If you are stumbling upon this, the novel begins here.

——-

Chapter 1b

Next up were the Ford twins, Grace and Allison. They were not identical twins but were as close as any siblings could be. They were both mathematicians at the College and were wicked smart. Full professors and two of only a handful of tenured women academics in the Empire. I had no idea what they were talking about once they discussed mathematics.

They rarely attended the meetings, as they had a full schedule of teaching and research. Besides expertise in obscure areas of mathematics, they had their own Babbage-Ada Universal Knowledge Machines (UKM) and were known throughout the Empire for their advances in UKM design and application. I knew the sisters from my college days, where Grace had been my professor for some required calculus. I never understood the requirement; I have never had the need to differentiate or integrate once in my job. I had struggled with some of the maths, and she had been a patient instructor. It was Grace who had let me know about Skeptics in the Pub during an impromptu discussion about whether calculus represented reality or was a fictional construct. She had convinced me calculus described how some, but not all, parts of reality actually worked. And she suggested if I were interested in how to understand reality, I might start with the Order of Arcesilaus.

Grace started. She was the shorter, rounder of the two, and the more talkative. “One of our interests,” she said, “is trying to make numbers more understandable. Complex concepts like reality are more easily understood if converted to numbers or pictures such as graphs and other visual aids. Worth a thousand words and all that. We,” she gestured at her sister, “know numbers. Others do not.

“As you know, we have our own Babbage-Ada Universal Knowledge Machine. It is an older machine which we helped build and was the first at the College. When the College upgraded to a newer model, they were going to sell all the brass for scrap. Scrap. Can you imagine? What a waste. We convinced them to let us keep it. We have modified and expanded the capabilities of the machine over the years. Not only can we communicate with other UKMs using the telegraph system, but we can send the output to a mechanical drafting table to turn any properly formatted numbers into graphs or pictures.

“Darin,” Grace went on, “was kind enough to supply us with preliminary numbers from his research. We have turned those numbers into graphical information. We think it adds a layer of understanding to the Cholera. Let us show you.”

She opened a satchel and pulled out some papers, holding them up for everyone to see. “This shows cases over time for the outbreak of 1999. Note the shape of the curve. It starts with an exponential growth, cases doubling every week. And then an abrupt end of the outbreak. The other line is cumulative deaths.

“Then there are cases of the Cholera plotted against temperature. Warmer days led to more cases until the cold snap. Then the Cholera vanished once the temperatures reached freezing.”

“Whether there are similar results with other outbreaks is unknown. We lack the numbers. The pattern seems to be that the Cholera occurs when it is warm and vanishes when the weather turns cold.

“This is all very preliminary. Our graphs would be far more robust if we had better information. But you can see that the graphs suggest that temperature is key to the epidemic. So, everyone: remember us as you get deep into the Cholera. If you can, send information our way. We want numbers. Lots of numbers. Allison has a most intriguing idea of displaying the numbers graphically using a kinetoscope so that you could watch the information change over time. I am not sure if we can make it work satisfactorily, but if we had good numbers, it would be fun to try.”

I looked at the graphs she had provided. They were worth more than a thousand words. “Do you mind if I keep these?” I asked.

“Not at all,” Grace replied. “We expected as much, and we made copies. But in return, you will give us more numbers. We need more numbers.”

“If I can,” I replied. “The Ministry is always circumspect about sharing information.”

The sisters both grinned. “We always say it is easier to get forgiveness than permission,” said Grace.

“Not with the Crown,” I said.

“Sadly, true. But if we were hired as consultants…”

“Unpaid consultants,” added Allison. “Will work for numbers.”

“I will see,” I replied, making a mental note to make it so. “I doubt the Ministry would refuse the help of such noted and respected professors at the College. Give me a day or two. And thank you.”

The sisters returned to their seats.

Faith Mallinson, Cody Cunningham, and Travis Smith stood up simultaneously, looked at each other, and sat down simultaneously, leading to laughter and the banging of mugs from the audience. All three looked a little chagrined, but none made a move to stand again. Faith was a retired teacher, Cody, a retired librarian, and Travis, a retired engineer. Many members of Skeptics in the Pub had a specialty, an area of interest and expertise. These three shared a deep curiosity about the workings of Natural Philosophies, with a focus on Medical Societies. All had lost friends or family who had been under the care of one of the Societies. The care had resulted in bitterness, anger, and the urge for payback. They were convinced that the Medical Societies were not only worthless for diagnosing and treating illnesses, but they also suspected the Societies actually killed some patients with the interventions promoted as “cures.”

