Following this strategy of cooperation and appeasement, Worthingham asked Kenny to participate in an NFIP-funded study of “Physical Therapy Treatment in Poliomyelitis” a few months after the therapists’ visit to Minneapolis. The APTA, Worthingham explained, was sending questionnaires to hospitals, crippled children’s schools, private practitioners, charity and governmental agencies, and physical therapy training schools in preparation for a conference to evaluate the collected material and to make “recommendations as to methods of approach.”71 Kenny replied predictably. Such a survey, she said, would be of “no value” for “all observers [had admitted] … that I have evolved a satisfactory and commendable treatment … which holds out more hope for recovery than any other method produced anywhere.” She was “pained and surprised” that money would be spent funding yet another study considering that “for twenty-five years results have been tabled and compared and no advance has been made.”72 This query promoted Kenny to remind O’Connor that the funds of his “very splendid organization” should “be better employed” if they were “used to teach technicians the method while I am still available, rather than go over old ground.” She reiterated her provocative claim that the twisted bodies of disabled children were largely the result of inappropriate and ineffective therapy—“the after-effects of orthodox treatment”—rather than the disease itself.73
Kenny’s method rapidly became seen as a legitimate polio therapy. As early as November 1941 Emil Rosner, a physical therapist at the New York Hospital for Joint Diseases, boasted to the Kendalls that he was “familiar with the Sister Kenny Method, the Mayo Clinic Method, the Janet Merrill Method, and the Hansson Method—and your splendid work.”74 Rosner had not recognized that the Kendalls did not consider Kenny’s work in the same pantheon as other respected polio authorities.
CRAFT AND CONTROL
Kenny did not see the Kendalls’ report for some time. Not long after the therapists’ visit, she left for Australia, ostensibly to supervise her Brisbane clinic staff during a local polio epidemic. NFIP officials assured her that they would continue to pay the living expenses of herself and Mary, who remained behind to continue the work. The NFIP also agreed to pay for both travel and living expenses of the 2 Australian therapists (Kenny’s nephew Stanley Willis (Bill) Bell and Brisbane nurse Valerie Harvey) she would bring back to Minnesota.75
Both Kenny and the medical school needed to prove that Kenny’s results were not the result of suggestibility either to her patients or to local physicians. Her trip to Australia helped “spike … a romantic theory in which many had indulged,” a reporter noted later, the theory that Kenny’s method worked “by dominating the patient’s mind” and that “perhaps she was a faith healer with some of the talents of a hypnotist.”76 Thus, Kenny’s absence helped solidify the scientific nature of her work as, under Mary’s calm supervision, treatment and clinical improvements went on without her.77
Kenny spent 3 months in Australia. Her medical supporters in Brisbane, in a gesture they considered open-minded, were allowing parents to choose whether to have their paralyzed children cared for by Kenny-trained technicians at the Brisbane General Hospital or in the wards where medical orthodoxy reigned. According to Kenny’s recollections “almost eighty percent chose the Kenny treatment.” Nonetheless, she felt such a situation was “not in keeping with the dignity of the medical profession,” and the choice “was not between a better and a worse method … [but] really a choice between the right and the wrong, the correct and the incorrect.” She was further distressed to learn from Abraham Fryberg, the hospital’s superintendent, that in the orthodox wards polio treatment was “compounded from as much of the Kenny method as they [the staff] could remember” from her earlier lectures. Not only did such practice suggest a bastardized version of her work, but most of those techniques, she protested, had been designed for convalescent rather than acute care. Unable to alter the hospital’s polio admissions policy or its practice in the orthodox wards, Kenny concluded that “I was still a bush nurse who was supposed to know nothing except what lay within the narrow limits of her own sphere.”78 She was, however, delighted to be sent a draft copy of a positive report on her work by Cole and Knapp. She showed the report to Australian government officials, drawing attention to their statement that “we personally firmly believe that this method will be the basis of the future treatment of infantile paralysis.”79
