Polio Wars (17 page)

Alice Lou Plastridge (1889–1993) was a prominent clinician whose career reflected the best polio training of her generation. After graduating from Mount Holyoke in 1911 she worked first as a physical education teacher and then in 1916 was trained in physical therapy by Boston orthopedist Robert Lovett and his physical therapist Wilhemine Wright during the worst polio epidemic that had hit the nation to date. Plastridge moved to Chicago where she worked as a private practitioner, and in the mid-1920s accompanied one of her patients, the daughter of a wealthy manufacturer, to Warm Springs. In 1926 Plastridge traveled to Hyde Park to work with Roosevelt who, the therapist later recalled, “was sort of at a stalemate in his therapy.” She recognized that his legs were unlikely to improve, but she was able to teach him to use crutches more efficiently. By 1930 she had been appointed senior physical therapist at Warm Springs and later helped organize a physical therapy training program there.
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Plastridge's work at Warm Springs gave her a sense both of the strength and physical limitations of bodies disabled by polio, and she trained her therapists to help patients create lives that accepted these limitations.

Gertrude Beard (1887–1971) and Mildred Elson (1900–1987), like Plastridge, were of Kenny's generation and had seen the flowering of physical therapy during the 1910s and the rise and fall of many overly optimistic therapeutic systems. They were concerned that Kenny's method—naturally grasped by desperate parents with disabled children—should not detract from the respectability of American physical therapy. Elson was a founding member of the APTA, the editor of its professional journal, and later its first salaried executive director. A professional organizer, she sought to improve her profession's educational standards and its relations with physicians and hospital administrators.
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Beard, a Chicago physical therapist, had trained first as a nurse, and like Kenny, had worked as an army nurse during the Great War. She had developed physical therapy at Chicago's Wesley Hospital and at Northwestern University and, unusual among her peers, she had published research articles on muscle physiology.
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Florence and Henry Kendall were a decade or so younger than Kenny and the other therapists and were the standard bearers of orthodox polio care, much of which they had developed. Working with Johns Hopkins orthopedic surgeons they had transformed the Children's Hospital-School in Baltimore from a forlorn crippled children's home into a leading rehabilitative facility that attracted even Warm Springs patients dissatisfied with their progress.
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Hospital-schools were popular institutions founded during the 1910s and 1920s to rehabilitate physically disabled children somatically and morally.
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The Baltimore facility had been founded in 1905 by the local Crippled Children Society and, like other hospital-schools around the country, was shifting its therapeutic focus in response to increasing numbers of patients with polio.
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Although some orthopedic interns and residents from Johns Hopkins worked at the Hospital-School supervised by its senior orthopedist George Bennett, in most respects the Hospital-School was isolated from the major medical activities of the city, reflecting the poor reputation of rehabilitative medicine, a field that dealt with the slow and sometimes hopeless task of trying to heal the disabled. When in 1935 Florence Peterson, who had been trained to care for both military and polio patients, married blind veteran and rehabilitative expert Henry Kendall, the couple was able to combine rehabilitative therapy and the model of an autonomous disabled professional in a creative and long-lasting partnership. The Kendalls, who had 3 daughters together, became a respected and admired clinical team.

Henry Otis Kendall (1898–1979) was typical of the men who practiced physical therapy in this era: a disabled veteran who had gained professional training as part of his own rehabilitative therapy. The youngest of 13 children from a poor mountain family in Smithsberg, Maryland, Kendall had joined the Army in 1917 and become a sapper in the 41st Engineers. After a shell hit his face, destroying one eye and injuring the other, he was sent to the Evergreen School for the Blind in Baltimore where he learned physical therapy.
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He began working at the Hospital-School in 1920 and became director of its physical therapy department, which also functioned as a facility for professional expansion. Its training program was affiliated first with Johns Hopkins and later with the University of Maryland. In the 1930s the Kendalls founded Maryland's first APTA chapter.
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Kendall's colleagues were able to integrate or at least ignore his disability in a field in which disabled men with a military background were considered appropriate directors of the care of disabled patients.

