Toms River (14 page)

A strike at the Bound Brook plant initially slowed down the operation, but soon Fernicola and his drivers were making two trips a day—or sometimes just one, on days when they parked their rigs at Freehold Raceway and spent the afternoon betting on the horses. It was not all fun and games, though. Sharkey, belatedly recognizing how much profit Fernicola was clearing, began to squeeze him, upping his price to $20 per truckload and threatening further hikes, according to Fernicola. He responded by convincing Union Carbide to agree to pay him an extra dollar per drum. Fernicola also tried to generate more income with a scheme that hearkened back to his father’s trade in Newark. Instead of rolling the drums into the pit, he
started tipping them and letting the waste run out and splash directly onto the earthen floor of the unlined landfill. Then he would put the empty drums back on his truck and try to resell them. Unfortunately for Fernicola—and for the families of Toms River, as things turned out—most of the drums were already beat-up and leaking and thus valueless for resale.

Whatever its rewards, Fernicola’s hauling operation was not without its risks. One rainy day in early September, some drums freshly deposited in the town landfill exploded after coming in contact with water. One of them blew fifty feet into the air. The landfill manager blamed Fernicola, who insisted he had nothing to do with it. By then, though, his arrangement was already unraveling. According to Fernicola, Sharkey had upped his demand to $50 per load—and Fernicola had turned him down flat. He was already working on a new plan.

In 1837, two years after the pioneering statistical analyses of the French physician Pierre Louis had laid the groundwork for investigations of disease clusters, tuberculosis claimed a woman known to history only as “Miss Langford.” There is no record of her first name, only that she was a farmer’s daughter from Shropshire, in the West of England, and that she had been married for three years to a struggling young London physician named William Farr, an admirer of Louis’ statistics-based “numerical medicine.” The bereft widower consoled himself by studying the death records of the City of London, looking for patterns in the waves of communicable disease that regularly washed across the metropolis, killing thousands in their wakes, including his own Miss Langford. Perhaps, he thought, the same kind of rigorous statistical analysis that Pierre Louis had used to such great effect to discredit bloodletting could also be used to understand and even master the much greater terrors of tuberculosis and cholera.

He was not the first to try. Investigators had been trying to discern and interpret patterns of disease outbreaks ever since Hippocrates, who wrongly thought that swamp water caused malaria because the disease was more prevalent in swampy areas (he knew nothing about mosquito-borne parasites). The Greeks were bested by Avicenna, the Persian physician whose fourteen-volume
Canon of Medicine
, completed
in 1025, was hurled into a bonfire by Paracelsus five centuries later in Basel. The torching was undeserved. Despite Avicenna’s wrongheaded devotion to humoral theory, his many insights included the identification of tuberculosis as an airborne communicable disease. He proposed quarantines and suggested that contagious diseases could be transmitted through water and soil as well as “pestilential” air.
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The spread of his ideas to Western Europe led to the founding of hundreds of quarantine hospitals for lepers. When the bubonic plague arrived in 1348, many cities—including Basel—adopted laws requiring improved sanitation and, later, the isolation of anyone afflicted with a disease considered contagious. Isolating its victims did little to curb the Black Death, which was caused by a bacterium carried by fleas and rats, but cleaner streets helped marginally.

Fear of communicable disease also led to another crucial innovation: the collection of statistics on disease rates, which began in London in the 1530s with the issuance of weekly bills of mortality. Originally devised as an early warning system for outbreaks, the weekly reports were scrutinized by anxious English nobility who would flee to their country estates at the first sign of the Black Death’s return to the teeming, filthy city.
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In 1837, Parliament created the General Register Office to centralize and expand collection of vital statistics, including the successors to the old bills of mortality. The young widower William Farr, meanwhile, was busy publishing articles based on his research into disease statistics, including one influential book chapter in which he argued that there was a mathematical symmetry, and thus predictability, to the rise and fall of disease outbreaks.
¹⁰
His work caught the attention of some prominent Londoners, and in 1839 Farr was appointed “compiler of abstracts” in the new General Register Office.