By the time she returned to the Twin Cities, local officials and physicians at the university had decided that her work was worth learning. She was now in charge of wards in both the city hospital (Station K) and in the university hospital (Station 43), and was growing confident that her base in Minneapolis would enable her to alter the minds of doctors, nurses, and physical therapists across America. “I have a very nice set up at the University,” she wrote to a Brisbane ally, “and am in the proud position of being consultant in all the hospitals of the Twin Cities for all polio cases.”80 Local boosters in Minnesota had already begun to retell Kenny’s story as one of civic acumen. “Minneapolis was the only city in America to give her a friendly hearing,” the Minneapolis Star-Journal claimed, “previously she had offered her services to New York, Chicago, Denver and San Francisco.”81 The Star-Journal featured patients like Bob Gurney, an 18-year-old patient from St. Paul who had been paralyzed by polio “so bad[ly] [that] I could only wink my eyes,” but was now leaving the hospital and planning to return to high school.82
By the time America’s 1941 polio season arrived the Kendalls’ doubts were subsumed by a wave of professional and public interest provoked by Cole and Knapp’s enthusiastic article on “The Kenny Treatment of Infantile Paralysis” published in JAMA that June.83 But in print the article looked quite different from the draft Kenny had read. The careful crafting of this report for publication showed the hand of Morris Fishbein who was trying to dampen what the New York Times later called the “silent controversy raging behind closed doors in medical circles ever since Miss Kenny introduced her method of treatment in this country.”84 JAMA was the most important medical journal in North America and as its editor Fishbein was one of the most influential American physicians. Throughout the 1940s JAMA’s high circulation numbers matched the circulation of the next 6 largest medical journals combined.85 Fishbein wanted to be very careful in approving this first JAMA article on Kenny’s work. In his role as chair of the NFIP Committee on Information he had “returned it to be dissected by a special committee” and had “finally accepted [it] with some misgivings and published [it] with many deletions.”86 Fishbein asked Frank Krusen, the Mayo specialist in physical medicine, to head this “special committee.” Some of the behind-the-scenes machinations can be guessed at from a private note Knapp sent to Krusen apologizing for asking him “to sign a statement explaining an article you have not seen about work you have not observed.” Knapp added that he had been told this should be done in order to “prevent ‘the report from being misunderstood.’ ”87 In another glaring change, the published article did not use John Pohl’s name even though he had done much of the work, but Fishbein did publish a separate article by Pohl 10 months later.88
The preface to Cole and Knapp’s published report was full of caveats warning that the report was only preliminary, that “several years must elapse before a definite evaluation of the method” could be made, and that “it is, of course, recognized that spontaneous recovery may occur.” The preface authors did acknowledge that “the currently accepted methods of treatment of the disease are far from satisfactory” and they urged that Kenny’s method “should be given a fair trial and should be studied with open minds.” In examples that contradicted this, however, the preface included lengthy quotations from earlier critical reports on Kenny’s work by British and Australian physicians.89
In the rest of the article, written in a distinctly different tone, Cole and Knapp not only praised Kenny’s “highly refined and detailed method of muscle reeducation” but also her rejection of splinting, a t
echnique that they pointed out did not prevent deformities. With confidence they explained that “obviously in this treatment there is no place for ‘muscle testing’ as usually performed … for this testing can definitely cause ‘incoordination’ and may slow down the patient’s recovery.” The 26 acute patients they had observed treated with Kenny’s methods and without splinting were “much more comfortable and cheerful,” and, to date, not one had developed “contractures or deformities following this treatment.” Most strikingly, they defended Kenny’s ideas of incoordination and alienation, explaining that muscle training could “maintain normal nerve pathways and restore those which are damaged.” While they agreed that these ideas were new they made much of the evidence of efficacy. And how had Kenny been able to identify something unrecognized by generations of polio experts? In the Australian bush her “keen, analytical mind [was] unprejudiced by previous contact with theory or training in the prevalent conception of treatment of this disease … [and] without knowledge of postmortem pathologic appearances.”90 Insight through ignorance was a strange defense made by physicians about a clinician. But Cole and Knapp recognized how many of their peers were dissatisfied with not only current therapeutic options but also polio scientists’ seemingly endless attention to pathological lesions in monkeys rather than pain and disability in living patients.
