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PROFESSOR ARTHUR STEINDLER, ORTHOPEDIC SURGEON & SISTER KENNY

The O.H.M.S. cover had a green 1d KGV Head and a red 2d Anniversary of South Australia stamps cancelled with a BRISBANE/ 8 -PM/ 16 SEP/ 1936/ QLD roller cancel with the slogan SOUTH AUSTRALIA/ CENTENARY CELEBRATIONS/ 1936. It was addressed to Professor A. Steindler, The State University of Iowa, Iowa City, Iowa, United States America and it had the return address for the Royal Commission On The Investigation of Paralysis, 33 Queen Street, Brisbane. The reverse was not seen (Figure 1).

 

I was not even a teenager in Australia in the 1930's decade, but the scourge of poliomyelitis, also known as infantile paralysis, immediately came to my mind when I saw the return address on this cover, even though the Royal Commission on the Investigation of Paralysis had omitted the term, ‘Infantile’. Once this connection was suggested, the mind turned immediately to the name of Sister Elizabeth Kenny. The strange thing in retrospect was that I have no memory of the great controversy that existed about the woman herself, particularly her nursing qualifications; this was not only in Australia, but also in the United States and Great Britain, as well as other countries where polio long-term deformities were common.

However, I am ahead of myself, for this cover was addressed to Professor A. Steindler in Ohio, and I was soon to find that he was not only a celebrated orthopedic surgeon with expertise on correction of the spastic aftermath of polio deformities, but he had researched the nervous system pathology lesions of polio as well. Of particular interest was he not only had contact with the Royal Commission in Australia, he also had communication with Sister Kenny in Minneapolis.

Arthur Steindler was born in Vienna, Austria on June 22, 1878 and he finished his undergraduate work at the University of Prague in 1898, and he received his MD at Prague in 1902, practiced medicine there for 5 years before emigrating to America in 1907. He worked in Chicago at the Home for Crippled Children, and at Rush Medical College. He became a professor at Drake University’s College of Medicine in 1910. When Drake’s medical school closed in 1913, he was hired as an assistant professor of surgery at Iowa State, bringing to Iowa City his vast experience in pediatric orthopedics; he introduced innovative surgical treatments for clubfoot, scoliosis of the spine and other musculoskeletal defects. He attracted other doctors to study under him not only from U.S. centres, but also from overseas. Steindler is seen as a master teacher in Figure 2.

He lobbied Iowa’s politicians and received funds to set up a Children’s Hospital with a hundred orthopedic beds and in 1925 the College of Medicine created the Department of Orthopedics with Steindler named to its first chairman, a position he held for 2 decades. He retired from the University in 1949 to devote more time to private practice. In 1954, the Royal College of Surgeons of England of London conferred an Honorary Fellowship on him, and he died on July 21, 1959. Steindler wrote numerous orthopedic books and papers, an devised operations to ameliorate contractures produced by polio. He was an early advocate for restriction of long -term bed rest, restriction of muscle use, and splinting of the affected limbs. In this regard, he was cautious proponent of the principles espoused by Sister Kenny. He quoted her twice as "Miss Kenny" in his article ‘The Newer Pathological and Physiological Concepts of Anterior Poliomyelitis and Their Clinical Interpretation’ J. Bone Joint Surg Am 1947; 29: 59-77. A close-up photo of Arthur Steindler is seen is seen Figure 3.

At this stage of my research I am unable to find even a summary account of the mandate for the Royal Commission on the Investigation of Paralysis, but the following facts can be substantiated: Elizabeth Kenny’s nursing qualifications were questioned by the medical profession; the principles of her treatment of polio paralysis and contractions were often maligned by same; the results of the 1935-38 Commission were largely influential in her going to the USA, where her acceptance was greater. She did have some medical and nursing proponents in Australia, and she did have some governmental support, particularly in Queensland, the place where the Commission was convened. I even have documentation that Steindler, who may have never met her, he did send colleagues to her Minneapolis clinic, as described in this letter he sent to her:

"Letterhead: The State University of Iowa

University Hospitals

Department of Orthopedic Surgery

Iowa City, Iowa

Jan, 26, 1942

Sister Kenny,

Minneapolis, Minn.

