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I awoke before sunrise and was out the door with the first light. 5:30 is too early to start the day. The tearoom did not open until 6 a.m., so I began the day without a tea-induced buzz or food. An inauspicious start to the day, but like starting the morning in the dentist’s chair, at least it meant the day could not get worse. I settled into my seat on the trolley and looked at the morning paper.


It can always get worse.

Cholera Rampage Continues

Kenton Epicenter

35 dead 76 cases

Officials Stymied

Portland — The Cholera continues to plague the Kenton neighborhood of NE Portland. As of press time, there have been a total of 35 deaths and 76 cases. Almost half of cases are succumbing to the Cholera, as the numbers continue to increase. Yesterday, at press conferences by both the Medical Societies and the Ministry for Public Hygiene, no specific solutions for the crisis were offered.

Joseph Bosworth, Commissioner of the Oregon Social Hygiene Commission, had this to say, “The Crown is deeply concerned about the Cholera and its effects on our people. We have instituted the quarantine and are actively tracking the cases. We do not completely understand the Cholera but the experience from other outbreaks suggests that the Cholera may be spread by mal aria or bad air and crowding. It may be best to avoid crowds.

“That said, it is beyond the responsibility of the Ministry to manage victims of the Cholera, which, as you know, is the sole purview of the Medical Societies, and I defer to their expertise as to the cause and treatment of the Cholera.”

When asked about the Cholera, Maxwell Pettenkofer, Homeopathy Society Master, said,

“All the Medical Societies are keenly aware of the Cholera and its impact on the citizens of Portland and Kenton. We are doing everything in our power to help diagnose and treat the Cholera. We remind the people of the greater Portland metropolitan area that should they suspect the Cholera, or want to prevent it, to consult with the Medical Philosopher from the Society of their choice.”

When asked for specific advice on the cause, prevention, and treatment of the Cholera, he would only say, “it is critical in health and disease, including the Cholera, to have the body balanced for proper functioning. For specific advice concerning the Cholera, we suggest people consult their preferred Medical Philosopher.”

Similar responses were offered by the Naturopathic and the Chiropractic Societies.

Continue reading page 3.

Same as it ever was with the Societies. Publicly they recommended neither a specific preventative nor therapy. For that, you had to see a Medical Philosopher. Which meant a fee. Nor did they ever comment on another Society’s approach to disease. Those of us who work for the Ministry of Hygiene are prevented by law to treat any disease. Which is as it should be, given our lack of training in any Medical Philosophy. We needed the Medical Society’s advice and guidance, but little help or insight was likely to be forthcoming if it meant that their income might be threatened.

It was a grim situation.

I thought I would be first at the office, but the rest of the Department was arriving at the same time. Although we had been told that for the duration of the outbreak that our work was to be directed towards the Cholera, try telling that to the usual responsibilities. Unaware it was a holiday, other diseases still appeared in the community demanding our attention, and everyone was pitching in to get the work done.

While there were no epidemics of childhood illness in the county, there were still the day-to-day needs of sporadic cases of Diphtheria, Rheumatic Fever, and other diseases. The non-Cholera tasks complete, we met in the conference room at 10 a.m. We had yesterday’s reports: 20 deaths and 44 cases. The Cholera was accelerating.

I looked at the sheaf of papers and handed them to George Webster, the more diligent of our clerical assistance. “George,” I said. “Do you feel comfortable reading these reports and transferring the relevant information to the cubbyholes?”

“Yes, sir,” he said. “Seems straightforward enough.”

“Good. Then I give the task over to you. If you have questions or think of something new or different, let me know. I would always prefer a question over a mistake.”

“Yes, sir.”

“I am heading out to Kenton and should return around four. I will come by and see what you have. Tomorrow, unfortunately, there are likely to be more cases. Consider it short-term job security.”

“Yes, sir.”

He took the papers and, carrying them to a desk, got to work. I looked over at Leo Greaves, our other support staff.

