I decided, as I grabbed my morning bun and tea, that I was not up for reading the Times. The front-page headline again said CHOLERA, and the headline font was getting bigger.

What I did not know could not hurt me, right? Besides, there would be plenty of copies around the office and at the tea shops to catch up on the day’s events. I needed something different, a mental amuse bouche, to start my day. I grabbed the latest copy of the River Weekly, a free paper that focused on local culture, politics, and entertainment. Long anti-Royalist, they were using the outbreak as an opportunity to attack the Crown and more. It was not the most reassuring reading for the trolley ride to work.

The headline also said CHOLERA. With three exclamation marks. But at least the font size was not enormous. The rest of the article was less pleasant.


Running amok in East County

Public Hygiene Failing

Your complete guide to the Cholera

Prevention & Treatments

By Blair Colvin

The Cholera continues to cause diarrhea and death in East Portland. Since it began ten days ago, the disease has relentlessly progressed. As of press time, there have been 245 cases and 101 deaths. We are on track to rival and surpass the outbreak of 1999, which had the same number of cases at a similar point in the epidemic.

To date, the Crown’s response has been good-for-naught in halting or even slowing the epidemic. With no explanation for the cause of the Cholera and no plan for its prevention or treatment, the Royal Ministry has been limited to observation and quarantine as death, and the flux, has run amok in the city.

When pressed for answers, Joseph Bosworth, the head of the Ministry for Social Hygiene, said: “The Crown is using all the tools at our disposal to stem the tide of this outbreak.”

An anemic response at best.

The tools used by the Crown are the quarantine and threatening fines and imprisonment for those who ignore the quarantine. Neither approach seems to stop the spread of disease.

What is the Cholera?

The symptoms of the Cholera are fevers, abdominal pain, and the flux. The flux can be mild, but many are afflicted with a severe form that can kill in as little as two hours. In these cases, the flux can produce a quart diarrhea an hour leading to severe dehydration and death. The flux, it should be noted, often looks like rice water, even when the victim has not consumed rice.

What causes the Cholera?

While there are many theories as to the cause of the Cholera, there is no consensus among the Medical Societies. The Crown and the Ministry has always been silent on the matter, deferring to the “expertise” of the Medical Societies, perhaps not wishing to alienate an important source of Royal revenue.

Cholera Theories
These are the theories of the major Medical Societies concerning the cause of the Cholera.

Homeopathy: the disease is due to miasma.

Humorists: disease is due to an imbalance of humours.

Chiropractic: disease is due to spinal subluxation blocking innate intelligence.

Naturopathic: disease etiology is variable, depending on the Naturopath, but often related to diet and toxins.

Eastern Medicine: disease is due to blocked chi.

There are also other ideas that have been put forth as a cause of the Cholera by practitioners in the Guilds. These purported causes of the Cholera run in the dozens.

What these theories all have in common is they have nothing in common.

As each Society offers a different explanation for disease, it is no surprise that they all provide different solutions. Differing causes of disease and differing remedies.

Can they all be right? Can only one be right? Or are they all wrong? Each Society claims to understand the one true cause of disease, and with it, the remedy. But so far, their ministrations have done little to alter the course of the Cholera, either in 1999 or now.

Other Approaches

There have been reports and rumors from the Continent of a different understanding of disease and its treatments. We have been unable to verify the validity of these rumors. We only have hints as to their existence. However, these reports, if true, have been, along with everything else from the Continent, suppressed and actively prohibited by the Crown.

It is time the Crown and the Continent tear down the wall that has separated the two Empires since the time of Napoleon. If the French do have a new understanding of the cause and treatment of the Cholera, we need to know.

The health and welfare of both our peoples demand it.

That took courage, more than I have. Not only were they attacking the Crown and the Ministry’s reaction to the Cholera, but they were also attacking the Medical Societies. That was not done. The Medical Societies were under the protection of the Crown. They had deep pockets with a propensity to sue.

The Empire had lost to the French in the Napoleonic Wars. In 1816 the last Crown soldier left the Continent, and the Crown stopped any and all interactions with the French Empire. It was more a fit of pique as Parliament passed no laws. Instead, it became part of the social contract, the way things were done. And social mores are far more potent in the Empire than laws. What the Crown wanted, the Crown received.

Over the years, the prohibition on anything from the Continent had eroded a bit. Some interactions were tolerated, but always on the sly. But it was never suggested that the Continent offered anything superior to that of the Empire. Not even the wines, even though everyone knew the best were from France.