Dear Miss Kenny:

Please let me express my appreciation and thanks for your kindness you have shown to Mrs. Anthony and Dr. Greteman when they went up to Minneapolis to study your method of treatment. I am quite sure that what they brought back, although the time was necessarily very short, will be of great benefit to our patients. It is a matter of great regret to me that my very pressing duties prevent me from coming up to observe your work myself but I hope that this will be possible sometime in the future.

Kindest regards and best wishes.

Yours very sincerely,

Arthur Steindler, M.D."

This is not a resounding endorsement and in "The Kenny Treatment of Poliomyelitis" British Medical Journal Nov. 28, 1942, pp. 639-40, Dr. Steindler’s opinion is quoted in the penultimate paragraph:

"In this regard we feel bound to comment particularly upon a report from Dr. Steindler's clinic, in which a more critical note appears. These workers suggest that the pathological concept must be changed from the old idea of a purely motor deficiency originating in a lesion of the anterior horn cells, but they believe that it would be a mistake to relinquish all methods and devices which customary treatment instituted for the preservation of muscles, for the control of pain, and for the avoidance of fatigue; they do not believe that all fixation should be abandoned."

Mark Onken, Hardin Reference Library, University of Iowa, who supplied the above, comments: The final sentence of this article one suspects is by Steindler himself; it is certainly characteristic: "I believe that when we are convinced of the soundness of the newer clinical observations in infantile paralysis, the application of common sense and of general biologic principles will make apparent the proper road of conduct, free from orthodoxy and from radicalism". The source from which BMJ derived this information comes from Archives of Physical Therapy, 1942, 23, 325.

The stories about Sister Kenny, the animosity and praise heaped upon her, the claims for her treatment are legion, and yet the Commission’s results, led by Sir Raphael Cilento MD, an expert in Tropical Medicine, are still not available to me. A picture of Sister Elizabeth Kenny in 1950 is seen in Figure 4.

 

Elizabeth Kenny, nurse, was born on 20 September 1880 at Warialda, New South Wales, daughter of Michael Kenny, farmer from Ireland, and his native-born wife Mary, née Moore. She received limited education at small primary schools in New South Wales and Queensland. There is no official record of formal training or registration as a nurse. She probably learned by voluntary assistance at a small maternity hospital at Guyra, New South Wales. About 1910 Kenny was a self-appointed nurse, working from the family home at Nobby on the Darling Downs, riding on horseback to give her services, without pay, to any who called her. In 1911 she used hot cloth fomentations on the advice of Aeneas McDonnell, a Toowoomba surgeon, to treat symptomatically puzzling new cases, diagnosed by him telegraphically as infantile paralysis (poliomyelitis). The patients recovered. Kenny then opened a cottage hospital at Clifton.

During World War I, using a letter from McDonnell as evidence of nursing experience, she enlisted on 30 May 1915 and was appointed staff nurse in the Australian Army Nursing Service, serving on troopships bringing wounded home to Australia. On 1 November 1917 she was promoted Sister, a title she used for the rest of her life. Her army service terminated in March 1919. After the war she resumed her home nursing and became the first president of the Nobby chapter of the Country Women's Association. In 1927 she patented the 'Sylvia' ambulance stretcher designed to reduce shock in the transport of injured patients.

In 1932 Sister Kenny established a backyard clinic at Townsville to treat long-term poliomyelitis victims and cerebral palsy patients with hot baths, foments, passive movements, the discarding of braces and callipers and the encouragement of active movements. At a government-sponsored demonstration in Brisbane doctors and masseurs ridiculed her, mainly because they considered her explanations of the lesions at the site of the paralysis were bizarre. Thus began a long controversy at a time when there was no vaccination for poliomyelitis. The strong-willed Kenny, with an obsessional belief in her theory and methods, was opposed by a conservative medical profession whom she mercilessly slated and who considered her recommendation to discard immobilization to be criminal. Despite almost total medical opposition, parental and political pressure with some medical backing resulted in action by the Queensland government which was influenced by Home Secretary E. M. Hanlon and his public service adviser, C. E. Chuter. In 1934 clinics to treat long-term poliomyelitis cases were established in Townsville and later in Brisbane. The Brisbane clinic immediately attracted interstate and overseas patients. Kenny clinics in other Queensland cities and interstate followed.

