On the eve of the 70th anniversary of her passing we will explore the life of this Australian ‘nurse’ whose work with polio victims opened the modern-day era of rehabilitation and physiotherapy.
Whilst working in outback Queensland in 1909, Kenny found that several children suffered from a disease that she couldn’t diagnose. She wired a description of the symptoms to a city hospital and asked what kind of treatment she should give to the children. When the answer came, it wasn’t encouraging. The disease was infantile paralysis or polio, and there was no known treatment. “Do the best you can,” she was told.
Elizabeth Kenny was born in Warialda, New South Wales in 1880. She received no formal nursing training, simply teaching herself, observing and caring. There were few physicians in rural Australia at the time. Self-appointed ‘Nurse Kenny’ did not bother to apply for a formal nursing job, as she had no qualifications. The need for health care in the bush was so great that many were not concerned that she did not have a certificate to practice nursing and many did not even know what a “certificate” was. They were simply grateful to have someone to care for them.
Kenny noticed that in the early stages of polio, the victims suffered from muscular spasms and she was determined to relieve them. She tore blankets into strips, soaked them in hot water, wrung them out and packed them around tortured legs and arms. She kept up these hot pack or foment treatments until the spasms had disappeared and the child’s flesh had a rosy, healthy glow.
In 1910, a year after the polio epidemic, Sister Kenny was granted a leave of absence for some rest. Instead of vacationing, she traveled to meet the head doctor who had telegraphed her to “do her best” for the polio victims. When he discovered that all of them had recovered, he begged Sister Kenny to show him what she had done.
She was rushed to a ward where doctors and nurses were working on several new polio cases. To the astonishment of the attendants, the doctor ordered the young bush nurse to get busy. Sister Kenny quickly went to work. She stripped off the splints and bandages that kept the victims rigid. The doctors had been using splints on the theory that they kept contracting muscles from distorting healthy muscles. The use of this splint method was widespread. For Kenny to remove these splints was revolutionary. Only the doctor’s presence kept the attendants from stopping her by force.
Calmly she tore blankets into strips, converting them into warm, wet packs called foments, for the children’s arms and legs. In three or four days the patients were free from pain while with splints or casts, the pain lasted for weeks and months. Then while the polio was still in its acute stages, Kenny began the massage and passive movement she had used in her remote nursing post. As the children improved, she persuaded them to move their own muscles. Once again, her methods worked. With this second success, Kenny was prepared to pit her unconventional treatment against the more conventional, widely accepted use of splints.
Kenny had a battle on her hands. Some earnest Australian doctors opposed her. They felt that the risk of removing the splints from the limbs of the children was too great. Where one child might be helped, another might be injured for life, they agreed. Neither were they convinced of the importance of treating the muscle spasms which had gotten very little attention as part of the polio progression.
There was a small group of individuals who were calling for more physiotherapy, which, at the time, was an unfamiliar term. Rehabilitation, in a modern sense, simply did not exist. The therapy that did occur was mainly directed at treating resultant paralysis and not at preventing it. And only those with ample financial resources were able to receive any long-term treatment.
Kenny had seen immobilization treatment and considered it a desecration of the body. She said the children looked as if they were being crucified. They moaned in pain and agony and begged for the splints to be removed. Eliza began to work with many of these patients during the acute phase of the illness. This practice was contrary to all medical beliefs about the treatment of polio. She taught patients about their muscles. She told them to concentrate on the muscle. She persisted day after day with her treatment with hot packs and re-educating the muscles to move. One physician said, “She’s a saleswoman. She talks the patient into thinking he’s better when he really isn’t”. But other physicians said that she knew that constant, graded exercise could obtain good results, if the paralysis was not irreversible.
Kenny did have allies in her fight. Her methods were radical, but they worked. They didn’t cure the disease, but they did offer relief from pain and in most cases, freedom from crippling.
The opposition she got from some doctors didn’t shake Kenny’s faith in her methods or her conviction that she had to work through the medical profession. Her friends urged her to operate independently, but she couldn’t agree to that. Kenny knew that her treatment worked only when applied in the first stages of polio. In order to help the children she had to reach them through the doctors that their parents consulted. All that Kenny asked was that the doctors observe her methods and judge for themselves.
Until the outbreak of the First World War, Kenny demonstrated her methods anywhere, anytime. When war broke out, she became a nurse on a troop transport ship and turned her innovative talents to inventing a transport stretcher for moving wounded men without jolting. Another much appreciated invention Kenny’s was a camp–like device to keep the bunks of the injured men aboard a rolling transport ship steady. Later, the royalties from these inventions helped her to live while she went on with her crusade on behalf of polio stricken children.
