A Summer Plague: Polio and Its Survivors by Tony Gould (Yale University Press)
A belief in single causes has motivated medical researchers since the introduction of the germ theory in the late nineteenth century. In this formulation, every disease has one instigating factor which is the sole determinant of the evolving pathological process. Having accepted such a proposition, the aim of research becomes to identify the distinctive etiological agent and then to discover a method of preventing it from wreaking its havoc on the body. Although it is now well known that the likelihood of an individual's actually developing a particular disease is the result of multiple influences, biomedical science is focused, correctly so, on discovering what might be called the sine qua non, the entity without which the disease would not occur.
The paradigm for the principle of single causes was constructed as a result of Louis Pasteur's demonstration in the 1850s and 1860s that fermentation is the result of the activity of specific micro-organisms. A rapid series of developments resulted from Pasteur's work, culminating in Robert Koch's proof in 1876 that sheep anthrax is caused by one particular germ, which would appropriately be named Bacillus anthracis. Koch's research led him gradually to a set of criteria, first put forth in 1882, which must be satisfied in order to prove that a distinct microbe is the cause of a distinct disease. Now famously known as Koch's postulates, the criteria are four in number: (1) the microbe must be found in every case of the disease being studied; (2) it must be isolated from a case of the disease and grown in pure culture uncontaminated by other microbes; (3) when inoculated into an experimental animal, the pure culture must be capable of producing the disease; and (4) the microbe must then be recovered from the sick animal.
Although circumstances have not always permitted rigid adherence to these strict standards, Koch's postulates have been enormously influential in the steady sequence of twentieth-century advances in the field of microbiology. So remarkable are those advances that they seemed, until the advent of the aids pandemic, to be leading inevitably toward a total victory over infectious disease. In a historical sense, however, the four criteria have done far more than merely to provide the structure for scientific proof. They have become the perfect expression of medicine's unending search for single causes.
Of all the multiple pathways of biomedical investigation, the field of infectious disease research has been the most characterized by that search. Not only is it the original model from which other fields have taken their cues, but its very nature of well-defined syndromes caused by specific agents epitomizes the thesis on which the principle is based. Even before individual types of germs could be isolated and identified, the introduction of a single prophylactic or therapeutic measure sometimes changed medical history and made its lone proponent a hero, usually in his own lifetime. Pasteur and Koch were not the only celebrities of their kind; there were also Paul Ehrlich of the "magic bullet," Joseph Lister of antisepsis fame and Ignac Semmelweis, who fought childbed fever by telling obstetricians to wash their hands. It is no accident that so many of the medical names that became familiar to ordinary people are associated with research to combat bacterial or viral diseases. Jonas Salk and Albert Sabin, the central scientific figures in Tony Gould's book, are two of the most recent of the breed.
The principle of single causes has yielded a bountiful harvest in terms of medical progress, but it has sometimes had a rather inhibiting effect on the recognition of other factors that either contribute to the evolution of a disease or are necessary conditions required for the single cause to result in pathology. Even the discovery of such surprises as the existence of three separate immunologic strains of the polio virus did not shake faith in the thesis. The notion's appeal is understandable: not only is the concept a vital stimulus to science, but it has been very attractive to a general public which often sees biomedicine in terms of campaigns, breakthroughs and conquests, and has traditionally hailed successful researchers as figures to be lionized. Since today's scientific endeavor has become increasingly complex and interdependent, however, it demands much more collaboration than in generations past. There will be no Jonas Salks or Albert Sabins among the geneticists. The day of the biomedical lone eagle is over.
And yet the memory of such soaring demigods continues to stir the hearts of a public woefully short of worship-worthy figures. Well-documented revelations of scientific fraud and a feverish quest for consulting fees and similar perks by some of today's researchers have fueled nostalgia for what are seen as the more direct truths of a previous era, and for less sullied idols. When Jonas Salk died this past June, an obituary writer waxed sentimental as he reminisced of the bygone day when "America's greatest hero was for a time a man in a white lab coat."
Almost exactly four decades ago, the name Jonas Salk was on everyone's lips. He was the white knight who had emerged victorious from doing single combat with the single cause of polio-myelitis. At a public meeting held in a large auditorium at the University of Michigan on April 12, 1955--it was, coincidentally the tenth anniversary of Franklin Delano Roosevelt's death--the Vaccine Advisory Committee of the National Foundation for Infantile Paralysis announced the long-awaited results of large-scale testing against controls of Salk's vaccine in schoolchildren. In that test, 200,745 children had been given the new preventive, with a resulting reduction of more than 50 percent in the number of cases of polio from what had been expected. Not one child had contracted the disease by being immunized.
