Polio Wars (31 page)

In 1943 the
Journal of Bone and Joint Surgery
published the first controlled clinical study of Kenny's work. Robert Bingham, a young orthopedist and the study's author, had met Kenny in April 1941 in New York City while he was a resident at the New York Orthopedic Hospital, and had watched her infuriate the hospital's orthopedic surgeons by telling them how wrong their treatment was and what terrible results they would get. He was further impressed by her demonstration of symptoms such as muscle spasm, which his teachers had not recognized. Bingham began using Kenny treatment experimentally a few months later at the hospital's White Plains branch, and when his patients seemed significantly better he substituted it for orthodox care. He had faced a “tremendous amount of antagonism … [and] a great deal of ridicule,” a colleague admitted privately, especially from orthopedists.
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Based on 60 patients in the convalescent stage at the White Plains hospital, Bingham's study had compared 3 groups of patients treated between May 1941 and May 1942: Group 1 (12 patients treated by “older” methods only); Group 2 (24 patients treated using Kenny methods later in their care); and Group 3 (24 patients treated with “only Kenny”). He had found the “extent of recovery of some patients under the Kenny treatment … so great” that he warned readers “in studying the final results considerable
careful judgment must be used in deciding which of the improvements in the patient's condition are due to the Kenny treatment and which would have followed from a mild or abortive attack of poliomyelitis.” In one crucial table, 46 percent of Group 3 had excellent “functional results,” compared to 8 percent of Group 1 and 25 percent of Group 2. Group 3 patients were “more comfortable, have better general health and nutrition, are more receptive to muscle training, have a superior morale, require a shorter period of bed rest and hospital care, and seem to have less residual paralysis and deformity than patients treated by older conventional methods.”
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One of Bingham's orthopedic supervisors felt his study was “unscientific and misleading” for it was not fair to compare the earlier patients whose paralysis had been much more severe to the milder ones who received the Kenny treatment.
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Kenny, though, was delighted by Bingham's study and frequently quoted its “gratifying results.”
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Kenny's claim that her patients had higher recovery rates than those treated by orthodox methods was refuted by critics who argued that she tended to select potential patients who could best be helped by her work. Florence Kendall had long complained, as she told a group of nurses, that “S.K.'s statistics are based on selected cases. She refuses to treat those which she knows are hopeless.”
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There were also many cases of patients who recovered, confounding their physicians. Most patients “recover no matter what type of therapy is employed,” pediatrician John Toomey argued, and those patients should be excluded from “the statistical study of therapeutic results, or at least tabulated separately.”
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Kenny's constant reference to McCarroll and Crego's 1941 study was also suspect because the study could be seen as an example of treating the most seriously paralyzed patients. Orthopedist Bruce Gill had wondered whether Kenny's work had been compared to patients who had “
really
been treated in accordance with
standard
principles and methods?”
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Throughout Kenny's career her critics demanded “scientific” tests and questioned the evaluations that she claimed supported her. Many suggested that her results could be explained by “a psychological factor,” and others mocked her “hypnotic training” and “her ministrations” as “abracadabra.”
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The false hopes Kenny created among many patients and their families were believed to have led to a kind of popular hysteria that made it even more difficult to evaluate her work.

There was a clear way to establish proper science from “cultist” claims and that was the clinical trial. This idea had been raised since Kenny's early days in Minneapolis.
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Three factors made this kind of rational assessment almost impossible: the power of public demand; Kenny herself; and the nature of polio. Public enthusiasm, a recognized feature of Kenny's work, threatened to undermine familiar strategies of control. Thus, patients in one Minneapolis hospital were intended to be in a control group, Philip Lewin recalled, but their parents “refused to permit the withholding [of] the Kenny treatment.”
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“The whole debate might be settled by a single experiment,” one science writer suggested, but “experts say such a test can never take place; no American mother would allow her child to be subjected to conventional treatment while some other child got Kenny hot packs.”
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Here the emotionality of the public—embodied in an irrational mother—was a roadblock to the pursuit of scientific truth.

Polio itself was a disease that was difficult to diagnose accurately and had wide variation in its clinical symptoms. A control study would never be possible, one orthopedist warned, “because of the variation in the effect of the disease in different individuals during the same epidemic and in different epidemics.”
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This notion became a truism, repeated by physicians
into the late 1940s. A growing awareness of different types of the polio virus (finally stabilized at 3 a few years later) created an additional concern with clinical variation. Not only did the unpredictability of polio make it “difficult to compare the statistics, mortality rates, and forms of therapy of different groups of workers,” Colorado physicians argued, but varying strains of the virus made it “difficult … to try to run controlled studies.”
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Recognizing that physicians were uncomfortable with a new method identified too closely with an individual—especially someone who was not a physician—the NFIP tried to separate the woman from the work. The foundation's national office, which regularly organized exhibits for the AMA's annual meetings, proposed an exhibit on Kenny's work to respond to the “tremendous demand,” to “furnish sufficient knowledge to enable a physician to competently apply the treatment,” and to “dispel many current bits of misinformation.”
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During the June 1942 AMA meeting an estimated 3,500 physicians, nurses, and physical therapists crowded into the NFIP corner exhibit where Cole, Knapp, Pohl, and Stimson were featured as lecturers.
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Two of Kenny's Australian technicians were invited to be special demonstrators but Kenny herself was not to be included. Knapp warned Gudakunst that “Sister Kenny was grossly insulted by being excluded,” but Gudakunst replied that “the Foundation is exhibiting Miss Kenny's method and not Miss Kenny.”
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Stimson and the 3 Minnesota physicians showed how to examine and treat a patient for muscle tenderness, muscle spasm, and other major symptoms, and, following Stimson's usual practice, used live models: a male college student and a young woman physical therapist.
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Outside the Scientific Exhibit Kenny's work was debated in the AMA's regular sessions. In Pediatrics, Stimson gave, as his chairman's address, a lecture on “A Rationalization of the Sister Kenny Treatment of Poliomyelitis.”
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An entire panel debated her work in a session jointly organized by the Section on Nervous and Mental Diseases and the Section on Orthopedic Surgery.
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More ominously, the Section on Orthopedic Surgery formed a committee “to study and evaluate the Kenny treatment of infantile paralysis.” The only Minnesota orthopedist chosen to be a member of this committee was Ralph Ghormley, Henderson's colleague at the Mayo Clinic who had not met Kenny or ventured any public comments about her work.
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This was the third committee of experts to assess Kenny's work, and its composition—prominent orthopedic surgeons—suggested that it was likely to be especially critical.

