Polio Wars (4 page)

More controversially she claimed that the efficacy of her work and her own clinical observations had led to a distinctive understanding of polio as not a neurotropic disease (a disease in which the virus infects nerve cells) but a systemic disease (one that affects a number of organs and tissues). It is possible that the debate over this theory influenced the work of American virologists who discovered in the early 1950s that the polio virus was spread throughout the body by the blood. Most elite physicians and scientists, however, were not convinced by the kinds of evidence she used or the authority she claimed; and her popularity with the American public further alienated scientists already sceptical of medical populism.

Kenny never married, choosing the single life typical of ambitious women professionals in the early and mid-twentieth century. The Hollywood movie based on her autobiography portrayed Kenny as being forced to choose between her work and a fiancé, a story that was probably false.
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In any case hers was an unusual career: crossing boundaries, breaching professional and social mores, a nurse claiming the authority of a scientist, a discoverer, a healer, and a celebrity. Kenny was able to carve out (at times with a rather blunt knife) a path for herself that led to fame, autonomy, and professional respect throughout much of the Western world. Challenging the mostly male world of virologists, orthopedic surgeons, epidemiologists, and pediatricians meant using her height (5′ 10″), her Australian-Irish humor, her age (a number that diminished over time), and, outside Australia, her identity as an exotic. It meant adopting a distinctive, feminine public persona. Dressed in dramatic hats and corsages, Kenny used her title “Sister,” ignoring its religious significance for many Americans, and presented herself as a mixture of Florence Nightingale and Marie Curie. She was a distinctive kind of celebrity who combined clinical skills and abrasive wit with demands for public expressions of loyalty. In the eyes of most orthodox physicians and scientists, her attitude to medical expertise and scientific evidence marked her as an outsider, despite her efforts to enter the medical mainstream. But it is through her refusal to be so easily categorized and dismissed that we can start to understand some of the boundaries of medical orthodoxy in this period.

Kenny sought to straddle the gendered medical culture of her time and to gain respect as both a hands-on therapist and a scientific discoverer. She presented an alternative paradigm of the body and by extension of patient autonomy. At a time when doctors rarely explained what they were doing or why and nurses were often close-mouthed and harried with the sense that the patient's foremost responsibility was obedience to medical direction, Kenny's emphasis was on explaining what was happening and arguing that the patient's active participation—physically and mentally—played a crucial role in the healing process. Her therapy demanded that patients understand the names of muscles and the reasons behind correct muscle movements, for, she said, “in the last analysis, it is the patient who must reopen the nerve path between mind and affected muscle.”
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Her notions of science were equally provocative. She was convinced that scientific theory had to be based on clinical evidence, even for an understanding of invisible microbes. Thus, she believed that the empirical evidence embodied in her patients'
recovery proved her therapy worked, and saw scientific investigation as a way of demonstrating the physiological processes underlying its efficacy. Kenny's suspicion of clinical trials and her emphasis on understanding disease in the living body rather than through tissue pathology convinced her detractors that she lacked an appreciation of true, strong, masculine science whose proponents were not swayed by weaker emotions of caring and empathy.

Kenny's efforts to transform polio care and polio theory brought to the forefront the competing claims for authority by physicians and unorthodox practitioners and exposed the dynamics among patients, families, communities, and medical experts. She interrogated themes of respectability, expertise, objectivity, and insight into the workings of the human body in sickness and health. Physicians and scientists in the mid-twentieth century claimed public respect and a rarefied command of medical science. But Kenny's success in presenting herself as a clinical investigator able to debate clinicians and scientists demonstrated that such claims were not as stable or as widely established as members of elite research institutions and academic medical centers wanted the public to believe.

Part One
of this book examines the strategies Kenny used to establish herself as a polio expert first in Minneapolis (the city that became her American base for the following decade) and then across the nation. It discusses the way in which the battle between Kenny and the experts became a gendered struggle, not only male doctors against a female nurse, but also a masculinized version of medical authority challenged by a female clinician claiming expertise in both patient care and medical theory. And it explores the way in which Kenny's work was enhanced by her emerging reputation as a celebrity and as an author.