They channeled that anger and bitterness into research, spending their retirement investigating, interviewing patients, reading monographs, and sniffing around the periphery of the Medical Societies. Between them, they probably knew more about the Medical Societies than anyone in the Empire. One day, they often said, they were going to expose the Societies to the light of truth. Their motto was “Cockroaches don’t like the light.” Their knowledge of the Societies was only exceeded by their contempt.

“OK,” I said. “Shall we go alphabetically or by height?”

“Height,” said Faith. “The best comes in small packages.” Faith was five feet tall, tops, if she stood perfectly straight. “What would you like to know?” she continued.

“Everything,” I replied.

“Could you narrow it down a bit?”

“How about the history of the Cholera and the Medical Societies?”

“That I can do. As you can probably guess, we do not have a lot of information. The last outbreak was twenty years ago, a decade before we became interested in the Societies. Most of those afflicted by the Cholera were cared for in their homes by whatever Medical Philosopher was consulted. It was a long time ago, and the few patients we have interviewed were too sick to remember what, if anything, was prescribed to treat their Cholera. The same with family members. Multnomah Falls levels of diarrhea are distracting for caregivers as well as patients, so recollections are spotty.

“The Cholera caught the Societies unprepared, and they did little advertising during the outbreak, but after the Cholera ended, they released full-page ads touting their success with survivor testimonials. These endorsements are moving and superficially compelling. Once at the brink of death from intractable diarrhea, they were restored to life. This one credited Chiropractic, and that one their Naturopath, and the other one said it was their Humourist that cured them of the Cholera. Details are, as usual, lacking. But there is no consistency or pattern I can see in the treatments victims received.

“The single largest care provider of the Cholera victims was the Lake Oswego Homeopathic Hospital. They claim that of the 124 people afflicted with Cholera treated in their institution, only 18% died, about half that of the usual mortality rate. They are already advertising their past success.”

She held up a newspaper showing a half-page ad.

Cholera

For the Best Remedy

The Lake Oswego Homeopathic Hospital

Proven Superior to All Other Therapies

Safe, Natural, Individualized, Side Effect Free

Are you or your loved ones suffering from the Cholera? Are you or your loved ones at risk for the Cholera?

In the 1999 Cholera Outbreak treatment with Homeopathy Halved the

Deaths

Homeopathy can be used for Treatment & Prevention

The Superior Remedy for Any and All Afflictions

Testimonials

“Without the care of the Homeopathic Hospital, I would likely have died of the Cholera.” Annabelle H.

“Homeopathy saved my daughter from certain death from the Cholera.” Jonthan B.

“Thanks to Homeopathy, no one in my household had the Cholera.” Karl O.

An ancient Philosophy discovered by Dr. Samuel Hahnemann over 200 years ago, it is based on LAWS as immutable as those governing the orbits of the planets.

Law of Similars: what a substance can cause, so can it cure.

Law of Proving: demonstrating that a substance given to a healthy person causes the symptoms of a disease so that the same substance can treat an illness with similar symptoms.

Law of Vital Force: the Vital Force is the energy that drives the living body. Disease is due to the dynamic morbid derangement, disorder, or disturbance in the rhythm of vital force.

Law of Simplex: Only give a single treatment at a time.

Law of Individualization: Each patient is unique, and so is each remedy.

Law of Minimum Dose: Homeopathic remedies are applied in the ultra-minute dose and so are nontoxic, perfectly safe, and sure to cure.

Law of drug dynamization: the process where crude substances are converted into powerful dynamic homeopathic remedies. Homeopathy has a unique method of drug preparation where the end product is in a dilute form devoid of any of the original substance. This process improves the beneficial property of the substance while at the same time, eliminating any poisonous or harmful properties.

Law of Miasmas: chronic disease is due to three miasmas, Psora, Sycosis, and Syphilis.

Visit the Lake Oswego Homeopathic Hospital

or

Send for our informational brochure.

Homeopathy: when you intend to diagnose, treat, cure, or prevent any disease.

Do Not Be the Next Victim of the Cholera

“That seems pretty impressive,” I said.

“Yes. Superficially. But we only have the word of the Homeopaths. We don’t have access to any of the primary information. We don’t have proof that patients had the Cholera or how and if they were treated with homeopathy. We do not even know if the number of patients is valid. We have no way to know if any of this information is true. The testimonials have no last name, so they cannot be contacted. We have no testimonials from the dead. There is no way to tell how much of this advertisement is true and how much is fiction. It could all be fiction. All unverifiable.

