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“Well,” I said. “Let’s see what we can do to prevent that from happening. Who is next?”

“A house down the street. Two cases in a family of six.”

It was a perfect Portland summer afternoon, sunny and no humidity. A day to play in the park, not die in your living room covered in your own shit. I hoped the rest of the day was free of the dead.

We arrived at the house and went up and knocked on the door. The Zhou family. No deaths this time, two young children were ill, and they had an Eastern Philosopher tending to the family. Those with the Cholera had already been treated, but the practitioner was ministering to the mother, who was lying on a sofa with needles in her arms, legs, and abdomen. The MP was holding what looked to be a smoldering piece of tobacco against the needles in the abdomen, although the room did not smell of tobacco.

While Helen talked with the husband, I introduced myself to the EP and inquired whether I could ask questions.

“By all means,” she said. “But I cannot reveal any proprietary information. You are no doubt aware of the rules regarding the conduct of the Medical Societies.”

“I am,” I said. “And I thank you. I have been tasked by the Ministry for Social Hygiene with managing and, hopefully, containing the Cholera. The more information I have, the better. I was hoping to enlist the expertise of the Medical Societies.”

“Of course,” she said. “You happen to be in luck as I am the current sub-Master of the Portland Eastern Philosophic Society. Gloria Nutella-Aziz at your service.”

She gave a slight bow. She was a slender, dark-haired woman with a pleasant, although tired, smile.

“Jordan Bruno.”

“I have heard of you,” she replied, “Nice to meet you. I am just about finished here. Let me complete my treatment, and then we can chat.”

I watched as she applied the smoldering herb to the stomach needle, then quickly pulled out each needle.

“Now that didn’t hurt a bit, did it?” she asked.

Mrs. Zhou shook her head no.

“Excellent. That should prevent you from getting the Cholera. I have cleared your heat and transformed your dampness. The Cholera should leave you alone. I did the same for your unaffected children.

“Everyone should take some herbal remedies for the next week.”

She pulled out a pad, wrote something down, tore it off, and handed it to Mrs. Zhou.

“This is for Sweet Flag. Boil a teaspoon in a quart of water and drink half a cup four times a day. Also, Prickly Chaff Flower. Mix a teaspoon in a cup of warm water and drink one a day. These can be filled at my apothecary. The address is on the top. Any questions?”


“Here is my statement; payment can be mailed to the address on the top. Thank you and be healthy.”

Nutella-Aziz then turned to me. “Shall we step outside for a bit of privacy?”

We walked out of the house and, at her suggestion, sat on the front doorsteps in the sun.

“I like the heat,” she said. “Nothing warms quite like the sun. It has been a busy few days, and I fear it will get busier, so it is nice to rest, if only for a moment. So, what can I do for you?”

“As I mentioned, I am the director of the local Oregon Ministry for Social Hygiene, and we have the responsibility of trying to manage and halt the Cholera. But we lack both the manpower and the knowledge for such a huge undertaking. We were hoping to enlist the help of the Medical Societies both to help us understand the Cholera and how best to manage it. This morning I instructed my assistant to arrange meetings with each of the Medical Societies so that we can collaborate. We will really need help if the Cholera is going to be as severe as the last outbreak.”

“I see.” There was a pause while she shut her eyes and turned her face to the sun. “I doubt,” she said, “that the other Societies will be of much use. Just between us, none of them know what they are doing; we Eastern Philosophers are the only ones who understand the one true cause of all disease and its treatment. The rest?” She waved her hand dismissively. “Posers. I only say this as with the Cholera, the stakes are too high to be politic about the distinguished competition. If you want real help, ask the Eastern Philosophic Society. But before I can divulge too much information, I will need to consult with my colleagues. We can start with some basic information, perhaps. Just what is it you would like to know?”

“What causes the Cholera, how does it spread, how is it treated, and how to prevent it?”

She smiled. “Oh, that’s all? Just everything.”

“Well,” I said, “I’ll take as much information as you can give me today; then we can meet later after you have conferred with the rest of your Society and can fill in the gaps.”

“OK. First, the other Medical Societies do not have a clue as to what they are doing, and in any thoughtful country, what they are doing would be banned as fraudulent. But that is not the way the Empire is organized. But their understanding of health and disease is as ignorant as it is laughable. Ours is an ancient and proven Philosophy used across the world for centuries with excellent effect. The others? Children playing Philosophers.