Part Two
examines the clinical, political, intellectual, and cultural challenges posed by Kenny's work and her concept of polio at the height of the polio wars. Kenny sought to redefine the healthy disabled body by making functionality more important than combating visible disability. She redefined the meaning of pain in polio treatment from an accepted adjunct of treatment to a symptom of something wrong. Her work countered a widespread therapeutic nihilism around polio care, and her methods demanded active patient involvement. This radical approach was adopted enthusiastically by many of her patients. These chapters explore how the voices of Kenny's patients and their families became increasingly central in shaping both clinical care and a new populist “Kenny movement,” which defined itself against the medical establishment, exemplified by the AMA and the NFIP, and how Kenny's cause provided a national forum for the public to express long-standing frustration with unresponsive physicians and hospitals, autocratic public officials, the dismissal of strong women, the neglect of chronic disease, and the enforced orthodoxy of medical care. Hollywood embraced Kenny's story as the basis for an RKO movie that dramatized the story of a beautiful, unblemished heroine who heals the “crippled” and understands polio better than the doctors. True to Hollywood conventions Kenny's character must reject love for the altruistic goal of saving the world's children while fighting professional prejudice every step of the way.

This section also discusses how Kenny's claims complicated the debate over what constituted scientific proof in medicine, how her theory that the polio virus was not restricted to the central nervous system but directly affected muscles and “peripheral structures” filled a large hole in the physiology and pathology of muscle function, and
how new ideas in polio virology in the late 1940s undermining the old neurotropic concept of polio began to make her theory sound less fantastical.

Part Three
examines the medical politics of polio in the early Cold War years, at a time when the Kenny Foundation—now with its own donation containers—was a significant competitor to the NFIP and set its sights on funding not only Kenny care and the training of Kenny technicians but also an alternative research establishment, epitomized by the work of Columbia University virologist Claus Jungeblut. It discusses the new kind of legitimacy Kenny garnered when in 1948 she was invited to Washington, D.C. as an expert witness at hearings on the proposed National Science Foundation, and describes the complicated medical politics of these hearings, as well as the way in which polio became part of the global health politics of the early Cold War and how Kenny promoted her work internationally. Finally, it describes how Kenny's name and work began to fade from public and scientific consciousness in the mid-1950s with the discovery of a polio vaccine and a new conservative domestic ideology that fashioned women as the wives of (male) scientists or as nurses who aimed not for professional respect but for physician husbands. And it notes the brief reappearance of her story in the 1980s with the emergence of Post-Polio Syndrome.

Kenny died at the age of 72, frustrated that her work had not achieved the scientific acclaim she so desired. But the changes in clinical practice she initiated and sought to direct were nonetheless profound.

1.
Truman Capote
Breakfast at Tiffany's: A Short Novel and Three Stories
(New York: Random House, 1958), 103.

2.
Bing Crosby as told to Pete Martin
Call Me Lucky
(New York: Simon & Schuster, 1953). Ruth Prigozy and Walter Raubicheck eds.
Going My Way: Bing Crosby and America Culture
(Rochester: University of Rochester Press, 2007) also fails to refer to Crosby's involvement with Kenny or the Kenny Foundation.

3.
Victor Cohn “Sister Kenny… Back in the Battle Again”
Minneapolis Sunday Tribune
March 26 1950.

4.
Erwin Ackerknecht
Therapeutics from the Primitives to the 20th Century
(New York: Hafner Press, 1973); Charles E. Rosenberg “Erwin H. Ackerknecht, Social Medicine, and the History of Medicine”
Bulletin of the History of Medicine
(Fall 2007) 81: 511–532.

5.
On polio's early history see John R. Paul
A History of Poliomyelitis
(New Haven: Yale University Press, 1971); Naomi Rogers
Dirt and Disease: Polio before FDR
(New Brunswick, NJ: Rutgers University Press, 1992).

6.
Jessie L. Stevenson “After-Care of Infantile Paralysis”
American Journal of Nursing
(1925) 25: 730–732.

7.
Robert W. Lovett
The Treatment of Infantile Paralysis
(Philadelphia: P. Blakiston's Son & Co., 1917); Arthur T. Legg and J. B. Merrill
Physical Therapy in Infantile Paralysis
(Hagerstown, MD: W. F. Prior Co., 1932); Frank R. Ober “Physical Therapy in Infantile Paralysis”
JAMA
(January 1 1938) 110: 45–46.

