Polio Wars Read online

  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.”47

  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.

  NOTES

  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 Paralys
is; 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.

  20. Ober “Physical Therapy in Infantile Paralysis,” 45–46; “Infantile Paralysis” American Journal of Nursing (1931) 31: 1142; Legg and Merrill Physical Therapy in Infantile Paralysis.

  21. Stevenson “After-Care of Infantile Paralysis,” 729.

  22. Evelyn C. Pearce A Textbook of Orthopaedic Nursing (New York: G.P. Putnam’s Sons, 1930), 40–41.

  23. Jessie L. Stevenson The Nursing Care of Patients with Infantile Paralysis (New York: National Foundation for Infantile Paralysis, 1940), 12–13, 25, 35; Stevenson “After-Care of Infantile Paralysis,” 730–732.

  24. Her major textbooks were Kenny Infantile Paralysis and Cerebral Diplegia: Methods Used for the Restoration of Function (Sydney: Angus and Robertson, 1937); Kenny Treatment of Infantile Paralysis in the Acute Stage (Minneapolis: Bruce Publishing Co., 1941); John F. Pohl and Kenny The Kenny Concept of Infantile Paralysis and Its Treatment (Minneapolis: Bruce Publishing Co., 1943); and Kenny Physical Medicine: The Science of Dermo-Neuro-Muscular Therapy as Applied to Infantile Paralysis (Minneapolis: Bruce Publishing Co., 1946).

  25. Philip Moen Stimson “Minimizing the After Effects of Acute Poliomyelitis” JAMA (July 25 1942) 119: 990; see also Kenny Treatment of Infantile Paralysis.

  26. See, for example, Michael S. Burman “Curare Therapy for the Release of Muscle Spasm and Rigidity in Spastic Paralysis and Dystonia Musculorum Deformans” Journal of Bone and Joint Surgery (1938) 20: 754–756.

  27. Kenny Treatment of Infantile Paralysis, 25.

  28. Kenny Treatment of Infantile Paralysis, 16–22, 38–39.

  29. Pohl and Kenny The Kenny Concept of Infantile Paralysis, 48.

  30. Pohl and Kenny, The Kenny Concept of Infantile Paralysis, 117–118; Kenny Treatment of Infantile Paralysis, 214. Hot packs were initially made in a complex system involving a small galvanized iron wash tub filled with boiling water mounted on a frame so it could be rolled from bed to bed, with a hand wringer on one side. Later hot pack machines were standardized, and the material for hot packs was Munsingwear, produced by a Minnesota company.

  31. Kenny Treatment of Infantile Paralysis, 109.

  32. Pohl and Kenny The Kenny Concept of Infantile Paralysis, 51–54, 133.

  33. Kenny Treatment of Infantile Paralysis, 39–40; Pohl and Kenny The Kenny Concept of Infantile Paralysis, 51–54, 77, 136, 139.

  34. Kenny Treatment of Infantile Paralysis, 109; Pohl and Kenny The Kenny Concept of Infantile Paralysis, 152.

  35. Kenny Treatment of Infantile Paralysis, 157; photograph on 158.

  36. Kenny Treatment of Infantile Paralysis, 40, 115.

  37. Pohl and Kenny The Kenny Concept of Infantile Paralysis, 51, 55.

  38. Kenny Treatment of Infantile Paralysis, 134–137; Pohl and Kenny The Kenny Concept of Infantile Paralysis, 56.

  39. Pohl and Kenny The Kenny Concept of Infantile Paralysis, 147, 151, 185.

  40. Kenny to Dear Dr. Pye, August 18 1939, Home Secretary’s Office, Special Batches, Kenny Clinics, 1938–1940, A/31752, Queensland State Archives, Brisbane (hereafter QSA).

  41. Pohl and Kenny The Kenny Concept of Infantile Paralysis, 303–313. She had used these techniques since the 1930s; see Kenny Treatment of Infantile Paralysis, 81.