In that brief announcement, the entire world heard the glorious news that had been so long awaited. Although at least 100,000 new cases of polio still occur every year in underdeveloped countries, the virus has been eliminated in the Americas and other Western countries. For this reason, and because the appearance of a new and universally lethal infectious disease has tended to blot out memories of previous epidemics of death and permanent disability, it is difficult for most people under the age of 45 to imagine the terrifying grip in which so-called infantile paralysis once held the entire nation and the world. It is primarily associated in the public mind with children, but poliomyelitis became, during the last decades of its prevalence, increasingly an illness also of young adults. In the height of summer in the early 1950s, when swimming pools and other publicly shared facilities came into greater use, it was common to encounter a hospital ward full of patients in their early 20s.
Despite speculation based on ancient tales and ancient art, no incontrovertible evidence has been discovered of polio's existence before the nineteenth century, at least not in its epidemic form. American historians think of it as a distinctly twentieth-century disease, since its incidence began to increase at a prodigious pace after the summer of 1894, when the nation's first real epidemic occurred in the form of 132 cases in Rutland County, Vermont. So rapidly did the numbers rise in various states following the Vermont outbreak that polio had become recognized, by 1910, as a major public health problem. Still, few were prepared for the dreadful watershed experience of 1916, when the incidence rate suddenly quadrupled. In that year 27,000 cases were reported from twenty-six states, and more than 6,000 deaths. A near-panic was precipitated in New York City, where an onslaught of 9,000 cases with 2,343 deaths occurred, causing authorities to resort to draconian (if ineffective) quarantine measures and even travel restrictions. Although epidemics continued to occur each summer, the numbers dropped back somewhat until the early 1940s, when the incidence began to increase gradually over the years. In 1952, health officers recorded 57,628 new cases.
Among neurological diseases of any significant frequency, polio is unique in its ability to cause rapid and often permanent paralysis in its victims. The crippling is the result of the destruction of motor cells in the spinal cord, occurring with such swiftness that it was not uncommon in my medical-school days more than forty years ago to see a child admitted in the morning with mild weakness of one leg who then went on to total neck-down paralysis by sundown and stayed alive only because he had been hastily placed in an "iron lung" respirator. Not a few of those patients died, and others needed some type of respiratory support for the rest of their lives.
Dr. Dorothy Horstmann, a leading polio researcher of that era, tells of visiting large hospital rooms where as many as thirty patients lay immobilized and helpless in their iron lungs, while nurses scurried about trying to attend to everyone's needs. As a third-year medical student, I saw a young woman die only a few hours after admission for lower extremity weakness, as the neurological damage progressed upward with such astonishing speed that she drowned in her own secretions while surgeons frantically attempted to make an opening into her windpipe. And these were not uncommon sights in American hospitals four decades ago. Even those who recovered were often left permanently disabled. Several hundred thousand Americans still bear the crippling residues of polio.
No wonder, then, the excitement of that April day in 1955, and no wonder that the long-hoped-for news was thought glorious. Despite every attempt at scholarly restraint by the levelheaded chairman of the committee, Dr. Thomas Francis Jr., the actual announcement of the Salk vaccine's success was accompanied, in the words of an observer, by "the rocket's red glare and flashbulbs bursting in air." The day's events were the stuff of extravaganza. Just as the field trials had represented the largest such medical effort in history, so the presentation of the outcome was turned into a public spectacle the likes of which had never before been witnessed. In addition to the auditorium full of newsmen and photographers, one of the vaccine's manufacturers was permitted to provide a special broadcast to 54,000 doctors in sixty-one cities by closed-circuit television. Years of research and a field study of meticulous scientific rigor were sensationalized to pander to the media and a worldwide audience hungry not only for good news, but for the appearance of a white knight. In the words of Dr. John Paul, a highly respected polio researcher of decades-long experience, "The information that had been gathered so painstakingly at the Evaluation Center and at such an expense of time, money, and energy, did not deserve to be so cheapened by the outburst that ensued."