Florence May Peterson (1910–2006) had graduated from the University of Minnesota in 1930 with a major in physical education and then studied physical therapy at the Walter Reed Army Hospital in Washington, D.C. During her student years, most of her patients were veterans suffering nerve and muscle injuries. But in a shift that reflected the growing significance of polio care for physical therapists, she spent 9 months during her second year caring for a polio patient in the Baltimore Children's Hospital-School under the direction of Henry Kendall. She then joined the Hospital-School's physical therapy department where she worked for the next 50 years.
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As polio experts the Kendalls saw themselves in a lineage beginning with Boston orthopedists Robert Lovett and Arthur Legg, and expanded through a network of physical therapists across the country including Janet Merrill in Boston, Alice Plastridge in Warm Springs, Gertrude Beard in Chicago, and Catherine Worthingham at Stanford. Polio care at the Hospital-School was conservative, based on the principles of rest and muscle protection, and structured around the fear, articulated in the Kendalls'
PHS Bulletin
, that inappropriately stretched muscles would further deform a patient struggling to regain muscle function.
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The Kendalls criticized the widespread enthusiasm for water therapy and popularized their methods with a one-hour, 5-reel film shown at the 1937 annual meeting of the AMA and the 1938 annual meeting of the APTA.
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But although widely known and emulated, the Kendall method did not provide the results that many polio survivors hoped for. It tended to produce stiff joints, weak muscles, and shortened limbs, and patients treated using this method often required a series of orthopedic operations.
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Feeling embattled, the Kendalls arrived in Minneapolis already prepared to see Kenny as yet another critic attacking the standard polio therapy they had developed. At the same time as they had learned of the NFIP's support of Kenny's work, the Kendalls had been given a draft of an article by St. Louis orthopedists H. Relton McCarroll and Craig Crego, later published in the
Journal of Bone and Joint Surgery
. In this study of 160 polio patients at the Shriners' Hospital for Crippled Children between 1935 and 1940, McCarroll and Crego found that no matter which method of polio therapy they used, including the Kendalls', there was no improvement in their patients. They had first treated patients with familiar immobilizing methods of solid plaster for 3 to 4 months, followed by plaster splints or bivalved plaster casts alternating with exercises in a heated pool or massage on a table, and had “very disappointing” results. In 1936 the orthopedists altered this therapy by hiring a physical therapist “trained by Mr. Kendall [and] … thoroughly familiar with his ideas and the details of his method of treatment.” They gave her a ward of patients to treat, which they argued was a way of ensuring an “impartial trial” of the Kendall method. The therapist used 1 to 3 months of immobilization and rest followed by physical therapy for 3 to 6 months, but in McCarroll and Crego's estimation, “the results in that year were no better.” In 1938 the surgeons read a description of Kenny's work in the
British Medical Journal
, which they characterized as “intensive physiotherapy.” Although they did not use the Kenny method themselves, they did try to develop a therapy “between these two extremes,” and for a period of 2 years treated patients with limited immobilization and various forms of exercise “without preconceived ideas as to the relative value of any particular form of therapy.” The results for this group were also no better. Most striking in their study was a group of 14 polio patients who received what the surgeons called “no treatment.” Reflecting the role of geography and also perhaps parental suspicion of surgeons and hospitals, these children were not seen by a physician until several months after the onset of paralysis. The parents refused to follow advice about rest or splinting and told the hospital staff that they believed “the paralysis would progress unless the child was forced to use the involved extremities and exercise them as much as possible.” The surgeons concluded that the length of time since the initial infection suggested that no therapy would now aid these patients. To the surgeons' consternation, this “no treatment” group had the “highest percentage of satisfactory brace-free extremities” (19 percent), yet they had been the furthest from the best professional care. Despite these results, however, McCarroll and Crego concluded that careful immobilization was essential to prevent deformities from muscle imbalance. Rather than suggesting that paralyzed children living far from an orthopedic hospital might have benefited from the avoidance of standard therapies, McCarroll and Crego stressed the “underlying pathological process” of the polio virus. With the destructive power of the virus during the acute illness, they declared, “the die for the final picture is cast.”
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In their view combating residual paralysis was essentially out of the control of any physical therapist, much less a parent, and only an orthopedic surgeon could address the physical abnormalities that resulted from paralysis through surgery.