“Leo,” I said, “I need to meet with all the major Medical Societies. Please arrange meetings for me ASAP. An hour each, I suppose. The Societies are our experts about the Cholera, and I need to try and get them to tell me more than what I can pick up from their newspaper advertisements.”

I turned to the others—Sherman, Susan, Kerri, and Helen. “Let’s go. There is still a quarantine to maintain.”

“Where’s Cassandra?” asked Sherman.

“Another assignment, working with the College. I hope to have useful information from her this afternoon after we return.”

We left the office to catch the trolley for the Kenton neighborhood. On the way, I bought a paper to read on the trip. The headlines were about Cholera, updating the statistics but adding no new information.

On pages 4 and 5 were a pair of advertisements.

Cholera Treated.

Cholera Prevented.

Naturopathic Remedies

Made by Nature

Proven by Time

With the return of Cholera to Portland, ask yourself:

Are you ready?

Cholera can attack any time.

Only Naturopathy can Boost your Natural Vitality to Prevent and Combat the Cholera.

Naturopathy is the only Medical Philosophy that relies on natural remedies to help the body heal itself. As such, it is uniquely positioned to help prevent and treat the Cholera.

Based on ancient wisdom, it is a Philosophy based on

The Healing Power of Nature (Vis Medicatrix Naturae): Naturopathic Philosophy facilitates and augments the natural self-healing process.

Identify and Treat the Causes (Tolle Causam): Identify and remove the underlying causes of illness rather than eliminate or suppress symptoms.

First Do No Harm (Primum Non Nocere): Naturopathic Philosophers follow three guidelines to avoid harming the patient:

Doctor as Teacher (Docere)

Treat the Whole Person: Every person and disease are unique and needs an exclusive remedy.

Prevention: An ounce of prevention is worth a pound of cure.


“Without the help of my Naturopath, I would not have survived the Cholera.” Tammy R.

“My children have never had an illness since they started seeing a Naturopathic Philosopher.” Roberta F.

Now seeing patients at the College of Natural Philosophy in SE Portland.

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

On the other page was a smaller advertisement by the Humourists.

The Scourge of Cholera Returns

Are your Humours in balance to prevent and fight the Cholera?

Black bile, yellow bile, phlegm, and blood must be in equilibrium or you at risk.

The only Philosophy that dates to the Greeks, humourism has over two thousand years of experience in treating and preventing all the illnesses that plague mankind.

With the Cholera in Portland, now is the time to visit your local Humourist for a preventative bloodletting.

Humourism: time-tested; time-proven.

For the prevention and treatment of the Cholera and all illness.

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

Faith had called it. The Medical Societies were going to use the Cholera to increase business.

The trip to Kenton was otherwise quiet, and we got off at the Paul Bunyan statue, the centerpiece of downtown,, Kenton. Paul was leaning on his ax, looking over the city park. He, at least, would not get the Cholera. At 37 feet tall, that was a good thing.

Looking around, it appeared to be just like any other day. People were out shopping, eating, and strolling in the park. No indication that there was a quarantine due to the Cholera and that nearby, people were likely dying. We went to a tea shop and sat down to have a cuppa and plan the afternoon.

“Here is what I would like to do,” I said. “First, I am going to join Helen as she evaluates the new quarantines, and then I am going to walk the neighborhood with Kerri or Susan, who is responsible for checking the old quarantines. Sherman will go with Kerri and Susan.”

“So, what are we looking for?” asked Sherman.

I shrugged my shoulders. “I haven’t a clue. What I suggest is get rid of all your preconceptions about the Cholera. Clear your mind and just observe. Who knows? Maybe you will notice something everyone else has missed, the key to understanding the Cholera. Or maybe not. But chance favors the unprepared mind. Or something like that. Any questions? Nope? Then let’s go.”

We finished our tea. Sherman, Kerri, and Susan, after looking at a list of addresses, started to the west, heading towards the first of the recovering Cholera cases.

I had known Helen since I arrived at the division. A mother of two, she had been with the Ministry for thirty-five years and probably knew more about the organization than anyone. She had worked during two other Cholera outbreaks, Portland in 1999 and the Eugene outbreak of 1997. Whenever there was excitement, she was as calm as the eye of a hurricane.

