Centralia where she spoke to a crowd of an estimated 5,000 including hundreds of workers who had helped to renovate the clinic.
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At the meeting hosted by Green, physicians on the Crippled Children Division's advisory board noted that state officials could not “purchase medical care in an institution where only one method of treatment of crippled children is practiced.”
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The director of the Crippled Children Division reiterated his agency's policy: the clinic must have a board-certified pediatrician and orthopedist living and practicing in Centralia. The clinic's selection of a pediatrician from St. Louis and an orthopedic surgeon from Chicago did not meet these requirements for these physicians were not suitable for emergency care.
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Centralia was a small coal-mining town without the medical facilities of nearby larger communities; its physicians were frustrated but not surprised when all the pediatricians they asked to serve at the clinic—in one estimate 50—turned them down.
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The Centralia community refused to accept this decision and believed that Kenny could alter the clinic's fate. In 1949 while Kenny was in Australia John Lucian Matthews, who had contracted polio in November 1948 and been treated at the Centralia clinic, flew to Toowoomba to see Kenny about keeping the clinic open.
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Kenny's limited influence became clear when the clinic's new administrator announced that Kenny had ordered the clinic to remain open pending her return from Australia in early 1949. Kline contradicted this immediately, saying the KF would no longer back the clinic, as it was unable to “economically meet the foundation's medical standards,” and he began to arrange for current Centralia patients to be treated at the Michael Reese Hospital in Chicago. He also said that the town of Centralia was too small and not close enough to a medical center, arguments that supporters pointed out could just as well have been made about Warm Springs.
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Suddenly, however, a polio epidemic in June 1949 changed this story. The
state department of public health agreed to fund the clinic—now called the “Centralia Polio Center”—along with assistance from the NFIP and the KF. But when the epidemic ended in September the center closed again and did not reopen.
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The Centralia center collapsed despite backing by a local medical society, grateful parents, and an enthusiastic community. Kenny alone had not been powerful enough to alter antagonistic bureaucrats backed by unhelpful prominent physicians, and the KF board in Minneapolis had not supported her. If she had another opportunity to open a new Kenny clinic she was determined to shore up all of these alliances from the outset.

The Congressional hearings in 1948 did not lead to the formation of a federal Polio Institute or convince Congress to support the idea of a federal Kenny clinic. Nonetheless, Kenny remained convinced that the regulatory power of government could help to promote her work and counter the influence of the NFIP. Both in America and especially on her trips to Europe Kenny focused more and more on a particular group of experts: public health officers. Hers was a vision of medical power based partly on her success in 1930s Queensland when she had the ear of bureaucrats within the state ministry of health, and also on her awareness of the power of federal and state officials within the expanding New Deal and Fair Deal administrations to control access to facilities for the care of disabled and infectious disease patients. Conscious of the tricky medical politics of her time, she carefully avoided speaking to European audiences about the organization of medical care, the status of nurses, or other health policy issues.
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It is possible that she did not see that her visits to European hospitals and health departments bore the imprimatur of an appearance by an American dignitary, but it is likely that the respect she received stemmed from that perception. Her discussion of polio care, just as epidemics were becoming a growing health problem in Europe, attracted attention from both European physicians and the public.

In America, as Kenny recognized, medical populism had deep popular and political roots. A number of congressmen and members of the public shared her sense that laymen and women should play a role in directing medical policy (including scientific research) to ensure fairness and objectivity. In the 1940s and 1950s, the expansion of government investment in medicine and science provided a new platform for the articulation of populist critiques of professional elitism and monopoly, phrased in the Cold War language of democracy and freedom.

To be sure, Kenny, Congress, the AMA, and the NFIP all agreed that modern scientific research was the best way to fight polio. However, populists such as Kenny and her supporters demanded that science be linked to medical freedom, which in Kenny's case meant freeing her patients from braces and crutches and from the crippling effects of elitist orthodoxy. Populists wanted more than the freedom to chose the medical treatment they wanted; they also wanted some say over the kinds of research that would be funded. For Kenny twentieth-century science was a resource, not a threat, and she confidently demanded the right to the vocabulary and technology of the laboratory. Clinicians' access to the fruits of laboratory science, she warned, was blocked by the monopoly of the NFIP and the AMA. Only the government, responding to popular outrage, could ensure a true
democracy of science. Kenny's demands for scientific respect and her self portrayal as an isolated outsider attracted a public suspicious of corporate elitism. Perhaps medical freedom could be ensured by government fiat, opening the doors of hospitals and laboratories so that the resources of medical science would be available to all.

The excitement of being a Congressional witness, surrounded by eager reporters, Congressmen, and members of the public was not matched by Kenny's personal experience. By the late 1940s Kenny was in a newly isolated position. In the years after the war most of her Australian technicians left the Institute. Mary Farquarson, Kenny's niece from Queensland, had replaced Mary Kenny as Kenny's assistant and companion in 1946. Unwilling to endure the restricted social life Mary Kenny had led, Farquarson married a local Minnesota businessman in 1949 and began to raise a family.
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Bill Bell, Kenny's nephew and technician who had come from Australia to work with her in 1941, moved to New Zealand where, backed by the minister of health, he introduced Kenny's work in hospitals across the North Island, and began to work at a hospital in Wanganui designated for Kenny's work. Bell, who combined Kenny's “crusading zeal and optimism” with his own “persuasiveness and tact,” later trained his sons to work as Kenny therapists.
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Only Valerie Harvey, the former Brisbane nurse, remained in the United States, practicing at the Jersey City clinic. Harvey was convinced of the value of Kenny's work, but she had a gentler and more patient style, and many technicians considered her a better teacher than Kenny herself.
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