I grabbed my usual morning tea, scone, and paper. I was not up for the Times, which had the largest circulation, but supported the Crown and was pro-Medical Society. Instead, I tried a copy of the Oregon Journal. Not that it was much better. Newspaper coverage of the Cholera was never favorable, but why would it be? Why expect a headline that said To the Delight of City, Cholera Cases Increasing or Hooray! More Diarrhea. It is not as if we were doing anything to stem the tide of diarrhea.

The front page had the incredible expanding headline, a feature in all newspapers as the Cholera progressed.


341 Stricken

150 Dead

First Cases in Lake Oswego and Hillsboro

Crown Response Ineffective

Time to Quarantine Neighborhoods?

Portland—the Kenton neighborhood Cholera epidemic, now with 341 cases and 150 deaths, has traveled to the West-side. Yesterday cases were reported in both Lake Oswego and Hillsboro, the first instances of the epidemic on the west of the Willamette River.

When asked, Joseph Bosworth, Head of the Ministry for Social Hygiene, had no explanation for the spread.

“The Commission, through its County Hygiene Departments, has been keeping a close eye on the outbreak. We have been aggressively applying the quarantine. It has always been the responsibility of the Medical Societies to prevent and treat diseases in the Empire, including the Cholera. It is the basis of their charter, and I direct you to their organizations for further information.”

The head of the Homeopathic Society, Maxwell Pettenkofer, said, “Homeopathy is the only proven Natural Philosophy for treatment and prevention, not only for the Cholera but for all human ailments. The main reason the Cholera continues unabated is that people are failing to take advantage of the benefits of homeopathy and, instead, are seeking alternative remedies. The Cholera would soon be banished from Portland if Homeopathy was more widely used and promoted by the Crown.”

When asked to comment, Tobin Watkinson of the Society of Chiropractors said, “Sadly, the Homeopathic Society is misinformed. Spinal health is the only way to prevent the Cholera, and regular spinal manipulation by a Chiropractor is the only effective prevention and remedy for the Cholera.”

The other Medical Societies were unavailable for comment at press time.

West-side citizens are voicing concern that the Cholera will accelerate as it did in east Portland and are calling for Portland to close the bridges across the Willamette to prevent further contamination. Portland Mayor Fred Ivanov said, “The Medical Societies and the Ministry of Hygiene have not suggested bridge closure as a method for containing the Cholera. Until we know that closing the bridges would indeed stop the spread of Cholera, we will avoid the major economic disruption of bridge closure.

More dissension in the ranks. I could not remember a Master of one Medical Society ever suggesting that one of the other Societies could be “misinformed,” a nice way of saying wrong. Infighting in the Societies was not going to make it any easier to combat the Cholera. Egos always get in the way.

I flipped through the rest of the paper: half-page and full-page advertisements touting each of the major Medical Societies and their approach to the Cholera. If nothing else, the Cholera was going to be good for the newspaper’s bottom line; those advertisements were not cheap. If the advertisements were repeated in the other two dailies and the three weeklies, not to mention the local neighborhood papers, it was going to cost the Societies some serious money. But no doubt financially worth it if the epidemic surpassed 1999 levels.

For the first time, there was an advertisement from the Guild of Independent Medical Philosophers. Always be careful naming your organization. It should not rhyme with an obscenity nor have an unfortunate acronym.

The Societies were the oldest and most influential Medical Philosophers in the Empire, but try as they might, they had not been able to maintain a total monopoly. There was a hierarchy of organizations in the Empire for workers and professionals: Societies, then Guilds, then Trade Associations. To work in the Empire, one had to belong to some sort of association that could be taxed and, to some degree, controlled.

Societies, such as Medical, were at the top of the pyramid. They had old money and old traditions with a charter from the Crown that provided them with a monopoly. The trades were at the bottom, laborers, and artisans. They did not have job security, and people moved from Association to Association if they changed jobs. If there were a new occupation, like dirigible mechanic, then a new Trade Associations was formed for the workers.

