Toms River

by Dan Fagin

  The extra privacy on Cardinal Drive was a special attraction for the families who moved there. The McVeighs already lived in Oak Ridge but moved to Cardinal Drive in 1977 because William McVeigh loved the idea of having a forest in his family’s backyard. “It was so peaceful,” remembered his wife, Sheila. “You’d be back there and you’d feel like you were in the country. You couldn’t see anything or hear anything, it was just trees.” She first heard about the problems with the local groundwater when a neighbor came over to report that the county health department had refused to let her use well water to fill her swimming pool. That sounded disturbing, but what did it really mean to have chemicals in the earth a few feet underneath your property? Sheila McVeigh was not sure, but she was glad that she and her husband, seeking more play space for their two young daughters, had replaced a backyard vegetable garden with sod when they moved into their house. The previous owner, an avid gardener, had died of cancer.

  Ray and Shelley Lynnworth had lived on Cardinal Drive even longer—so long that when they first moved into their split-level brick home in 1968, there was no back fence. The yard just trailed off into the woods, giving the quarter-acre property a certain bucolic majesty. Even after the fence went up in the early 1970s, the Lynnworth children—Jill, born in 1967, and Randy, in 1969—did not regard it as an inviolable barrier. “Did Randy climb over the fence sometimes and go into the woods of Ciba-Geigy? Of course he did. All the neighborhood kids did that,” Ray Lynnworth remembered. The children swam in the nearby river, too. The Lynnworths knew that the land belonged to Toms River Chemical, but they did not consider that a bad thing. Quite the contrary, they loved the privacy. There were unpleasant odors at times—usually at night, since that was when the factory’s smokestacks, out of sight but not out of range, were busiest. Their home’s west-facing windows, looking toward the hidden smokestacks, were a bit grittier to the touch than the other windows, as if they had been finely etched by dust particles. But these were small inconveniences, easily overlooked.

  There was talk on Cardinal Drive about unexplained illnesses, just as there was more than a mile away in Pleasant Plains, in the shadow of another toxic waste site at Reich Farm. But unlike the residents of Pleasant Plains, the families who lived on Cardinal Drive and in the rest of the Oak Ridge subdivision got their water through the pipes of the Toms River Water Company, not from their own backyard wells. The neighborhood had been hooked up to public water since the early 1960s, and it tasted fine most of the time. Some homeowners still used their old backyard wells or drilled new ones to save money on their water bills. They used this backyard water to irrigate their lawns and gardens or fill their swimming pools, though rarely for drinking or showering because the well water had a faint but unpleasant odor, a bit like paint thinner.

  Toms River Chemical had said nothing to its neighbors about the risk of well contamination, even though on the other side of the fence, the aquifer beneath the factory property had been so contaminated for so long that the company had resorted to drilling a well more than two thousand feet deep in its neverending search for unpolluted water for the factory’s own use. The company was acquiring so much expertise in groundwater testing, in fact, that in 1980 two of its executives, Jorge Winkler and David Ellis, bought a local water-testing firm and set up their own private testing business, staffed by their wives, both of whom also had some scientific training. The firm’s clients included the Toms River Water Company and several homeowners in Oak Ridge. Winkler and Ellis did not consider this to be a conflict of interest because no one could say for certain if Toms River Chemical was responsible for the contamination in Oak Ridge and also because their wives—not they—did the analytical work at the firm, known as J. R. Henderson Labs. “It was very clear that eventually one day Henderson Labs potentially would find things that Ciba-Geigy was responsible for. Until that happened, I didn’t see any reason to change course,” Winkler recalled. To Winkler, the arrangement made perfect sense: Who in town had more expertise with groundwater contamination than they did?

  At first, the test results from the Cardinal Drive irrigation wells were comforting: Henderson Labs conducted the county health department’s standard battery of tests for bacterial contamination and found nothing. Starting in 1982, however, the lab started urging its clients to pay for a more expensive analysis capable of detecting toxic chemicals, not just bacteria. The new tests found dozens of hazardous compounds. All of a sudden, the same wells that neighbors had been using for years to water their lawns and gardens—and occasionally as sources of drinking water—were regarded as so contaminated that the county health department declared that they had to be immediately abandoned and plugged.1 Of course, no one could say for certain how the chemicals had gotten in those backyard wells, or whether they had made anyone sick.