The JAMA article became the basis of numerous stories in the popular press. Accompanied by a picture of Kenny in a wide-brimmed black hat, a Time article described the “new and apparently successful treatment for infantile paralysis—reversing all accepted methods of treating the disease.” “No doctor invented this method,” the magazine noted, “but a nurse in the Australian bush.” Still, in an effort to mend the disturbed gender relations and to make this medical discovery less transgressive, Time explained that Cole and Knapp had invited “strapping, soft-spoken Sister Kenny” to work in local hospitals. 91 Thus, Kenny was presented as a nurse with stereotypically deferential characteristics whose work had been recognized by insightful medical men.
Kenny immediately saw that this article was not the same as the version she had read in Australia. She identified Fishbein’s editorial hand even before O’Connor told her that Fishbein had required the article “be edited and prefaced.”92 Cole and Knapp, Kenny believed, had provided a ringing endorsement of her work. Yet sentences in the draft such as “we have been favorably impressed with this work both as to rationale of therapy and as to results so far observed” were replaced by the more tepid claim that results were better than “previous generally accepted therapeutic procedures.” The sentence “we personally firmly believe that this method will be the basis of the future treatment in infantile paralysis” was missing.93
The most serious alteration in Kenny’s view was Cole and Knapp’s original statement that “muscle spasm is a constant accompaniment of the muscle pain of acute anterior poliomyelitis, and it may be the real and sole cause of the pain,” which now read “she believes that muscle spasm is a constant accompaniment of the muscular pain of acute poliomyelitis.” Kenny could see the epistemological shift in this phrasing. “The statement was made by the observers, not by me,” she pointed out to O’Connor, but the JAMA version “would lead your readers to believe this announcement was made by me. I am not qualified to suggest or make the statement that spasm may be the real or sole cause of the pain. I consider the medical supervisors are qualified to do so.”94 This effort to distant the authorship of medical claims about her work was part of a process she had honed during the 1930s in response to critical reports on her work. Public approval by physicians was crucial for the status of her clinical and teaching work. These alterations, she warned, had “completely cut the ground from beneath my feet as far as teaching my method is concerned.” The NFIP had paid for her to return with 2 technicians in order to teach this method, but “in order to teach, the students must first understand there is something of value to learn, otherwise I would only be wasting valuable time.”95
In June 1941 Kenny and Pohl appeared again before the city’s Board of Public Welfare. Aware that he was becoming one of Kenny’s most prominent medical supporters, Pohl declared, “I think it would be criminal to treat any child afflicted with acute infantile paralysis by the methods we formerly employed,” praise echoed by the director of the city hospital and by the city’s health commissioner. The board voted to fund 2 graduate nurses who would work with Kenny for a year and then be able to “carry on the work.” The board also seconded the university’s request to the NFIP for a $10,000 grant to set up a 25-bed polio clinic at the university hospital.96 When the NFIP agreed to fund the new clinic and the training of technicians as well as cover the expenses of Kenny, Bell, Harvey, and Mary Kenny for another 8 months, officials at the NFIP and the medical school believed that these decisions had been made among themselves. NFIP officials, with Fishbein’s assistance, hoped to keep Kenny in line and ensure that her clinical and teaching work remained under the supervision of medical school faculty.
But even in this early period, Kenny was able to reach over the heads of NFIP officers and senior AMA members and claim the independence she wanted. She began to complain to local reporters and NFIP officials that the NFIP had not praised the worth of her work publicly. Without a “definite statement” by the NFIP or JAMA, Kenny declared, she and her Australian staff would only “carry on for a short time,” and, she told O’Connor, “I am sure my country will arrange for the reimbursement of all funds spent and for my return to Australia.” “Other countries desire my presence,” she reminded readers of the Minneapolis Star-Journal, but if her work was publicly acknowledged “I am prepared to stay and teach.”97
At the same time as she was threatening to leave Kenny urged O’Connor and his medical director Don Gudakunst to visit Minneapolis so that she could demonstrate her work and provide them with defining evidence that could be followed up by a formal statement from the NFIP.98 O’Connor tried to explain to Kenny why any visit by him or Gudakunst to Minneapolis would not confirm her work’s value, explaining that the NFIP was cooperating with “its grantee, the Medical School of the University of Minnesota” and it would be unwise for the NFIP “to attempt to make any separate evaluation of that method.” He refused to bow to Kenny’s threat to leave along with her staff, reminding her that the final evaluation of the work lay with physicians at Minnesota’s medical school, which would be done with or without “your continued presence.”99 But his effort to have Kenny recognize the difference between the director of an organization and its expert advisors failed. O’Connor was the head of NFIP; he had agreed to fund her work; he should put the weight of his organization behind it. It made no sense for the NFIP to encourage polio professionals to use her work at the same time the work was continuing to be evaluated. Kenny had come back from Australia determined to have her work formally approved and then spread across the country. She did not see herself as dependent on the medical school or the NFIP, points she reiterated in longer and longer letters to O’Connor.