Then there were the Guilds, mostly filled with white-collar workers. I belonged to the Guild of Crown Administrators, all those trained at Crown colleges and employed throughout the Empire. Nurses and pharmacists and police and fireman all had a Guild. All Trade Associations hoped one day to become a Guild, and every Guild wished for Society status. Those were infrequent events, but all five Medical Societies had, at one time, been Guilds. They had all been elevated to Society status by the Crown and granted exclusive charters during the China War of 1860, a time when the Crown had been particularly short on funds.

The Guild of Independent Medical Philosophers was eclectic, taking the title Independent seriously. It often seemed that no two members practiced the same Philosophy, although some practices were similar. Some Guild Philosophies were passed on from Guild Philosopher to Guild Philosopher, and others a unique discovery with no prior example. Their variability made it impossible for the Guild to graduate to a Society because they could never agree on anything except that they needed a Guild; otherwise, it was every Philosopher for themselves. The Guild members were too niche to ever gain enough mass to become a Society.

There were Philosophers of Magnetic Therapy and Animal Magnetism and Voodoo and Tong Ren and Therapeutic Touch and any number of diet therapies and on and on and on. It is remarkable how many unique Medical Philosophies existed. They all had their proponents, providing an endless stream of testimonials proving beyond doubt that theirs is the one true medical Philosophy. And who could gainsay them? If a patient improved, it must have been an effective treatment.

There were occasional Society knockoffs, where a Guild Philosophy appeared to be identical to a Medical Society Philosophy but with a different name and based on slightly different concepts. Homeopathy where the dilution was made with alcohol instead of water. Acupuncture, but called Therapeutic Needling. Chiropractic, but renamed Osteopathy. The Societies were jealous of any posers, and these Philosophies were often litigated into oblivion. It was never permanent, and where one Philosopher was sent into bankruptcy, another soon appeared to take their place. The world of Medical Philosophy was always in ferment, bubbling up with new approaches to health and illness.

The Guild of Independent Medical Philosophers was too fragmented to ever have the power and authority of the Medical Societies. You needed to be unified in purpose to become and maintain a Society. That brought in the money, and with the money came Crown recognition.

But they did have an advertisement, and, to the best of my memory, it was a first. The Guilds usually were more circumspect about spending money on promotion and risk angering the Societies. They must have seen the Cholera as a real opportunity to cash in.

Again, with the big fonts.


Spreading in Portland

Medical Societies Helpless

Find A Medical Philosophy That Works

The Guild of Independent Medical Practitioners

The Cholera has returned to Portland. Over 350 cases. Over 150 dead. The Cholera is getting worse.

In the 1999 outbreak, the Medical Societies were impotent in the face of the Cholera, which only stopped by the grace of God.

Do not be fooled. The Medical Societies claim to have the One True Cause and Treatment of Disease.

They do not.

They failed the people of Portland in 1999 and will do so again.

Each person is unique, and so is the cause, prevention, and treatment of Disease.

Only the Guild of Independent Medical Philosophers has the ability to find a cure and prevention of the Cholera tailored specifically for you.

Do not become another brick in the wall or another corpse in the cemetery.

Visit the local chapter of the Guild of Independent Medical Philosophers and find the perfect provider to prevent and treat the Cholera and all your family’s unique medical needs.

“The Guild saved me from purpuric fever.” Randy L.

“No Cholera in my family because of the Guild of Independent Medical Philosophers.” Melinda K.

The Guild of Independent Medical Philosophers.

For a Medical Philosophy as unique as you.

When you intend to diagnose, treat, cure, or prevent any disease.

I folded the paper and tucked it in my coat pocket. That was not going to go over well with the Societies. It was a declaration of war, and I suspected those with the Cholera and other illnesses were likely to be the casualties. I did not want to be in the middle of this battle, but I knew I was not going to be so fortunate.

I wondered how the Guild was going to distribute Cholera patients to their members. Randomly? Alphabetically? Zip code? What criteria would necessitate receiving Tong Ren vs. Therapeutic Touch vs. Magnet Therapy? And who would make the decision? I could not see an Osteopathic Philosopher referring a patient to a Magnetic Philosopher. But maybe I was being cynical. Or realistic.

And worst of all? I had been scooped by the newspaper, since I was not yet aware that the Cholera had spread west of the Willamette River. When I arrived at the office, Bosworth was again waiting for me. After closing the door to my office, he stood in front of my desk.

