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Galloway spoke first. “As of the most recent reports,” he said, ’there have been thirty-two deaths from the Cholera and perhaps seventy cases total. The total is difficult to estimate since we only hear about the severe cases. And there is a delay in the reporting, so the actual numbers are likely a bit higher and climbing. All the known cases seem to be in one Eastside neighborhood, Kenton. The Cholera does not appear to have moved beyond Kenton.”

“Yet,” said Cassandra.

“Always the optimist, Cass. But yes. Yet,” said Sherman. “Here’s hoping it stays put.”

“Anything else?” I asked.

“Not really. This looks to be the fourth or fifth day of the Cholera. The first few days, it was called a stomach flu or food poisoning and missed. It was not until the end of last week that the Cholera was recognized when it ripped through a household, killing everyone. We were notified it was likely the Cholera late Thursday.”

“Great,” I replied. “And just this morning, we were tasked with the responsibility of bringing it under control. Does any of you know much about the Cholera?”

This time it was Cassandra who spoke. “I know a bit,” she said. “I spent Sunday at the library reading up. The Cholera is the worst of all the forms of the flux. It causes a severe, watery diarrhea that can kill in as little as two hours. It often kills at least half of its victims, and there seems to be little in the way of altering the course of the disease. The victims simply cannot drink water fast enough to keep up with the loss; they fall into a coma and die. An awful way to go.”

“And the cause?” I asked.

“Unknown. Of course, it depends on who you ask. Each Medical Society has their own explanation, and they are already advertising treatments in the papers. The Homeopaths suggest it is due to miasmas. The Chiropractors say the flux is due to a blockage of innate intelligence by spinal subluxations. The Eastern Philosophers say it is due to blocked chi. The Humourists say humours are out of balance. The Naturopaths say it is due to an unnatural diet. There are likely more explanations from the Guilds, but they have not yet advertised. The public thinks it is due to bad air, given how often outbreaks of all kinds seem to start and are worse in the crowded buildings where they live. That was the official explanation in 1999, but being ignored by the Societies. And there is the always popular the wrath of an angry God.”

“And you?” I asked. “Which explanation do you find most compelling?

“I think they are all full of shit. Look. Plagues come and go. People suffer and die. No one knows why, because, well, if they did, they would have put a stop to it long ago. The perpetual coming and going of disease suggests to me that the Medical Societies are clueless. The proof is in the pudding, and there is a failed pudding ….”

She trailed off. I had thought of approaching Cassandra to join the Order, but I had only known her for a few months, and we were cautious about new members. With the revelation from Bosworth that we were being watched, I was now glad I hadn’t approached her. But she would fit right in.

“But I rant,” she said.

“But you do. What do you think the cause of the Cholera is?”

“No clue,” she replied, “except I would wager it is due to something they ate, not something they inhaled. It seems simple to me. If you inhale it, you get a breathing problem. If you eat it, you get the flux. In one end, out of the other.”

I raised an eyebrow. Now that was an interesting idea. It has always been an unquestioned principle by each of the Societies, and in the teachings in the collegiate, that all diseases have one cause. The Medical Societies differed on just what that one true cause was, but it was a universal understanding that there was but one cause of all disease.

“What you are suggesting is that there is more than one cause of disease.” Just like Travis suggested last night. Perhaps it was an idea worth considering.

“I am?” Cassandra paused. “Huh. I guess I am.” She looked at the others. They shrugged.

“But,” said Sherman, “How would that explain dropsy or a convulsion or mania or any number of other afflictions. There must be a unifying cause beyond breathing or eating some disease-causing substance.”

Cassandra looked nonplussed. “Got me. I’m no Medical Philosopher. Which may be a good thing. I was shooting from the hip. I will have to think on this more.”

“In the meantime,” I said, “we have work to do. A complete revamping of our understanding of health and disease will have to wait until after lunch.”

I thought back to the Empirical Method. At its core was collecting information and organization. Then looking for connections, real associations, between and among that information. Could I apply those concepts to the Cholera? Perhaps find relationships that had been missed in the past? If successful, I just had to pretend that it was my idea all along.

“What we need,” I said, “Is a lot more information. We have so little understanding of the Cholera it is impossible to really know what to do to control it. So, I have some tasks for today.”

“Susan, Helen, Kerri? For now, we have to make sure the quarantine is in place. That will always be our primary responsibility. Everyone in houses and apartments with the Cholera cannot leave their homes except to go to a hospital. And that must be in an ambulance. No public transport for the afflicted.

“Sherman, could you write a press release detailing what we know about the Cholera and the steps we are taking to combat it? Make sure you try to involve the Medical Societies. It needs to be honest and calming. We don’t want to cause a panic and have large numbers of people fleeing the city. We don’t want to make things worse.

“Cassandra, I need you for some more research. I need more about the history of the Cholera, not only in Portland, but find out what you can about outbreaks in other cities in the Empire. It may give us some insight. We are going to approach this problem from scratch, as if the collected wisdom of the Medical Societies never existed. No preconceptions, no baggage.