8.
Fred H. Albee “The Orthopedic Treatment of Infantile Paralysis”
Bulletin of the New York Academy of Medicine
(September 1926) 2: 463.

9.
Richard Kovacs “The After-Care of Poliomyelitis: Electricity in the After-Care of Poliomyelitis”
American Journal of Nursing
(1932) 32: 2.

10.
[Cohn interview with] Robert Bingham, May 19 1955, Victor Cohn Papers in Elizabeth Kenny Papers, Minnesota Historical Society, St Paul (hereafter MHS-K).

11.
Donald A. Neumann “Polio: Its Impact on the People of the United States and the Emerging Profession of Physical Therapy”
Journal of Orthopaedic and Sports Physical Therapy
(2004) 34: 479–492; Lovett
The Treatment of Infantile Paralysis
; Henry O. Kendall and Florence P. Kendall
Muscles: Testing and Function
(Baltimore: Williams & Wilkins Co., 1949).

12.
Robert W. Lovett “Orthopedic Problems in the After-Treatment of Infantile Paralysis”
Journal of Bone and Joint Surgery
(1917) 2: 690.

13.
Charles L. Lowman “The After-Care of Poliomyelitis: Physiotherapy in the Water”
American Journal of Nursing
(1932) 32: 8–10; see also C. L. Lowman “Underwater Gymnastics”
JAMA
(October 10 1931) 97: 1074–1076; William H. Park “Epidemic Poliomyelitis or Infantile Paralysis”
Scientific Monthly
(September 1931) 33: 261–264.

14.
On Roosevelt and Warm Springs see Hugh Gregory Gallagher
FDR's Splendid Deception
(New York: Dodd, Mead, 1985); Davis W. Houck and Amos Kiewe
FDR's Body Politics: The Rhetoric of Disability
(College Station: Texas A&M University Press, 2003); Theo Lippman, Jr.
The Squire of Warm Springs: F.D.R. in Georgia 1924–1945
(Chicago: Playboy Press, 1977); Turnley Walker
Roosevelt and the Warm Springs Story
(New York: A. A. Wyn, 1953); Amy L. Fairchild “The Polio Narratives: Dialogues with FDR”
Bulletin of the History of Medicine
(2001) 75: 488–534.

15.
For a brief survey of changes in polio treatment between the 1910s and early 1940s see Richard Kovacs ed.
The 1942 Year Book of Physical Therapy
(Chicago: Year Book Publishers, 1942), 273–275; Daniel J. Wilson
Living with Polio: The Epidemic and Its Survivors
(Chicago: University of Chicago Press, 2005).

16.
Henry O. Kendall “Some Interesting Observations About the After Care of Infantile Paralysis Patients”
Journal of Exceptional Children
(1937) 3: 107–112; G. E. Bennett, M. C. Cobey, and H. O. Kendall “Molded Plaster Shells for Rest and Protection Treatment of Infantile Paralysis”
JAMA
(October 2 1937) 109: 1120–1121.

17.
Kendall “Some Interesting Observations About the After Care of Infantile Paralysis Patients,” 107–112; Henry Otis Kendall and Florence P. Kendall
Care During the Recovery Period in Paralytic Poliomyelitis
(Washington, DC: Government Printing Office, 1938, rev. 1939, Public Health Service Bulletin No. 242); see also John G. Kuhns et al. “Sixty-Sixth Report of Progress in Orthopedic Surgery”
Archives of Surgery
(1938) 37: 336–337.

18.
Frank H. Krusen
Physical Medicine: The Employment of Physical Agents for Diagnosis and Therapy
(Philadelphia and London: W. B. Saunders, 1941), 594–595.

19.
Polio frequently appeared in textbooks under “Diseases of the Nervous System”; see Heinrich F.
Wolf Textbook of Physical Therapy
(New York: D. Appleton-Century, 1933); see also W. Russell Brain
Diseases of the Nervous System
(London: Oxford University Press [1933], 3rd ed. 1948), 454–464. For the argument that polio patients needed both immobilization and rest see Lovett
The Treatment of Infantile Paralysis
; Robert Jones and Robert Williamson Lovett
Orthopaedic Surgery
(New York: William Wood and Company, 1929); Krusen
Physical Medicine
, 592–593.