Kenny tried to have her visitors recognize that the symptoms she was describing were “exactly opposite to those recognized by Orthodoxy,” urging them “to understand that if I had to make any harsh remarks about the Orthodox method, it was only meant for our mutual benefit. As I understood, we were all out for the benefit of the afflicted.” After seeing Kenny’s slides of twisted and stiff posterior neck muscles compared to patients who had received the Kenny treatment and were now normal, Florence immediately remarked that “all of these cases recover anyhow,” adding that this kind of spasm “recovers very quickly.” Hearing this allusion “to a condition that she and her husband deny existed in their book,” Kenny pointed out that Florence “was admitting the source of a symptom that was not supposed to exist.”38 The Kendalls retorted that “there was a confusion of terms,” for the term “spastic” was not the same as “spasm or contracture” and that in any case orthodoxy did recognize the condition of muscle spasm in acute polio. When Kenny protested that their PHS Bulletin had not mentioned the term, they replied that “the Bulletin does not deal with acute but with convalescent poliomyelitis.”39
After this tense encounter, Kenny invited the visitors to be her guests at a luncheon but the Kendalls had already made plans to have lunch with John Pohl. Annoyed at this rebuff, Kenny gave the other 3 therapists who did accept her lunch invitation a “private showing” later that afternoon where she demonstrated the details of her work and put some of her patients in the city hospital “through a severe test to show what she considered normal.”40 Not only did she relax in these less combative environments she also joked and showed a side of herself that the Kendalls never saw.41
On the following day the Kendalls hoped to be shown the concrete details of Kenny’s techniques. Instead Kenny began by discussing “certain inaccuracies in accepted theories” including “muscle testing and its dire results.” She then presented some of her recovered patients. “The audience was interested,” she reflected later, “but the task was irksome,” for the observers were looking at results from a treatment for symptoms “they did not recognize.”42
When Kenny finally presented her patients she was challenged by the Kendalls over her diagnoses. In the Kendalls’ notes from that day Kenny insisted that a paralyzed foot was now normal, although they felt that it “showed marked proration & flatness of long arch.” When explaining the cause of an arm’s paralysis, Kenny claimed it was the result of a spasm in the pectoral major muscle but Henry “raised arm thru range of motion & showed that range was entirely N[ormal].”43 Kenny then asked Henry to describe the deformities he saw in certain patients and to explain their cause “according to Orthodoxy.” When he finished she pointed out how his explanations differed from her own views.44 Kenny then shocked her audience by declaring that she rejected any use of muscle testing in polio for “the extreme effort necessary on the part of the patient would only exaggerate the inco[-]ordination” and also cause “further spasm and contractures.”45 This was a direct attack on the physical therapists’ standard tool of assessment.
On the third day the physical therapists met Kenny at Station K, her city hospital ward. The Kendalls were eager to see Kenny’s techniques in action, but were not surprised when Kenny announced that she first “wished to discuss principles regarding treatment.” Speaking as an expert with a touch of arrogance, Florence told Kenny that “we thought she had a contribution to make in her treatment” and that “by being open-minded and discussing the problem … we probably would find there were not as many points of difference as appear on the surface.”46 The Kendalls saw themselves as trying to be agreeable but Kenny “became very much annoyed” and replied “you say there is no difference between my treatment and yours, and I maintain they are entirely opposite,” adding that she had already proved her work in Australia. After further discussion the Kendalls concluded that “it was obvious that to disagree with Sister Kenny or question her was as great a mistake as agreeing with her.” They said they wanted to discontinue any discussion until the doctors arrived, reminding Kenny that “Dr. Pohl had invited us to observe treatment.” Kenny replied dismissively that “she didn’t care what Dr. Pohl had invited us to do, she did not intend to show us any treatment.” With rising ire she also criticized the NFIP “for sending us out” and “permitting us to write a report on the basis of a three-day visit.” The NFIP had told them to stay as long as they needed to, the Kendalls countered, and it was Pohl who had suggested 3 days “otherwise we would have planned to stay longer.” Unless they were permitted to see treatment, they warned, “we would have to state in our report that we were refused the opportunity,” and Henry angrily added “we’re going to stay just long enough to expose you.”47 The meeting broke up when the Kendalls left to talk to Pohl. According to Kenny, she waited for an hour for them to return, but the Kendalls recalled instead that she left the hospital “in a huff” threatening to leave for Australia.48
