Imagine, if you will, that North Americans didn’t know germ theory, that they were part of the British Empire still, and that the Empire was still beefing with continental Europe (France specifically). And so when cholera breaks out in Portland in 2017, all the people have is alternative medicine, like homeopathy and naturopathy, run by Medical Societies. It’s a cool concept, as I got to find out. I know that I only really got into this novel because of my background in science and healthcare, and that most people won’t get the same mileage from it, but it is something I recommend for those with the same interests. It’s a great reminder of what the scientific method did for medicine, and the author’s background (I believe they’re a medical doctor?) is what makes the novel make sense.

So, it’s definitely not for everyone, but it was a fascinating thought experiment for me, and I found myself enjoying it (even though it’s true that there are some overwritten parts that I had to skim over). It’s always fun to see science in fiction, and this novel succeeds in making medical science very accessible. It’s also so relevant because cholera is still killing people when it really shouldn’t be, so.

Thanks to NetGalley and Bitingduck Press!

The Double-Blind Thought Experiment
Skeptics in the Pub: Cholera by Mark Crislip

One day I'll have to write an in-depth analysis of that neglected step-child of the speculative subgenres, the motivational business fable. If you've ever heard of Who Moved My Cheese?, you know what I'm talking about. Among the few enjoyable moments I had in business school were when teachers assigned us those bizarre manuals of corporate culture disguised in the garb of fiction. The underlying reason for this form of literature is that top management is allegedly too busy to read an entire tome on organizational theory, so any new developments in the field have to be communicated in bite-sized format.

That's how I felt while reading the novel Skeptics in the Pub: Cholera. More than a novel proper, this is a vehicle of public education. Published during the coronavirus pandemic, and written by a real-life doctor who has done very important work in fighting pseudoscience for years, this book imagines an alternate timeline where the US never became independent and its system of free enterprise and free academia never developed. In the 21st century of this version of the British Empire, all doctors must belong to one of a handful of Crown-approved Medical Societies that have a legal monopoly on diagnosis and therapy. (An exception are surgeons, who have their own Guild and come from a separate tradition without fancy philosophy.) The problem is that these Medical Societies are founded on tradition and prestige, so they never bother revising their settled doctrines. Thus you see doctors prescribing obvious rubbish such as bloodletting, moxibustion, or homeopathy. And no one outside of those very distinguished clubs is legally allowed to learn or practice medicine. This is, of course, one of the most horrifying dystopias I've ever read.

The plot concerns an epidemic of cholera in Portland, Oregon, in a fictional 2017. This is only the latest in a series of periodic returns of the disease. But this time, someone has smuggled forbidden papers from France that speak of an “empirical method.” Any sympathy for French ideas is seen as traitorous in the British colonies, but the documents say that this method has already succeeded in proving Mesmerism wrong, so our protagonist, a mid-level public health bureaucrat, hopes that it can help him find the true cause of cholera and therefore its cure.

This mystery proceeds in the manner of a detective novel, which makes this book a very curious read, since we in this timeline and decade already know the answer. The protagonist starts collecting clues, making deductions, running some tests, and it's to the author's credit that he has managed to make these steps feel exciting even though the solution is not a mystery to the reader. We basically watch him invent the entire science of epidemiology in real time, with index cards and a mechanical computer. Of course, the political intention of writing this book is not to popularize the state of the art in therapies for cholera; it's to illustrate the catastrophic social consequences of letting pseudoscience take over the medical profession. At a key point in the plot, when the bureaucrat has finally figured out that the origin of the infection is a defective water pump in a city park, the heads of the Medical Societies stage a public event where they drink water from that pump to prove that their respective methods are effective. I don't need to tell you how successfully the theory of the four humors and its all-purpose treatment of bloodletting fares against a case of severe dehydration, or what awaits those patients who try to protect themselves against cholera by taking homeopathic drops made with water from the same pump.

In an obvious wink to the reader, the protagonist has a scene where he compares his situation to that of detective novels, and wonders, “Why would a novel be any kind of guide to reality?” This soapbox approach to literature reoccurs throughout the text; later on, we find remarks like “It is amazing how much information in the world appears to be hidden in boxes, gathering dust in basements, waiting to be discovered,” and “We need something more akin to engineering to take over Medical Philosophy.”

The author (who, let's remember, is a doctor) was obviously more interested in expressing a position than in telling a story. It's for that reason that I haven't dedicated any space here to speak of the literary qualities of the text; it's just correct prose without stylistic aspirations. More than a work of art for art's sake, this is a fable with the tone of an exasperated cry for good sense.

