Polio Wars

by Rogers, Naomi

  5

  The Polio Wars

  1943 HAD BEEN a bad year for polio, and 1944 was worse. With a total of 19,272 reported cases, it was the second-largest epidemic year yet recorded in U.S. history. Impossible to predict or prevent, polio epidemics followed Americans as they moved around the country seeking jobs in the wake of wartime industries, especially in the mid-Atlantic region and the South.

  During the early 1940s Kenny, the National Foundation for Infantile Paralysis (NFIP) and the American Medical Association (AMA) had worked as uneasy allies. But in the mid-1940s, this alliance turned into a fierce battle over medical orthodoxy and professional self-interest. In February 1944 Kenny announced that the NFIP had refused her Kenny Institute the $150,000 it needed to expand its training program and to hire anatomists and physiologists to pursue research. She did not make clear how she or the Institute had requested this amount, but she did claim that Fishbein and O’Connor continued to treat her with skepticism and hostility. Recently Fishbein had told her to “leave the United States because other countries need my assistance.”1 This was the opening salvo of the polio wars between Kenny and the NFIP.

  The polio wars were medical culture wars, played out in the popular and professional press with a feisty, uncontainable woman at the center. As they escalated, Kenny accused the NFIP of never having supported or respected her and of funding worthless polio treatments recommended by antagonistic physicians. Even its support of research was wrong-headed, she complained, because scientists working under NFIP grants ignored the insights of her work. By this time Kenny had behind her supporters in business, politics, and the press, along with expansive public good will. Despite a frantic effort to contain the fight the NFIP found itself on the defensive, and by 1945 it was losing allies among the wealthy, many women, and even Hollywood moguls.

  The AMA’s lock on power began to unravel as well, as the conservative policies of its leaders—especially Morris Fishbein—fell out of favor with policymakers, patients, and many physicians. While the AMA had been successful in lobbying to keep federal health insurance out of the 1935 Social Security Act, it suffered a major public humiliation in 1943 when the Department of Justice won an antitrust suit against the AMA and its affiliated medical society in Washington, D.C. The society, backed by the AMA, had sought to deny hospital privileges and membership to doctors associated with a prepaid health insurance plan.2 Sensing weakness, Congress began debating new health insurance programs. Meanwhile, Fishbein became an easy target for discontent within the association. At the AMA’s June 1944 annual meeting California delegates tried to oust him as general secretary and editor of JAMA. Their resolution was defeated 144 to 9 but each year the vote became closer. It was the beginning of the end for Fishbein, whom the Saturday Evening Post characterized in 1946 as “the best-known and least-liked doctor in the United States.” Grudgingly, the AMA’s House of Delegates formally approved limited group medical practice and voluntary insurance plans sponsored by medical societies (later called Blue Shield).3 In the mid-1940s, however, Fishbein still held the reins, and he continued to see Kenny as an annoyance who would be easily controlled.

  The polio wars were invigorated in July 1944 when the Kenny Institute boldly applied for a large research grant from the NFIP, an application O’Connor managed to thwart by asking yet another group of experts to assess and reject the Institute as a site for clinical research. Frustrated, Kenny tried to expand her clinical practice at the Institute by accepting patients with other neuromuscular conditions such as cerebral palsy, but a combination of city and professional politics ended that effort. Kenny’s claim that her work was being undermined by an “organized opposition” was taken up by a few national politicians who saw a way to attack both the AMA and President Roosevelt. And in Minneapolis the Institute’s board reorganized itself into a fundraising corporation known as the Kenny Foundation. But after Roosevelt’s death in April 1945 polio politics shifted into a competition between 2 polio philanthropies both trying to convince the American public of social and financial support.

  MUST KENNY LEAVE?

  In February 1944 Kenny announced that because the NFIP was not willing to provide the Institute with funding, although her work in America was not done, she would have to return to Australia. At the same time, recognizing the role that research breakthroughs played in the March of Dimes publicity, she announced a new diagnostic sign, a distinctive muscle condition to help professionals begin treatment even before the first signs of paralysis appeared. The misdiagnosis of polio had continued to be a serious problem for families and health professionals, with a number of patients admitted to already overcrowded polio wards who were later diagnosed with, for example, diphtheria and meningitis.4 Earlier treatment, she claimed, would improve every patient’s chance of recovery, ameliorate polio’s symptoms, and reduce pain “almost entirely.” This would be “the greatest contribution that has yet been given to the medical world in connection with this disease.” The sign was a peculiar rubbery sensation in the muscle that could be felt by a technician rotating a patient’s joints. It indicated, Kenny said, that the muscle would soon go into spasm and would probably become paralyzed. But, she added, although many physicians had begged her to teach them, without the support of the NFIP and the AMA she would be unable to do so. “I am loath to leave this country,” she told reporters dramatically, “but there is not much use in me staying unless I get greatly increased support.”5