“I assume you saw the newspaper this morning?” he asked.

“Yes. They got the jump on me. I had no idea that the Cholera was now on the west side.”

“I know,” said Bosworth. “I was also unhappy to find out from the newspapers. I discovered last night that the Ministries in Clackamas and Washington County were not promptly reporting the cases as they should out of fear of panicking the population. I let them know that it was not acceptable.”

“But now we have new problems. Kenton is one thing, but those who live in Lake Oswego and Hillsboro have money and influence. And they will use it. It is not fair or just, I know. But that is the way of the world.”

“Well, have them complain to the Medical Societies,” I said. “They are the ones with the charters for the diagnosis and treatment of diseases in the Empire.”

“But the Societies also have influence. And money. And position. No one outside of the River Weekly is fool enough to go after the Societies.”

“Except the Guild,” I said.

“The Guild?”

I showed him the ad in the Oregon Journal.

When finished reading, he gave a disgusted shake of the head. “Great, just great,” he said. “Now we will not only have the Societies at each other’s throats but turning on the Guild as well. It will be a miracle if they find the time to attend to the ill. When the Cholera spins out of control, there will be scapegoats. The Societies will not take responsibility. And we don’t want to be the one to get the blame.”

“So, what can I do?”

“Simple,” he replied. “Fix it.”

“Simple. I wish.”

“Look,” he said, “I never said what I am about to say. Remember how I mentioned that the Crown is aware of your extracurricular activities? But there is a faction that is more, let’s say, liberal about these issues. And this faction is interested in keeping the Cholera under control or stopped by any means possible. Even Continental means. They are very much the end justifies the means in this particular case. So, if you succeed, and only if you succeed, they will turn a blind eye to any creative measures you come up with to stop the Cholera. If you try and fail? Well, there will be the usual consequences. A sacrificial lamb will be required.”

“And this is what you want?” I asked.

“Do not misunderstand my motives. I want the Cholera stopped. The ’99 epidemic took family from me. No one should have to experience that kind of loss. I am just the messenger. My position in all this is that of a mid-level functionary. I am as much a pawn in all this as you, but a pawn, if maneuvered correctly, can sometimes checkmate.”

“Well, shitte, piss and waste,” I said. “Damned if I do and damned if I do.”

“Yes. Sorry.”

“So, do you have a suggestion of where to start?”

“The River Weekly?” said Bosworth. “Maybe start there. But, still, be discreet. Very discreet. If you have to use extracurricular methods to solve this, fine, just try very, very hard not to give credit where credit is due.”

I nodded. “Understood,” I said.

“Good. Then we are done here. I’ll let you get to the more pressing matters. Have a good day.”

That was unlikely.

Bosworth left the room, while a knot of anxiety grew in my stomach with a pinch of nausea. I wonder what that was. As best I knew from my rudimentary understanding of anatomy, there was nothing in my abdomen that could form a tight ball. The pancreas could not do that, could it? I did not think so.

Damn it all, I thought. Can I do this? I was not sure. But I thought back to the row of dead children. The least I could do was try.

The morning was spent helping sorting reports, orienting the new workers to help with the quarantine, and writing replies to the increasing number of letters and telegrams about the Cholera.

It was likely going to be a while before I had a day off, but at least we had some back-up. The quarantine today would be managed by “volunteers” from Columbia County.

Much to my surprise, the State had stepped up to the pitch. For now, we had enough people to cover the work and give others time off. Sherman made a schedule that gave everyone one day off a week. Except for me. Sometimes it is not good to be the boss. Of course, the schedule was going to fall apart if the number of cases continued to increase. As it would.

At the top of the pile of correspondence—By chance? By design? —was a letter from Blair Colvin, the author of the River Weekly article. My hands shook with a surge of anxiety as I opened the letter. Typewritten, it read

Mr. Bruno,

I would like an opportunity to interview you concerning the Cholera and the Crown’s strategy for controlling the outbreak. Please respond by letter or telegraph of your interest. I am available anytime.

Thank you for your consideration,


Blair Colvin.