The savior had been known as a modest man, shy in fact. He had already been made uncomfortable by the premature glare of the limelight two years earlier, when Time magazine printed his picture in an article proclaiming the imminence of a polio vaccine. The publicity following that article resulted in intense criticism from some of the other major workers in the field: John Paul, Thomas Francis and Albert Sabin. To worsen his discomfiture, a letter had come to Salk from Sabin, purportedly to advise his younger colleague not to "let them push you to do anything prematurely," but tinged with sarcasm and censure nevertheless. It was not the first time, nor would it be the last time, that Sabin would let fly a dart. And the darts were succeeded by flaming arrows.
Salk was 40 years old, the son of a worker in New York's garment district. He seems in retrospect to have been without resources to deal with his new fame. As Tony Gould nicely describes it, "Everyone wanted to shake or kiss his hand or touch the hem of his garment, write him letters of gratitude, shower him with cash and presents. Film stars wanted to visit him, film companies to immortalize him in Hollywood fashion; organizations voted him money, medals and honorary degrees; and finally Eisenhower himself summoned him to the White House to receive a Presidential citation." Had the Hollywood moguls gotten their way, they would probably have chosen someone like Jimmy Stewart to play Jonas Salk. But it would have been all wrong. It was not only that the balding, bespectacled City College graduate was neither handsome nor tall. The real problem was that Stewart's accustomed screened reticence would have been badly misplaced in a portrayal of the post-announcement Salk.
An egotism appeared that seemed not to have been evident before. The strongest charge leveled against the young superstar was his inability or unwillingness to share credit for an accomplishment that was felt by his colleagues to be the culmination of the work of so many others. Salk ignored even those who toiled in his own laboratory at the University of Pittsburgh. Perhaps most unforgivable to the scientific community was his lack of acknowledgment of the contribution of Dr. Isabel Morgan of Johns Hopkins, who, between 1945 and 1950, had accomplished the crucial step of immunizing monkeys against polio by using a vaccine made with virus that had been inactivated, or "killed," with formalin. By doing exactly the same thing in humans, Salk was only taking the next logical step in the journey begun by Morgan and others. None of those who had established the principles and the practices upon which the new vaccine was based was granted a share in the public acclaim.
Salk paid dearly for letting himself succumb to fast fame. Within three weeks of the day of celebration, some 4 million children had received doses of his vaccine, prepared by a total of five commercial laboratories. By late April, 200 cases of polio with eleven fatalities had been traced to a faulty vaccine made by Cutter Laboratories of Berkeley, California. There would be many more the following year. Accusations flew in all directions, but Salk was able to overcome those directed at him. What he was not able to overcome was the fact that his transformation from promising young virology researcher to the conquering hero of polio did not sit well with his colleagues.
Although the publicity must have been a factor, the real reason Jonas Salk was never fully accepted by those whom he would have liked to consider his peers is simply that the scientific quality of his contribution was not thought to be great. When a Nobel Prize was to be awarded for the solution of the polio challenge, it went not to Salk but to John Enders, Thomas Weller and Fred Robbins, who had enormously magnified the field's potential by devising the method of growing the virus in a culture medium other than nervous tissue, a magnificent achievement without which continuing research progress would not have been possible. Even the distinction of being elected to the National Academy of Sciences eluded Jonas Salk because that pantheon of investigators did not think his career merited it.
Compared to establishment figures such as Enders, Francis, Paul and Sabin, Salk was a Jonas-come-lately. His only previous noteworthy contribution was his work with Francis on an inactivated-virus influenza vaccine. Since the basis for his polio studies had been so well constructed by others, it was felt by those close to the field that Salk had overcome no great obstacle. In later years, his bitter rival Sabin would tell the medical historian Saul Benison, "You could go into the kitchen and do what he did." Despite the flagrant exaggeration of Sabin's comments, they seemed to echo the sentiments of other scientists as well.
There was far more at work here than the mere absence of high regard for a colleague's work. The fact is that the weight of scientific opinion in the late 1940s and the '50s favored the search for a vaccine made from live but attenuated, or "weakened," virus. The inactivated or "killed" variety that Salk developed is more difficult to administer and would confer a degree of immunity far less lasting. An attenuated virus vaccine produces mild subclinical infection in those to whom it is administered, as well as the likelihood that it will spread, like any contagious disease, to the non-treated population. Thus, many who have not been immunized develop antibodies that protect them against the disease.
