POLIO WARS Polio Wars SISTER ELIZABETH KENNY AND THE GOLDEN AGE OF AMERICAN MEDICINE Naomi Rogers Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offices in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Oxford is a registered trademark of Oxford University Press in the UK and certain other countries. Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016 © Oxford University Press 2014 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by license, or under terms agreed with the appropriate reproduction rights organization. Inquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above. You must not circulate this work in any other form and you must impose this same condition on any acquirer. Library of Congress Cataloging-in-Publication Data Rogers, Naomi, 1958– Polio wars: Sister Elizabeth Kenny and the golden age of American medicine/Naomi Rogers. p. ; cm. Includes bibliographical references. ISBN 978–0–19–538059–0 (hardback: alk. paper)—ISBN 978–0–19–970146–9 (updf ebook)— ISBN 978–0–19–933413–1 (epub ebook) I. Title. [DNLM: 1. Kenny, Elizabeth, 1886–1952. 2. Nurses—Australia— Biography. 3. Poliomyelitis—history—Australia. WZ 100] RA644.P9 614.5′49—dc23 2013011373 9 8 7 6 5 4 3 2 1 Printed in the United States of America on acid-free paper For Nat, Dory, and JH Contents Introduction Acknowledgments List of Archives PART ONE 1. A Bush Nurse in America 2. The Battle Begins 3. Changing Clinical Care PART TWO 4. Polio and Disability Politics 5. The Polio Wars 6. Celluloid PART THREE 7. Kenny Goes to Washington 8. Fading Glory 9. I Knew Sister Kenny Index Introduction STANDING ON MY bookshelf is a coin container in an outrageous bright orange that was popular in the 1940s. Under white letters urging me to “Sock Polio” are 3 figures: a toddler in a loin cloth standing awkwardly but steadily; singer Bing Crosby, with a pipe and a jaunty hat; and a white-haired woman in a black dress and pearls, her hands reaching up toward the child with a look of intense pride. “Please Give to the Sister Elizabeth Kenny Foundation,” the container pleads. Crosby was the national chairman of the foundation’s 1945 appeal, but who was Sister Kenny? When this can was passed down the aisle at movie theaters, no one in America needed to ask. She was so familiar and iconic a figure that Holly Golightly in Breakfast at Tiffany’s declared that she would not testify against a friend, “not if they can prove he doped Sister Kenny.”1 Sister Elizabeth Kenny, an Australian nurse, came to the United States in 1940 to seek medical approval for her new methods of treating patients paralyzed by polio. (“Sister” was a British designation for senior nurse, not a religious title.) Despite the skepticism and even hostility of American physicians, she succeeded. With the sometimes grudging support of the National Foundation for Infantile Paralysis (NFIP), a polio philanthropy committed to funding patient care, research, and professional training, her methods were made standard polio care by the mid-1940s. Kenny became one of the most prominent women of her era: the subject of a Hollywood movie Sister Kenny (RKO 1946) starring Rosalind Russell; an expert witness at Congressional hearings on the founding of the National Science Foundation; and in 1952, not long before her death, chosen in a Gallup poll as America’s most admired woman, outranking former first lady Eleanor Roosevelt. Yet by the mid-1950s she was almost forgotten. Crosby’s 1953 autobiography Call Me Lucky never mentioned her.2 Kenny’s was a life of passionate outrage. She spent years defending her work, inspiring her patients, and attacking prejudice. She knew how to stir up controversy and how to play medical politics using the media, the public, and politicians. Challenging established medical knowledge on its weak points and inconsistencies, Kenny was a quick study, adopting insights pointed out by her critics and making them integral to her work. Her feisty style mocked the deference nurses were expected to show physicians but she could also make fun of herself as a middle-aged woman. With what was called her Irish humor she thanked one group of doctors who greeted her at an airport carrying roses, telling them it was gratifying to receive flowers from doctors while she was “still here to smell them.”3 This book tells the story of Sister Kenny and the Kenny method. Kenny’s battles with American medical professionals illuminate the medical politics that lay at the heart of American medicine, even during its Golden Age. After her struggles with government bureaucrats and medical professionals in Australia Kenny was neither shocked nor fazed by the need to pull strings and gain influential allies in order to alter clinical care in the United States. Polio was a high-profile disease, and responsibility for its prevention and treatment rested on diverse authorities: local and state health officials and the U.S. Public Health Service; individual physicians, nurses, and physical therapists; civic and charity groups that ran hospitals and “crippled children’s homes,” did surveys, and set up services for families with disabled members; and the NFIP, which supported its activities through an annual national fundraising campaign known as the March of Dimes and numerous regional campaigns organized by its local and state chapters. Kenny’s heated battles with the NFIP and organized medicine captured the public imagination. Standing outside the elite scientific community, she sought to gain its respect through clinical and laboratory confirmation of her theories of polio. Simultaneously, however, she resented being held to standards of scientific rigor that she suspected were imposed more strictly on her because she was a woman and a nurse and because she dared to question the expertise of male orthopedic surgeons. This book also focuses on the limber, healthy child patient featured on the 1945 container. Here is a dramatic, if sentimentalized, depiction of the results of a special kind of clinical care, yet the container does not show any doctor, hospital bed, syringe, or other symbol of medical science. For the American public the most powerful omission may have been the familiar picture of a polio patient: the crying child in a hospital bed with arms or legs in plaster casts; the fearful child waiting for an orthopedic operation; or the “recovered” child discharged with crutches or braces, all images typical in March of Dimes campaigns. On this “Sock Polio” container, health has been achieved in another way, through compassion and care based on a distinctive understanding of the body shared by Kenny and her staff but not by other professionals. In an era when nurses were seen as the recipients of medical science rather than its designers, Kenny knew that her claims to a new understanding of polio were controversial before their content was even known. At first she presented herself as a supplicant to scientists, seeking their assistance to explain the meaning of the new symptoms she had identified and the reasons her methods worked. Her 1941 textbook had the temperate title Treatment of Infantile Paralysis in the Acute Stage. But as the Institute prospered and Kenny was feted as a savior, she began to argue that her work embodied a new concept of polio drawn from a close reading of the body. Polio, she said, was not solely a neurological disease but also a disease of muscles and “peripheral structures.” By the time Kenny published her 1943 textbook The Kenny Concept of Infantile Paralysis she had begun to argue that it was impossible to teach anyone to treat the symptoms she had identified if they did not understand her concept of the disease. Indeed, she frequently added, the prognosis for a patient treated without this new knowledge would always be far poorer than for a patient treated by professionals who fully understood the Kenny concept of polio. Kenny knew to speak of “improvement” rather than “cure,” but she often did exaggerate her results. As early as the 1930s she learned the power of the press and the importance of a good story. She was accused by her critics of being a publicity hound, of practicing mistaken and perhaps even harmful methods, and of making unrealistic promises to disabled patients and their families. At times she boasted of her distance from the medical establishment; at other times she made much of her medical allies. She found strong public support when she attacked the elitism of the medical profession in both Australia and North America, but she also sought out and relied on the financial and social assistance from the elite in business and society. She said she chose to follow only “orthodox” physicians, but her clinical practice and its values drew on alternative attitudes toward medical science, toward the disabled, and toward chronic care. Her patients as well as the nurses and physical therapists she trained to become Kenny technicians were central to the functioning of her work. Her students saw her life as one of struggle and sacrifice, a story that was central to the image she projected and one they frequently retold as a way to keep their own spirits up as they battled for clinical autonomy and professional