Recognizing that the AMA committee would be unlikely to complete its work for a year or so, Fishbein made sure that there was a balance between proponents and opponents when he published the 1942 AMA papers on Kenny's work in
JAMA
. As a result the overall impression was that some experts endorsed clinical change and some opposed it. Two physiologists supported her theory that immobilization was dangerous. In experiments with rats whose nerves had been crushed Harry Hines found that immobilization
“definitely retarded recovery” but that forced activity like swimming or exercising in a revolving barrel had aided neuromuscular recovery.
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Donald Solandt similarly found that decreased fibrillation and electrical excitability in rat muscles were the result of disuse rather than overwork. Making an analogy to human bodies, he suggested that “splinting should be used with caution [for] … possibly this observation indicates the rationale for one feature of the Kenny method of therapy.”
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The 2 orthopedic surgeons whose papers were published took opposing views of Kenny's work. Harvard orthopedist Frank Ober, who had met Kenny in Minneapolis a few months earlier, believed her treatment was “superb nursing and common sense.” He was convinced by her call for treating polio's early stage and believed that “deformities in the early stages are due to pain, muscle spasm and muscle contractures.” With his own patients Ober had not used “prolonged rest and immobilization in plaster” but wire splints and hot packs 2 or 3 times a day. Spasm, he argued, was a serious symptom, although how it was caused “at present is not quite clear to us.” The clinical signs Kenny highlighted implied a new kind of pathology for he doubted that “pain, spasm in muscles, unexplained bone growth changes and vascular disturbances on the extremities” could all be the result merely of a lesion in the anterior horns.
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In contrast St. Louis orthopedist Relton McCarroll was shocked that some of his peers were taking Kenny's work seriously, especially after the publication of his and Crego's 1941 study. He dismissed her methods as yet another popular fad based on the mistaken idea that polio was “a purely local muscle lesion,” an idea that could not “be reconciled to our present knowledge of the proved pathologic process in this disease.” “It is easy to understand how physical therapists, enthusiastic in their work, might lose sight of this primary pathologic process,” McCarroll reflected, but he found it impossible to understand how orthopedic surgeons could “wholeheartedly endorse any of these methods.” He was “certain that this method in time will take its place among the others offered by the field of physical therapy as having been tried but found wanting.”
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McCarroll was attacked by Kenny supporters whose letters were published in the next several issues of
JAMA
. Despite the “purely empiric origin” of Kenny's concept, Wisconsin physical medicine specialist Frances Hellebrandt argued, “her observations were so acute that they approached truth, as truth is revealed in nature.” In any case, “newer knowledge” of polio's pathology and physiology had shown the “rationale of her physical therapeutic methods.”
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Pohl pointed out that McCarroll had completely missed the main point of Kenny's work: “that there are muscle conditions which are far more damaging to the bodily mechanics if unrecognized and untreated.” Unlike McCarroll, he and other Minnesota physicians had “taken the time during the past two and one-half years to observe her work” and found that Kenny had decisively proved her point for only the methods she had developed “could have been effective in treating the disease of poliomyelitis, since it is based on symptoms which she alone discovered.”
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In her own letter, which appeared in the December 19 issue of
JAMA
, Kenny claimed that she was not “referring to the pathology of the disease but to the symptomatology.” In an unusual interpretation of Kendalls'
PHS Bulletin
and McCarroll and Crego's study she suggested that both had showed that traditional physical therapy methods had “failed to achieve results.” In any case, she argued, the clinical evidence quoted by Cole, Knapp, Pohl, and Bingham, who had properly treated “the true symptoms of this disease … speak for themselves and need no comment from me.”
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Back in Minnesota Kenny tried to design her Institute drawing on models of the Mayo Clinic and the Rockefeller Institute. She was impressed by the way that the nearby town of Rochester appeared to be run as a kind of Mayo medical marketplace and hoped her institute could combine a scientific research center like that at the Rockefeller Institute with a clinical research hospital.
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She also deliberately designed a uniform for her Kenny technicians to make them stand out: long, light blue dresses in cotton and polyester with a full blue veil. These headdresses, which resembled Australian nursing uniforms of the early twentieth century, were scorned by nurses at the neighboring Mayo Clinic who wore small round hats that looked like donuts. For her part, Kenny considered that traditional starched collars, cuffs, and aprons were not modern and did not “appeal to young girls.”
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As Institute director Kenny did not wear a uniform. She wore a suit or a full-length dress in all black or all white, suggesting someone dependent on nothing and no one. Her oversized accessories (hats, corsages, and dress pins) also presented the visual opposite of the ordinary nurse's outfit: dramatic, bold, the image of an assertive equal rather than a timid doctor's assistant, the sign of a respectable lady.
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