FISHBEIN AND KENNY
As the AMA’s cultural censor behind the scenes and as a professional editor aware of the lasting power of the written word, Fishbein tended not to put much on paper. He usually responded by phone and thus we do not know how he answered O’Connor who sent him a copy of an especially long letter from Kenny with the query “How should I answer this?.” Fishbein did send O’Connor a comic note a few months later wishing him “profound sympathy in this affliction.”100 Increasingly Fishbein recognized the potentially unsettling power of Kenny and her work, especially as reporters began to tell the story of a nurse who trumps the doctors and challenges medical orthodoxy. Indeed he was one of the first American physicians to understand the threat Kenny posed in gender relations, medical authority, and professional orthodoxy. But initially he saw her as just another quack, the designation he applied to most of his antagonists. His best-selling 1925 expose The Medical Follies; an Analysis of the Foibles of Some Healin
g Cults, Including Osteopathy, Homeopathy, Chiropractic, and The Electronic Reactions of Abrams, with Essays on the Antivivisectionists, Health Legislation, Physical Culture, Birth Control, and Rejuvenation revised in 1927 to include the Cult of Beauty, the Craze for Reduction, Rejuvenation, Eclecticism, Bread and Dietary Fads, [and] Physical Therapy had sought to convince the American public that all these groups should be considered harmful to the progress of medical science.101 During the 1920s and 1930s he had led fierce attacks on alternative practitioners and proponents of government health insurance, and defended medical societies that were resisting group practice. In the late 1930s, after members of Washington, D.C.’s medical society sought to censor local physicians who had formed a group practice, New Deal officials, frustrated with AMA leaders’ intransigence over federal efforts to expand health and welfare services, named Fishbein along with members of the local society in an antitrust case brought by the Justice Department. Fishbein was confident that his own power as well as the rising status of American physicians and the AMA would continue, irrespective of the outcome of this case.
Monitoring the Kenny story seemed to Fishbein to be a question of cultural rather than scientific politics. Not only did he control what was published in JAMA but as chair of the NFIP’s Committee on Information, Fishbein had dictatorial power over the popular press as well. After the publication of Cole and Knapp’s JAMA article, Fishbein received drafts of numerous articles on Kenny. He approved an article for the Saturday Evening Post by Robert Yoder, a Chicago Daily News journalist.102 However, Fishbein rejected the overly effusive “Infantile Paralysis Loses the First Round” when its author, freelance writer Walter Quigley, seemed unwilling to be deferential enough.103 Reminding Quigley that he was one of NFIP’s medical advisors, Fishbein explained that “for me to undertake to pass on your manuscript” Quigley would need to correct the identified mistakes and his “several unwarranted inferences.” If he did this, “we will be glad to have you indicate to the prospective publisher that the manuscript has been passed on by the [NFIP] Committee on Information.”104 “There are indications that he is trying to be very much of a smart aleck in this affair,” Fishbein concluded in a separate note to O’Connor, and “it is obvious from his manuscript that he knows nothing whatever about the subject.”105 Recognizing the threat behind Fishbein’s words, Quigley apologized abjectly, saying he was “anxious to get this accurate” and would “rewrite the MSS to make it correct.”106 But his backtracking was too late, and without Fishbein’s approval no magazine agreed to publish Quigley’s piece.
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