Toms River (21 page)

Where were those unhappy but epidemiologically fecund places? In the late nineteenth century, one of the best candidates was a region Paracelsus had passed through 350 years earlier: the Erzgebirge
Mountains, which straddle the border between the German state of Saxony and Bohemia in the Czech Republic.
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The Erzgebirge (German for “metal ore mountains”) had been continuously and heavily mined since 1410. The silver deposits discovered in the sixteenth century near the Bohemian town of Joachimsthal (Saint Joachim’s Valley, in English) were so bountiful that
thaler
came to be a synonym for coinage; in English-speaking countries, it was translated as
dollar
, since
dale
was a synonym for valley.

Even in Paracelsus’s day, the Erzgebirge miners were known to die young, often from the same set of debilitating symptoms that came to be known as “mountain sickness” or “miners’ exhaustion,” among many other descriptive terms. In fact, mountain sickness was lung cancer, although Paracelsus did not fully recognize it as such.
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In the late nineteenth century, the largest complex of mines was in Schneeberg, on the German side of the mountain range. It was a desultory region of impoverished villages, and there was almost no work to be had outside of the mines, which by the late 1800s were mostly producing bismuth, nickel, and cobalt. The latter two metals were extracted from a gray crystalline mineral called smaltite that consisted of cobalt, arsenic, iron, and nickel. For centuries at Schneeberg, smaltite had been mined by pickax, but by the 1870s miners were blasting it out with dynamite, which Alfred Nobel had commercialized in 1867. It mattered little to the health of the miners, because both techniques, by ax or by blast, generated thick clouds of toxic dust in the poorly ventilated mineshafts, some of which were more than two thousand feet deep. The conditions were so brutal that miners who managed to survive to middle age were often so incapacitated that they could no longer work in the mines and instead scratched out a living carving wooden toys and nutcrackers like the one in Tchaikovsky’s ballet.

Into this pathetic tableau entered a young doctor named Walther Hesse in 1877. As the newly appointed district physician in the Schneeberg region, Hesse was responsible for eighty-three villages, which he set about visiting, traversing the mountain roads via horse and buggy and occasionally on foot. At thirty years old, he was already a man of the world, having trained in Dresden and Leipzig and fought the
French as a battlefield surgeon in the Saxon Army.
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He was appalled by what he saw in the villages and mines of the Erzgebirge. “As a rule,” he later wrote, “the miners marry early and leave behind a large number of children in pitiful circumstances, who naturally must look for [a] line of business as soon as possible.… Like their fathers, they age quickly, and with the greatest probability face the same previous mentioned fate of their fathers.”
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There was one other physician in the region, Friedrich Härting. The medical officer of the largest mine in Schneeberg, Härting kept track of the number of deaths at the mine and had been quietly urging his employer to improve working conditions. To build a more persuasive case, the two physicians decided to conduct a study together to measure the prevalence of “mountain sickness” and perhaps even identify its likely cause. Like John Snow and other pioneers of the nascent field of epidemiology, Hesse and Härting attacked the problem on multiple fronts. They counted cases, autopsied dead miners (confirming for the first time that mountain sickness was, in fact, lung cancer), searched for similarities among the ill, and measured environmental conditions in the mineshafts.

In two manuscripts, a short article Hesse wrote in 1878 and a longer one he coauthored with Härting the following year, the two physicians disclosed their findings. Between 1869 and 1877, they reported, 145 of the approximately 650 miners in Schneeberg had died of lung cancer, most of them under age fifty. Excluding accidents, lung cancer accounted for 75 percent of all deaths. It was a shockingly high percentage, even compared to miners elsewhere. Clearly, the Schneeberg mines were a particularly fertile environment for lung disease and early death, but why? The doctors’ autopsies of twenty dead miners suggested that they had inhaled something highly toxic: Their lungs had shrunk to the size of two fists, were riddled with bronchial tumors, and contained almost no air. What could have done all that damage?

