Authors: Naomi Rogers
After visiting major polio centers in the United States, McSweeney concluded that physical medicine as a specialty was far more advanced in the United States than it was in Ireland. He also noted that polio patients were discharged from the hospital in as little as 3 or 4 weeks, a speed that surprised him. Polio treatment, he discovered, was “a field of controversy which is not yet finally resolved”: most hospitals combined heat, hydrotherapy, muscle reeducation, and massage; avoided immobilization other than foot blocks and sand bags; and tried to postpone orthopedic surgery for as long as possible.
8
While McSweeney deliberately sought out Kenny-oriented and anti-Kenny centers, he found every institution used some elements of her work. At the Willard Parker Hospital in New York Philip Stimson explained muscle spasm to him and showed him hot packs, which technicians applied twice or 3 times a day, along with body-length prone packs and hot baths. “Unlike packs,” McSweeney noted, “hydrotherapy seemed to be liked and looked forward to by patients.” In Minnesota he went to St. Mary's Hospital in Rochester where Mayo clinicians applied packs only twice a day and therapists told him they were “not sure that heat in any form is essential for the treatment of poliomyelitis.” In Minneapolis Miland Knapp and Kenny technician Vivian Hannan showed him the Institute's practice, which relied on hot packs every hour or so during the acute phase and slightly less frequently thereafter. “There is no doubt that the application of these packs causes pain,” McSweeney reported later, which could mean that “their routine employment in Europe might not be easy of attainment.” “To pack or not to pack, that is the question,” he concluded in his formal report of his trip. He and other Dublin physicians “think baths are better” and find that “the patients appreciate them much more.”
9
By the time of McSweeney's visit, pain seen as a serious symptom that required therapy was now at the heart of polio care in the United States. The use of heat was a central technique, with hot packs only one of many such therapies.
10
Doctors still debated the use of polio drugs (now termed “antispasmodic pharmaceuticals”) such as curare and neostigmine in terms that could be “occasionally quite heated.”
11
Proper care, physicians
now argued, entailed the utilization of everything that could benefit a patient's progress “without concession to orthodoxy or dogma.”
12
The fervor around Kenny's term mental alienation had also died down; even James Spence in
Modern Trends in Pediatrics
(1951) reflected that this concept had “caused the medical profession to think again about the management of patients with paralysis.”
13
So widely accepted was the idea that both spasm and pain were important symptoms that one symposium held at the University of Colorado's School of Medicine was called “Pain and Spasm in Poliomyelitis.”
14
A brochure handed out to the families of patients with polio who entered the Los Angeles County Hospital assured anxious relatives that muscle spasm and pain would be part of the patient's thorough clinical history. In language Kenny would have used, the brochure warned that muscle spasm could persist for weeks after fever abates and “may become more severe unless treated.”
15
Although it was not often acknowledged in print, Kenny's attack on muscle testing had also had an impact. Two California pediatricians urged that patients not be examined frequently for “early complete muscle tests cause unwarranted pain and fatigue to no good purpose.”
16
Kenny's promotion of muscle exercises assumed a different view of the polio body, as Marjorie Lawrence had noted in her 1949 autobiography when she compared Kenny's methods to those of doctors and nurses in Mexico and Arkansas who “were forever cautious not to âstretch' my muscles.”
17
Physicians had “developed a saner view concerning the movement and handling of paralysed muscles [which] ⦠are not the fragile structures they were once believed to be,” agreed one British expert in 1950.
18
Even orthopedic operations were no longer seen as the automatic end to a process of rehabilitative polio care; surgery, argued a study in
Pediatrics
, was “formerly attempted with zeal which was perhaps mistaken.”
19
Kenny had long protested modifications of her methods, although she accepted that the small number of technicians trained at her Institute could not alter care everywhere. Still, she was dissatisfied with the impact of her work. She spent as much time in New York City as she did in Minneapolis, and no longer worked as a clinician or teacher. She continued to raise money for the KF and tried to develop strategies to convince the American public that the modifications of her methods, which NFIP officials called “modern treatment,” were not the proper Kenny method and could be harmful in their diluted form.
20
Her methods were integrated in hospitals around North America, her ideas were widely publicized, and the Kenny technicians who graduated from the Institute were a prized group. The Institute remained her original center, and she proudly quoted from a survey by the American College of Surgeons that praised the Institute's efficient administration and the high caliber of its medical staff.
21
But the facility itself was under strain. Publicity had led to many applications, especially from neglected and seriously paralyzed patients. The Institute's wards were overcrowded, and without air-conditioning the use of hot packs created an almost unbearable level of heat and humidity.
22
The Kenny clinic in Centralia had closed for good after the summer epidemic in 1949, but clinics in Jersey City and Buffalo continued to prosper.
23
In any case, Kenny recognized, the expansion of her work could not depend on a single center. Instead of just raising money to pay for
care provided by Kenny technicians, Kenny argued that the KF should become a major philanthropy, funding a network of Kenny clinics to provide technician training as well as patient care and to compete with the NFIP for the public's dimes and loyalty.
In April 1949 after a trip to Australia Kenny returned to the United States, telling reporters dramatically that she would go back “to her native land only if Australia calls for me,” a remark, NFIP officials noted privately, that sounded “the same whether it's here or in Australia.”
24
In Australia, she had discovered, she was no celebrity. Her work had few allies and the Australian technicians who had returned home were now immersed with their own lives. Her longstanding ally Charles Chuter had retired at the end of 1947 and died of a heart attack a month later.
25
Except for the clinic attached to the Brisbane General Hospital, her other Australian clinics had disappeared. There were no training facilities and, other than a small group in Brisbane, no interested physicians. Even the Brisbane clinic, one of her medical supporters admitted, was “just ticking over” and its patients were of such long standing that the treatment they were receiving probably had only psychological value.