I enjoyed this book. Tio me, its strengths are the satire regarding alternative medicine, and the stepwise working on a problem. I also liked the lesson about not allowing science to go where it needs to go. I enjoyed the re-imagining of the John Snow Broad Street pump story and the humor Dr. Crislip injected. The tone of the book is highly conversational and very easy to read. The one weakness of the book was the world-building. I found it a tad confusing because I wasn’t sure how or why the alternative world ended up the way it did. Overall, this was a very good read. Thank you to Netgalley and Bitingduck Press for the digital review copy.

Sickness is as old as us; is always on the verge of us. Yet even though it happens within us it always remains in some way a stranger, distinct. Here, illness is strange in a way we don't want to remember.
Within the story's world, our current understanding of medical science rooted in biology remains undiscovered. Instead, medicine is governed by various Royal colleges--an engaging, if terrifying, notion. Money is a protagonist of its own within the text--money that promises to save people, money that protects those who take the role of saviour. In this way we witness an alternate history of the discovery of epidemiology, offering new questions in the search for a standardised approach to health intervention.
The narration is sharp and funny, if a little repetetive, and the author employs a lucid and easily comprehensible prose style, rendering the novel a comfortable and accessible read.
Personally, I felt that the narrative could have benefited from more elaborate descriptions of this alternate world. The resemblance to Victorian Britain was strong but not fully explored. A more detailed approach to worldbuiling would have stopped me from feeling a little frustrated with aspects that I didn't understand or just couldn't touch. For eaxmple, the role of other countries and their knowledge--was there a specific reason there was not more of a collaboration in understanding?
Otherwise, this was a unique and thought-provoking read for me.--even if it left me feeling a little ill.
Thanks to NetGalley for the ARC.

I enjoyed this unusual book, which was essentially the retelling of the story of Jon Snow’s discovery of the sources of cholera in London Broad Street Soho in a water pump. In this story, however, although the setting is present day 2017 UK the background life has changed considerably. In the world of the story, the current biological basis of medical science has not been discovered and instead or medicine is run by a selection of Royal colleges including those for homeopathy chiropractors, Indian, traditional medicine. Before the narrator discovers that cholera is transmitted through the water by bacteria, which he calls animacules ., Traditional medical colleges earn a lot of money from the public by claiming that their cures were the most effective. of course, not everybody dies from the cholera, and therefore these colleges were able to claim their survival was due to this particular style of medicine.
As well as the differences in the medical understanding, there are other differences throughout the story in this world, including the Americas still being ruled by the UK, the lack of computers, and apart from what sounds like Tauring type machines. I felt that the story could’ve done with more description of the alternate universe as it really sounded very much like Victorian Britain and the story therefore was ultimately just the retelling of the actual discovery of the cholera bacteria. Having said that I do you have a person interested in epitomeology and found the narrative. Interesting interesting.
The author has a clear easily read prose style, making the novel an easy and comfortable read.

My other minor comments is that this story is primarily a story driven novel rather than character driven, and I would’ve liked personally more character development.
I read an early copy of this book on NetGalley UK, the book is published in the UK on the 3rd of August 2023 by biting duck press. This review will be published on NetGalley UK, good reads, and my book, blog, bionicSarahsbooks.wordpress.com.

An interesting idea but I had issues with the execution. The novel is heavy on exposition and light on storytelling/worldbuilding. The narrator, Jordan Bruno, explains that the alternate US of 2017 is still part of the British Empire and that science, such as it is, is controlled by secretive, competing societies (kind of like Medieval guilds?). When another cholera outbreak strikes in Portland, they have no idea of the cause. Then at a meeting of his group of Skeptics the speaker gives a speech which repeats the same information. There's also a lot of superfluous/repetitive dialogue.

On the plus side, Jordan, whose role in the ministry is to try and manage Portland's cholera outbreak, is an amiable and at times humorous narrator. (Too amiable, he seems like a well-meaning but harried middle manager rather than someone facing an epidemic bringing mass death and suffering.)

There isn't much in the way of plot or characterisation. More significantly, it's not clear why an expanded British empire, which controls the wealth and resources of significant parts of the world, blocks scientific progress, particularly as John Snow identified the cause of cholera in London in 1866 which is pretty much peak empire. Could there have even been a British empire without the linked projects of capitalism and the enlightenment?

And why, in this alternate universe, hasn't any other country, group or individual solved the mystery of cholera? India, China and Turkey were practising inoculation against smallpox long before Europe, so why wouldn't they also have insights into cholera? I'm not saying this alternate timeline couldn't work, but it needs more explanation.

If the book was shorter and snappier it would be a fun introduction to scientific principles for schoolkids (and in a short story you'd have less time to question the underlying ideas) but for me it doesn't quite work as a novel.
*
Copy from NetGalley

Originally the concept of this book was what got my attention, I thought it was an absolutely horrifying idea for a alt-history novel and it handles it quite well. Definitely a terrifying thing to think about and will haunt me for a while.