A Medical Sea-Change

Polio Wars:

Sister Kenny and the Golden Age of American Medicine

By Naomi Rogers

New York: Oxford University Press, 2014, 456 pp., $35.00, hardcover

Reviewed by Patricia Kullberg

In the spring of 1940, Sister Elizabeth Kenny, a snowy-haired nurse from the Australian outback, landed on US shores, determined to sell her radical new concept of polio treatment to America’s medical men (and they were, in large majority, men). To her mission she brought a shrewd intelligence, a brash personality, and a letter of introduction from the premier of her home state to Basil O’Connor, a close confidant of President Franklin Roosevelt and the powerful director of the National Foundation for Infantile Paralysis (NFIP).

Within a few years, Kenny and her supporters had not only overturned the orthodox system of polio therapeutics but sparked a polarizing debate over the nature of scientific inquiry in medicine. Her detractors attacked her as a liar and a fake, ignorant and unschooled, even unhinged. The public, whose children were spared the worst of the crippling effects of polio through her innovations, hailed her as a hero. In a Gallup poll of 1952 she was named America’s most admired woman. Kenny succeeded within the highly gendered world of medicine despite her outsider status and abrasive personality. Or perhaps that’s what it took to succeed.

In her meticulously researched and detailed history, Naomi Rogers, professor in the Program for the History of Science and Medicine at Yale, charts the course of this remarkable woman through more than a decade of skirmishes with some of America’s most powerful men. Kenny’s career was notable, Rogers writes, “[for] crossing boundaries, breaching professional and social mores, a nurse claiming the authority of a scientist, a discoverer, a healer, and a celebrity.”

It was a rare moment in history, when the accepted concept of a disease was radically overthrown. Victor Cohn tells the story in an earlier biography, Sister Kenny: the Woman Who Challenged the Doctors (1975). However, in her account, Rogers adds a wealth of detail and analysis, particularly in her discussion of medical science, which illuminates the “disturbingly messy” history of therapeutic change within midcentury medicine. It was a highly contested process, bound up with the race, class, and gender politics of polio, as well as with social changes within nursing, physical therapy, and disability rights. What emerges in Rogers’s book is the complex and fascinating history of one of the first challenges to the stranglehold of money and power on the science of medicine and the ways of thinking they imposed.

At the center of this story was the larger-than-life Sister Kenny, whose title was a nursing rather than religious designation, a confusion Kenny played to her advantage. Rogers reveals Kenny as a physically imposing and opinionated character, who harbored suspicions of her opponents that verged on the paranoid. She fought bitterly with the very doctors whose respect and admiration she most craved. She presented herself as a nurse investigator and innovator at the same time that she denigrated nurses as resistant to innovation. She was a publicity hound who shaved six years off her age and favored strands of pearls, fresh corsages, and large, outlandish hats. She did not shun alliances with conservative, anti-Communist, or anti-Semitic elements when it suited her purpose.

By the 1940s, medicine, in alliance with big business, had left behind the era of blistering, bleeding, and purging, and grounded itself in scientific investigation, driving out the quacks and charlatans (a history documented by Paul Starr in The Social Transformation of Medicine [1979] and E. Richard Brown in Rockefeller Medicine Men [1982].) It was a so-called golden age of medicine, when doctors asserted and won their authority as technical experts and molded the profession into an exclusive hierarchy, at the bottom of which lay the patient—passive, obedient, and ignorant.

Medical orthodoxy taught that polio was a neurological disease that effectively severed the connection between nerves and muscles, causing a flabby paralysis. The afflicted muscles were then pulled out of place by the healthy muscles around them. Eventually the diseased muscles atrophied and the victim was left twisted and paralyzed. Early splinting could prevent the deformities. Arms and legs were forcibly straightened and immobilized in plaster casts or steel splints for weeks to years, a treatment that withered the limbs. Because the muscles were considered dead, acceptable appearance was the object, not restoration of function.

Kenny did not see it that way. The muscles the doctors insisted were strong and healthy, shortened only because they lacked the opposing force of their diseased partners, she perceived as hard, tender, and contracted, their tendons stretched taut: muscles in spasm. She believed the principle cause of crippling was this painful spasm, which she said caused a “pseudo-paralysis” in the opposite, unaffected muscles—those the doctors saw as polio-afflicted. Splinting, she believed, only made things worse. She further theorized that polio was a systemic disease that affected not only the nervous system but the skin and muscles as well.