“And that is not even considering we have no way of knowing, big picture, if homeopathy or any of the remedies offered by the Medical Societies actually work. All we have their say-so.”

I turned to Mary, the closest we had to a Medical Philosopher. “What do you think of Homeopathy?”

Mary shrugged. “I know as much as you,” she replied. “But their basic Philosophy never made sense here.” She tapped her heart. “Or here.” She tapped her forehead. “The idea that the more you dilute and shake a treatment the more potent it becomes troubles me. Natural Philosophers have done the calculations. Somewhere around a 12 C dilution there is one part remaining of the original substance. Would I get drunker faster on 12 C beer with one part of alcohol in each pint? I don’t think so. And most people get their homeopathy delivered at 30 C dilution. Or more. There should be nothing in it but water. Homeopathy feels wrong. But I, like everyone, have to take the Homeopaths at their word. Or not. They are the ones responsible for the dissemination of the cause and effects of their Philosophy.”

She paused. “It is not like they could have any reason to give the world faulty information,” she said with a sneer and an eye roll.

Faith held up the paper again and continued, “You know the other Medical Societies are going to see this advertisement and respond in kind. They did not advertise with the last outbreak, but this time? I bet we’re going to see glowing advertisements from each of the Societies boasting about their Philosophy. This is likely to be the beginning of an advertising offensive.”

I sighed. “What about the other Medical Societies?”

“Same thing, just less. For several months after the 1999 Cholera, there were advertisements and testimonials extolling the effectiveness of bleeding or acupuncture or a special diet or magnets or therapeutic touch for the treatment and prevention of the Cholera and, by extension, any number of other human ailments. They all had the same message: the Cholera was cured or prevented because they had the one true Medical Philosophy to guide the understanding and treatment of the Cholera and all other ailments. The problem? There are multiple one true causes of all diseases and their treatment, at least as many as there are Medical Philosophies.”

She shook her head. “I still think that only one of the Medical Philosophies can be correct.”

“Or they are all wrong,” interjected Cody, “which is what I suspect. Here is my interpretation. None of the Medical Societies really know what they are doing. But you all knew I would say that.” He stood up and looked at Faith. “May I?”

She gestured for him to continue and sat down.

“Each Medical Society base their interventions on theories that, as best I can tell, have never been proven. There are the proofs offered by mathematicians and the proofs of the Natural Philosophers like Sir Isaac Newton’s Mathematical Principles of Natural Philosophy. These are, of course, mathematical proofs.”

“The best kind,” said Grace, to the banging of mugs on the table.

“Yes. The best kind of proofs,” continued Cody, “but not the only kind. Perhaps. Medical Philosophy, with no underlying mathematical foundation, lacks a similar rigor. As do many other Natural Philosophies. And it may be that Medical Philosophy is not amenable to the rigor of mathematical proof. But there needs to be some similar scaffolding upon which we can build an understanding of the Medical Philosophies.

“The only proof we have is in the pudding. Someone tries a treatment, improves, and concludes the treatment was the reason. That treatment becomes the status quo. At least surgeons, when they take out an appendix or drain an abscess or remove a tumor, have something objective to show that their diagnosis and intervention were effective.”

“Correct,” interjected Mary, with mugs banging agreement.

“But the Societies? They never have anything tangible to show for their diagnosis or treatment. We have to take their word for it. Advertisements, self-serving pamphlets, and the word of unverifiable testimonials.

“When was the last time you read a testimonial against a Medical Society’s intervention? Never. The Societies never criticize each other. Ever. They have money and influence, and they use it to protect themselves. But someone, somewhere, at some time, must have tried Acupuncture or Homeopathy or Chiropractic, and it failed. You would never guess it from available information, which always suggests that any treatment failure lies with the patient, either because they did not follow the treatment plan carefully enough or that the Society was involved too late in the disease. But did the treatment fail? Uh-uh, oh no, not them. All the available material from the Societies suggests they are always effective.

“I have examined all the Societies carefully, and at their core, I find there is no there there. No one has seen a miasma or a vital source or innate intelligence or chi or any of the other forces purported to cause disease and which they manipulate to cure and prevent illness.”

He paused and pointed in the air for emphasis. “No one. None of them have the slightest clue as to the cause and treatment of the Cholera. Or any illness. My advice is to ignore the Societies. They have nothing to offer.”