“So where do we start?” I asked.

She looked down at a sheaf of papers with the addresses of all the new Cholera cases. “Two blocks from here, over on McClellan Street.”

“Lead on, MacDuff.”

“It was “Lay on, MacDuff,” you know,” she said.

“I know. But “lay on” sounds wrong.”

“Perhaps,” she replied. “But perhaps the original is more appropriate to the circumstances.”

I nodded in agreement as we headed down Denver Street towards McClellan.

“You know,” she said, “We have twenty-five cases here, from thirteen addresses. I will likely be able to see two thirds of these cases today, but if they continue to increase—and in prior outbreaks cases increased rapidly—we are going to need lots of help, and we are going to need it soon.”

“I know. I already sent a request to Bosworth this morning for more workers. If we are not proactive, this will rapidly get out of control, something you never want with a diarrheal illness.”

“I’m glad to hear it,” she said with an eye roll.

“So, do you have any ideas about the cause of the Cholera?” I asked. “You worked the two prior outbreaks. How did you avoid getting it?”

“Not a clue,” she replied. “That would be way above my pay level. I’m not paid to speculate about Medical Philosophy. I’m paid to put people in quarantine. At least today.”

“Uh-huh,” I said. “We need to understand the Cholera and how to stop it. You have been doing this for almost forever. I thought you might have some ideas.”

She shot me a look. “Are you saying I’m old?”

“No. No.” I said, “Nothing of the sort. Experienced. That’s a good thing, experience. It leads to wisdom.”

She grinned at me. “Relax,” she said. “Just taking the mickey.”

“OK. But you are the only person in the department with experience of the Cholera. So, pardon me if I suspect you have plenty of philosophizing potential.”

She sighed. “OK. I’ll play the Medical Philosopher. But I do not have any great insights. To my way of thinking, none of the current explanations of the Cholera make any sense, at least as far as diarrhea goes. I try and think simply. Most of the time, the simple solution is the correct solution. Most problems do not require a degree in Zeppelin science. People have diarrhea. Severe, sometimes fatal diarrhea. What goes in comes out. It had to be something they ate.”

“Yes,” I said, “So one would think. That was Cassandra’s reasoning.”

“Smart girl,” she interjected.

“But if it was something they ate, then why hasn’t it ever been identified? That should be simple to figure out. And if it was something they ate, why did it not affect the taste or look of the food?”

She shrugged. “Got me. You asked me what I thought. I gave it to you. As to proving it, well, that’s for wiser folk than I to confirm or deny. And here we are.”

We had stopped at a five-story granite block Victorian-style apartment building. There were a lot of buildings like that in the neighborhood. Helen glanced at her papers.

“All on the fifth floor, two families, two cases in each as of the morning report.”

We walked into the lobby, and I commented that there were no quarantine signs to be seen.

“Yes,” she said. “I guess you were not informed. That was a ‘request.’” She made air quotes. “It came from Bosworth with the first cases. He said we did not want to generate a general panic by putting quarantine signs in public areas. The signs are to go on the entry door to the apartments. On houses, they can go on the front door, but behind the screen door.”

“Do you think that is wise?”

“I don’t know. As far as I can tell, few of the cases have occurred in adjacent houses or apartments. The cases tend to be physically separated.”

“Really? That was not in any of the reports.”

“It was certainly true in 1999. I know because I had to walk to every case, and my feet were sore at the end of the day. It would be a lot less tiring if the Cholera were all in one apartment building instead of spread out over the neighborhood.”

“Is there any way for you to keep track of the distance between cases? I would be interested.”

“Funny you should ask,” she said. “I just bought this mechanical step counter because I was curious how much I was going to walk with this outbreak. I like to keep track of things like that. Yesterday I walked 6.3 miles.”

“Can you keep a log of how far you walk between each case?”

“Probably,” she said. “I can make notes on the report sheets.”

“Thank you,” I said. “It may be important.”