Communicable diseases turned out to be ideal proving grounds for the new “numerical medicine” Farr had embraced. Certainly they were more suitable than cancer. Copper smelting might cause scrotal cancer, as John Ayrton Paris suspected, but that was mere speculation unless other possible causes—including mere chance—could be identified, tested, and excluded. Highly transmissible diseases like
cholera or tuberculosis, on the other hand, were much easier to study as they sliced through a city, afflicting thousands of people at a time. These diseases could be diagnosed just days or even hours after infection, and their transmission routes were often apparent—or soon would be.

In fact, the causes of these outbreaks seemed so obvious to Farr that he did not wait for conclusive evidence before campaigning for preventative measures. Like most of his peers, he thought that tuberculosis and cholera were caused by “miasma”—air poisoned by vapors from garbage and feces—so he championed legislation to improve sanitation. As he wrote in 1847, “This disease-mist, arising from the breaths of two millions of people, from open sewers and cess-pools, graves and slaughterhouses, is continually kept up and undergoing changes. In one season it is pervaded by cholera; in another, by influenza; at one time, it bears smallpox, scarlatina and whooping-cough among your children, at another it carries fever on its wings. Like an angel of death it has hovered for centuries over London. But it may be driven away by legislation.”
¹¹

And it was. Cholera was the turning point. The Victorians did not know its cause (they were wrong about “miasma”) and had no effective treatment for it, but Farr and his colleagues managed to devise a robust response that more or less held cholera outbreaks in check. In the process, they pointed the way toward a new kind of medical science that focused on patterns of illness within and across communities. They created modern epidemiology. In fact, just about all of the key ideas that would eventually be utilized to try to understand pollution-induced cancer in Toms River would be developed not through investigations of lumbering maladies like cancer but through much simpler investigations of fast-moving communicable illnesses.

The first important test of Farr’s ideas was the cholera that swept through London in 1848 and 1849. Farr assumed that the miasma, or fetid air, was at its worst near the filthy Thames River, so he checked the General Register Office records to see whether cases were concentrated near the river. As his successors would do in Toms River exactly 150 years later, Farr also looked to see where the affected neighborhoods got their water. In both cases, his analysis implicated the
Thames: Cholera rates appeared to be high among those who drank contaminated river water. When cholera returned in 1853, Farr again counted cases in various parts of the city, noticing that there were slightly fewer in an area where the water supply had recently been improved. As he pressed the city’s water companies to find cleaner sources of drinking water, Farr speculated that a much larger epidemic would strike the following year. He made little headway with the companies, but a quirky forty-year-old physician named John Snow began paying close attention to Farr’s reports and started compiling his own data, too.

Farr’s prediction was correct. Cholera returned in the summer of 1854, killing tens of thousands in a much larger outbreak. John Snow regarded the epidemic as a preventable tragedy. A bachelor who did not smoke, drink alcohol, or eat meat, Snow was a pioneer in the use of anesthesia (earlier that year, he had given chloroform to Queen Victoria during the birth of her son Leopold). He took pride in being unencumbered by orthodoxy, including the prevailing miasmic theory of disease. Since cholera’s symptoms were centered in the gut, Snow thought it spread via bad water, not air. He practiced what he preached by refusing to drink water unless it had been boiled first.

Like Farr, Snow thought that cholera’s secrets could be unmasked by analyzing the geographic distribution of cases around London—and he had a more sophisticated idea of how to do it. Snow knew that after the cholera outbreak of 1849 devastated South London, one of the district’s two major water suppliers, the Lambeth Company, had responded to Farr’s entreaties by moving its intake pipes to a cleaner, upriver portion of the Thames. Meanwhile, its main competitor in South London, the Southwark and Vauxhall Company, continued to draw from a highly contaminated stretch of the river in the central city. That set up the conditions for what Snow later called a “grand experiment” in which his theory that cholera was a waterborne contagion could be tested in neighborhoods supplied by two different water sources. When the major epidemic struck in 1854, Snow used Farr’s data tables to test his theory. He found that the death rate in houses supplied with contaminated water from Southwark and Vauxhall was almost nine times higher than in nearby houses that used the
much cleaner Lambeth water, and more than five times higher than the death rate in the rest of London.