“All life is powered by a fluid. Not blood or lymph or some inane intelligence of the Chiropractors or vibrational energy of the Homeopaths. That fluid is chi, and it carries the life force and courses through the body in channels called meridians. Disease occurs when these meridians are blocked, and the life force cannot flow in its natural channels. The natural balance of the body, its yin and yang, are disrupted.

“Chi also interacts with the Five Elements of Wood, Fire, Earth, Metal, and Water to communicate with the organs to maintain balance and health. That is the barest of outlines. Eastern Philosophy is a complex and subtle system of interconnections that takes years to completely understand and master. And, of course, proprietary.

“Eastern Philosophers can determine the nature of chi blockage by examining the pulse and tongue of the afflicted. Then, with a variety of techniques, depending on the needs of the patient, we unblock the chi, restore balance, and prevent or cure disease. All disease.”

“In the case of the Cholera, we, unlike the other Philosophies, recognize four kinds. There is Cold Cholera, Heat Cholera, Dry Cholera, and Damp Cholera. The current outbreak is due in equal parts to Cold Cholera and Heat Cholera.”

“So why the outbreak now?” I asked. “What happened?”

“Why? That I do not know. Why are a large number of people all suffering from abnormal chi? That is a question for the gods, not man. But the way to prevent its spread is the same as its treatment. People must be in balance, and we Eastern Philosophers are the only ones capable of applying the correct remedy or preventative.”

“How many Eastern Philosophers are in the Portland area?”

“Around one hundred.”

“And if we have a larger outbreak than 1999? Say three or four thousand cases of the Cholera?”

“We lack sufficient numbers to care for that many patients, much less provide preventative care.”

“At that point, would you be willing to share your treatments?” I asked.

She paused again. “That would up to a vote of the Society. But I suspect not. For centuries, we have been entrusted with special knowledge, making sure that Eastern Philosophy is used safely and effectively. What would happen if we taught everyone how to alter the basic life force without our training and safeguards? In the wrong hands, it could be catastrophic. So, I suspect not. Any other questions?”

“Not at the moment. But you have given me a lot to think about.”

“Then, I am off. I suspect we will meet again in the not-too-distant future.”

“I hope so. And thank you again.”

While I talked with Master Nutella-Aziz, Helen had explained the rules of the quarantine to the Smiths, who had answered their questions, posted the quarantine sign, and met me outside just as I finished my conversation.

“I have always wondered about the Eastern Philosophers,” she said.

“What’s that?”

“You know how they say the life force flows through channels in the body? And they stick needles in those channels to fix blockages?”

“So, Master Nutella-Aziz informs me,” I said.

“Well, they always show these channels overlaid on a human figure. You ever look at the figures closely?”

“No,” I said. “But I know what you are referring to. What of it?”

“It is just curious where there are no channels. The fingernails. The eyes. And the genitals. Interesting there is not life force in the genitals.”

I laughed. “Well, the only people who could stick needles in those areas are masochists or torturers,” I said.

“I suppose. But given the Societies eat their own dog food, it is mighty convenient they need not get a jab in any of those sensitive areas. I also wonder how they unblock a channel by sticking a needle in it. It would be like removing a dam by adding another dam.”

I had no answer for that. It was odd when you thought about it.

We continued our work.

That was how it went for the rest of the day. I never found the time to join Kerri on her post-quarantine rounds. Perhaps tomorrow. Some households had deaths, some households were doing fine, a few were receiving care from one or another Society Philosopher, most were not, and everyone had no information pointing to anything out of the ordinary that could have led to the Cholera. All victims of the Cholera were willing to pass on any information if it came up; the few Medical Philosophers were polite, but to a provider said they would have to check with their respective Society before they could supply any information beyond what was available in the newspapers.

By 4 o’clock, we had seen all but the last house on the list. I still could not shake the sense of responsibility for the deaths and disease I had seen. I had been on the job for only two days. Impossible to have any effect on the Cholera. But I kept thinking about the dead family that had started the day. There would be more deaths and my inability to halt the Cholera would make all those deaths my fault. Not a rational response, I knew, but who said I was rational?

“I’m surprised we got it all done,” I said. “It was a long list.”

