Polio Wars

by Rogers, Naomi

  DRUGS TO TREAT SPASM

  Whatever the physiological explanation for spasm, it was generally accepted as a clinical sign that required attention. Physicians began to look for ameliorative techniques less complicated and labor intensive than Kenny’s methods. The drug Prostigmine (or neostigmine), first synthesized in 1931 and used to treat neuromuscular disorders like myasthenia gravis, seemed promising.261 Prostigmine was first tested on patients with polio in Kenny’s new hometown. Knapp began testing the drug with the help of Herman Kabat, a young neurophysiologist, in early 1942. Knapp and Kabat found that Prostigmine was a distinct help in decreasing spasm and pain and restoring “muscle coordination.” According to science writer Paul de Kruif who had stayed away from the Kenny story but wrote about Kabat, Kabat gave his first injection of Prostigmine to a “badly spasmed woman” who, even after intensive Kenny treatment, was still unable to sit as “her back was stiffened and knifed through with pain.” This patient improved as did a boy whose case of boils had meant he was not able to have hot packs; soon after the injection, he could turn over easily in bed and then do push-ups.262 Kabat published his work in Science and the Journal of Experimental Medicine and with Knapp in JAMA and in the Journal of Pediatrics.263 In October 1943 the NFIP gave the University of Minnesota a large grant that included this research, but after problems working with Maurice Visscher, the head of the physiology department, Kabat left Minnesota and took a poorly paid position in the U.S. Public Health Service in Washington, D.C.264 Kabat then began to treat a variety of disabled patients with “spastic” muscles, and found that Prostigmine was astonishingly successful. One stroke victim “within 24 hours after the first injection” was able to “put a cigarette in his mouth with his right hand.” His work with multiple sclerosis patients, publicized by de Kruif in the Reader’s Digest, caught the attention of California industrialist Henry Kaiser who asked him to treat his son and later founded the Kabat-Kaiser Institute (later part of Kaiser-Permanente).265 Even though de Kruif presented Kabat as dismissive of many of Kenny’s ideas, Kabat himself promoted his “neuromuscular reeducation” techniques for multiple sclerosis, polio, and cerebral palsy that “like the Kenny treatment … [help] patients recover nerve-muscle control.”266

  Another drug was even more intriguing: curare, a muscle relaxant used as an anesthetic and to treat spastic muscles in tetanus convulsions and cerebral palsy.267 In 1945 New Jersey orthopedist Nicholas Ransohoff added curare injections to his clinical treatment of polio to ease spasm. After a brief note in JAMA he offered a long paper on curare at the AMA’s 1946 annual meeting, which, according to Colliers, “convinced some doctors it may be as important, or more important, than the famous Sister Kenny technique.”268 Despite warnings by anesthesiologists that curare could cause respiratory paralysis and death and that it was “a dangerous weapon in the hands of the inexperienced and untrained,” physicians were eager to try it.269 Ransohoff’s technique promised to alter the routine of hot pack care, enabling patients to leave bed more quickly and thus, he claimed, taking a heavy burden off the nursing staff of a hospital.270 In Pittsburgh Jessie Wright tried curare on her patients at the D. T. Watson Home and agreed that “we need to get away from packs. I think they have been very much overdone.”271

  Kenny was not convinced that any drug could work as well as her system of hot packs and muscle exercises. When she examined one of Knapp’s patients whose spasm was supposed to have been corrected by Prostigmine, she found “spasm very evident.” “I would not consider Prostigmine a reliable drug,” she began telling medical audiences. “It may be a suitable adjunct but of itself it has not proved satisfactory.”272

  NEW CRITICAL SCIENCE

  Fishbein’s growing hostility to Kenny and her claims was reflected in a series of studies published in JAMA during 1943 on polio’s physiology. The critics Fishbein published replayed the old story that much of Kenny’s method was not good, and what was good was not new. The Kenny concept was inadequate as a physiological explanation, Harvard physical medicine specialist Arthur Watkins and Mary Brazier, a neurophysiologist at the Massachusetts General Hospital, argued, and in any case “muscle shortening” through spasm had been recognized for many years.273 In “The Significance of Muscle Spasm” Plato Schwartz and Harry Bouman agreed, adding that her theory of the disease, based “solely on clinical observation,” could hardly be as reliable as a “logical premise” that had been “slowly developed from the work of many men in various countries.”274

