Toms River by Dan Fagin

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 ErzgebirgeMountains, 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