Kenny’s treatment consisted of prompt relief of spasm with moist hot packs, followed by intensive physical therapy, in which the patient worked the muscles herself. Kenny’s practice was, as Rogers points out, “optimistic, energetic and patient-centered”—in contrast to what many observers saw as the therapeutic nihilism of the orthodox approach. The Kenny treatment often resulted in what appeared to be miraculous cures of the hopelessly paralyzed.

At stake in this argument was nothing less than the nature of scientific inquiry in medicine. To men of medicine, such as Basil O’Connor, and their powerful allies, research was a laboratory-based activity conducted by an elite corps of (male) physicians and financed by private foundations under the thumb of big business. Spasm, doctors contended, could not exist in polio, because it had no basis in the known pathology of the disease.

Kenny argued for a place for clinical signs and symptoms as clues to underlying pathology. Later investigations would unearth the scientific evidence that supported Kenny’s concept of spasm and systemic infection, and significantly advanced the understanding of polio.

Many questions were raised during this dispute, among them: what constitutes scientific evidence? Which evidence can be used to formulate theory? Who should conduct research? How should investigations be funded? Who decides what to investigate?

Rogers pursues this years-long and multilayered debate (which eventually included congressional hearings, at which Kenny testified) with such clarity and detail that those unschooled in the clinical sciences can easily follow the narrative. However, Rogers never adequately explores the most intriguing question: what personal characteristics enabled Kenny to perceive the muscle spasms that generations of physicians had missed? And further, how were these characteristics related to Kenny’s environment? How social conditions shape scientific conceptualization is a critical question to anyone who seeks to understand science. Kenny’s story offers a rare opportunity for investigation.

Rogers notes that Kenny’s observations were unprejudiced by orthodox theories, and that she was a brilliant examiner of the human body. But these factors, however important, are not alone a sufficient explanation.

The 1946 biopic Sister Kenny, starring Rosalind Russell (for which she was nominated for an Oscar) told what Rogers dismisses as a “safely domesticated story of scientific discovery”:

Kenny’s understanding of polio comes from her heart and from her clinical experience…Her hands, her knowledge of sick bodies, and her ability to use tools of the domestic environment…build on her “natural” understanding of healing.

Rogers is right about the movie. It romanticizes the Kenny saga and confines her to a standard, nonthreatening narrative of female achievement. Still, Rogers offers no alternative story to explain Kenny’s unprecedented perception. In contrast to her detailed account of Kenny in America, she offers few clues about the conditions that shaped Kenny’s imagination at that moment in the outback of Australia in 1911.

To her work, Kenny brought a worldview honed out of a life of independence and hardship in a rugged and remote land: a belief in self-reliance and positive thinking; an emphasis on physical capacities; and a reverence for the body and its ability to heal itself. Her theories emphasized a hands-on reading of the body with the imperative to maximize physical function. Other influences were surely at play. Kenny was not merely a more skilled or open-minded observer. She saw things differently.

Kenny spent a decade battling for her ideas in Australia before coming to the US. An investigation of her practice, commissioned by the government of Queensland, was issued in 1938. The scathing report roundly damned her methods. Despite a huge popular following, Kenny’s ideas failed in her native land.

The later acceptance of her concepts in America was, like Kenny’s perception of spasm, an historically specific phenomenon. Rogers details many of the contributing social currents, which were not present during the earlier era in Australia, for example, pressure from World War II veterans for a more aggressive approach to physical disability, a striving among nurses for more authority and independence, and popular resentment of the medical neglect of pain and suffering in favor of laboratory investigations.

Kenny died in 1952, two years before the first trial of the Salk polio vaccine. Rogers documents the attempts made following Kenny’s death by NFIP and others to erase her achievements from history. By bringing this buried story to light, Rogers makes a grand contribution to the history of medicine.

Patricia Kullberg, MD, MPH, is a former primary care and public health physician who has written numerous articles on the politics and practice of medicine for both the academic and lay press. She is currently working on a novel that features Sister Kenny.

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