Kenny, the Kendalls, and most other American physical therapists rejected a clinical conclusion that made rehabilitative therapy irrelevant. The Kendalls were especially appalled at McCarroll and Crego's characterization of their own work. The surgeons had boasted that they had relied on a Kendall-trained physical therapist and that Henry Kendall had come to St. Louis to oversee the work of this therapist. In fact, both Kendalls
had visited the Shriners Hospital in 1937 and as Florence later recalled, “indelibly imprinted in my memory is the moment of shock and incredulity we experienced walking into the [therapist's] ward and finding all of the patients with involved extremities encased in solid plaster! Our first reaction was, ‘You must get the patients out of the plaster!' ”
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Nonetheless, the St. Louis study and later Kenny's frequent references to it reinforced many American professionals' sense that the Kendall method was the “immobilization” method and the epitome of orthodox polio care.

The therapists had not intended to converge on Minneapolis at the same time, but shortly before Christmas, Kenny slipped on the ice and broke her wrist. Early in January, John Pohl wrote to all of them, asking them to visit together so “that she will not be faced with repeating her demonstrations,” for she “feels that her strength will only allow her about three days of work and talking at any one stretch.”
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Reading between the lines, Pohl's message suggests that Kenny was aware of how much emotional and physical strength it would take to confront this onslaught of visiting experts and was perhaps hoping to gain some sympathy for her injury, which was in a plaster cast and “debarred me from demonstrating any treatment satisfactorily.”
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Her fall had only deepened the frustration she had been feeling about the progress of her work both in Australia and in the United States. There was now a small polio epidemic in Queensland, and she feared the nurses she had trained at the Brisbane General Hospital would not be able to cope with so many acute patients.
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She was also beginning to sense that her Minneapolis audiences were watching rather than listening, and that she and Mary were being used as demonstrators rather than as teachers: “it appeared as if I was expected to go on demonstrating indefinitely, when my one hope was that I might teach others and make them proficient in my methods.”
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Her demonstrations were being seen as a kind of show rather than as an integral part of a training program.

The January visit did not go well. The visitors were conversant with polio's physiology and neurology, and were confident that they could understand and critique Kenny's theories, especially her claim that she had identified symptoms that required a new kind of therapy and whose success indicated a previously unrecognized physiological process. Kenny had expected to find the experts skeptical and defensive, and her expectations were fulfilled. “I regret to say,” Kenny later reported to Baltimore orthopedist George Bennett, that “it was impossible for me to demonstrate my work to these visitors, owing principally to the fact that they were absolutely non-receptive.”
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On the first day Kenny invited the group to the city hospital's auditorium to hear her lecture. The lecture was based on evidence from Australian and local patients, interspersed with many references to doctors' responses to her work. Her method, she claimed, “evolved by myself … presents the disease in a different light from that accepted by orthodoxy throughout the world.” She listed the authorities she disagreed with, beginning with the Queensland Royal Commission, British orthopedic specialist Sir Robert Jones, Australian polio expert Jean Macnamara, New York's Kristian Hansson, the Kendalls, George Bennett and Robert Johnson of Baltimore, and Robert Lovett, Arthur Legg, and Janet Merrill of Boston. These authorities believed that splinting prevented deformities
but nonetheless deformities occurred in their patients. “Deformities do not occur with our system,” Kenny announced boldly, even among patients “who have received the best orthodox treatment in Australia and America, including Georgia Warm Springs.” “I do not claim,” she said, careful to distinguish herself from the exaggerated press, “that a complete cure for the disease anterior poliomyelitis has been established.” But disabilities could be significantly reduced “by putting into practice the original conceptions which I have presented to medical men and which have been acknowledged by them to be of great benefit to mankind.”
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Here was caution matched with breathtaking confidence.