Sister Kenny: Confronting the Conventional in Polio Treatment
November 2008 Issue
It is hard to imagine now, in the post-vaccine era, the panic that gripped the United States as waves of polio epidemics swept through the country, peaking in 1952 with 58,000 cases. The United States was not alone. Between 1946 and 1953, polio epidemics occurred more often, more severely, and in more parts of the world than ever before, according to the Smithsonian Institution (http://americanhistory.si.edu/polio/).
Isolated cases of what was called "infantile paralysis" had occurred for centuries, even as far back as ancient Egypt although doctors did not describe its distinctive damage to the spinal cord until about 1860, or give it the scientific name "poliomyelitis" until 1874. However, polio began to emerge as an epidemic beginning in the 1880s and into the 20th century. In 1916, the northeastern region around New York City was struck with one of the worst epidemics up to that time, with about 27,000 cases resulting in 6,000 deaths.
|Sister Elizabeth Kenny (right) with her daughter, Mary. Photographs courtesy of Margaret Opdahl Ernest.|
An article from TIME magazine, August 5, 1946, provides a glimpse into that epoch. "As inevitably as warm weather breeds poliomyelitis, polio breeds panic. This year's epidemic, now nearing its peak, is bad-50 percent greater than last year-the worst since 1934.... Health authorities, faced with demands to 'DO something,' have outdone previous efforts to exorcise the disease. Latest efforts: dusting cities with DDT [dichloro-diphenyl-trichloroethane] from planes, draining of swamps and pools, street cleanups...."
Into this maelstrom of fear and disease strode a tall, imposing woman with an unorthodox and controversial method of treatment-Sister Elizabeth Kenny from Australia. Said the TIME article, "Her controversial treatment-hot packs [and] exercise of affected limbs-was first adopted in the U.S. in 1940. Objective: to evaluate the work and prove 'the ability of Kenny technicians to meet an emergency.'"
Sister Kenny was not a nun. Although a largely self-taught nurse, she earned the title of "Sister," based on the British title for a chief nurse, which in the 1917 World War I Australian Army Nurse Corps was equal to a first lieutenant.
Despite considerable controversy and struggle with the medical field over her method, Kenny gained recognition in Australia, establishing several clinics throughout the country.
|Patients arrive at Great Northern Depot, 1946.|
In 1940 the Queensland government sent Kenny and her adopted daughter, Mary, who had become an expert in Kenny's method, to the United States to present her controversial polio treatment to doctors. She received a cool reception from the U.S. medical establishment. Not only was Kenny's method almost directly opposite of conventional treatment, but the terminology she used in describing her treatment was also foreign to doctors. She used such terms as muscle "tightness" (later she used "spasms"), "mental alienation," and "muscle reeducation," which added to the medical community's skepticism. In an interview with The O&P EDGE, her office administrator, Margaret Opdahl Ernest, recalls that when she first accepted the position, "I didn't know her that well at that time. I didn't know whether she was a quack or not, but I found out in a hurry that she knew what she was doing." Kenny was dedicated to her job, says Ernest. "She started her days early and ended late-work was her life."
Ernest continues, "Patients idolized her, but she could be impatient with some of the doctors."
Kenny Method Versus Conventional Treatment
Conventional treatment at the time involved enforcing strict immobilization during the acute and convalescent phases with standardized splints and Bradford frames, to which children were strapped on boards, sometimes for months. They were then often put into cumbersome metal leg braces.
Richard Owen, MD, retired medical director of the Sister Kenny Institute in Minneapolis, was himself struck with polio at age 12. "I was put on a Bradford frame," he told The O&P EDGE. "I was lying flat on that for six or seven months, and then about two months later I was fitted with heavy metal braces."
|Sister Kenny with a patient.|
Sister Kenny's method involved using moist, hot compresses to ease muscle spasm pain, eliminating immobilization during the acute phase of the disease, and gently exercising the paralyzed muscles.
She also didn't believe in braces, Owen notes. "She thought they taught bad gait habits."
Finally, three prominent physicians in Minneapolis-St. Paul, Minnesota-Miland Knapp, John Pohl, and Wallace Cole-were impressed and took a chance on her, despite being shunned by some of their colleagues for this decision.
A 1942 TIME magazine article noted that Kenny's amazing 80-percent recovery rate through her methods "forced [the doctors] to recognize her unorthodox work."
According to a 1943 article in the Journal of Bone and Joint Surgery, "The Kenny Treatment for Infantile Paralysis: A Comparison of Results with Those of Older Methods of Treatment," by Robert Bingham, MD, "Patients receiving the Kenny treatment are 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. The Kenny treatment is the method of choice for the acute stage of infantile paralysis."
The Journal of the American Medical Association (JAMA) endorsed her methods in 1941. She became a celebrity and in a 1952 Gallup poll even edged out former First Lady Eleanor Roosevelt as the most admired woman in America.
|President Franklin D. Roosevelt and Sister Kenny. Roosevelt contracted polio in 1921. His legs were paralyzed, but he learned to walk with braces and a cane.|
Sister Kenny was a child of the bush. She was born at Kelly's Gully, New South Wales, Australia. In the 18th and 19th centuries, many convicts were sent from the British Isles to Australia, and, along with the large number of their descendants, helped build the country. Kenny's mother, Mary Moore, was the granddaughter of James Moore, who was transported from Ireland to Australia in 1828 for stealing a horse. She was the fifth of nine children, two of whom died early in life. "Eliza," as her family called her, loved the outdoors. "Every chance she got, she jumped on a horse bareback and was off into the bush riding like a wild thing," according to Wade Alexander, author of Elizabeth Kenny: Maverick Heroine of the Polio Treatment Controversy.