We climbed the five flights of stairs and came out into the hallway. The air changed. Now it smelled like shit. Literally.

I wrinkled my nose. Helen noticed.

“You get used to it. Or you can cover it up.”

She handed me a vial of peppermint oil.

“Just a bit under the nose. It covers the gentle fragrance from eau de toilette. Be careful. If you use a lot, you will get a rash. A little dab will do you.”

“Thank you,” I said. “I should have thought of this.”

I put a dab on my upper lip, and now I only smelled peppermint.

“As I said, the cases are never close together. These are at opposite ends of the hall.” She started to the left and stopped at apartment 513. “Family of 5. The Smiths. Three cases.” She knocked on the door. No response. She knocked again, louder. No response. “Uh-oh.”

She tried the door, and it opened.

Inside were five people sprawled on the floor. Two adults. Three children. All dead. Sightless, sunken eyes staring at nothing, lying in pools of liquid. I was glad for the smell of peppermint, but it was not enough. Flies buzzed around the corpses, disturbed by the draft from opening the door, then settling back on the bodies.

Helen quickly closed the door and made a retching noise. “Too late. Nothing we can do for them. I hate this part of the job. I saw a fair amount of this in 1999, a room or house full of the newly dead. When everyone gets the Cholera at once, there is no one to care for the ill, and everyone dies. Every household needs at least one caregiver if they hope to survive. It sucks.”

I also fought down the urge to vomit and nodded. I think if I tried to talk, I would lose the battle with my stomach. I would never eat peppermint candy again. I had never seen the dead before, much less an entire family dead from the Cholera. It was ghastly and I felt somehow responsible. An awful feeling that since the Cholera control was my responsibility, these deaths were partly my doing. I felt lightheaded and clammy.

Helen pinned a quarantine sign to the door, drawing a cross on the lower left-hand corner, a notation meaning that the room only contained the dead. We would notify the coroner later. She looked at the door, bowed her head, and said, “Rest in peace.”  She looked at me. “You all right?”

I have a weak thumbs up, afraid if I talked it would be accompanied by my breakfast.

“Understood,” she says. “It’s a grim business. Sadly, you will get used to it.”

I didn’t think so. Dead children were not a sight I would forget or become accustomed to. Especially as I had the feeling, however undeserved, that the deaths were partly my fault. The Cholera needed to be stopped.

And a moment later, and Helen back to business.

“Let’s move on.”

I took in some deep, slow breaths as we walked to the other end of the hall, to number 500, and knocked again. I felt a little better, less like I was going to faint. This time the door opened, a haggard-appearing young woman in the opening.


“Mrs. James?”


“I am Helen Finnegan, and this is Jordan Bruno. We are from the Ministry for Social Hygiene. We understand someone here has the Cholera.”

“Yes. My husband and my eldest. Both seem to be doing better.”

“Have they seen a Medical Philosopher?” I asked.

“Yes. A Homeopathic Philosopher was here earlier. She prescribed them each a remedy.”

“How many others in the family?

“Just two others, my younger children. They are fine. The MP gave us a preventative as well.”

“You understand that this apartment is now under the quarantine,” Helen said. “No one can leave the apartment until everyone is free from the flux for at least 48 hours. And you will need clearance by either someone from a Medical Society or from the Ministry. However, someone from the Ministry should be by every day to check the quarantine, so getting an all clear should not be a hardship. Failure to obey could result in a minimum fine of five hundred dollars and a month in jail. Minimum. Do you understand?”

Mrs. James nodded. The Crown takes the quarantine very seriously. It is one of the few areas of the law with no wiggle room or exceptions. Rich or poor, if you were put in quarantine, you stayed in quarantine. Once or twice a year, the Crown made a very public example of someone who violated the quarantine. Like the Tax Ministry, no one crossed the quarantine.

“Do you have someone who can bring you food and water?”

“My sister.”

“She is not to pass through this door. Understand?”

Mrs. James nodded again.

“Thank you, Mrs. James. One of my colleagues will be checking daily to make sure you are OK and to confirm when it is safe to stop the quarantine. Any questions?”