“Then what causes the Cholera?” I asked. “I always assumed that the various Medical Philosophies were all just metaphors for whatever energy or force that is responsible for life. Something must animate us. That stands to reason. We aren’t just conscious meat. And it seems equally reasonable that when that force, whatever it is, is deranged, illness ensues. Am I right? It only makes sense.”

There was quiet for several seconds while Cody, Faith, and Travis looked at each other as if they wanted someone else to speak. Finally, Travis spoke.

“Look. No one can answer that. This is just between all of us. We have spent the last decade trying to understand the ins and outs of the Medical Societies. We have concluded that they are all based on smoke and mirrors. They are all equally wrong, just in different ways. We strongly suspect that the Societies are, to quote the Bard, all sound and fury, signifying nothing. With a Philosophy told by an idiot. When it comes to the Cholera, and all human disease, we suspect that there is no one cause of all disease, despite that being the paradigm for hundreds of years. There are, we suspect, dozens and dozens of diseases, each with its cause and likely each with its unique remedy.

“What we don’t have is an alternative understanding of the Cholera. Or any disease. We are not Natural Philosophers, trained in the Medical Arts. We only suggest you start with an open mind, a clean slate, and approach the Cholera as if you know nothing and, more importantly, as if the Societies know nothing. Because you, and by you, I mean everyone, knows nothing. Assume that the real Medical Philosophy, the cause, and treatment of health and disease, is likely yet to be discovered. Maybe you can be the first and discover the real cause of the Cholera.”

He stopped and stared as if challenging me to disagree with him. I decided not to.

“What we need is an alternative to the Societies. An Alternative Medicine if you will.”

That was an unexpected idea. That the combined expertise of all the Medical Societies amounted to nothing. That they were all a fiction. And it was up to me? Me? To discover the true nature of health and illness? To invent, or perhaps discover, an Alternative Medical Philosophy?

No way.

“That may be a bigger task than I can manage,” I finally said.

“Of course, it is,” said Travis. “But maybe, just maybe, you can give it a start. You know the old saying: A journey of a thousand miles starts with a single step. Yours will be the first step for all of us.”

“Or tripping and falling flat on my face,” I said.

“Sure. Be, Mr. Pessimistic. But after you fall on your face, you can lie there and whinge. Or you can get up and start walking. So, get moving. Figure out the Cholera. Save a few lives. You have nothing to lose and everything to gain after all.”

“I guess so,” I said without enthusiasm. I thought they were grossly overestimating my abilities. “Anyone else have anything to add?”

No one else had anything else to say.

“Then the meeting is adjourned,” said Mary. “Have another beer. And don’t forget to tip your waitress,” she said, pointedly staring at Darin Boyles.

“What,” he objected. “What did I do?”

Mary just stared for a few more seconds.

For the next 30 minutes, we chit-chatted about nothing in particular as everyone finished their beers and prepared to head home. It was a work night, and no one wanted to be up late.

After the room emptied, Mary, the Ford sisters, and I discussed New York. I had primarily been there for work for the national meeting of the state Social Hygiene Ministries. And really, it had been boring.

But my personal reason for being in New York was to meet with some East coast members of the Order of Arcesilaus. They had connections with the European Continent, about which there were many fantastical rumors. Although I will say that the beer in Portland was far superior.

At one of the meetings, I received a treatise titled On the Méthode Empirique, a New Approach for Investigating Natural Phenomena. In addition, I received two English translations of the French Commission’s report on their inquiry into Mesmer and Animal Magnetism. They had applied the Méthode Empirique to a French Medical Philosophy, Mesmerism, popular on the Continent. The papers made for fascinating reading on the train trip back from New York.

While none of the meetings with the Order in New York had been illegal per se, they had pushed the boundaries of what the Crown would consider appropriate behavior. The French Revolutionary Empire and the British Empire had been at odds since the failure of the American Revolution. The French and the Crown has continued a cold war ever since the Empire defeated the French at Yorktown, with occasional flare-ups on the periphery of their respective spheres of influence.

The main result was virtually no contact between the British and French Empires. There were, of course, always small cracks through which information and trade flowed. Not everyone in the Empire could do without their Bordeaux.

“The Méthode Empirique is a method for evaluating the validity of information, independent of personal experience. It appears simple enough,” I said. “Seven steps.”