Salk's experience with the inactivated virus he developed against influenza determined his decision to pursue a similar course when he began polio research in the late 1940s. Sabin, on the other hand, had begun studying polio as early as the epidemic of 1931; and in 1939 he had been the investigator who debunked the long-held theory that the route of entry of the disease was by way of the nose. His vast experience with the microbe had convinced him that the advantages of live-virus vaccine far outweighed the consideration that an inactivated preparation could be developed in a shorter time period.
Some of the most convincing support for the live-virus concept came from studies done by John Paul in 1950. Testing the blood of a large group of Eskimos in several Alaskan communities where the last polio exposure had occurred in a 1930 epidemic, Paul found that 80 percent of the adults but none of the subjects under the age of 20 had antibodies to the virus. "This meant," he wrote, "that once these Eskimos had been exposed and infected the resulting immunity was lasting!" This striking finding, which the usually undemonstrative Paul accented with italics and an exclamation point, was convincing evidence that a vaccine made from live virus was far preferable to Salk's approach.
1960 was Sabin's time to ride the white charger--or it would have been, had his thunder not been stolen five years earlier. In June of that year, the American Medical Association endorsed the live-virus vaccine that he had developed and tested extensively in Russia (and later elsewhere, including the United States). Within several months it was federally licensed and was rapidly replacing its inactivated predecessor as the vaccine of choice. Salk continued to argue that converting to live vaccine was "both unnecessary and ill-advised," because it carried some minimal risk of developing polio. In 1977, nevertheless, the authoritative Institute of Medicine came out in favor of Sabin's vaccine. With the exception of a few countries, it has become recognized worldwide as the proper method of immunization.
Unlike the newcomer Salk, Sabin had long been acknowledged by 1955 as one of America's leading virologists. His investigations, while serving in the Middle East and Mediterranean areas during World War II, of sandfly and dengue fevers and hepatitis had added to the luster of his earlier achievements with polio. In the postwar period he studied Japanese B encephalitis and continued his polio investigations. By the early 1950s, he was among the world's most experienced researchers in the use of both inactivated and attenuated virus vaccines. It was comparison with a background like Sabin's that made Salk seem a lightweight, especially to the competitive Sabin himself.
There was certainly an intense rivalry between the two, but there was no race between them (notwithstanding a statement to that effect in the breathless publicity accompanying Gould's book). Even though many proponents of a live vaccine knew it would be years beyond 1955 before they could develop their method of immunization, they considered it unwise to "waste" vast resources funding Salk's work when they had better uses for the money. He and his minority of supporters, on the other hand, made the appropriate point that a vaccine was needed soon, and in this he was backed by Basil O'Connor, the dynamic and shrewd president of the National Foundation for Infantile Paralysis.
Gould paints a lively portrait of O'Connor, whose deep involvement in the fight against polio began soon after he initiated his law partnership with FDR in 1925. A man of wit, charisma and wily charm, he goaded scientists and laity alike in every aspect of research, treatment and fund-raising, from provision of social services all along the spectrum to the most esoteric laboratory-bench research. O'Connor was indefatigable in his efforts, visionary in his ability to project short-term and long-term goals, and firm in his certainty that he knew what needed to be done. He was a man of determination and was possessed of the self-confident pragmatism needed to achieve his objectives. In the conflict over attenuated versus inactivated virus, he allied himself with the side that would produce a usable vaccine first, and he became, in a sense, Salk's mentor.
Publicity was beneficial to the foundation and O'Connor pursued it vigorously, encouraging Salk in the same direction. In spite of his preference for early and highly visible results, however, he understood the goals of scientific research as few laymen of that or any other time, and it is for this reason that he never stopped his openhanded funding of Sabin's investigations. It was this kind of vision and perception that lay behind O'Connor's most lasting and perhaps greatest contribution, which transcended even his role in the conquest of polio. Almost singlehandedly, O'Connor created the concept of the voluntary health organization.
Such groups as the American Cancer Society, the American Diabetes Association and the Alzheimer's Disease and Related Disorders Organization owe much of their present form and direction to the example set by Basil O'Connor. The foundation supported the research of a generation of virologists in the United States, and played a large role in the training of orthopedists, physical therapists, nurses and social workers. The organization's pioneering work in this regard is often forgotten. Fifty-nine percent of its budget went to such programs as the care and rehabilitation of those crippled by polio, while only 13 percent was spent on administration. Today, when so much academic research is funded by government in the form of the National Institutes of Health, it is interesting to remember that the foundation spent nearly $2,000,000 on polio research in 1953 while the NIH contributed only $72,000. O'Connor was never able to disguise his own self-interest, but his social conscience was the final measure of the man.