“You are in luck. As dull as the meeting in New York had been, I did learn one thing. Did you know that there is a new network connecting the Empire? It turns out that all the Collegiate libraries are linked by telegraph, and they are also connected to Babbage-Ada Universal Knowledge Machines. They call it the Tele for short. And for public health purposes, the Ministry can access this information for free, courtesy of the Crown. The official announcement was to be next week.”

Cassandra looked amazed. “And you were going to tell me this when?”

“Today,” I said, “I just did. But the Cholera got in the way. But we have Tele at our disposal. You can access it at the College Library. Any questions? Then to work. I have a stack of reports, and I expect they will take some time to read.”

Everyone filed out of the room, and I turned to the stack of Cholera reports on my desk. Just what was I going to do with them?

A good two inches of reports. Cholera cases and deaths. How to make sense of this pile of information?

Start from the basics of the Empirical Method. Organize the data. How best to do that? I decided to use a table, a large table. As I read the reports, I tried to extract what might be valuable information about the Cholera.

The reports were not standardized, but narratives from whoever was involved in their care: a few from Medical Society members, a few from our nurses, the coroner’s office, the police, and the fire department, the funeral director. Short notes, meeting the legal reporting requirement that during epidemics those involved with the victims had to make a report of their findings and send it to the Ministry for Social Hygiene.

It was a chaotic mess. I was going to need to standardize these forms. But what information should I collect? What would be important?

I needed what? Names, ages, genders, addresses, number of family members, last meal, time, and date of onset and resolution of the Cholera. Animals in the house. Occupations. Religion. Food eaten. Fluids drank. Drunk. Drunken? Consumed. Eye color. Political affiliation. Astrologic sign. I needed everything reported because I had no idea what might be important. Where to stop? How to analyze it? I had not started, and I was already feeling paralyzed by the enormity of the job. What I had in front of me were incomplete bits and pieces of information that made it impossible to see a whole. After going through fewer than a dozen cases, I had an unwieldy and impenetrable table of all the reported characteristics of the cholera victims, and I had thirty more cases to read.

This was going to be a mess. I sat back and looked at the reports. How to organize this information? Then it hit me—the mail sorting room now used as a conference and storage room. I stood up and walked down to the first-floor conference room and stepped inside.

Against the far wall, which ran the length of the room, were hundreds upon hundreds of two-by-six-inch cubbyholes that had been used to sort mail for a hundred years—a perfect arrangement for a filing system.

I overlaid the cubby holes with a map of the Kenton neighborhood, with tags on each vertical and horizontal division identifying a street name or number. It was crude, with each cubbyhole representing a city block. I was happy that whoever planned the city was a fan of straight lines. If this had been London, with its twisting and turning streets, it would have been impossible to translate the roads into a wall of slots. Then in each slot, I placed a 3 × 5 card with the characteristics of each case I wanted to track. One cubby would not take any cards, but upon investigation, there was an old wasp nest filling the back. I removed the nest and a few dead wasps, and I was back to sorting.

Over the next several hours, as the cubbyholes filled, I could recognize a pattern by stepping back and seeing which slot had the most cards. Halfway through and I could see a pattern starting to emerge.

Most of the deaths and most of the cases were clustered around the center of Kenton, with only a few outliers. That was curious. What was it about downtown Kenton that resulted in so many cases of the Cholera? I looked at the cards in those cubbyholes but could find no obvious commonality.

Hrm. I went back to work, reading the reports, and filling the slots with 3 × 5 cards, a simultaneously engrossing and mindless task. I had just finished the last of the reports when the door opened, and Cassandra burst into the room.

“Hey,” I said. “I may have found something interesting.”

“What the hell?” she replied. “Do you know it is nearly 5 o’clock and everyone is wondering where you had gotten to? It is not like you told anyone where you were. I only found you as I was walking to the break room for a bite.”

I will admit to blushing. I had set everyone to work and to report to me and then had disappeared. That was cheesy. “I’m sorry,” I said, “but I got lost in what I was doing. Go get anyone who is around and let me show you what I have managed.”

She glanced at the wall of cubbyholes.

“OK,” she said, “And this better be good.”

“It is,” I said.

Five minutes later, the group was assembled.

I gave them a quick explanation of the problem of collecting and organizing data and my solution. Confusion turned to amazement when I demonstrated that by simply looking at the cubbyholes, they could see patterns in the Cholera.

“Looking at the wall and pulling out the cards, you can tell two things,” I said. “The young and old tend to die, and all the cases are clustered around the center of the Kenton. The first is no surprise with a little thought; illness is always worse in those at extremes of age. The young and old lack the reserves to handle the stress of the flux, although it is curious that no one in the Medical Societies has made a note of that before. I think.

“The second, though, is a surprise. Why are all the cases concentrated not in Kenton but in central Kenton? There is a pattern here that needs explanation. What does downtown Kenton have that other parts of the neighborhood, or the city does not? It must be something. Tomorrow I am going to go and look, and I will join one of you on the quarantine squad. That is my insight for the day. Anyone else learn anything of interest?”