During a period of convalescence from a broken wrist, Kenny studied anatomy books and a model skeleton that belonged to her physician, Aeneas McDonnell, who became a lifelong friend and mentor. While living in Guyra with a cousin, she may have received some basic nursing teaching from a local midwife and a local physician. In 1911, she returned to Nobby, Queensland, where her family was now living, and began working as an unofficial bush nurse.
She earned enough money from brokering potato sales between farmers and markets to open a cottage hospital in Clifton, not far from Nobby. There she treated her first cases of polio, following the advice of local doctors.
Kenny's life as a bush nurse and during World War I was often an adventurous one. "She found her way to her patients by any means available-horseback, on foot, and if the family came for her in one, by horse and buggy," according to Alexander. The aborigines, knowing she was out to aid the sick, looked after her. Once when she was far away from any town, an aboriginal man emerged from the woods and cautioned her about the danger of a white woman being alone in the bush, since the area had its share of "bush rangers" (outlaws). The man used the "bush telegraph" (bullroarer-an instrument with a sound that carried over long distances and could be used for communication) to tell his friends where she was going and to look after her.
During World War I she was assigned to "dark ships," vessels that ran between Australia and England with their lights off, carrying war equipment and soldiers one way and wounded soldiers and trade goods on the return voyage.
|January 1943, Sister Kenny in Hollywood. From left: Rosalind Russel, who was to star in the movie, "Sister Kenney"; Mary McCarthy, writer; and Sister Kenney.|
After the war, instead of settling down to a spinsterhood dedicated to caring for her mother, which was the expected role for women in her situation at the time, Kenny continued to work as a nurse from her mother's home. Seven years spent caring for a girl with diplegia honed her rehabilitative knowledge and skills.
Her life story sounds like a movie script, and indeed it did become a movie, Sister Kenny, in 1946, starring Rosalind Russell, a four-time Academy Award Best Actress nominee. Sister Kenny, based on the book And They Shall Walk, by Martha Ostenso, earned Russell one of those nominations; Russell and Kenny became close friends.
Polio, Post-Polio Syndrome Threats
The looming menace of polio ended in 1955 with the announcement of the development of a vaccine by Jonas Salk, MD, followed in 1962 with an oral vaccine discovered by Albert Sabin, MD.
Despite the vaccine, polio still casts a long shadow. It has yet to be eradicated completely and still is a threat in many parts of the world. As survivors of the epidemics of the 1940s and '50s enter their later years, many are experiencing post-polio syndrome, a condition affecting poliomyelitis patients several decades after the initial attack that is characterized by fatigue, muscular deterioration, pain in the joints, and respiratory problems.
Sister Kenny's Legacy
Some have called Sister Kenny the founder of modern physical therapy. Not so, according to Marilyn Mofat, PT, DPT, PhD, FAPTA, CSCS, president of the World Confederation for Physical Therapy (WCPT) and a former president of the American Physical Therapy Association (APTA). Mofat is the author of "The History of Physical Therapy Practice in the United States" (Journal of Physical Therapy Education, Winter 2003).
|Sister Kenny is surrounded by patients at the first anniversary observance of the Sister Kenny Rehabilitative Institute, December 1943.|
"I would definitely not call Sister Kenny the founder of modern practice physical therapy," Mofat told The O&P EDGE . "Her contribution to the treatment of patients with poliomyelitis was unique, but controversial in some ways.... A combination of her treatment techniques...led many to change their approach to the treatment of patients with this often devastating paralysis. Her theories were applied only to the management of polio. Although she did not recognize polio as a neurological disease, her muscle re-education techniques continue to be used in some forms in individuals with lower-motor-neuron lesions, of which polio is one."
Sister Kenny died in 1952 and was buried beside her mother in Nobby cemetery; a small museum in Nobby holds artifacts and documents relating to her life. The Sister Kenny Memorial Fund awards scholarships to students with an interest in remote and rural nursing.
Kenny and her trainees leave behind not only several facilities-including the Sister Kenny Rehabilitative Institute, which treats many disabling conditions-but also a legacy of thousands of child polio survivors who regained more mobility, recovered faster, and suffered less pain than they would have otherwise. Her legacy could also be considered a testimony to open-mindedness-examining and weighing something new on its own merits rather than on established ideas.
Miki Fairley is a contributing editor for The O&P EDGE and a freelance writer based in southwest Colorado. She can be contacted via e-mail at firstname.lastname@example.org
Author's note: Besides the references cited, other sources of information for this article include the Global Polio Eradication Initiative; "Gentle Hands-Fear of Polio Grips the Nation," Minnesota Public Radio, August 22, 2002; Wikipedia; Polio's Legacy: An Oral History, by Edmund Sass, EdD; and the History Channel.