In 1917 Kenny earned the title “Sister”, which in the Australian Army Nursing Corps is the equivalent of a First Lieutenant. Kenny used that title for the rest of her life
After World War I, Sister Kenny returned to Queensland and set up a clinic. Her repeated success in her battle against polio won her recognition throughout Australia and the government supported Kenny clinics in eight large hospitals. She was also able to establish a government clinic on an experimental basis for the training of therapists. Although Kenny had operated small bush hospitals in the past, this was the first government support she had received. The son of the proprietress of the Queen’s Hotel, Dr. James Vivian Guinane, was doing his surgical training in England. When he returned, he brought Sister Kenny physiotherapy texts, taught her some physiology, and improved her knowledge of anatomy in an attempt to ameliorate criticism of her lack of knowledge and training.
With her work in Australia well established and several young student nurses well versed in the Kenny method, Sister Kenny was anxious to expand her crusade. She felt that she could be of help in the United States and Canada which together had more cases of polio than the rest of the world combined.
Sister Kenny wanted her campaign in the United States and Canada to have scientific sponsorship, so she waited until that sponsorship came. That happened in 1940, when one of the chief surgeons of the Mayo Clinic invited Sister Kenny to demonstrate her methods at the University of Minnesota Medical School and at the Minneapolis General Hospital. The National Foundation for Infantile Paralysis would underwrite the cost of the technical work and the assistant nurses. Kenny felt that this was a green light and she and her devoted staff traveled to the United States.
In Minneapolis, and in Little Rock, Arkansas, during an epidemic and in many other centres Nurse Kenny produced remarkable results. About 80 percent of her patients recovered completely. These results were enough to convince laymen, but doctors still asked pointed questions. They interrogated Sister Kenny most about the use of her active exercise program. They admitted that she could persuade children to make their ailing arms and legs move, but they attributed this to her strong personality. More than one of her critics suggested that she hypnotized the children into moving. Another person might not be able to do this and a treatment to be effective must be effective in the hands of any trained person.
To answer this criticism, Sister Kenny turned to the records of the Australian clinical nurses trained in her methods. They had been as successful as Sister Kenny herself. They had to undergo a stiff, two-year course in the Kenny method, but once trained they practiced on their own. Sister Kenny felt it would benefit hundreds of young American nurses to take the same training course. In 1942, she organized the Elizabeth Kenny institute in Minneapolis for the purpose of spreading her methods throughout the United States and she served as its director until 1949, when she became a consultant.
In order to establish a broader public base, Sister Kenny agreed to let Hollywood make a film about her life, but with two stipulations. She insisted that none of the facts would be distorted and that Rosalind Russell must play the part of Sister Kenny. Sister Kenny believed that Miss Russell could best portray the vigorous common sense of the youthful Elizabeth Kenny without glamour or over sophistication. Hollywood released Sister Kenny in 1946 and Rosalind Russell earned an academy award nomination for her work in the film.
Kenny recognized the high status granted to physicians in American society. She was driven to be accepted by them. She realized that challenging the male-dominated medical establishment meant using a different approach. She was physically strong and tall and had a typical Australian-Irish sense of humour and she used this effectively most of the time. Although she found it uncomfortable, she developed a feminine persona and dressed in large, dramatic hats and flowers. She often referred to herself as a mixture of Florence Nightingale and Marie Curie.
Kenny continued her crusade against polio. Her methods also aroused controversy among some American doctors, but the National Foundation for Infantile Paralysis recognized her work. She felt that she was still operating within the medical cooperation that she considered so necessary
A 1943 article in the Journal of Bone and Joint Surgery reported that patients who underwent the Kenny treatment were,
more comfortable, have better general health and nutrition, are more receptive to muscle training, have a superior moral, require shorter periods of bed rest and hospital care, and seem to have less residual paralysis and deformity than patient treated by older conventional methods.
Kenny filled her final years with extensive journeys in America, Europe and Australia in an effort to increase acceptance of her method. She tried, unsuccessfully, to have medical researchers agree with her that polio was a systemic disease. She attended the second International Congress about polio in Copenhagen, where she was shunned and unable to participate. Suffering from Parkinson’s disease, she stopped on her way home in Melbourne to meet privately with internationally respected virologist Sir Macfarlane Burnet. He wrote of the visit in his autobiography:
She had treated more cases than anyone else in the world – she gave the precise number, 7,828 – and no one else was in the position to speak with her authority. She is now almost forgotten by the world. But there was an air of greatness about her and I shall never forget that meeting.
References:
Sister Elizabeth Kenny Fought Polio with Physical Therapy – STORIES IN SCIENCE (weebly.com)
Sister Elizabeth Kenny: Conviction and Controversy | Nurse Key