  Even more definitive was a study by Columbia neurologist Joseph Moldaver whose testing of muscles suggested that spasm did not exist, and that paralysis was the result of nerve destruction. Moldaver had attended one of Kenny’s courses in Minneapolis in 1943 and, while she was away, had tested her patients, finding that a number of their muscles scored zero. Extremely annoyed to find out a visiting researcher had overridden her strict rules against muscle testing, Kenny had reminded her staff about the worthlessness of such tests before spasm had been relieved.275 But Moldaver presented his work to the New York Academy of Medicine in May 1943, and it was reported in the New York Times and Time and published in JAMA. His analysis of electrodiagnostic tests of 49 patients was widely interpreted as contradicting Kenny’s theory that untreated muscle spasm could lead to neuromuscular degeneration. Moldaver did not believe that spasm explained polio paralysis at all. Spasm, he argued, was a complex phenomenon involving the meninges covering the nerve roots of the spinal cord, and incoordination was the result not of the diminution of nerve impulses but “the inability of partially or totally degenerated muscles to respond to otherwise normal nerve impulses.” This study, according to Science News Letter, reaffirmed “the century-old view of infantile paralysis as a disease of nerve destruction or damage.” Thus, as orthopedists had long argued, polio had to be treated not by active exercises but with rest to avoid further nerve damage.276 So potent were Moldaver’s conclusions that even researchers who found some evidence of muscle changes resisted Kenny’s explanations. In the American Journal of Clinical Pathology, for example, when researchers discovered “degeneration of nerve and muscle,” which, they acknowledged, could be “considered to show ‘spasm,’ ” they instead described these changes as secondary to injured nerve cells of the spinal cord.277

  Kenny recognized that Moldaver had tried to use physiological techniques to undermine her theory while leaving the evidence of her clinical results untouched. Indeed he had told reporters that “his criticisms were in no way concerned with the Kenny treatment methods.”278 “According to Dr. Moldaver, my concept is wrong, but my treatment, which is based on that concept, works,” she commented to a friend. “Are we to infer that medicine must reject good treatments because doctors disagree with the theory? If so, the practice of medicine is a farce.”279 Moldaver, Kenny assured reporters, “didn’t know what he was talking about” and was “clinging to old, obsolete theories despite the fact [that] clever neurologists have proved the new theory correct.”280

  Moldaver’s attack made it easier for other antagonists to dismiss Kenny as a theorist. “No one now denies that Sister Kenny is good with her hands,” remarked Time, “but her critics insist that she does not really know how she does it.”281 Her allies saw such criticisms as additional evidence that physicians and scientists were jealous of her impressive clinical results. In his popular weekly radio program “Confidentially Yours,” Arthur Hale announced that Moldaver’s study demonstrated the “undercover opposition to Nurse Kenny.” Moldaver had not questioned “the nature of Nurse Kenny’s treatment, nor their [her] results” but had claimed that because Kenny was not a doctor she did not understand polio from a medical standpoint and therefore “her concepts of the disease are unsound.”282 The issue of whether clinical results could be judged irrespective of pathological theory continued to be raised by physicians with much heat but no resolution. One orthopedist, who praised her “excellent method of muscle re-education” and “great gift in the healing art” in t
he Journal of Bone and Joint Surgery, noted that she had reported results “which we have not yet been able to duplicate.” Like Gill, he wondered how much of the Kenny concept would remain intact in the future, adding that “many of her ideas of kinesiology are still difficult to accept. Others are so simple and apparent that it seems incomprehensible that they were not recognized long ago.”283

  Clinical and laboratory investigations had shown that the principal tenets of Kenny’s concepts “were found wanting,” Richard Kovacs noted as he summed up advances in physical medicine at the end of 1943; thus physicians’ “reluctance to accept Miss Kenny’s explanation for the success of her method appears to be justified.” Still “her path-finding and enthusiastic work” had led to a more effective use of physical treatment in polio’s early stage.284 Here was a narrowed sense of Kenny’s contribution: her enthusiastic work had inspired research and led other professionals to reassess polio therapy and to engage in measured research.

