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Introduction

Elizabeth Kenny (20 September 1880 – 30 November 1952) was an unaccredited Australian nurse who promoted a controversial new approach to the treatment of poliomyelitis in the era before mass vaccination eradicated the disease in most countries. Her findings ran counter to conventional medical wisdom; they demonstrated the need to exercise muscles affected by polio instead of immobilizing them. Kenny's principles of muscle rehabilitation became the foundation of physical therapy, or physiotherapy.

Early Life

Elizabeth Kenny was born in Warialda, New South Wales in 1880. Lisa (as her family called her) was home-schooled by her mother before attending schools in New South Wales and Nobby, Queensland (on the Darling Downs). At age 17, she broke her wrist in a fall from a horse. Her father took her to Dr. Aeneas McDonnell in Toowoomba, where she remained during her convalescence. While there, Kenny studied McDonnell's anatomy books and model skeleton. That began a lifelong association with McDonnell, who became her mentor and advisor. Kenny later asserted that she became interested in how muscles worked while convalescing from her accident. Instead of using a model skeleton (since they were only available for medical students), she made her own. From age 18 until her mid-twenties, she worked as an unaccredited bush nurse in the Clifton district. In 1907, Kenny returned to Guyra, New South Wales to live with a cousin. While there she claimed to receive basic nursing training from a local midwife, but there is no record of her undertaking formal nursing training. She also brokered agricultural sales between Guyra farmers and northern markets in Brisbane. Contrary to some sources, she was not a member of a religious order; in British Commonwealth nations, the title "sister" is applied to senior qualified nurses and does not necessarily indicate a religious vocation.

Work

In 1909, Kenny returned to Nobby and assumed the role of a qualified nurse after paying a tailor to make her a nurse's uniform, complete with cap and cape. Using the money she earned by brokering produce in Guyra, she opened a cottage hospital (St. Canice's) in 1911 at Clifton, Queensland, a village about 9 kilometers (5.6 mi) from Nobby. Kenny provided convalescent and midwifery services at St. Canice's, and treated her first confirmed cases of infantile paralysis (as polio was also known) under the supervision of the local Lodge Doctor.

Kenny claimed in her 1943 autobiography (co-authored by Martha Ostenso) that she treated her first cases of infantile paralysis in 1910 while working alone as a bush nurse in the Clifton district. That episode was romanticized in the 1946 film Sister Kenny, featuring Rosalind Russell (who befriended Kenny). Surveillance records from the early 1900s show that infantile paralysis was a rare disease in Queensland prior to World War I, although there is evidence that sub acute cases were brought to Kenny's cottage hospital in Clifton. In her memoir, Kenny claimed she was baffled by the cases she encountered and sought assurance from Dr. Aeneas McDonnell. He wired back, "...treat them according to the symptoms as they present themselves". Sensing that their muscles were tight, she did what mothers around the world did: applied hot compresses and weights made from woolen blankets to their legs. Kenny wrote in her autobiography that a little girl woke up very much relieved and said, "Please, I want them rags that well my legs". Several children recovered with no serious aftereffects. Many years passed before Kenny treated anyone else who might have had polio. The story of Kenny's first encounter with an acute case of polio is a 20th-century medical legend, but there is no documented record other than her memoir. The chief witness to the discovery of her method for treating poliomyelitis was Aeneas McDonnell, who died before the story was widely publicized.

World War II

Press reports from Australia during the 1930s quote Kenny as saying she developed her method while caring for meningitis patients on troopships during World War I. When the war began, Kenny volunteered to serve as a nurse. She was not officially qualified, but nurses were badly needed; she was accepted and assigned to "Dark Ships": transports that ran with all lights off between Australia and England carrying war goods and soldiers one way, and wounded soldiers and trade goods on the return voyage. Kenny served on these dangerous missions throughout the war, making sixteen round trips (plus one around the world, via the Panama Canal). In 1917 she earned the title "Sister" (which in the Australian Army Nurse Corps is the equivalent of a first lieutenant), and used that title for the rest of her life. While she was criticized by some[who?] for doing so (in the British Commonwealth, it was reserved for qualified nurses), but Kenny was officially promoted to that rank during her wartime service. During the final months of the war, she served for a few weeks as matron in a soldiers' hospital near Brisbane and was honorably discharged with a pension.

