In 1937, a terrible disease of heart failure was reported in some rural areas in Heilongjiang, a far northeastern province of China. Women and children were its primary victims. The disease frequently occurred without warning and led to the death of a large number of people. The major symptom of the disease was myocardial necrosis, which led to acute hypoxia, vomiting, and finally death in several hours. Preliminary investigations were conducted in the late 1930s and 1940s but biotic infecting agents could not be identified. The peculiar disease was then named after the county, Keshan, where the first cases of death from the disease were reported. Since then, Keshan disease was found in another 12 provinces across China between the 1940s–60s. About eight million people lived in the affected areas in the country during that period of time, and thousands of people died of Keshan disease every year. The disease was so severe that a special government office was established to coordinate the nationwide efforts against the disease in the 1950s. In the 1950s and 60s, large-scale epidemiological investigations were launched in the provinces affected by Keshan disease, including Heilongjiang, Jilin, Liaoning, Hebei, Shandong, Henan, Inner Mongolia, Shanxi, Shaanxi, Gansu, Sichuan, Yunnan, and Tibet. A variety of biotic or abiotic factors, such as indoor carbon monoxides, nitrite in drinking water, parasites, fungi or bacteria in the local diet, etc., were considered during the investigations. The campaigns did not prove any of the factors related to the incidence of Keshan disease with convincing evidence. However, the nationwide investigations demonstrated that Keshan disease occurred within a geographic belt stretching from the northeast to the southwest of China. In some places, the affected and unaffected areas had clear boundaries. It was not uncommon to see two adjacent villages differing in disease status substantially and constantly for decades. Through the field investigations, the possibility that Keshan disease was an infectious one was excluded. The striking spatial distribution of Keshan disease implied that there could be some geographic or geological factors causing the disease. In fact, the local villagers whose families had lived in the affected areas for generations insisted that the disease was caused by the local ‘‘soil and water.’’ A number of medical researchers started looking in a new direction, the geochemical environment. In 1966, Dr. Haijiang Cai, one of the pioneer medical researchers studying Keshan disease in China, declared ‘‘We must team up with the geologists who are interested in the medical issues.’’