It was a penetrating observation, but Snow’s iconic status as the pivotal figure in the history of public health rests on what he did next. In the late summer of 1854, as what he later called “the most terrible outbreak of cholera which ever occurred in this kingdom” raced through the Soho district, near his home, Snow decided to attempt a more direct investigative approach—one that would be emulated in Toms River.
¹²
With Farr’s help, Snow got the names and addresses of victims in three of the hardest-hit districts in Soho and resolved to determine the circumstances of each of the eighty-three deaths that had occurred there between August 31 and September 2, 1854. With assistance from a local minister, Henry Whitehead, Snow spent the next four days questioning families or friends of each victim, asking the same questions each time to avoid bias. He quickly discovered that all but a handful of those who had died had gotten their water from the same well, on Broad Street. Intent on showing exactly when and where the victims were infected, Snow drew maps showing where they lived and also how the epidemic had waxed and waned over time. Both kinds of mapping—geographic and temporal—would become standard techniques in Toms River and elsewhere.
¹³

There was still no direct evidence that the Broad Street well was the source of the epidemic in Soho—microscopic examination of the water was inconclusive—but John Snow refused to wait for more deaths. When he met on September 7 with the board that served as the parish’s local government, Snow presented his circumstantial evidence so forcefully that the board agreed, as an experiment, to disable the well by removing its pump handle. The outbreak, which was already waning as residents fled the area, quickly ended. Still, city authorities were reluctant to accept his theory that cholera was a waterborne contagion, even after Snow identified an old cesspool that was three feet from the well as the likely source of the outbreak.
¹⁴
To Snow’s dismay, the pump handle was replaced soon after the outbreak ended because residents wanted the convenience of a nearby well. As in Toms River, comfort trumped precaution; memories were short. Cholera would strike London again in 1866, though this time Farr
was able to prevent another outbreak by identifying a particular water company as the contamination source. By then, the frustrated Snow was dead, felled by a stroke at forty-five, despite his abstemious lifestyle. His ideas would not be fully vindicated until 1885, when Robert Koch identified a rod-shaped bacterium that thrived in sewage-contaminated water,
Vibrio cholerae
, as the cause of cholera.
¹⁵

The creativity, doggedness, and ultimate frustration of John Snow’s investigation of the Broad Street outbreak presaged the experiences of generations of public health researchers who would follow him. They would use many of the techniques pioneered by Snow and Farr, including close analysis of vital statistics, standardized interviews, and meticulous geographic and temporal mapping of cases and suspected environmental causes. And in some of those cluster studies, including the one in Toms River, they would take the disease-tracking tools Snow and Farr had developed for cholera and try to adapt them to investigate cancers and other chronic illnesses that took many years to develop. Compared to cancer, they would discover, tracking a fast-moving infectious disease like cholera was a cakewalk.

The conquest of communicable disease that began in earnest in 1837 with William Farr’s scrutiny of the London mortality lists not only gave birth to modern epidemiology, it also clinched the case that waste in all forms, including sewage, was too important a problem to be left solely to private enterprise. Yet the necessity of regulating waste also created unexpected opportunities for canny entrepreneurs like Nick Fernicola, whose actions would pose health risks that Farr and John Snow could never have imagined.

A simple pecking order has always characterized mankind’s relationship to waste: The wealthy throw out what they do not want, the poor scavenge what they can, and whatever remains is left to rot. A few ancient civilizations were adept at reusing excrement, ash, and other waste as fertilizer. The more common waste disposal technique, however, was simple dumping, which is why heaps of midden—shells, feces, bones, pottery shards, and other refuse—are conspicuous features of archaeological sites.