26
In her adopted home, too, Kenny had to face a weakening of her clout. On her return the KF board told her she was no longer the Institute's executive director, a position that would now be held by a physician. With bravado she told reporters that “my mission has been fulfilled” for scientific research “concerning the new concept of infantile paralysis and its treatment ⦠now has been established.” Yet her authority as the originator and interpreter of her work would, she hoped, remain. She had resigned only as the administrative head, she assured the public, and would continue “as a teacher and consultant.”
27
Behind the words and bluster, the Associated Press photograph that accompanied the story of her resignation caught a sense of her inner fears of mortality and irrelevance. Not only had the defection of her beloved ward Mary led to a great emotional crisis in her life, but death was in the air. While she was in Queensland her brother Henry had died, and then William died a few months later. It felt so strange, she told a niece, in one of the few personal letters that have survived, “to have no brother left after all these years. I felt as if the bottom had dropped out of the world when Mother died, and now I feel as if the world is not worth anything.” Perhaps she reread these words and was uncomfortable with their tone, for she added, without much conviction, “but Time is a great healer.”
28
Time, though, no longer felt so elastic. She was now aware that her own unsteady balance and shaking arm were signs of Parkinson's disease, a diagnosis she had not yet shared with anyone.
29
The AP photo shows her sitting stiffly, leaning back away from the physician who was replacing her as Institute director, her expression turned inward, almost in pain, and her eyes avoiding both the photographer and the physician beside her.
30
As one Brisbane friend remarked insightfully, “What will Queen Elizabeth do if she is not actively engaged in running her organisation!”
31
The physician who replaced Kenny as the Institute's new executive director saw his role as mending bridges between the medical profession and the Institute. Now, announced pediatrician Edgar J. Huenkens, there would be “a change of atmosphere.” Respected as a clinician with allies in the state legislature and the local medical community, he had accepted the position of medical director of the Institute in 1948, assured by the KF board that a more senior executive position would soon be his.
32
Huenkens began to say publicly and privately that the direction of the KF was now “entirely in the hands of members of the medical profession.”
33
He composed a Dear Doctor letter inviting physicians “to visit
[the] Kenny Institute whenever you have occasion to be in this vicinity. The medical staff will welcome an opportunity to discuss the Kenny work with you.”
34
Such language suggested that Kenny would not be involved in these discussions.
Huenkens also sought a more amicable relationship with the NFIP. He assured medical director Hart Van Riper that the KF was “making every effort to get Miss Kenny to return to Australia.” Van Riper withheld judgment, noting in an internal memo “I believe that we should continue to be cooperative with Dr. Huenkens until he demonstrates that he, like Miss Kenny, cannot be trusted.”
35
All medical meetings at the Institute, Huenkens told NFIP officials, would now focus on “actual demonstrations of the Kenny treatment to be followed by round table discussion in which each person who desires to be heard will be afforded an opportunity to present his views,” another sign that Kenny's typical interruptions would not be tolerated.
36
Using the model of professional training set by the NFIP, the KF began to offer more technician training scholarships to nurses and physical therapists.
37
Huenkens also published a lukewarm assessment of Kenny's work in
Postgraduate Medicine
arguing that hot packs, while important, were “definitely of secondary value” compared to muscle exercises, and warning against the many “over[-]optimistic reports” about the results of Kenny treatment. He did, however, note that “it is possible that the virus attacks the muscle directly” and may not be “purely neurotropic but may invade the viscera and peripheral tissues.”
38
This emphasis on physician-directed meetings was a response to a wider discomfort among American doctors over the rising influence of physical therapists in polio care. Throughout the 1940s therapists, using their special knowledge of Kenny's work, had claimed clinical and professional power. Even at Queen Mary's Hospital, in England doctors complained that they were not going to take orders from therapists, leading to “one battle after another.”
39
Patients and families, inspired by the hope of a nondisabled body that Kenny had publicized, felt that physical therapy was the answer, however long such care might take.
NFIP pressure had begun to alter hospital policy, opening the doors of voluntary and community hospitals previously resistant to polio patients and convincing administrators to shorten the official isolation period from the standard 3 weeks to around 1 week. Armed with new psychological arguments about the danger of psychic trauma in long periods of hospitalization, particularly for children, the NFIP began to encourage chapters to fund visiting nurse services, outpatient clinics, and new rehabilitation centers where patients “will receive intelligent care, and a chance to live again without complexes.”
40
But when NFIP officials tried to limit inpatient care they found that “unfortunately” the public and many physicians believed polio was “a disease requiring long periods of hospitalization.”
41
In
JAMA
Hart Van Riper warned physicians and administrators not to rely “so heavily upon the guidance of physical therapists and nurses.”
42
When physicians leave “the patient and therapist without direction or supervision,” agreed another senior NFIP official, “overly zealous or inexperienced, medically abandoned therapists often may continue under such circumstances to treat the patient long beyond the need for hospitalization ⦠[or] after any further practical benefits may be expected.”
43
Promotion of home care was part of an effort to deskill and deinstitutionalize polio therapy in ways that directly contradicted Kenny's reliance on properly trained technicians, even though she had taught mothers to use elements of her work before bringing their child to a hospital. It also reflected a broader cultural reliance on the availability
of American women returning from wartime jobs to become domestic caregivers again. But during the 1940s polio had been significantly medicalized, the result of an effective campaign by the NFIP. Now many families sought out professional care in modern, expensive hospitals. Urging communities to rely on mothers seemed to undermine these changes, suggesting that polio care did not require the work of professionals in an institution.