  “Must Sister Kenny Leave?” asked the Chicago Herald-American, the New York Journal-American, and other newspapers. Fishbein quickly told the press that he had meant only that “her work needs dissemination throughout the world.”6 But his antagonism to Kenny was widely known. A few weeks earlier in a JAMA editorial entitled “Physiologic Nonsense and Poliomyelitis,” he had quoted with relish the assessment of the eminent neuroscientist Stanley Cobb who praised “qualified investigators” like Joseph Moldaver and warned that “new and empirical methods of treatment backed by uncritical enthusiasm may produce many cures but much physiologic nonsense. The treatment may be good, but the ex post facto conclusions of the therapeutist are usually bad.”7 A “therapeutist” was obviously far from a scientist.

  Seeing this at first as a minor skirmish, O’Connor and his staff defended the NFIP with a few brief statements. There was no “controversy between the National Foundation and Sister Kenny,” O’Connor told reporters. “We have put [up] all money ever requested to evaluate and teach the Kenny method. Our reports and all our public statements show that.” He recognized that Kenny had expressed her dissatisfaction with continuing investigations of her work, but declared that the NFIP would “continue to evaluate the Kenny method … in the hope of finding greater values in it.”8

  These denials were not effective. Amplified by the Hearst newspapers and later the Reader’s Digest, they became weapons in a nascent populist movement. Here was a woman wronged, a selfless nurse devoting her life to healing children, yet being given no respect or honor by the men of the medical profession. Americans sent letters of outrage to Kenny, Roosevelt, O’Connor, their congressmen, and their local newspapers. They formed campaigns to raise money for the Kenny Institute, and warned local and national NFIP officials that the March of Dimes would receive no further support from them if its policy did not change. Most of all, Americans debated the nature of professional authority and research priorities, and the role that gender, social status, and character played in determining who received the respect of the medical establishment and the funding of powerful philanthropies. To its great surprise the NFIP found itself forced to defend and define what constituted scientific evidence, how medical expertise was and should be determined, and the purpose of research. Inspired by Kenny’s struggles, the media campaign rapidly became a wider 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 enforced medical orthod
oxy.

  This was a new moment in American medical politics. Although on other occasions Kenny had threatened to leave, accused the NFIP of not supporting her work, and mentioned her early diagnostic sign, the story had always faded quickly. This time it caught fire. In the fervor of this battle, Kenny succeeded in challenging the public to rethink the medical establishment’s claim to a monopoly on scientific truth and medical authority, and forced a powerful philanthropy to defend its research funding policies. She made the battle personal—about respect for herself and proper care for the disabled—as well as political. Her accusations that a medical cabal was attacking her and denying proper care to patients rang true to many Americans. How did the NFIP decide who to give money to? Was it just a club of elite physicians, funding each other? The NFIP, once able to command the public’s unlimited faith, now encountered every philanthropy’s worst nightmare: the suspicion of its donors. In pulling the powerful down to the level of public debate Kenny revived and expanded a medical populist movement that had previously been restricted to male entrepreneurs such as John Brinkley and female evangelists such as Aimee Semple McPherson.

  PUBLIC OUTRAGE

  The March of Dimes campaign in January 1944, like earlier campaigns, had featured Kenny. But now it looked as if the NFIP had falsely claimed her as a symbol of its commitment to the battle against polio. “To the millions of Americans who contributed generously to the ‘March of Dimes’ a week ago” the news that the NFIP “will not give $150,000 for the budget of the Kenny Institute … will come as a shock,” said the editor of the Tulsa Tribune. “She doesn’t get a nickel from it.”9 With headlines like “After 10 Years of Giving America Begins to Wonder” newspapers made this a story about money and arrogant medical men. A New York Journal-American editorial described Kenny’s “discouraging and unhappy experience in the United States” as she “faced the skepticism and even the active hostility of some sections of the medical and scientific professions.” As a result, her work “has never had adequate financial support.” Yet leaving “is the very last thing Sister Kenny wants to do.”10

  The NFIP had always said it spent the “people’s money”; now Americans began to demand accountability. Although he had “always supported the drives for funds,” one supporter warned NFIP officials, “if she leaves this country because of lack of funds to continue her work I will definitely refuse to continue to contribute funds.”11 “I have been a contributor to the ‘March of Dimes’ ever since it was started,” an executive at a Tulsa oil company similarly told the chief surgeon at Warm Springs, “but I can assure you that if this editorial is true there will be no more contributions from me.”12

