The Fourth Horseman is Death. The story is well told. A new plague with no known cure is decimating the worlds population. A pharmaceutical company develops a drug to cure it but it can be made cheap by any drug company so there is no money in it. They bury it and sell another product instead. Learn how people cope. See how the drug eventual makes it to production. Recommend it. ( )

My reactions upon reading this book in 1988. Spoilers follow.

A disaster novel that stands in marked contrast to John Christopher’s No Blade of Grass. It could be argued that Nourse, unlike Christopher, he postulates too little return to anarchy and too little power for the civil authority. However, especially given the more complacent thought about disease epidemics when this book was written, the unthinking urban masses are credible as is the notion an epidemic could deliver a knockout blow before it could be contained. The characters do not become to the ruthless people of No Blade of Grass. Nourse is a doctor and almost all the main characters of the novel are imbued with a doctor’s sensibility to alleviate suffering in however small a way even though it makes little difference to the grand picture. One of the high points of the book is when a freehold doctor Ben Chamberlain refuses to turn away people and add, however insignificantly, the suffering of the world. It is a scene that stands in counterpoint to many post apocalypse stories including good ones like Niven and Pournelle’s Lucifer’s Hammer and Christopher's novel. Nourse proves, with the gripping picture of civil disintegration and burning in Savannah, George, he can do the epic scale, but he chose to make his story more personal. I would have liked a bit more grander picture at times. I expected a rationale for the dirty, evil-visaged boy that was the avatar of the plague. However, Nourse left him appropriately creepy and supernatural. I had some quibbles with Norse’s account of plague history (attributing Athens epidemic and two early Roman epidemics to plague and claiming plague showed up on European ships prior to 1347). Even the seeming villains, the CDC who oppose a new antibiotic, have good reasons for doing their actions.. The only true villain was a pharmaceutical company operating out of greed and selfishness and exploitation which came out (especially in New York and Kansas City) during the plague. The general theme of the dangers of selfishness and greed was constantly emphasized. It is a coincidence that the person who really breaks the disease out of its containment is a sleazy, exploitive businessman? Nourse also throws in several comments on the medical plight of the poor and came out in favor of substantial welfare plans. In short, Nourse has written a different and human work of apocalyptic fiction. ( )