  These kinds of reports left the NFIP in a difficult position. Critics were complaining about inappropriate propaganda while supporters said that her method was not being expanded quickly enough. Although NFIP officials had effectively sidestepped many disputes within the American medical profession, the Kenny controversy was one they could not avoid. Relations between the NFIP and orthopedists began to deteriorate as reports surfaced that “physicians are being pushed into the position of having to accept the skills of nurses in this field about which they know nothing” and that the NFIP had encouraged “the use of the Kenny method by nurses without appropriate supervision by doctors.”285

  To be seen as both responsive and balanced, NFIP officials decided to tighten the standards and content of the Kenny courses offered in Minneapolis. Although physicians who came usually for only a week had praised the institutional setting whether at the university’s hospital, the city hospital, or the Institute, many of the nursing and physical therapy students who stayed for 3 weeks or longer were less enthusiastic, complaining that they felt “disappointed, confused, and dissatisfied” in a poorly organized program with “inadequate supervision of experience with patients.”286 At the end of 1943, pressured by the NFIP, the University of Minnesota’s medical school reorganized the Kenny courses it continued to direct. Therapists and nurses now took separate courses that included lectures on the basic nature of polio followed by clinical instruction and supervised experience in the application of Kenny’s methods. To be sure that graduate technicians had the character as well as professional background to become “qualified teachers,” the university introduced new entrance requirements, including a physical examination and a series of tests “concerned primarily with intelligence, manual dexterity and personal adjustments” conducted by the university’s testing bureau.287

  Although physicians had not formally complained about their course, the dean reorganized it as well, renaming it “The Management of Infantile Paralysis.” The course now covered the etiology, epidemiology, pathology, and physiology of polio, followed by a presentation of the Kenny technique along with a report of investigations on its value, and finally a broader discussion of the treatment of the disease.288 Demonstrating its approval of these changes, the NFIP’s national office agreed to continue its teaching grant to the university’s medical school and to keep paying the living and travel expenses of Kenny and her associates.289

  These curricula changes reflected a shift in professional thinking whereby Kenny’s work was categorized as a technological innovation rather than as a contribution to medical science. Kenny, however, had a different vision of her work. She continued to demand recognition for her concept of polio and envisioned a far more thorough training for the nurses and physical therapists who would then call themselves Kenny-trained. She reminded Diehl that she had consistently asked for the teaching courses to be longer and that her medical supporters had said that “the details of this method of treatment cannot be learned quickly.”290 Gradually Kenny began to envision Kenny technicians as graduates of a 2-year course who would be qualified both to teach her work and to train others to become technicians. Such a course would be directed not by a physician from the university’s medical school but by one of her medical allies at the Institute.

  CELEBRITY

  Even as medical journals were beginning to attack her concepts a few universities began to recognize Kenny as an appropriate subject for an honorary degree. In 1943 she received 2: a doctorate of humane letters from New York University and a doctorate of science from the University of Rochester.291 New York University’s vice president praised her as a “heroic daughter of the Australia bush” whose “revolutionary treatment” had “proved amazingly successful.” After she had “patiently, persistently and triumphantly labored against untold opposition … today the foremost medical scientists of many lands acclaim it incomparably effective.”292 In Rochester the nursing school dean lauded Kenny as an altruistic humanitarian who had accepted no money for her work and “looked for no reward” other than as a nurse. Now, though, “leading scientists in the United States and Canada … endorse her theory” and “hundreds of nurses and physiotherapists multiply the benefits of her teachings.”293 More dramatically, Rochester president Alan Valentine declared “in the dark world of suffering you have lit a candle that will never be put out.”294