“Today we did,” said Helen. “But not tomorrow. Tomorrow we will start to be overwhelmed with the number of cases, and the back-up will always be insufficient for the demand. Been there, done that.”

“That is one of the reasons I am going back to the office now, if you don’t mind,” I said. “I want to send an amended request for help. I see where this is going, and I want to try to get ahead of the curve. Also, I agreed to meet up with Cassandra to follow up on her investigations. Unless you need me?”

“No, I’m good. I am heading straight home after the last house rather than go to the office. I have a birthday party to attend for my granddaughter. Number eight if you can believe it.”

“That should be fun. Enjoy.”

“I will.”

We parted, and I went to the trolley stop while Helen moved on to the last household of the day with the Cholera.

I returned to the office about 4:45, went to my office and sent a memo to Bosworth requesting twice as many workers for the quarantine. I warned him that if the Cholera cases continued to increase at the current rate or matched the growth of the 1999 outbreak, that those extra workers would rapidly become insufficient. I was about to sign the note when I had a flash of inspiration and added a postscript.

“It has been observed that the 1999 Cholera outbreak stopped with the October cold snap when the temperature fell below freezing for a week. If that was the reason for the end of the outbreak, then we may be in for 4 or 5 months of the Cholera before we have a fall cold spell and an end to this outbreak. We need to put all our efforts into early prevention and quarantine to avoid a catastrophe, and that will require extra manpower.”

It was worth a try, I thought. I signed the request and sent it off. It was 5 o’clock, so I went back to the cubbyhole room to meet Cassandra. I saw her walking in just as I came out of the stairwell.

“How did it go?” I asked as I walked into the room.

“It was an interesting day. I got some information, but the tele is slow. Very slow. So, I expect answers to my queries to trickle in over the next week. But.” She paused and looked at the cubbyholes, distracted. “Hey,” she said at last. “The Cholera is worse and is expanding its range, isn’t it?”

“What do you mean?”

She pointed at the cubbyholes. “Those slots are filling up. More cases. And there are others that have slips in them that I bet were empty when I left this morning. New city blocks are involved. The Cholera is intensifying in the middle of Kenton and is starting to spread out.”

I looked at where she was pointing and saw she was right. The slots were an excellent depiction of the Cholera spread.

“Hell,” I agreed. “You are right. I was using this more for the organization, but it does show that the Cholera is intensifying and spreading. Double hell. Now what?”

We looked at the slots in silence for a few moments. Neither of us had an answer.

“Tell me some good news,” I said.

“I have news—good or bad I will leave for you to determine. For starters, today I learned what I can and cannot do with the tele. While there is a massive amount of government information stored on the Babbage-Ada Universal Knowledge Machines, accessing that information, a whole nuther matter. You have to ask precise questions in a precise way to get an answer. It took most of the morning just to get the two questions worded in just the right way to get the right response. They use a special language to communicate with the UKM called Ada. A little recursive, I think. So, you come up with a question that has to be translated into Ada, and the Ada is entered into the local UKM, that is then telegraphed to distant UKMs. The distant UKM has to read the Ada and then do its thing. In the meantime, you wait. And wait. And.”

“Wait?” I asked.

“Good pick up. During the wait, all the UKMs across the Empire are telegraphing information back and forth. Or so they told me. It seems like magic. Then all the information is telegraphed back to the local UKM, which collates and summarizes all the information. Kind of. Because it then prints out a report. Reams and reams of reports. Which has to be translated into English by hand. Usually. The Sisters have come up with a clever way of translating the Ada results into readable cards.” She bent over and took a stack of cards out of a satchel. “There are about five hundred cards here.”

“And it says..?” I prompted.

She shrugged. “I haven’t a clue. I have yet to dig into it. I received these cards around four, just before I left to report to you.”

“Well, what did you ask?

“It should contain cases, deaths, the year, start and stop month, and location of every Cholera case in the Empire going back as long as there have been reports, maybe two hundred and fifty years. And every high and low temperature during that month.” She held up the first card of the stack. “For example, 3,2,1886, 8/2, New Orleans, 72, 58. Or on August 2, 1886, a high of 72 degrees and a low of 58, and they had 3 cases of Cholera with 2 deaths.”

She read the next card. “6,4,1886, 8/3 New Orleans, 73, 58. I bet you can interpret it.”