Alice Plastridge stood somewhat apart from the heated exchanges between Kenny and the Kendalls. Her work at Warm Springs based around its thermal spring pools with patients in the convalescent rather than the acute stage had shown her the potential of muscle exercises and heat. Warm Springs also emphasized functionality over straightening twisted bodies, which may have led Plastridge to be less concerned by Kenny’s rejection of testing muscles to assess the exact extent of their weakness. Indeed, orthopedist Charles Irwin, Plastridge’s Warm Springs supervisor, had argued in JAMA that “no immediate effort should be made to make a complete muscle analysis” in polio for “it causes the patient too much discomfort” and until tenderness subsides “it can’t possibly be correct.”49
Plastridge had come to Minnesota with an open mind. She arrived 2 days before her meeting with Kenny in order to talk to local therapists who were being trained by Kenny. These therapists explained some of “the underlying principles of this treatment” to her and tried to clarify Kenny’s “seemingly contradictory theories.” With the comment “forewarned is forearmed,” they warned Plastridge about Kenny’s tendency to hear every question as a criticism, which was the result, they explained, of her effort “for so many years to get her ideas across and prove the worth of her work” with “ridicule … heaped upon her for so long.” Thus, the “only way of learning her theories” was “to let her do all the talking.” Plastridge should therefore not ask questions or raise objections for she might be “singled out for derision and unanswerable questions.” The lessons she learned from these therapists, Plastridge reflected, “made me a little more tolerant of Sister Kenny’s peculiarities.”50
Plastridge was especially interested in Kenny’s claim to have healed Henry Haverstock, a former Warm Springs patient whose case had professional significance for her. Haverstock’s case had been featured by local newspapers with, Plastridge noted, “remarkable claims made about his progress.” She went to examine him herself and sent a separate report to her supervisor in Georgia. Before Haverstock had come to Warm Springs, Plastridge noted, he had been extremely active at home, “even trying to walk.” As a result, his muscles were “so fatigued and so weak” that the Warm Springs staff had advised “complete rest, in plaster” for the first 2 months before he was allowed to exercise in the pools. He was finally taught to walk with the aid of leg splints, a canvas stomach corset, and crutches, and after 4 months was sent home.51 All this equipment had been removed by Kenny who claimed that her method was treating his “true symptoms.”52 In Plastridge’s assessment after some months of Kenny’s treatment he “showed a very pendulous abdomen and hyperextension of the right knee” as well as a “Trendelenberg limp [the result of a weak gluteus medius muscle].” Haverstock tried to show Plastridge how he could walk but could only manage 3 steps; she felt that the stability that might be gained from using a brace on his right leg and a pair of crutches would have given him more self-confidence and “increased rather than decreased his independence.”53 A year later, Haverstock was featured in national magazi
nes as a college student who could climb 3 flights of stairs daily to different classrooms and in JAMA John Pohl used his case as a prominent example of the worth of Kenny’s work.54 But in 1941 Haverstock’s limited recovery did not provide evidence to convince visitors that Kenny’s methods enabled convalescent patients to improve their strength and functionality. Thus Plastridge did not consider Kenny’s results with Haverstock and other patients with long-standing paralysis “very different from those obtained by any conscientious physical therapist.”55
Kenny’s results, though, convinced all the visiting therapists that her methods were of great psychological benefit to patients.56 Plastridge, Elson, and Beard had observed her methods in the afternoon session that the Kendalls had not attended. Plastridge was especially impressed with the way Kenny worked with patients whereby every movement was “done with the most meticulous care.” This new method, Plastridge agreed, “aids circulation, muscle tone and (what is most important to Sister Kenny) it aids in keeping up the patients’ ‘mental awareness’ ” so that “the patient never forgets how to make the effort to move the different parts of his body.”57 Plastridge’s positive assessment reflected her more nuanced view of Kenny herself, gained through observing her not only as a didactic lecturer, but as a genial host and as a clinician at the bedside. Unfortunately Elson and Beard left no record of their experiences.