Many of these things are to be found in Tony Gould's book, described in a colorful, fluid style that brings O'Connor and Salk and other protagonists in the drama of polio vividly before a reader's eyes. The patrician Enders, the prickly Sabin, the direct and hard-driving Tom Rivers: these scientists, and the labyrinthine relationships among them, are the stuff of fiction, and Gould does ample justice to the entire panorama.
Still, one wishes that such a gifted writer had dug somewhat deeper. Gould relies almost entirely on secondary sources for historical material, even to the point of quoting extracts from several easily accessible medical articles directly from the popular books in which he found them, rather than reviewing the paper in its original setting. It is difficult to avoid wondering how many of the more than twenty bibliographical entries for scientific or scholarly publications were actually read by Gould. Extracts, quotations and similar material affect an author's perspective much more than is generally realized; separated from their place of origin and read only in the context of someone else's popularized version of events, these materials are sometimes misleading.
The secondary sources that provide the bulk of context for Gould's historical descriptions are those by Richard Carter, Jane Smith, Greer Williams, John Rowan Wilson, Saul Benison and John Paul. The first four of those books are popularizations. Only the ones by Saul Benison and John Paul are sufficiently authoritative and detached to be reliably used for proper historic documentation. Carter's Breakthrough: The Saga of Jonas Salk is an overt hagiography written at the suggestion of Basil O'Connor, with the aim of raising money to support the Salk Institute. No wonder Gould finds Carter "a skeptic" about statements by Russian officials concerning the hugely successful field trials of Sabin's vaccine.
None of the medical writings of Enders, Sabin, Salk or the others appear in the bibliography appended to A Summer Plague, and this lessens the book's value for readers who want to look further. When a book is so extensively (if inconsistently) annotated as this one, readers assume a certain thoroughness, but it is not to be found here. A number of the major players in the polio story were still alive when this book was being written, but Gould seems to have spoken to none of them. Rather than rely so heavily on the printed page of popular writers, he might have derived much of real value from the personal recollections of Dorothy Horstmann, Hilary Koprowski, Joseph Melnick, Fred Robbins and Jonas Salk himself. (Horstmann lives less than a mile from Gould's publisher. Yale University Press, which is ordinarily so scrupulous in having its books reviewed by authoritative readers before accepting them for publication, never contacted her.)
A visit with the eminent historian of polio Saul Benison might have added to Gould's perspective on the live versus killed virus debate, and would certainly have enlarged his familiarity with the leading personalities. Not only did Benison work closely with Basil O'Connor on the foundation archives, but as a leader in the field of oral history he conducted an extensive series of interviews with Sabin between 1974 and 1980. (Not yet published, the Sabin interviews have added a vital dimension to Benison's vast knowledge of the entire polio saga.) Had Gould spoken with Benison he might have learned, for example, that the generosity of John Enders was even greater than he knew: during the course of being interviewed for Tom Rivers: Reflections on a Life in Medicine and Science, Rivers told Benison that Enders insisted that his young associates, Fred Robbins and Thomas Weller, share the Nobel Prize with him. A good historian might also have directed Gould to the source of the culture medium that led them to their discovery and eventually the prize. Their studies took place during one of the periodic surges of enthusiasm for universal circumcision of newborns, and foreskins were plentiful at the Boston Lying-In Hospital. Embryonic or near-embryonic tissues being needed for the research, a readily available source presented itself.
Gould does claim that "three medical historians, Saul Benison, Naomi Rogers and Daniel J. Wilson, all spoke to me either in person or on the phone about their work." Since the book's historical descriptions show no evidence of a serious talk with Benison, I contacted the vigorous septuagenarian, and he told me that his only contact with Gould was a brief phone call, in which the conversation consisted of his answering questions about Naomi Rogers's 1992 book Dirt and Disease: Polio Before FDR, which the historian reviewed in the pages of The Journal of the History of Medicine and Allied Sciences. Gould's exaggeration somewhat qualifies his claims for authenticity.
A Summer Plague, in sum, cannot be taken seriously as a contribution to the study of polio's history. Perhaps it is better to think of it as a well-written tale, even if most of it is twice-told. Gould's storytelling is what will attract readers to his book, and keep them turning its pages. Although Gould is forced by the vastness of his subject to describe it in what are essentially separate pieces, he makes the whole narrative unfold naturally. He begins his tale in New York City at the height of the devastating polio epidemic in 1916. A keen sense of place pervades this chapter so intensely that the pessimism and the misdirected efforts of the health authorities seem almost to arise from the very conditions of daily life in the city.