Our nurses shook their heads, no. The quarantines were being followed. Sherman handed me a copy of his press release; I would read it on the way home. We had worked together long enough that I knew it would be fine.

“Nothing from me,” said Cassandra, “But I would like a pass on the trip to Kenton tomorrow. I went to the College today and talked with the Fords about the UKM and the Tele. It is more amazing, and potentially useful, than you let on. It turns out that some of the East Coast and English files from the local governments have been converted to a card format that can be read by the UKM, then sorted and analyzed. As best as I can tell, it is the machine equivalent of your cubbyholes. So, I sent a request for information on all the recorded Cholera outbreaks in the Empire. The request was telegraphed to all the UKMs, which will flip through all their files and send me a report by tomorrow. I want to be there when it arrives.”

I nodded approval. “Works for me. Everyone get a good night’s sleep. We are just at the beginning of this disaster.”

I still had other tasks to complete before I could leave for the day. Payroll, letters, memoranda that needed to be answered, and so forth. The usual maintenance work of running a department, even one as small as mine.

It was twilight as I finished and walked out the door. Rather than going directly home, I went to see Mary and tell her about my conversation with Bosworth.

I was feeling more than a little creeped out as I stood waiting for the trolley. Were any of the people on the street watching me? Or someone in the open windows of the office buildings? And if someone was watching me, how would I know?

I tried to scan the crowd surreptitiously, but I did not feel like I was all that subtle. It appeared no one was paying any attention to me. And why would they? But I had read enough thrillers to know that if you think you are being followed, the way to discover your shadow was to change carriages several times, initially going the opposite of your intended direction. Right? Or was I being foolish? Why would a novel be any kind of guide to reality?

But I flagged a carriage heading south and, after four blocks, hopped out and walked north. No one changed direction to follow me. At least I didn’t think so. So, I took another carriage, this one straight to Mary’s house.

Mary lived in a new row house down by the river, costing more than I made in a year. She did well for herself and deserved it. I saw that the lights were on, so I rang the bell. There was a brief pause while the light in the peek hole briefly vanished, then the door opened.

“Jordan,” she said. “It cannot bode well that you are here. What is the problem?”

“Can I come in?” I asked. “We need to talk.”

“Of course, of course.” She led me to the kitchen and gestured for me to sit while she prepared some tea.

“Well,” she said. “I’m waiting.”

I quickly filled her in on my conversation with Bosworth and summarized the issues.

Maybe the Crown thought skeptics could be an enemy of the State.

Maybe the Crown was keeping an eye on us.

Maybe the Crown knew of my Continental contacts, and they approved, or at least tolerated them, as Continental ideas might be of use against the Cholera.

“So,” I finished. “We both have copies of the Méthode Empirique and the Mesmer report. What should we do with them? And do you think someone in the Order is a spy?”

Mary was quiet for a long while. “I have always wondered if that might be the case,” she said. “Any government that wants to stay in power would have to keep an eye on potential subversives, however gently and kindly. Even though it has been 250 years since the failed revolution, the Crown always feels the need to treats us Colonials very carefully. They do not want a repeat of 1776, even though we are all loyal subjects. I, for one, am proud to be a citizen of the Empire.”

I nodded in agreement.

“But I suppose the seditious sins of our fathers are still considered to have been passed on to their descendants,” she continued. “We Colonials have been careful with new ideas, especially if they come from the Continent. We can’t be too forward, too blatant, too seditious, even if there is no intent of disloyalty. As long as we are good citizens, then they let us do as we want.

“It appears they are more interested in stopping the Cholera and are willing to let Continental ideas trickle in, so for now, I suggest caution. Keep the manuscript and study it. It is what I intend to do. But try and keep it somewhere safe and certainly do not show it to anyone else. Let it be our secret.”

“I don’t know, Mary,” I said. “I am not sure I am made for this, now that there is the chance, however remote, of a noose at the end. I am a loyal subject of the Crown. I might die for the Empire, but I don’t want to be killed by it.”

“And you won’t be,” said Mary. “I feel sure of that. As long as you are careful in how you go about investigating the Cholera. It all must appear to be your doing. Don’t mention the French, or Mesmer, or the Empirical Method. After all, you have a responsibility. People are going to die if you are not successful. And I would bet no one at the Pub is a spy for the Crown.”

I sighed and nodded. “Damn. You’re right, unfortunately. I need to look beyond myself. But I doubt that this will be easy.”

“Hang tough, Jordan. I have faith in you, even if you do not. It will pay to be circumspect at the next meeting.”

“Indeed. Thanks for the advice, Mary. And you be careful yourself. It may be more dangerous out there than we suspect.”

She showed me to the door, and as I left, the streets appeared empty. No spies. Right? Right.

I felt a frisson of fear and panic that raised the hair on the back of my neck. I pushed the panic, and the hair, down. People were going to die of the Cholera. I had a job to do. So, I went home and fell immediately to sleep.

To be 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