“Am I going to get the Cholera?”

“I do not know, but pray that you do not. It is in God’s hands, but hopefully, the MPs preventative will help. Anything else?”

“No, ma’am.”

“Then I will let you get back to tending to your family. Thank you.”

As she started to close the door, I asked, “Do you have a moment for a few questions?”

She hesitated, looking over her shoulder at the bedroom.

“It will only take a minute.”

She reopened the door.

“When did the Cholera start?” I asked.

“Two days ago. It started in my husband, and my child became ill less than a day later,” she said.

“In the days just before the illness, can you remember anything unusual? Any travel, anyone around you ill, any new or different foods? Did your husband or eldest do or eat anything differently than you or your other children? Anything at all out of the ordinary come to mind?”

She thought for a few moments and shrugged. “No, sir. Not that I can remember.”

“Did you know the family in 513? Do you have any contact with them?”

“No, sir. Do they have the Cholera as well?”

“I am afraid so. Well, I know this is a bad time,” I said. “But please reflect upon my questions. If you should think of anything, please notify one of our colleagues when they visit. Anything you think may be different that could have led to the Cholera. Thank you.”

Mrs. James closed the door, and Helen attached the quarantine sign to the door with a pair of thumbtacks.

“This is just like the “99 outbreak,” she said. “The quarantine will be too little and too late. If it did anything at all. Who knows? But when all you have is a hammer, everything is a nail. We should not let any of these people be cared for at home. They need to be moved to someplace where they can get medical care, nursing, food, and water. But only the Homeopathic Hospital will take patients, and that is not practical since no one with the Cholera can make it safely from Kenton to Lake Oswego.” She sighed. “It is all such a waste.”

“We do what we can,” I said.

“Which is nothing.”

“Boy, aren’t you the optimistic one.”

“I have been here before. Last time we did little, if anything, to alter the course of the Cholera. And since? We do not know what causes the Cholera. We don’t know how it spreads. We don’t know how to prevent it. The quarantine appears to be just as effective as the last time. As in not. The cases are not related; how would the quarantine have prevented the Cholera from spreading here? It can’t.”

“I don’t think I am a pessimist. I am a realist. But the metro area has almost 100,000 more people than it did twenty years ago. So, we have more people to get the disease, and so more will die. Two thousand last time. So, what is it going to be this time? Three thousand dead? Five thousand? More? And our response? Six people tasked for a literal shit storm. To predict the future, look to the past. This is going to be ugly.”

“I have already requested more help,” I said.

“It won’t be enough. I remember the last time. We will need hundreds of workers, if for no other reason than to bury the dead. And we need to know how to stop the Cholera. And we have? Nothing. Or next to nothing. Unless we get lucky, this is going to be a disaster.”

As we talked, we walked down the steps and out into the sunshine. Normal life returned around us, oblivious to the death and suffering in the building behind them.

Helen pointed. “There is a post office one block that way.” She pointed in the opposite direction. “There is a tea shop that way. I will go and telegraph the coroner that they have a pick-up. Why don’t you get us a pair of very strong teas? I want a Scotch, but I’ll take tea. I meet you there in ten.”

“Sounds good,” I said.

Helen gave me something to think about. She may have said she had nothing to offer, but she obviously had thought long and hard about her experiences with the Cholera. I suspect that she was more old school, from a time when nurses were expected to be seen and not heard. They were supposed to be doers, not thinkers. But Helen was the only one among us with experience with the Cholera and with it, wisdom. Her observations would be invaluable.

I made it to the tea shop, an Astros, and ordered two Earl Greys to go. They had a new product from South America. Coffee. I had heard of it; they drank it on the Continent, or so I understood. It looked terrible. Thick and black. Maybe some other time.

I found a table outside, and as I sat down, Helen joined me.

“All done,” she said. “Now, to repeat the process.” She took a sip of her tea and sighed. “Sorry, I was Gloomy Helen. But it sure looks to me that history is going to repeat itself with the Cholera. And more.”

To be continued.

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