It was not signed. I reread the letter several times, turning it over to see if there was anything else. Like what? A booby trap? A coded message? Invisible letters?

I thought for a while and then sent off a telegram telling him I could meet at the end of my workday, around 7:30, and that I would come to his office at the River Weekly.

Now I was committed.

The rest of the day slowed to a crawl. Most of it was spent trying to get information on the Cholera cases in Lake Oswego and Hillsboro. I wanted the who, what, where, and why. If the disease had jumped twenty miles in a day, how had that been possible? There might be a clue, something outside of the ordinary, that could indicate a reason for the Cholera’s spread.

What could spread an illness at such a distance, leaving everyone in between untouched by the Cholera? The wind? Smoke from fires? A bird?

Finally, just after the lunch hour, I received a pair of reports by messengers from both locations.

Lake Oswego had two cases in a family of four and Hillsboro one case in a family of five. No deaths. No spread beyond those families. In response to questions, I had sent that morning, no one in either family had been to the west side of the city in months, and neither family had had contact with each other. The only commonality was both families had been attended to by the Homeopathy Society, both as a preventative and for treatment.

I spent the afternoon in the field seeing post- Cholera cases with one of the ‘volunteers’ from Columbia County Health, John Bonham. He seemed happy to be working on a weekend, and I commented on it.

“I lost both my parents to the Cholera as a child,” he said.

“I’m sorry.”

“Thank you. It was a long time ago. I was only two, a small outbreak in Louisiana. I moved here shortly after to be raised by my aunt. I had always hoped I would have an opportunity to help combat the Cholera.”

“And?” I asked. “Any insights?”

“Not really. I have studied the Cholera and other epidemics, looking for the reason these diseases intermittently run through our cities like, well, like Cholera. Part of a history degree, not with the goal of becoming a Medical Philosopher, although I did give some thought to becoming a Naturopathic Philosopher. I could not afford the tuition. Part of the problem is much of the information I needed for my dissertation is known only to the Medical Societies, and they are not talking. So much of the information I needed was either considered proprietary or was contradictory.”

“Tell me about it,” I said.

“Yeah. I made my final dissertation kind of sketchy. It made me realize that we need an independent medical organization, like the Ministry for Public Hygiene, only with the authority to track outbreaks and disease and keep complete publicly accessible records. Not only keep track diseases but on treatments. Something independent from the Societies that everyone could use and learn from. A library devoted to Medical Philosophy. Knowledge is power.”

“A nice idea that will never happen,” I said. “The Societies have money and power because of that information, and I can’t see them letting go of either.”

He sighed. “I know. But I can dream. But I will tell you one thing.”

“And that is?”

“From my studies, however limited and incomplete they have been, I would bet my eye teeth that there is no one cause of disease. At least as far as these outbreaks are concerned.”

I raised an eyebrow. Yet another skeptic? They seemed to be everywhere.

“I don’t see it,” I said. “If there is one truism in all this mess, from the ancients on, it has been a settled fact that there is but one cause for all disease. The question has always been which Philosophy is the closest to understanding that one true cause.”

“Scoff if you want,” he replied. “But the Cholera is different from the Smallpox, which is different from the Mumps, which is different from the Measles. They have nothing in common that I can see. Now I have not studied all diseases in detail, so I cannot comment on Dropsy or the Vapors. But I have studied those diseases that cause outbreaks. They have no similarities. Each disease has a unique cause.”

“That is because diseases are different manifestations of the same process,” I said. “Like water, ice, snow, or stream are all different manifestations of the same substance.”

He snorted. “You sound like the head of a Medical Society. That is what they all say. But have you ever looked where that idea came from? I have. Nowhere. It was pulled out of someone’s ass a long time ago, and people keep repeating it as if it is true, with variations depending on what the underlying Medical Philosophy is. But no one has proven it so.”

“Proven it how? How would you even go about proving such a fundamental idea?”

He shrugged, and as he did, I remembered the Méthode Empirique. How? Maybe I had the answer and had not realized it. The answer to the understanding of all diseases? Hubris much?

“I also studied math and geometry in college,” he said. “You can prove principles in some Natural Philosophies, starting with a few basic postulates. Look what Newton did. I don’t think it is a fact that all diseases have one true cause and treatment. That should be the conclusion from the proof, not the starting point.”