  By the time Randy Lynnworth was twelve years old, he could outrun his equally athletic father in a five-mile race; sometimes, just to keep things close, he would spin around and run backward until his father caught up. Randy was bright and funny, an excellent student who seemed destined to become an equally accomplished adult. He was almost never ill, so when he got a splitting headache and nearly collapsed during a relay run in late 1982, his parents were worried. They got their answer three weeks later, from a brain scan: Randy Lynnworth, at thirteen, had an advanced case of a highly malignant cancer known as medulloblastoma. As with Michael Gillick’s tumor, Randy’s was a blastoma, which meant that it began with the malignant transformation of precursor stem cells—in his case, the cells were located at the base of the brain beside the cerebellum. The tumor formed by those rogue cells was large and virulent, and Randy might not even survive the operation to remove it. A few days after the surgery, he lapsed into a coma. After several agonizing weeks during which Randy was unresponsive, the family was advised by a physician to stop feeding him and let him die in his own bed. They did so for less than a day before changing their minds and resuming his meals. Shockingly, after ten weeks in a coma, Randy abruptly awoke, as talkative and quick-witted as ever, albeit with a speech impediment, memory lapses, and a battery of physical disabilities.

  That was an electric time on Cardinal Drive and in the larger community. If Randy Lynnworth could wake up, then anything seemed possible. His sudden and horrific illness had been widely publicized, and now it seemed like the whole town was participating in his recovery. The former long-distance runner could not walk, so his parents installed a set of parallel bars in the living room and Randy began working to strengthen his upper body so that he could confidently pilot his wheelchair. In the fall, he made a triumphant return to school (by now it was high school), steering his wheelchair through the halls with the same spirit of reckless abandon he had brought to his running. Camp was not an option, so during the summer of 1984 his parents organized a day camp on Cardinal Drive for all the neighborhood kids and Randy, too. Life was far from normal, but Randy was writing poems and cracking jokes, and that was enough.

  As the months passed, the Lynnworths dared to wonder if the doctors might be wrong and Randy might beat cancer after all. For the first time, they even allowed themselves the freedom to wonder why he had gotten sick in the first place. It was impossible to live on Cardinal Drive and have a child with cancer and not think about Toms River Chemical. Initially, Ray and Shelley Lynnworth had a hard time believing that there could be a connection. “The idea that there might be a cancer cluster, that was something that built very slowly,” Ray Lynnworth recalled. However, he did remember how the oncology surgeon at New York Hospital reacted after first hearing about Randy: “Another one from Toms River,” the doctor had said. There certainly did appear to be an unusually high number of local families touched by childhood cancer. Was there really a cluster of cases, perhaps even one that was somehow caused by exposure to manmade chemicals like the ones that Toms River Chemical had vented into the air and dumped into the ground? Would it ever be possible to find out? The Lynnworths wondered.

  The tr
iumphs of John Snow and William Farr during the cholera epidemics of the mid-nineteenth century finally proved what had been suspected by observers as far back as Hippocrates: Infectious diseases waxed and waned across populations in nonrandom patterns that could be mapped in space and time. In other words, they clustered. But what about diseases like cancer that took years to develop and generally were not infectious? Percivall Pott, with his wretched chimney sweeps, and John Ayrton Paris, with his Cornish copper smelters, had described what they thought were associations between those occupations and scrotal cancer. Other physicians noticed apparent clusters of scrotal cancer among workers in factories that manufactured paraffin wax derived from coal tar.2 But their observations, involving just a handful of cases, lacked the scope and precision of Farr’s statistical ledgers and Snow’s maps. Skeptical peers were mostly unconvinced, their doubts bolstered by the work of Siméon Poisson and other pioneering statisticians who showed how easy it was for apparent clusters to be caused by nothing more sinister than random chance, especially when only a few cases were involved.

  But why shouldn’t cancers cluster? If Rudolf Virchow was correct that all cancers begin when an external event disrupts a healthy cell and triggers a frenzy of cell division, it stood to reason that the external trigger—whatever it was—would have similarly lethal effects for many other individuals exposed to it, just as the cholera bacterium did. The patterns of cancer incidence deduced by a well-designed epidemiological study might even provide crucial clues about the identity of those triggering events, just as Snow’s maps implicated a water-borne contagion for cholera.

  Cancer was immensely more difficult to study than a cholera epidemic, however. Through his microscopic analysis of cancerous cells, Virchow had helped to prove that cancer was not one common disease but many rarer ones, each with its own pathology and place of origin inside the body. Besides uncontrolled cell division, just about the only characteristic that most types of cancer had in common was that it usually took years for a tumor to grow large enough to be noticed. So a John Snow–style study of potential environmental causes of cancer—incorporating columns of figures, maps, questionnaires, physical exams, environmental measurements, and all the rest—stood a chance of being fruitful only if a researcher was lucky enough to stumble upon an island of misery whose population had just the right characteristics. The population had to be definable and stable, without too many people coming or going over the years. It had to be affected by an unusually intense and easily measured form of pollution, one that might be carcinogenic. And it had to be afflicted with so many cases of a particular type of cancer that the cluster could not reasonably be dismissed as an unlucky fluke.

  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.3 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.4

  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.5 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.”6

  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.7

  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.