Hesse and Härting tried mightily to find out, but could not. They were looking for something that was present in the Schneeberg mines but not elsewhere, since they had written to the managers of other mines and were assured that there were no lung cancer epidemics
there. Smaltite, the arsenic-infused mineral, was their leading suspect. It was much more common in Schneeberg than elsewhere and was known to be a lung irritant. Another clue: Schneeberg miners told the two physicians that mountain sickness seemed most commonly to afflict laborers who spent their time extracting minerals, instead of blasting tunnels or doing other jobs. Since nickel and cobalt miners worked most directly with smaltite, while bismuth miners did not, the physicians tried to compare cancer rates in the two groups but were thwarted because the miners constantly changed jobs and because the smaltite dust was everywhere, even in the bismuth-mining areas. Hesse and Härting looked for other ways to make comparisons, too, including the use of wax paper dust-collectors to see if some tunnels were dustier than others and of filter-equipped facemasks to try to measure how much ore dust miners inhaled.

In their 1879 report, however, they conceded that each of those attempts failed to pinpoint a specific cause for the cancers. After two years of investigation, they were stymied. They wrote up their inconclusive results, called for improved conditions in the mines (again, to little effect), and never again published on the subject. Härting returned to his quiet work as a mine physician, and the peripatetic Hesse moved to Berlin and embarked on what he doubtless regarded as a much more fruitful area of medicine than cancer epidemiology: infectious disease.
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For all his progressive impulses, Walther Hesse, who died in 1911, never fully grasped the importance of what he and Friedrich Härting accomplished in Schneeberg in 1878. For the first time, someone had taken the tools of infectious disease epidemiology—case counts, geographic and temporal patterns, interviews, environmental measurements, physical examinations—and applied them rigorously to cancer. The result was a confirmed cancer cluster, the first one that could withstand doubters’ scrutiny. Later, other German scientists—most notably Ludwig Rehn, who first linked bladder cancer to aniline dye manufacture in Frankfurt in 1895—would be inspired by the Schneeberg work. True, Hesse and Härting had failed to identify the specific cause of the lung cancer epidemic in Schneeberg, but as subsequent generations of epidemiologists would affirm in Toms River
and elsewhere, it was extremely difficult to complete even the first step of confirming a nonrandom, true cancer cluster. The second step, determining a true cluster’s likely cause, was just about impossible in most cases—but not in Schneeberg, as it turned out.

What Hesse and Härting did not know was that the mineshafts of Schneeberg were veritable shooting galleries of high-energy gamma rays and fast-moving particles emitted by the unstable nuclei of radioactive elements like radon, bismuth, cobalt, nickel, and uranium in smaltite and other local minerals. Experimenting in the 1890s with minerals from the Erzgebirge, Henri Becquerel and Marie Curie, among others, identified the basic processes of radioactivity. Soon after, researchers returned to the mines with photographic plates, Geiger counters, and other tools to measure radiation. Most of the sources of radioactivity in the mines, it turned out, were metallic elements, but one—radon, formed by the radioactive decay of uranium and radium—was a gas that could be easily inhaled. Soon after the Nazis occupied Bohemia in 1938, they discovered that lung cancer was an epidemic among miners in Joachimsthal as well as Schneeberg. The Germans launched an ambitious study of the two mining centers, conducting autopsies on dead miners, experimenting on animals, and taking extensive radon measurements in the tunnels.
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By 1939 they were certain that radon was the cause of the lung cancer epidemics in Schneeberg and Joachimsthal, and they were right. That knowledge, however, did not end the abusive conditions at both locations, especially after the prospect of atomic weaponry made uranium the most precious natural resource in the world. After the war, Joseph Stalin used slave labor at Joachimsthal to build the Soviet Union’s atomic stockpile. The U.S. government, meanwhile, downplayed similar evidence of widespread lung cancer among miners on the Colorado Plateau as it rushed to secure fissionable uranium for nuclear weapons. Even now, radon remains one of the few environmental carcinogens over which there is little debate—it is second only to cigarette smoking as a cause of lung cancer in the United States, responsible for an estimated twenty-one thousand deaths each year thanks to its ubiquity in many types of soil.
⁹

Using every technique and tool he could think of, Walther Hesse
had managed to find a cancer cluster in one of the most obvious places in the world to look for one. His successors even succeeded in identifying its cause. For the nascent science of cancer epidemiology, it was a misleadingly promising start.