Return to Queensland

Although exhausted by her war service, Kenny supervised a temporary hospital in Nobby, Queensland which had been established to care for victims of the 1919 influenza epidemic.[citation needed] When the epidemic subsided, Kenny traveled to Guyra to recuperate (without success) and returned to Europe to visit doctors there. After her return to Nobby, she was called to Guyra by a girlhood friend to care for her daughter (Daphne Cregan), who was disabled with what was known as cerebral diplegia. Kenny's three years of rehabilitative work with the child, plus her experience with sick and wounded men during World War I, is probably the foundation for her later work in polio treatment and rehabilitation.

Instead of settling down at home in what was most expected (a spinsterhood dedicated to caring for her mother) Kenny continued to work as a nurse from her mother's home, often brought to her patients in the sidecar of a motorcycle or by automobile. When his daughter Sylvia was injured by falling into the path of a horse-drawn plough, a family friend called Kenny for help. She improvised a stretcher from a cupboard door, fastened Sylvia to it and accompanied her the 26 miles (42 km) to Dr. McDonnel's Toowoomba office. Sylvia recovered, primarily due to Kenny's careful attention during that transport. Kenny improved the stretcher for use by local ambulance services, and for the next three years marketed it as the "Sylvia Stretcher" in Australia, Europe and the United States. She turned the profits over to the Australian Country Women's Association, who administered sales and manufacturing.

Polio Treatment

When sales of the Sylvia Stretcher declined, Kenny returned to home nursing. During one of her sales journeys she met a family who arranged for her to visit their station west of Townsville, Queensland in 1929 to care for their niece Maude, who was disabled by polio. "At the time the normal medical procedure for dealing with infantile paralysis consisted of immobilizing the affected limbs in splints," said Jim Franklin. After 18 months under Kenny's care Maude was able to walk, return to Townsville, marry and conceive a child. The newspapers in Townsville took up the story, referring to it as a cure. In 1932, Queensland suffered its highest number of polio cases in 30 years; the following year, several local people helped Kenny set up a rudimentary polio-treatment facility under canopies behind the Queens Hotel in Townsville. In a few months (after further success with local children), she moved into the bottom floor of the hotel. The first official evaluation of Sister Kenny's work took place in Townsville in 1934, under the auspices of the Queensland Health Department. This evaluation of her work led to the establishment of Kenny clinics in several cities in Australia.

During these years, Kenny developed her clinical method and gained recognition in Australia. She was adamantly opposed to immobilizing children's bodies with plaster casts or braces. At this time, Kenny requested that she be permitted to treat children during the acute stage of the disease with hot compresses (as she claimed to have done in Clifton before the war). However, doctors would not allow her to treat patients until after the acute stage of the disease or until "tightness" (Kenny used the word "spasm" much later) subsided. She instituted a carefully-designed regimen of passive exercises, designed to recall function in unaffected neural pathways (much as she had done with Maude). On her own she began treatment of a patient in the acute stage in her George Street Clinic in Brisbane, then transferring her to the Ward 7 Polio Clinic in Brisbane General Hospital. That child (and others) recovered with fewer aftereffects than those placed in braces. In 1937 she published an introductory book about her work and began another (The Treatment of Infantile Paralysis in The Acute Stage), which was later published in the United States. The most comprehensive appraisal of her methods was published in collaboration with Dr. John Pohl in 1943.

Between 1935 and 1940, Kenny traveled extensively throughout Australia helping to set up clinics. She also made two trips to England, where she set up a treatment clinic in St. Mary's Hospital near Carshalton; a rehabilitation facility still exists there. Between 1936 and 1938, a Queensland Government Royal Commission evaluated Kenny's work and published its Report of The Queensland Royal Commission on Modern Methods for the Treatment of Infantile Paralysis in 1938. Its most critical comment (because Sister Kenny opposed using splints and plaster casts to immobilize the areas of polio patients affected by the disease) was, "The abandonment of immobilization is a grievous error and fraught with grave danger, especially in very young patients who cannot co-operate in re-education." They stated that her clinic (then in Brisbane) was "admirable". The Commissioners' strongest objections were against the Queensland government, which was funding Kenny's work when her clinic was not under the purview of the BMA. The Queensland Government rejected the report, continuing to support Kenny's work.