“I can,” I said. “So how is this organized?”

“It isn’t, except each outbreak is listed chronologically, from first to the last case. The outbreaks themselves were printed first come first serve to the local UKM. Further, the organization of the information takes even more time. Writing the correct commands in Ada for the UKM is a specialized and difficult skill, but the sisters seem impressed with how quickly I am learning. They think I have an aptitude. Actually, going through all this information to make sense of it, to find a pattern, would take days or weeks with pen and paper. But I am going to go through the raw information and try to write an Ada algorithm to analyze it and then send the result to their mechanical drafting table. Once I get it all set up, the UKM should be able to analyze the information and produce graphs in much less time than if I were to attempt it by hand.”

“Really?” I will admit to a bit of whine in my voice. “How long will that take?”

“Couple of days, I hope. So now what? Do you want me to keep working on this? It will take time, but the sisters are willing, even excited, to give it a try.”

I sighed. I needed information sooner rather than later, and this seemed a long shot. I took the stack of cards and hefted it. Would a stack of cards prevent a stack of Cholera corpses? Would it be worth the time and expense? Was there an epiphany buried in all this information? Or was it a nothing scone? I looked up at the cubbyholes again as George Webster walked into the room. I had to decide. Cassandra was too smart and too clever not to make it work.

“OK. Do it.”

She gave a fist pump, and I turned to George.

“Perfect timing,” I said. “What do you have to report?”

“It took me all day to do the reports, all sixty-seven of them. If there are more cases than that tomorrow, I will need some help.”

“Already requested and on the way,” I said. Or so I hoped.

“I did make one minor modification to the process. You just put a card in the slot for each issue. I added a note indicating which report it came from and what the information was. It gives you a bit of redundancy for checking the data. See?”

He reached up and pulled a card out of the cubbyhole labeled 97217-2213. On the card was written “#23 ′ and” 97217-2213.”

“Case number 23 and postal code 97217-2213. The card and the cubby match. In case there is misfiling, it can be corrected.” He replaced the card and pulled out one from another cubby.

It said “#47, 97217-2213.”

He replaced the card and started to reach for a third.

“I get it,” I said. “An excellent improvement.”

“Thank you, sir. I did have to go back and change all the cards you had placed in the cubbies. That took some extra time.”

“Thank you,” I said. “It means I don’t have to. So did you find anything?”

“It would appear that not only are the cases increasing in number, but they are spreading out of the initial two postal codes. But not many so far.”

“Anything else that you have noticed?”

“No. The number of deaths seems to hover at around four in ten. You can’t really tell by looking at the cubbies; it looks like half. But I did the calculation. 39.9%. I also made a note, if reported, of the treatments of those who died and those who survived.”

“Apparently, the Humourists have a death rate about 10% higher than the others. And, perhaps, the Eastern Philosophers have more deaths as well—but, oddly, and I am not sure, but they have several deaths from gangrene, not the Cholera. At least that is what the reports say.”

“That’s curious,” I said.

“Well, sir,” he said, “I am not college trained. I only had A-Levels. But that is what it looks like to me.”

“Lots of stupid people are College trained, and a lot of smart people never went past the A’s,” I said. “Quality work is quality work.”

Webster grinned at the compliment. “Thank you, sir.”

“Now,” I said. “Just how am I going to deal with all this information? I feel like I have all the parts to build a house, but I lack both a plan and the experience to put it together.”

I stared at the cubbyholes and the huge UKM report with a sinking heart. This was going nowhere fast. I hoped Cassandra and the Ford sisters could make some headway. I sighed.

“Well, that’s it for today. Have a good evening.”

“You as well, sir.”

I walked home instead of taking the trolley. Being outside was an excellent way to clear the mind and unwind. It was a beautiful summer evening, but the streets seemed a little empty. There were fewer people out than usual. Perhaps people were becoming worried about the Cholera and either staying in or leaving town. That did not bode well. And the vague feeling of guilt followed me home.

To be continued here.



  • Mark Crislip, MD has been a practicing Infectious Disease specialist in Portland, Oregon, from 1990 to 2023. 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

Posted by Mark Crislip

Mark Crislip, MD has been a practicing Infectious Disease specialist in Portland, Oregon, from 1990 to 2023. 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