  42. Alice Lou Plastridge “Report of Observation of Work of Sister Elizabeth Kenny in Minneapolis, Minnesota, January 1941” [read to Georgia Chapter of American Physiotherapy Association on February 14 1941, at Warm Springs], Florence Kendall Collection, Silver Springs, Maryland, 3. For a similar description see Wallace H. Cole and Miland E. Knapp “The Kenny Treatment of Infantile Paralysis: A Preliminary Report” JAMA (June 7 1941) 116: 2579–2580.

  43. Ober “Physical Therapy in Infantile Paralysis,” 45–46; Wolf Textbook of Physical Therapy, 239–241; William Joseph Mane Alois Maloney Locomotor Ataxia (Tabes Dorsalis): An Introduction to the Study and Treatment of Nervous Diseases, for Students and Practitioners (New York: D. Appleton & Company, 1918), 147.

  44. Carmelita Calderwood “Nursing Care in Poliomyelitis” American Journal of Nursing (1940) 40: 629; Krusen Physical Medicine, 592; Stevenson The Nursing Care of Patients with Infantile Paralysis, 22.

  45. Kenny Treatment of Infantile Paralysis, 232.

  46. Victor Cohn Sister Kenny: The Woman Who Challenged the Doctors (Minneapolis: University of Minnesota Press, 1975), 34–36.

  47. Kenny quoted in Marvin L. Kline “The Most Unforgettable Character I’ve Ever Met” Reader’s Digest (August 1959) 75: 205.

  FURTHER READING

  For discussions of medical practice see Rima Apple Vitamania: Vitamins in American Culture (New Brunswick, NJ: Rutgers University Press, 1996); Barbara Clow Negotiating Disease: Power and Cancer Care, 1900–1950 (Montreal/Kingston: McGill-Queen’s University Press, 2001); Christopher Crenner Private Practice in the Early Twentieth Century Medical Office of Dr. Richard Cabot (Baltimore: Johns Hopkins University Press, 2005); Christopher Lawrence ed. Medical Theories, Surgical Practice: Studies in the History of Surgery (New York: Routledge, 1992); John E. Lesch The First Miracle Drugs: How the Sulfa Drugs Transformed Medicine (New York: Oxford University Press, 2007); Martin Pernick A Calculus of Suffering: Pain, Professionalism, and Anesthesia in Nineteent
h-Century America (New York: Columbia University Press, 1985); John Pickstone Ways of Knowing: A New History of Science, Technology and Medicine (Chicago: Chicago University Press, 2001); Anson Rabinbach The Human Motor: Energy, Fatigue, and the Origins of Modernity (New York: Basic Books, 1990); Morris J. Vogel and Charles E. Rosenberg eds. The Therapeutic Revolution: Essays in the Social History of American Medicine (Philadelphia: University of Pennsylvania Press, 1979); John Harley Warner Against the Spirit of System: The French Impulse in Nineteenth-Century American Medicine (Princeton: Princeton University Press, 1998); John Harley Warner The Therapeutic Perspective: Medical Practice, Knowledge, and Identity in America, 1820–1885 (Cambridge, MA: Harvard University Press, 1986); Elizabeth Watkins The Estrogen Elixir: A History of Hormone. Replacement Therapy in America (Baltimore, MD: Johns Hopkins University Press, 2007).

  Acknowledgments

  IN DECEMBER 1992 I traveled to the Minnesota Historical Society to look at its Elizabeth Kenny Collection for the first time. I also contacted Richard Owen, a rehabilitation specialist and polio survivor who had been treated by Kenny as a child, and Margaret Opdahl Ernst, Kenny’s first American secretary, who invited me to attend the fiftieth reunion of the Kenny Institute. At the celebration I was asked to interview former Kenny patients, most of them in their sixties and seventies, as they sat in front of a camera and talked eagerly about their lives. Being treated at the Institute with Kenny in charge of their therapy was for them an intense experience, made even more significant by their growing disabilities as the result of Post-Polio Syndrome. Polio had defined their childhood, had been conquered to a lesser or larger extent, and was now returning to redefine their senior years. Kenny herself—her height and bearing, her Australian accent and idiosyncrasies, and most of all her techniques—had left an indelible mark. For them clinical care was not a question of intellectual debates or professional boundaries but the fabric of their lives. These impressions have stayed with me through years of research and writing.