In the US

In 1940, the New South Wales government sent Kenny (and her adopted daughter Mary, who had become an expert in Kenny's method) to America to present her clinical method for treating polio victims to American doctors. After a sea journey from Sydney to Los Angeles and by railway to San Francisco, Chicago, New York City, back to Chicago and to the Mayo Clinic in Rochester, Minnesota, she was given a chance to demonstrate her work in Minneapolis, Minnesota. Doctors Miland Knapp and John Pohl (who headed polio treatment centres there) were impressed, and told her that she should stay. They found an apartment for Kenny and Mary; several years later, the city of Minneapolis gave them a house. The city was Kenny's base in America for 11 years. In a 1943 letter to the British Medical Journal, Kenny noted that "there have been upwards of 300 doctors attending the classes at the University of Minnesota".

During this time, Kenny treatment centres were opened throughout America; the best-known were the Sister Kenny Institute in Minneapolis (now Sister Kenny Rehabilitation Associates), a facility in the New Jersey Medical Center and her favorite, the Ruth Home in El Monte, California. She received honorary degrees from Rutgers University and the University of Rochester and lunched with U.S. President Franklin D. Roosevelt, discussing his treatment at Warm Springs. In 1951 Kenny headed the Gallup Poll's most-admired women's list, the only woman in the first 10 years of the list to displace Eleanor Roosevelt for the #1 spot. The Sister Kenny Foundation was established in Minneapolis to support her and her work throughout the United States.

Controversy

Kenny's success was controversial; many Australian doctors (and the British Medical Association) questioned her results and methodology. Dr. Raphael Cilento, who was in charge of the QHD evaluation, wrote a report that was mainly critical, but somewhat complimentary. Sister Kenny replied publicly, fiercely taking Dr. Cilento to task for his criticisms (unusual from a self-taught bush nurse at that time in Australia). This response caused a contentious relationship among Kenny, Dr. Cilento, the BMA and the Australian Medical Association (AMA). During her stay in the United States, Kenny faced many sceptical doctors and needed to get the American Medical Association's support for her method. The AMA director at that time saw her as an "ignorant quack seeking money for her own gain". Some doctors found their initial professional scepticism groundless when they saw the effects Kenny's method had on her patients (both children and adults). Kenny was the subject of American magazine articles; however, Victor Cohn (who wrote the first detailed biography of her life and work) noted that her pursuit of publicity led journalists to tire of her campaign. During her first year in Minneapolis the National Foundation for Infantile Paralysis (NFIP) paid her personal expenses, financing and arranging trials of her work; that support ceased, however, after a series of disagreements. Kenny was a determined and outspoken woman, which irritated the NFIP director (and many doctors).

Final Years & Death

Kenny filled her final years with journeys in America, Europe and Australia in an effort to gain further acceptance of her method. She returned home to Toowoomba in 1951, where she died of complications from Parkinson's disease on 30 November 1952. Kenny was buried beside her mother in Nobby Cemetery.

Legacy

Between 1934 and her death in 1952 Kenny and her associates treated only a few thousand patients, but her methods were used to treat thousands of polio victims throughout the world. Their testimony to Sister Kenny's healing is part of her legacy, as is The Kenny Concept of Infantile Paralysis, and Its Treatment (known as the "Red Book" and written by Dr. John Pohl in collaboration with Kenny). Her most enduring legacy is the Minneapolis Sister Kenny Rehabilitation Institute.

In Kenny's home village of Nobby the Sister Kenny Memorial House contains many artifacts from Kenny's life, a collection of documents from her private correspondence, papers and newspaper clippings. In Toowoomba, the Sister Elizabeth Kenny Memorial Fund provides scholarships to students attending the University of Southern Queensland who will dedicate themselves to work in rural and remote areas of Australia. In Townsville, her life was commemorated in 1949 by the unveiling of the Sister Kenny Memorial and Children's Playground.

Sister Kenny is referenced in the TV movie An American Christmas Carol, in which the Tiny Tim character, Jonathan, would be sent for treatment for his disability (never referred to specifically, however, as polio). Her treatments are also suggested to be the basis for Livy Walton's recovery in The Waltons' first-season episode "An Easter Story". Livy's will to walk again after polio leads her to take the chance that Kenny's methods might work.

Cartoonist and amputee Al Capp was involved with the Sister Kenny Foundation during the 1940s and 1950s. As honorary chairman Capp made public appearances on its behalf, contributed artwork for its annual fundraising appeals and entertained disabled children in hospitals with pep talks, humorous stories and sketches.

Alan Alda credits the Sister Kenny treatments he received from his mother as a young boy for his complete recovery from polio, stating in his autobiography Never Have Your Dog Stuffed that he has no question about their efficacy.

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