“And how,” I asked, “do you suggest doing that?”

He sighed. “That I am not sure. I do not know enough to say. It is more of a hunch. It is as if I can see the outline of the possibility of the suggestion of an idea.”

We arrived at the next house.

“Listen,” I said. “We need to talk more about this. Are you working tomorrow?”


“I think you have an interesting viewpoint,” I said. “I need to think about what you have said, but I may have something you will find quite intriguing.”


“Perhaps. But it is going to have to wait until tomorrow. We have work to do. Let’s plan to meet at six or so, when all the work is finished.”

“All right. Any hint what this is going to be about?” he asked.

“I hope to stop the Cholera,” I said.

“Seriously?” he said slowly. “I mean, that sounds great, if a little megalomaniacal.”

I nodded.

“All right,” he said. “You really have me curious.”

The rest of the day was like the day before and the day before that. Mostly survivors and their families. A death here and there, maybe one or two in five, but no large-scale mortality killing an entire family like the day before. Thankfully. My ball of guilt only expanded a little.

I finished my rounds and went back to the trolley station by way of the commons and Paul Bunyan. I paused at the statue and looked out over the park. I was sweaty and thirsty and not in the mood for a hot tea. As usual, there was someone at the commons water pump filling multiple containers of water. I will admit I do have a bias in favor of fresh water. I really do think cool water straight from the earth tastes better than the water piped into the city. Nothing tastes as good as water straight from a Mt. Hood melting snowpack. Although I have never participated in a taste test to see which water reigned supreme. Huh.

There’s a thought. I had been to wine tastings and was disappointed to know discover that my ability to distinguish good from bad wines was almost nonexistent. Evidently, my tongue was numb to subtle flavors. Unlike my girlfriend at the time, who evidently had the ability to detect any number of subtle flavors in wine. But the taste test was the perfect analogy for what we needed to accomplish in the evaluation of the Medical Societies. Probably with far more severe hangovers. I made a note to pursue the idea further. Right now, I was thirsty. It was no glacier water, but it was free and should be fresh and cool. I walked across the commons to the pump.

“Good day,” said the man filling his containers. He had 6 containers. “Thirsty?”

“I am,” I said. “How’s the water?”

“The best,” he said. “Cool and fresh. None of that off taste of piped in city water.”

I did not have a cup, but the man at the pump gave the handle a push and the water overflowed my cupped hands. It was cool and refreshing and I thought it did taste better than city water.

“Thanks,” I said.

“My pleasure,” he said as he gathered up his bottles of water and left for home.

The day in the field was over, I had another stack of forms filled with the same hodgepodge of unrelated facts. At least I could not see any relationship. No commonalities that made the cases unique, either in the family or as a community. Everyone lived their lives as they had before the outbreak, but only a few developed the Cholera. There were a variety of treatments and preventatives from Medical Philosophers. Whether the interventions had benefit or if one was superior, I could not ascertain.

I made it back to the office around five o’clock to find Cassandra waiting for me.

“About time,” she said. “We are almost there. I have all of today’s information from the cubby room, but I needed your forms.”

“My forms?” I asked.

“Yes. The sisters think the information in the forms are critical to their investigations.”

That was a surprise. “There is nothing there,” I said. “Just a jumble of junk.”

“Oh, no. At least not what the sisters think. It is the combination of the official reports and your queries that are needed, or so they say. They are complementary in a manner that the sisters say will give a complete picture that neither set of information can do alone. I am starting, I think, to have a reasonable understanding of their methods and if the sisters are right, we may have some important results sooner rather than later.” She glanced at the clock. “But it is getting late, and they wanted your data hours ago. Gotta run.” Taking the papers from my hand, she hurried out the door with a wave.

Well, that sounded promising.

I looked over the wall of cubbyholes, each one documenting a different aspect of the disease. It was a visual reminder of what I knew: there were more cases, more death, and the disease was slowly expanding out of Kenton, except now we had those unexplained cases miles away on the west side.

It had to be birds. How else could the Cholera be spread that far, that fast?



  • 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