Mark Crislip's alternative history novel explores what the present day might look like if the purveyors of patent medicines had managed to suppress the germ theory. Conflicting models of disease and cure, ranging from balancing humors to homeopathy, form the basis of powerful guilds that control public discourse and stifle discovery. Cholera breaks out in 2017 Portland, Oregon, and all of the medical guilds rush to own a piece of the cure. But an unlikely team of skeptics have heard rumors from Europe that disease is caused by animalcules invisible to the naked eye. With a smuggled microscope and a gradually evolving hypothesis, the skeptics take histories, sample, and examine whatever they can. When the guild leaders find out, the skeptics must race against time and the vagaries of the cholera bacillus itself to keep the outbreak from decimating the city.