One never advertised any interaction with the French, and one certainly never criticized the Crown’s approach to the Continent. It was not illegal per, just as it was not treason. It just was not done. Unless you desired social ostracism.

Voicing approval of the Continent could result, it was said, of your name appearing on lists and could be used, surreptitiously, to ruin your life. If you were lucky, you became persona non grata. And it could lead to investigations that uncovered information that did lead to prison. The Crown kept an eye on those who were vocal about the Continent. It was often viewed as an act of sedition, even if not “officially.”

Mentioning the French and the Continent and suggesting they might have a superior understanding of the Cholera? It was worse than treason. It was impolite. You just did not go there. And it raised the question, how did the River Weekly acquire this information? The author and the River Weekly were likely to be in a world of trouble for this. Not official trouble, but trouble.

Bloody hell. I might be already under suspicion by the Crown for fraternizing with the enemy. Talking to the author of the article would sure as hell put me on a path to ruin my career. There was no way I was going to make that mistake.

I got off the trolley and looked around. The River Weekly had reignited my paranoia. Was anyone watching me? I could not tell. But I very ostentatiously tossed the paper in the rubbish bin with a grimace and dusted off my hands. Probably too obvious.

When I arrived at the office, everyone had already set off for the day’s work. I spent the morning doing paperwork and answering telegrams. There was always administrative work to do, no matter what the crisis, but I was itching to get out in the field.

There was a note on my desk from Sherman reminding me to ask for more help:

“Reminder: Cases are increasing with no end in sight. The extra help is already not enough. Whatever you think we need, double it.”

I tripled the request. Might as well.

By 10:30 I was finished with admin work and, with no meetings, prepared to leave. I looked up to see Bosworth standing in the doorway. I stood up quickly. “Sir. I didn’t see or hear you.”

“Sit down,” he said. “I did not want to interrupt.” He walked into the room. “How is it going?”

“Terrible,” I said. “Cases are increasing, and we seem to be doing little to stop them. I can’t see where the quarantine is doing much. None of the cases seem connected, and those with the Cholera are not able to go anywhere anyway. A severe flux keeps people at home, and near a loo. We spend a lot of time and effort with no effect on the new cases.”

Bosworth nodded in agreement. “I understand,” he said. “But the quarantine is your mandate. If not the quarantine, then what would you do?”

“Uhhh…” I hedged.

“Exactly,” he said. “Even worse than the Ministry employing the quarantine during the Cholera even when it does not work would be for the Ministry to do nothing during the Cholera. So even if you suspect the quarantine is a waste of time, it is good public relations. It gives the impression that the Ministry and the Crown not only care but are doing something for the populace. At one level, it is good optics.”

“So, we are responsible for bread and circuses?” I asked.

“Do not be so cynical. We need to keep everyone calm. We can’t have people panicking and leaving the city. That would be a disaster.”

“Oh.” I quickly searched my outbox and handed him an envelope. “This will save half a day. My update and a request for more help.”

He took the envelope and tucked it in his coat pocket. “I’ll read it and see what I can do. But don’t expect much; we are almost at the limit of local resources. I will be discussing it with the Governor this afternoon, along with another issue, the reason I dropped by.”

I grimaced.

“First,” he said, “The meeting with Master Pettenkofer was … interesting. He was very clear, in a completely indirect manner, that if the Ministry or its workers in any way impugned the Medical Societies and in particular the Homeopathy Society, we would be lucky to live to regret it. Quite the gentleman, Master Pettenkofer.”

“How did you respond?” I asked.

“I didn’t. Bullies are the same everywhere. Snakes in the grass. It is best to keep a poker face. But they do have money and connections, so as I said before, tread carefully. As I learned in the Navy, you don’t unnecessarily aggravate those in power. You need to choose your battles carefully.”

He continued, “At noon, Vancouver is going to close the two bridges over the Columbia to keep the Cholera out of Washington. Those from the northeast part of the city, Kenton and its surrounding postal codes, will not be allowed to cross the bridges into Washington. They will have to show proof of residence. It is going to make traffic a nightmare.”

“Can they do that?” I asked.

“Of course,” he said. “They have the same quarantine powers we do, and their authority starts at the border, which is right in the middle of the river. I assume once Vancouver makes the announcement, other cities up and down the Columbia will do the same. It will be awkward and disruptive, but they want to keep Oregon quarantined.