  In March 1944 nurse supporters in Chicago launched a movement to “Keep Sister Kenny in the USA” and to raise the $150,000 her Institute needed. Unusually, this group of nurses allied themselves with a group of disabled adult activists and a joint meeting was chaired by Harvey Church, president of the Disabled Persons Association of America. The meeting also featured Noreen Linduska, who had been disabled by polio during the 1943 Chicago epidemic and was a proponent of Kenny’s work. “It is we who are disabled who know what a blessing the work of Sister Kenny is,” Church told reporters. “There is a place for her in America and a great need for her.”13 Reports of this meeting in local papers featured the usual picture of recovered child patients, but in this case it was a fierce-looking group, holding a “Keep Sister Kenny Here” banner.14 The Sunday Mirror reprinted this image juxtaposed with a photograph of Kenny lying in what looked like a hospital bed in a white hospital gown. “Bewildered and discouraged by apparent neglect of her method in America,” the caption read, “Sister Kenny manages to smile while recovering from a cold in Los Angeles. Her comment: ‘If America had taken heed when I first arrived I could return to Australia today—my work ended.’ ”15

  Kenny’s story of being rejected by the AMA and the NFIP reinforced what many Americans saw as a complex dynamic: the impotence of orthodox physicians to heal combined with their arrogance in attempting to monopolize legitimate health care. “You have found a way to relieve the suffering and tortuous crippling of our little children, while our great, scientific medical specialists stood by helpless, hand on chin, brow wrinkled,” a man from Chino, California, told Kenny.16 Could “professional jealousy” explain the antagonism of American physicians, asked a Washington Post editorial.17 This hostility was a combination of prejudiced orthodoxy and professional exclusion, others suggested. “Where Sister Kenney [sic] made her mistake,” argued the Citizen’s Health News of San Diego, “was in trying to get the ‘medical trust’ to admit that a drugless method was superior to a medical method.” Kenny’s struggle against “medical monopolists” was part of a wider fight for what the magazine called “Health Freedom.” “We are fighting all over the world for democratic principles but still have a totalitarian health set-up here at home.”18 Physicians who were already jealous of Kenny were further motivated by the fear of economic competition, others assured her. “We must realize that anyone who cures anything, seriously jeopardizes the fee-splitting system of medicine,” wrote one man to Kenny. “Just think of the millions of dollars that have already been lost by you showing the world how to cure these little tots.”19 Gender, money, and professional jealousy were at the root of her trouble, one woman reflected. “Just realize what is against you,” she told Kenny. “First the fact you are a woman, second anyone giving your treatment can’t capitalize on it and get rich, third you lack a college degree and all that rot. (Just remember the greatest healer of all Jesus Christ wasn’t an M.D.) And fourth the money interests who are reaping a harvest from the manufacture of braces etc are against you.”20 A few supporters went further by suggesting that the corrupting power of the AMA was robbing Americans of the ability to choose providers. “Without the Kenny treatment,” Robert Gurney, the father of Kenny’s first acute patient in Minneapolis, told the St Paul Pioneer Press, “our son would have either passed away, or been a horribly deformed boy for the rest of his life.” Now he not only attended school but he could “shoot pool, kick a football, walk by himself, goes to shows with other boys and walks alone to a store over a block away.” “Has it come to pass that the doctors of this nation are going to say who will or will not treat us?”21

  FIGURE 5.1 First page of a 1944 comic book in the “Wonder Women of History” series. From Alice Marble, Wonder Women of History: Sister Elizabeth Kenny (Spring 1944) no. 8. Courtesy of D.C. Comics.

  Supporters believed accusations about Kenny’s personality were in fact veiled attacks on Kenny for acting in a way doctors found unfeminine. NFIP officials had said that Kenny was “hard to get along with,” the Tulsa Tribune mocked, but in fact she had simply refused to cooperate with certain doctors and NFIP officials. Was the NFIP unhappy because “she refused to leave the United States as soon as she arrived, as Mr. O’Connor suggested?” or because “she was not overawed by high medical authorities who did not want to be disturbed in the practice of letting sick muscles die in splints?” In fact her altruism proved she was not a charlatan, the paper noted. She had come to Oklahoma during the 1943 epidemic and asked for nothing but the travel expenses of herself and her assistant. The paper praised her as the epitome of the wholesome older woman untainted by the suspicious morals of the celebrities featured in March of Dimes publicity: “How different her attitude from the tearful pleas of mascara-ed Hollywood in the high-pressure campaign for the March of Dimes!”22 “You have fought your way through thus far with all the courage of a pioneer,” one letter-writer assured her in similar tones, placing her in the pantheon of American frontierswomen, “you have that fortitude and courage that never quits and never gives up, especially when the going is the toughest.”23

  And why did the NFIP not publicly attack these antagonistic doctors? Was it because its medical advisors were all part of the same elite establishment? The news that Fishbein had told Kenny to leave was “a most outrageous insult to every thinking American c
itizen,” a woman from New York City declared. “I represent ‘the public’ and am not known,” she told O’Connor; “You, however, are prominently known and I call upon you to make adequate reply to Morris Fishbein in the press.”24