The slow awakening on Cardinal Drive in the early 1980s was not happening in a vacuum. The world was changing, too, and some parts of it were changing much faster than Toms River. In 1977, a
Niagara Gazette
reporter named Michael Brown began investigating reports of illnesses and pollution in a working-class neighborhood of his hometown of Niagara Falls, New York. The neighborhood came to be known as Love Canal for its namesake feature, a never-completed canal that from 1942 to 1953 was used as a clay-lined dumpsite for drummed and uncontained waste chemicals, including aniline derivatives and benzene. In 1953, Love Canal was covered with dirt and sold by the Hooker Chemical Company to the local school board for the token sum of one dollar, plus the inevitable liability waiver. The members of the Niagara Falls Board of Education knew what was in the canal and had even toured the site with Hooker officials, who drilled holes into the clay so that school officials could see the chemicals beneath. But the school board members, like their counterparts in Toms River ten years later, were intent on finding cheap land for another school to serve their fast-growing community, so they built an elementary school right beside the old dump. Hundreds of new homes soon followed, in an area that had been mostly open land during the years when Hooker was dumping. Homebuyers were not told that they would be living beside (and in some cases on top of) an old hazardous waste dump.

By the 1970s, the Love Canal neighborhood was rife with reports of strangely colored water in basement sump pumps, dead backyard vegetation, foul odors, and illnesses including miscarriages, birth defects, and cancer. In some parts of Love Canal where the earthen cap atop the old landfill had collapsed, the tops of fifty-five-gallon drums poked through the surface, especially after heavy rains. Michael Brown’s stories in the
Niagara Gazette
galvanized the community, prompting a charismatic young housewife named Lois Gibbs to organize
street protests and attempt some do-it-yourself epidemiology, including mapping the locations of homes where there were health problems. Her son, Michael, had developed epilepsy and a low white blood cell count shortly after beginning kindergarten at the elementary school beside the dump. In the summer of 1978, after studies confirmed high levels of airborne chemicals in dozens of nearby homes, New York State took the unprecedented step of declaring a health emergency at Love Canal, closing the school and evacuating the residents of 239 nearby homes. Five days later, President Jimmy Carter followed with a federal disaster declaration—the first one ever prompted by a non-natural disaster.

Seemingly overnight, the long-slumbering issue of hazardous waste became a national crisis, with Love Canal its epitome. In Niagara Falls, the ensuing maelstrom of heavily publicized protests and worrisome medical studies—at one point, panicked residents briefly held two Environmental Protection Agency officials hostage at the headquarters of the local homeowners’ association—eventually forced the state and federal governments to expand the evacuation zone to include up to nine hundred additional homes in 1980.

Love Canal had laid bare the limitations of the EPA’s clout on hazardous waste cases, and Congress resolved to do something about it. Four years earlier, it had passed the Resource Conservation and Recovery Act, which gave the agency authority to compel emergency investigations and cleanups at waste sites. But the law’s reach was limited, and the short-staffed EPA used its authority only at the most egregious dumpsites. In most cases, the old dumps were left to the states to address or ignore as they saw fit. After the Love Canal crisis, however, Congress rushed to enact a powerful new law designed specifically to deal with hazardous dumps. Signed into law by President Carter in December of 1980, it was called the Comprehensive Environmental Response, Compensation, and Liability Act, but everyone knew it as Superfund. It directed the EPA to compile and rank a list of the most dangerous toxic waste sites in the country and then oversee their cleanups, which would be funded by the dumpers or, if they could not be found, by a special “superfund” raised from fees on the chemical and petroleum industries and from general tax dollars.
Under the doctrine of retroactive liability, companies could be held responsible for cleanup costs even if their dumping was legal at the time. If a dumper refused to comply with a cleanup order, the EPA could tap the Superfund to pay for the remediation and then take the company to court and recoup up to three times as much as the agency had spent on the cleanup.