Enter the man whom Gould calls "the laughing cavalier," Franklin Delano Roosevelt. A mood of optimism instantly suffuses the narrative. Since it was forbidden to photograph FDR in situations that might reveal the degree of his physical disability, a re-reading of history has recently appeared in which we are to believe that the public was barely aware of it. Those of us old enough to remember know that the truth was otherwise. And Gould shows us a Roosevelt so personally involved in the day-to-day campaign against polio, so acutely aware of his role as an inspiration to those crippled by it, that today's readers will see facets of that great-hearted spirit which have been forgotten.
"An Angel Abroad," the title of Gould's chapter on Sister Elizabeth Kenny, derives from a memo that was sent by Basil O'Connor to FDR. The designation is as controversial as was the woman herself. Gould begins by pointing out that there is no commemoration in the Polio Hall of Fame at Warm Springs for "the outspoken nurse from the Australian outback who revolutionised the treatment of polio in the teeth of powerful opposition--medical, political and personal." The rest of that paragraph gives the flavor of the book's style.
Not that one should feel too sorry for this strapping, upright Irish-Australian "Sister" (in the nursing rather than the religious sense): she was no mean bruiser herself, often pre-emptively lashing out at a potential opponent. She was also a tireless propagandist--worthy rival, in this respect, even to O'Connor--the subject of a schmaltzy Hollywood movie and for many years second only to Eleanor Roosevelt (and once first) in the U.S. women's popularity stakes, as conducted by Dr. Gallup.
That brief extract goes far toward explaining Elizabeth Kenny's absence from the Polio Hall of Fame, and it is also a fair sample of Tony Gould's writing. He further describes Kenny with words such as "authoritarian," "boorish" and "abusive." Writers are quoted to whom she is "a giant of a sea captain" and "a real pain in the ass." But the pain in the ass prevailed, and the National Foundation endorsed her innovative treatments in December, 1941, though it refused to fund the Kenny Institute less than two years later.
Sister Kenny did, in fact, accomplish a kind of revolution. Before her, the treatment of crippling polio was primarily conducted with prolonged rigid immobilization using splints or even plaster casts, even though no one could demonstrate any real benefits from such a psychologically harmful approach. It was Sister Kenny's hypothesis that muscle spasms must be relaxed with warm moist packs, followed by passive movement and the encouragement of early reactivation. To a greater degree than Salk, Sister Kenny allowed herself to become the subject of a cult and the creature of publicity, a mistake that angered physicians and slowed the acceptance of her teachings. She was a walking paradox. A pediatrician who visited the Kenny Institute in Minneapolis came away with feelings so mixed that he described her two facets in a single phrase: "Miss Kenny is an amazing woman with a rather unfortunate Messiah complex."
It is not for its portrayals of the polio conquerers that Gould's book is most valuable but for its description of the lives of its victims. In telling the individual stories of a group of badly disabled survivors, Gould's voice softens; the adjectives are gentler and seem fewer in number. These are people he really understands, and in him they recognize a comrade. The very matter-of-factness with which they tell of their experiences in long fascinating passages, and the straightforward manner in which Gould presents them to us, stand in stark contrast to the colorful interjections that characterize much of the rest of this book. An air of calm and familiarity pervades the hundred pages the author gives over to these tales of perseverance and courage as he relates them one by one.
But Tony Gould is on familiar territory here and needs no instruction. He contracted polio at the age of 20, while serving in Hong Kong as an officer with a Gurkha regiment. He came close to death, being saved only by the hurried insertion of a breathing tube into his windpipe. He progressed from iron lung to a leg brace and crutches, and finally to canes, all the time receiving intensive physiotherapy. Although he no longer wears the leg brace, he still requires two canes for balance when he walks. And so he is, to use his own words, "my own exegete." When he has completed the stories of the others, he writes about himself. The experience of polio, he writes, can help a person to "discover within yourself resources you might not otherwise have found." That has so often been said about one or another of the afflictions of life that it has shrunk to the dimensions of the shopworn. And yet there are many proofs of its truth, among which is now the simple eloquence of Tony Gould when he writes about things he knows well, when he tells his deeply affecting stories of those who have endured polio, and his own story, too.