And I listed them on a piece of paper:

  1. Define a question
  2. Collect information and resources (observe)
  3. Form a hypothetical explanation
  4. Test the hypothesis with experiments by collecting data in a reproducible manner
  5. Analyze the data
  6. Interpret the data and draw conclusions
  7. Repeat

“What was most remarkable about the Méthode Empirique is a complete rejection of personal experience to justify a conclusion or effect. “In my experience” is considered useless except as a starting point for inquiry. It is the data, the information, gathered without bias, that has primacy. When you read the report, pay close attention to how they did the evaluation of Animal Magnetism. Note how they attempted to make it impossible for those being treated to know whether or not they were receiving Mesmerism. They call it essai en aveugle, being blind to the therapy. Comparing real and imitation interventions allowed them to determine how much of the human response to medical and other therapies are real or due to the patient’s imagination.”

“That seems, well, quite a fanciful idea,” said Mary. “Deny the evidence of my own eyes? My own experience? That when I remove a tumor, it has not really been removed? Is this a tumor I see before me? Of course, it is. Please.”

“Like everything, it can be taken to extremes,” I said. “The French can be good at that. But the fundamental idea is interesting. The human ability to reliably understand the world from just our five senses is flawed and limited. We need an improved way of understanding the world that bypasses these limitations, and that may well be the Méthode Empirique. Make conclusions from information that is as free of human bias as possible instead of relying on experience and common sense. Common sense says a heavy object will fall faster than a light one. But it isn’t so.

“By applying the Méthode Empirique, they were able to evaluate the efficacy of Mesmerism, and the results were amazing. As a result of their examinations, the Commission concluded that Animal Magnetism did nothing and that Mesmerism’s effects, surprisingly, were solely the result of the imagination of the treated. They reached that conclusion by treating people with either real and fake Mesmerism, and the patient was not aware of which they were receiving. And the effects were the same. There was no difference in the effects of real and fake Mesmerism. So, they concluded that the effects of Mesmerism were an illusion implanted into the patient by the actions of the Mesmerist. Mesmerism had no independent objective reality. Just imagine if we could apply the same techniques to the Medical Societies. Then we would really know whose treatment reigns supreme.”

I found this disquieting. There are those problems—for example, a large boil—where you can tell improvement by looking. But the experience of pain and other diseases can be subjective. If a person says Mesmerism, or fake Mesmerism, improved their pain or anxiety, could you not argue that both were effective rather than neither? It was a conundrum I had not come to grips with. How to do fake acupuncture or spinal manipulation? That would be difficult, if not impossible.

And how to apply the Méthode Empirique to the Cholera? I was not sure how to apply the concepts to an epidemic of diarrhea, but it had made me wonder if Medical Society treatment effects could also be due to the imagination of those treated.

I handed Mary and the sisters a copy of the report in a manila envelope. The sisters seemed particularly interested.

“This looks fascinating,” said Grace. “A formal process to evaluate reality independent of personal experience. We have had similar ideas, but this has been nicely codified.”

Allison agreed. “Too bad there is only one copy for us. We will likely fight over who gets to read it first.”

“Which would be me,” said Grace with a smile. “As firstborn, I am the eldest and get priority.”

Allison just rolled her eyes.

“One issue,” said Mary, “Is we can’t go around using the French. Méthode Empirique will not do.”

“How about the Empirical Method?”

“Works for us,” Allison, Grace nodding in agreement.

“Empirical Method it is,” I said.

French ideas, as opposed to French manufacturing and agricultural products, were intangible and could not be blocked by walls and oceans. But French ideas were subject to such ridicule that few would risk the social stigma that would accompany their use. Discussing the Méthode Empirique among a few friends was one thing—applying it to the Cholera and, hopefully, publicizing the result was likely to be tricky. New ideas are hard enough to accept; new ideas from a sworn enemy to all that you should hold dear? That would be another matter.

“Enjoy,” I said. “I have yet to process it all. I am going to have to read it many times, I think, to truly understand the concepts. Let me know what you think and how we might apply the ideas to the Cholera. But it looks like I am going to have to start from scratch. Mary, I am going to need some help, and you are at the top of the list.”

She smiled—a worried smile. “This is uncharted territory for us. We may land on a new world, or we may fall off the edge. With terra incognito, hic sunt dracones.”

“Then,” I said, “We will slay them together. Good night, Mary.”

“Good night, Jordan.”

I drained my glass and left for home and likely a miserable night’s sleep.

Continued here.

Posted by Mark Crislip

Mark Crislip, MD has been a practicing Infectious Disease specialist in Portland, Oregon, since 1990. He has been voted a US News and World Report best US doctor, best ID doctor in Portland Magazine multiple times, has multiple teaching awards and, most importantly,  the ‘Attending Most Likely To Tell It Like It Is’ by the medical residents at his hospital. His multi-media empire can be found at edgydoc.com.