  Kenny tried to balance triple roles as clinician, teacher, and celebrity. She became more self-conscious about her appearance and began to dress like a wealthy woman, using lipstick which she once had scorned.295 She traveled more frequently by plane, wearing jeweled pins, fancy corsages, and even larger hats. “You certainly seem to be affluent,” a Brisbane friend teased her, “as it has been remarked that you have a different bonnet for every picture.”296 She also began to wear as her trademark a distinctive kind of hat with an overly wide brim she called a “digger” hat, modeled, she claimed, on the Australian Light Horse hat of the Great War.297 She never learned to drive, but the NFIP bought her a 4-door Buick sedan and paid for a driver.298 Her Minnesota base began to attract more celebrity patients such as Metropolitan Opera baritone Lawrence Tibbett’s son Michael who had previously received “the very best treatment” at Warm Springs.299

  In 1943 photographer Jack Delano, representing the Division of Photography of the Office of War Information, included Kenny in his travels around Minnesota. He took a series of photographs of Kenny in Minneapolis: in her apartment correcting a paper to be read at a medical meeting; relaxing while playing her favorite gramophone record; presenting 3 patients to a class of physicians and technicians; and being asked for her autograph by 2 visiting Australian soldiers.300 In each image she looms large, a woman participating in the professional world, in many ways more than a nurse.

  Journalists sometimes explained away Kenny’s belligerence by citing her ethnic background and her birth in the wilds of rural Australia. “A pliant and diplomatic person might perhaps have softened some of the criticism,” the Saturday Evening Post suggested, “but Miss Elizabeth Kenny, born on a frontier, half Irish and half Scotch, convinced she is right, is no diplomat.”301 Some used her age to justify her impatience. Perhaps she should use more tact with her opponents, but, another reporter concluded, “she hasn’t time for tact.”302 Reporters liked her direct manner and made her lack of artifice a sign of sincerity. “From the quietness of her low voice to the direct gaze which looks deep into you, she is as compelling as she is unaffected,” argued a Los Angeles Times reporter.303 Although reporters rarely saw a relaxed Kenny telling jokes and war stories, they did see evidence of her sharp tongue. When Gudakunst introduced her at an NFIP lunch held in Philadelphia at the Ritz Carlton hotel and praised her “new treatment” Kenny corrected him, delighting reporters with her retort: “ ‘I have not presented a new treatment … I have presented a new concept of poliomyelitis. And you should know that, Dr. Gudakunst. It would not need a medical man to see what I’ve been showing you. A blacksmith could see it.” Her nondeferential attitude to
doctors was a provocative antidote to the familiar doctor–nurse relationship. When a photographer pleaded for another picture with the words “ ‘Please, Dr. Kenny,’ ” according to one reporter, “she glared at him. ‘Young man … I am NOT a doctor.’ ”304

  NOTES

  1. See E. Daniel Potts and Annette Potts Yanks Down Under 1941–45: The American Impact on Australia (Melbourne: Oxford University Press, 1985); John Hammond Moore Over-Sexed, Over-Paid, & Over Here: Americans in Australia 1941–1945 (St. Lucia: University of Queensland Press, 1981); Ray Aitchison Thanks to the Yanks? The Americans and Australia (Melbourne: Sun Books, 1972); Edward J. Drea “ ‘Great Patience Is Needed’: American Encounters Australia, 1942” War & Society (1993) 11: 121–151.

  2. “Roosevelt Cites U.S. Humanity As Faith in Victory of Right” Christian Science Monitor January 31 1942; “Faith, Hope, Charity Still Rule World” Washington Post January 31 1942.

  3. Kenny to Dear Mr. O’Connor, February 19 1942, Basil O’Connor, 1940–1942, MHS-K. See also Kenny’s claim that she had offered her services to the U.S. government for training men in physical therapy but had not yet been called; J.M.G. [Janet M. Geister] “The Lady from Australia” Trained Nurse and Hospital Review (July 1942) 109: 37.