Friday, November 1, 2013

Polio Wars: Sister Kenny and the Golden Age of American Medicine, by Naomi Rogers

Oxford University Press, ISBN 9780195380590, November 2013

From around 1900 until the 1950s, when Jonas Salk developed his polio vaccine, the US and other developed countries were stalked by the fear of polio, the dreaded crippler of healthy children and adults. The treatment of polio rested on certain beliefs for which the medical community believed it had ample scientific evidence. Among these was the belief that the polio virus attacked the central nervous system and only the central nervous system--paralysis was the result of lesions on the parts of the brain that controlled those body parts. It was also believed that this caused affected muscles to be flaccid.

Treatment centered around immobilizing the limbs, and even the whole body, with splints or casts. Life-long crippling was believed to be inevitable, and the goal was to avoid deformities and keep the limbs straight and normal-appearing. There were few prospects for the permanently crippled, and institutionalization was frighteningly common.

The person who changed this was not Jonas Salk with his vaccine. He came later. The first liberator of the polio-afflicted was an eccentric Australian bush nurse, Sister Elizabeth Kenny.

Kenny was born in 1880, and after an extended stay with a doctor when she was ill as a child, she developed an interest in medicine and nursing. She worked for years as a bush nurse--the only easily accessible health care in much of small town and wilder regions of Australia. She served as a nurse in the Australian army during World War One (where she acquired the title "Sister," the title that the British and Australians give to senior nurses.) When she returned home after the war and resumed her bush nurse practice, she found herself dealing with growing numbers of polio patients. Without the medical education of a registered or graduate nurse, and with no doctors or hospital nearby, she developed a therapy plan based on her own careful observation of symptoms. Where doctors saw some muscles flaccid, she saw other muscles in spasm, and treated her patients with hot packs, manipulation, and exercise. She concluded that the polio virus did not limit itself to the nervous system, but directly affected muscles and skin.

This was turning not only the treatment but the understanding of polio on its head, and when Sister Kenny took her new therapy and new theory first to Brisbane and then to the UK and the US, she was embarking on a years-long struggle to be heard and to have both her therapy and her theory accepted by the medical profession.

Rogers gives us an enlightening view of Kenny, her supporters, and her critics, in Australia and in her second home in Minnesota in the US. Kenny was such a strong personality, hard-headed and often abrasive, and truly objective information is hard to come by; people loved her or hated her. She was not deferential toward doctors, as both gender and class expectations required; she tended to regard all questions as challenges; and she was so certain she was right that the prospect of controlled studies of her therapy vs. traditional polio therapy seemed deeply unethical and unacceptable. She was also, as mentioned before, abrasive, intolerant of questions, and a much better clinician than a teacher. She didn't make it easy for people to give up their own strongly-held views and adopt hers, instead.

On the other hand, her opponents disliked her therapy in part because she was a nurse demanding to be taken seriously as a medical innovator, and in part because her findings were "empirical"--based on her own clinical experience and observations--rather than "scientific," derived from laboratory work.

Rogers follows Kenny through her years of teaching, promoting, proselytizing her polio therapy, in Australia and the country of her greatest success and greatest frustration, the US. She gives us what is probably as balanced a view of Kenny as is possible. This is a woman who had a tremendous impact on polio treatment, yes, but also on medical attitudes to all crippling diseases and rehabilitation of patients suffering from those diseases or from physical handicaps due to injury. She was a celebrity in America, with friends and connections everywhere, including Hollywood, but rather less so in Australia.

Kenny's fame faded quickly after her death, in part because she died in 1952, just a few years before Salk created the first effective polio vaccine. She revolutionized the treatment of polio, and then treatment of polio became irrelevant in the developed world. That's an excellent development for all of us, but Kenny ought to be better remembered than she is.

Highly recommended.

I received a free electronic galley of this book from the publisher via NetGalley.