Kenny’s belligerent attitude frustrated all of her visitors, but Plastridge tried to separate the woman from the work. Kenny was the kind of person, she admitted, who “raises your ire to the boiling point with her aggressiveness and unreasonableness.” She considered her too “intolerant and impatient” to allow opportunities “for free discussion” and therefore not “a good lecturer or teacher—neither scientific nor logical in her explanations, although she does know her anatomy and probably her neurology.” But Plastridge admired her “imposing, almost majestic bearing [and her] … fine sense of humor,” as well as “her fund of stories and anecdotes from her own nursing experiences and extensive travels.” Impressed by Kenny’s “unusually good results,” Plastridge, like many observers, could not believe it was “possible they could all be a matter of chance.” Unlike the Kendalls she was willing to speculate about the validity of Kenny’s ideas, concluding that “whether her theories are scientifically sound or not only time and further investigation will prove.” She also anticipated that Kenny’s controversial theories would give “a tremendous stimulation to further research in this field” for Kenny’s claims had already “made many of us take serious stock of ourselves, and the type of physical therapy we are doing.”58
The Kendalls were given a copy of Plastridge’s comments, but they remained unconvinced. They completed their own 13-page report to the NFIP a few months after the visit in which they defended their criticisms of Kenny’s work, trying not to discuss their dislike of her character. They had, they said, sought to “distinguish between the real and apparent” value of this new method. “The Orthodox conception,” they emphasized, did recognize “early spasm (which accompanies meningeal irritation), followed by flaccidity in muscles (which accompanies onset of paralysis).” Yet Kenny “fails to recognize this transition from the symptoms of spasm to the symptoms of flaccidity.” Her outrageous claim that muscle tests were harmful was part of a pattern of what they saw as a lack of rigor: deficient clinical records and an inappropriate reliance on qualitative evidence.59 Comparing her to the standards of their own well-respected institution, they remarked in their private notes, “SK’s notes and charts are kept at home—not at the hosp!”60 The credit Kenny claimed for all recoveries ignored the likelihood that many of her patients had made a spontaneous recovery and therefore made accurate comparisons impossible. Her claims required a thorough statistical study including complete case histories and muscle examinations for all patients at the end of 6 weeks, but “unfortunately Sister Kenny advocates that it [testing] tends to produce ‘mental alienation.’ ”61
The Kendalls openly disagreed with Kenny’s assessment of some of her patients, doubted her theories, remained convinced that muscles without proper support would be damaged, and were appalled to hear Kenny reject the muscle test, the major tool of their own clinical and research program. They also disliked her confusing terminology. In their view, “she used terms freely and interchangeably, without regard for clear cut meanings of those terms” and her “knowledge of muscle function was not only very incomplete [but] … quite inaccurate.”62 They had been ready to accept that her unusual terms were the result of language differences, an argument proffered by Knapp who had warned the visitors “how easy it was to misunderstand Sister Kenny because of the differences in the meanings of words—even in English-speaking countries like Australia.”63 But Kenny made clear that she was not just giving new names to familiar symptoms in an exotic accent. Hers was a new language for new ideas. What was new, she tried to explain, were the distinctive symptoms she had identified that made polio—at least in its acute stage—a new disease, rendering any debate based on the orthodox conception of polio irrelevant. The Kendalls interpreted this as sloppy thinking; they did not see clinical signs such as spasm as crucial in the construction of polio itself. Thus, during a discussion of a shoulder whose muscle Kenny claimed was in spasm, the Kendalls found “no contraction.” Their notes read: “When facts pointed out she became confused & made statement—‘We are talking about a diff. disease.’ H.O.K. said ‘Oh no—I’m talking about muscles & deformities, not the disease.’ ”64 But to Kenny “muscles & deformities” were a critical, neglected element of polio care that proved both ineffective treatment and damaging physiological disruption. Kenny’s distinction between “affected” muscles and “alienated” muscles frustrated all the therapists, and the Kendalls concluded that her classification of “spasm” was neither a new symptom nor one that required distinctive treatment. She also seemed not particularly interested in a scientific explanation for the cause of these new symptoms. Her vague comment that muscle spasm was “caused by irritation in the spinal cord” was unconvincing. Of course Kenny also said that she had come to America to find scientific researchers who could explain the complex mechanism underlying the distinctive symptoms she had identified.65
In any case, the Kendalls argued, most of her ideas and techniques were “not so radically different from our own, even though differently applied.” As early as the 1916 polio epidemic, hospitalized patients in the acute stage after leaving the contagious disease hospital were placed in tubs of hot water while pain was severe; thus, “heat, in one form or another, is not new.” The maintenance of a normal mental attitude “has long been taken for granted as one of the most important phases of the recovery period.” As for exercises to regain muscle function, “a great deal depends upon the experience, conscientiousness and patience of the physical therapist” and, whether called muscle consciousness or mental alienation, “that is definitely one of the things we have worked for the hardest.” Many of her techniques were part of standard polio care: hot packs to stabilize body parts and a foot board and a wooden plank under the mattress as methods of immobilization. Such techniques, however, they feared, would not adequately protect weak or paralyzed muscles. Kenny’s early introduction of muscle training, allowing a patient complete freedom of joint movement, was even more harmful. Her claim about the danger of rest made no sense to the Kendalls, for the idea that rest could aid “the inflamed or potentially paralyzed part” had scientific confirmation from studies of polio for almost 100 years. Although these studies, they admitted, were almost all based on clinical evidence rather than laboratory evidence, they were nonetheless so extensive that there should be no debate over “the necessity of protecting weak muscles in cases of nerve injury.”66 She should not, they concluded, be given responsibility in the treatment of patients in the acute stage or “be entrusted with teaching the principles of muscle actions.”67 In their harshest assessment, they felt her idea that “brain power” could be reinvigorated by p
hysical therapy contradicted “the results of scientific studies by the most competent minds in medicine, and accordingly must be relegated to ‘cultism’ until further evidence is forthcoming.”68 The Kendalls sent their report to the NFIP and to JAMA, but Morris Fishbein decided not to publish it, seeing it as a bitter attack on Kenny’s method.69
The Kendalls began circulating their report to fellow professionals but were disappointed to find that the politics of polio had shifted away from their views. When Florence Kendall asked Catherine Worthingham, president of the APTA, for her reactions to the report, she was surprised to find that Worthingham reduced their many objections to the issue of terminology. Although Worthingham agreed that Kenny’s choice of terms was unfortunate, Worthingham and the APTA’s Governing Board believed “it would be very unwise to bring it up now,” and she reminded Florence there were “so many things that are important to us in our relationship to other organizations that it would be unfortunate to cloud the issues with the discussion of terminology.”70 Thus, as Worthingham was noting obliquely, Kenny’s work had drawn attention to the significance of physical therapy in polio care and thereby reinforced the relationship between the APTA and the NFIP, so the APTA would not want to take a public stance against the NFIP-sponsored nurse by making what might seem picky complaints about her terms. During the 1940s NFIP-funded physical therapists’ specialized training and professional development contributed to the expansion of the profession in both numbers and respectability.
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