In 1937 she published in Sydney Infantile Paralysis and Cerebral Diplegia, with a foreword by Herbert Wilkinson, professor of anatomy at the University of Queensland. Grateful parents having paid her fare to England, she was given two wards at Queen Mary's Hospital at Carshalton, Surrey. She shocked English doctors with her recommendations to discard splinting used to prevent deformities and her condemnation of the orthodox treatment of poliomyelitis cases. Returning to Australia, she was greeted with the report of a royal commission of leading Queensland doctors which damned her methods. However, she was given a ward at the Brisbane General Hospital and early cases of the disease to treat. Aubrey Pye, medical superintendent, stated that her patients recovered more quickly and that their limbs were more supple than those treated by the orthodox method. But the medical profession largely ignored her.

In 1940, armed with an introduction to the Mayo Clinic, Rochester, Minnesota, signed by six Brisbane doctors and her fare paid by the Queensland government, she arrived in the United States of America. At first most doctors rejected her theories of 'spasm', 'mental alienation', and 'incoordination' by which she explained the disability caused by poliomyelitis. However, orthopaedists Miland Knapp, John Pohl and Wallace Cole arranged for her to be given beds in the Minneapolis General Hospital. Her methods became widely accepted. She began courses for doctors and physiotherapists from many parts of the world. The Sister Kenny Institute was built in Minneapolis in 1942 and other Kenny clinics were established.

Kenny became a heroine in America and was awarded many honours. She accepted numerous invitations to lecture in other countries and received honorary degrees. Her autobiography, And They Shall Walk, written in collaboration with Martha Ostenso, was published in New York in 1943. In 1946 she was eulogized in the film, Sister Kenny. Abraham Fryberg, Queensland director-general of health and medical services, and Thomas Stubbs Brown, orthopaedic specialist, after an overseas visit recommended in 1947 that treatment based on the Kenny method be used in the early stages. They argued, however, that her concept that the disabilities in poliomyelitis were caused by the virus invading peripheral tissues, and not the central nervous system as traditionally taught, was not proven. In 1950 Congress gave her the rare honour of free access to the United States without entry formalities. Despite this success, she remained the centre of bitter controversy, partly because of her intolerance of opposition, and returned to Australia several times with little acclaim.

A big woman, with white hair which she often covered with large hats, Elizabeth Kenny was an imposing figure. She could speak gently to a patient one minute and harshly criticize a doctor the next. She gained basic knowledge as she progressed and, at times, submitted other people's ideas as though they were her own. Although her views on the pathology of the disease were generally not accepted, she made a significant contribution towards the treatment of poliomyelitis and stimulated fresh thinking. Developing Parkinson's disease, she retired to Toowoomba in 1951 and died there of cerebro-vascular disease on 30 November 1952. After a service in the Neil Street Methodist Church, she was buried in Nobby cemetery. Unmarried, she was survived by an adopted daughter. Her estate, valued for probate at £17,117, was left mainly to relatives, but a collection of memorabilia was left to the Kenny Foundation in the United States and a desk and prayer-book, belonging once to Florence Nightingale, were left to the United Nations Organization. Her book, My Battle and Victory, was published posthumously in London in 1955. A bust by L. Randolph is displayed in the Toowoomba City Art Gallery.

The biography of Sister Kenny is taken directly from the Australian Dictionary of Biography.

Penelope Whiteway, at the Library of the University of Queensland provided the contents of the letter from Athur Steindler to Miss Kenny

 

 

 
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