“The bigger issue, and of questionable legality since it is not a separate jurisdiction, is the Portland City Council may elect to close the bridges across the Willamette before the Cholera moves to the west side of the city. Closing the Willamette River bridges would be a larger disaster on many levels, and the word is that they are not quite ready to pull that trigger. But I thought you should be forewarned that the city may be putting pressure on the Ministry to widen the quarantine. Shut down everything in East County. The Crown would like you to resist.”

I sighed heavily. “Great. Just what I needed.”

“I am not saying it will come to that, especially if the Cholera is brought under control. Or, I would guess, if the Cholera makes it to the west side before the bridges are closed. Anything else I can help you with?”

“No, sir. But thank you for the warning.”

He patted his coat pocket. “I will read this on the way to my office. Again, don’t expect much in the way of additional help. There just isn’t any.”

“Thank you, sir.”

After Bosworth left, I stared at the doorway for a few moments, letting the bad news sink in. I looked at my watch—time to meet Kerri Becker. Kerri was new in the department, having been with us for three months. The Ministry was her second job after graduating from nursing school. Before that, she had worked for a Naturopathic Philosopher. I felt I knew her the least in the department. She was quiet, did her work well, but rarely volunteered personal information. I knew she had been recently married and that her mother was ill, but beyond that, nothing.

As usual, we were to meet at Paul Bunyan at the central square, but I was early, so I leaned against Paul’s left foot and enjoyed a brief moment of quiet.

It was a nice view. The Kenton neighborhood was one of the more secluded sections of Portland, past the core of the city, and still had a slightly rural feel. There was more open space.

Paul stood at the south end of what had been a commons, a small park that still had a functional water pump used by the neighborhood. On the north end of the park was the Columbia slough, and beyond that a farm with cattle and sheep. North Portland had a relatively large population from the Indian subcontinent and Nepal, who had migrated to the Northwest in the early part of the century following a massive famine. They owned or worked on many of the farms in the area. As best I could make out from this far away from the dress, it appeared that the farm was owned or operated by Nepalese.

Today several dozen tents filled the park, the weekly Farmers” Market. There was a sign at the front: Farmers” Market. Cholera Information. One Day Only. It appeared there was a flux festival as well.

Always in need of fresh tomatoes, I walked over to the market to examine the produce, perhaps have lunch, and to see what information was being offered about the Cholera. At the entrance to the Market, a man was handing out pamphlets.

“The truth about the Cholera,” he said as I accepted one.

The Truth About the Cholera

Do not be misled. The truth They don’t want you to know.

The Cholera is man-made.

The Crown is responsible.

The Cholera has been introduced into working-class neighborhoods as a form of population control and to suppress the rights of workers.

Ask yourself.

Why are the rich spared?

Why has the Royal Family never developed the Cholera?

Why are the Medical Societies at odds as to the cause and treatment of the Cholera?

Who Profits from the Cholera?

The Royal-Industrial Complex.

The Cholera is meant to keep the working class down.

Do not be fooled.

Act Today!

After reading the brochure, I walked back to the man handing them out.

“Can I ask you a question?” I spoke.

“You just did,” he replied. “Feel free to ask another.”

“OK. So just what do you think is the cause of the Cholera, and how is it spread?”

He shrugged. “I haven’t a clue. Those in power have access to all kinds of resources that we do not. Secret laboratories and Societies spread across the Empire. Their capabilities and access to arcane knowledge exceed those of most people. Their influence and reach can be inferred by the results. All overseen and directed by the Crown Prince without the knowledge of the King.”

“Why the Crown Prince?”

“He profits the most. His wealth comes from the oppression of workers. Their low wages mean more money for him.”

“And the King?”

“A good man. But out of touch with the machinations of his son. If the King only knew the truth, they are hiding from him, all would be well.”

“And how does the Cholera lead to more money for the Crown?” I asked.

“Misdirection. Workers will be too busy with surviving the Cholera to agitate for more rights.” He waved a pamphlet. “This exposes the truth.”

“Of the Cholera?” I said.

“Of the Cholera,” he agreed. “And more. The rot goes deep and is unseen and unsuspected.”

I thanked him and went back to the market. A wide-ranging conspiracy headed by the Crown Prince to kill and disable the working class with the Cholera to increase profits. Barmy.

Although I was not so sure about the whole secret Societies keeping an eye on citizens. Just because he was barmy, it does not mean he was not at least partly right.



  • 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