"Mentioned in whispers for decades; burned in Manchuria; worshipped in Peru; the only book to be listed on the Vatican's Index Librorum Prohibitorum twice, for emphasis; available again at last, in this definitive edition. Welcome to the Lambshead Guide. Disease-mongers, shudder."
-- Dr. China Miéville

    When people ask me "Jeff, how did you come up with the crazy idea for a fake disease guide?" I always tell them two people are to blame: Dr. Thackery T. Lambshead and, perhaps more importantly, Alan Ruch, creator of The Modern Word Web site.
    Alan's e-mail moniker is "The Great Quail." (I'm sure a long essay, complete with footnotes, would be required to explain that one, but there's no room for it here.) One day toward the end of 2000, the Great Quail happened to include a P.S. that read "I think I have contracted Mad Quail Disease."
    Mad Quail Disease. Suddenly, the image of a chapbook of odd fictional diseases materialized in my brain.
    "No," I told myself. "That's just too weird."
    A week later, the image hadn't faded -- it had, if anything, gained strength and legitimacy. I had a soon-abandoned name for it: The Buckwaldo Mudthumper Guide to Eccentric Diseases. I even had the beginning of Mad Quail Disease (never completed; probably a good thing):

Mad Quail Disease usually begins with a sudden overpowering desire to cook eggs. This manic impulse may lead to the cooking of several dozen eggs, either hardboiled or sunny-side up. Once this phase has passed, the patient may exhibit signs of enhanced plumage. However, it is only in the third phase that the condition becomes serious. For weeks, perhaps months, the patient will accumulate all manner of books on avian subjects -- from the Illustrated Encyclopedia of the Auk to the Quick Man's Guide to Quality Quailing -- which he or she will proceed to use as building material for a dwelling approximately 30x30x30 feet. The patient will secrete a glue-like substance in his or her saliva which is used to "cement" the books together into the aforementioned dwelling. When the dwelling is complete, the patient will curl him or herself up into a ball and the skin will fade, eventually replaced by a hard, shell-like surface. Over time, the remaining landmarks of elbows, knees, and protruding feet will be eroded by the coming of the Great Egg That Was Foretold in the Book of the Emu, which will spread its munificent glory across the whole of the decadent human body, so that the patient may be reborn in some future age in which avians have finally taken their rightful place as the heirs to Humankind -- hatched, as it were, into Nirvana.

Dr.Thackery T. Lambshead has studied medicine at so many universities, it is not worth mentioning their names. He is best-known for his contributions to the field of muscle-organ mimicry and lymphonic gut-rot endocrinitis. He has gained the nickname of "Thwack" because of his insistence on leading his expeditions into the jungles and "thwacking" all vegetation out of the way with his machete. Not because of the sound a rubber glove makes when you take it off, as some have surmised. In the 1950s, he had a brief love affair with the occult, leading to some rather bizarre disease entries.

First "published" in 1921, The Thackery T. Lambshead Pocket Guide to Eccentric & Discredited Diseases was for many years disseminated to doctors around the world in the form of loose-leaf carbon copies and photocopies. In 1945, London's Chatto & Windus published the first formal edition of the Guide. Twenty editions later, the Guide was discontinued, but continued to be updated by Dr. Lambshead and his colleagues and privately printed by friends. From Freetown to Istanbul, Timbuktu to Ulan Bator, it has proven its worth under less than ideal conditions. When a doctor lost in the Congo rainforests with only a few antibiotics and feral pigmy elephants for company cannot diagnose his odd spinal condition, he reaches for his handy copy of the Guide. When a family practice doctor cannot understand why a patient of 30 years with no history of mental defect suddenly begins to mimic inanimate objects, she turns to the reliable Lambshead Pocket Guide.

The Annoying But Inevitable Lecture: The sonnet form in poetry has rules that, by restricting the poet, ironically create a certain freedom. The friction between the form and the poet's ingenuity in satisfying the requirements while retaining a fluid originality can result in great art. Although the point here is just to have fun, the example fits: the form restrictions should point the writer to narrative solutions not necessarily used in a traditional short story. Examples (admittedly in a longer form) include Calvino's Invisible Cities and Pavic's The Dictionary of the Khazars. Writers might also take heed of tales, wherein plot and characterization are often conveyed through summary. False quotes from "experts", references to other texts, suggested falsified medical histories of entire countries, disease theories that constitute alternate theories for historical crises, the literary kidnapping of historical personages for dubious disease reasons, blatantly made-up characteristics of non-existent fungus, and anything else that strikes the writer's fancy may help to illuminate and make three-dimensional the disease in question. To sum up: be magnificent liars. And, above all else, the watchwords while writing should be: fun and meticulous attention to detail. Also please note that while all genres of work will be considered, every disease must have some basis in the "real world" -- i.e., no diseases on Mars -- even if the writer has a slanted or tilted view of the world.

    I think the point when I realized we had a project that was building on itself almost independent of our editorial efforts is when Rachel Pollack, after receiving the invitation, suggested we contact Neil Gaiman about it -- and Gaiman promptly sent us a wonderful submission. Really, all we could do after that was go with it wherever it took us.
    One thing we quickly realized is that we were accumulating such a wealth of material that the small book might be a longer book -- and a longer book would be beyond Chimeric's resources. It was also beyond the resources of my own publishing company, Ministry of Whimsy.
    So we began searching for a larger publisher. Our agent, Howard Morhaim, did a heroic job of getting the proposal in front of the right people, but the timing couldn't have been worse: our proposal reached editors shortly after September 11, 2001. No one was in the mood for humor -- we certainly weren't, and we were the editors of the project.
    Eventually, Night Shade Books not only made an attractive offer, but also displayed the kind of enthusiasm we thought the book would need for any PR efforts to be successful.
    By this time, we had great work in hand from Michael Moorcock, Kage Baker, Liz Williams, Rikki Ducornet, Brian Evenson, China Miéville, Alan Moore, and many others. We had also solicited reminiscences from writers of their doctor personas working with Dr. Lambshead in the field. Stepan Chapman, a Philip K. Dick Award winner whose work has appeared in McSweeney's, not only contributed a reminiscence -- he wrote us a secret history of the 20^th century as seen from the perspective of the Guide.
    Clearly, our little book had become a Big Book. But not only had it become a Big Book, it had become a Real Medical Guide -- in terms of the amount of work required to edit it.
    "I've never seen anything like it in terms of the prep work required," Mark wrote to me via e-mail during the midst of the worst of it. "It's madness!"
    We had to deal with issues of medical authenticity (for which we relied on family physician Mark Shamis), standardization of references in each of the 65 contributors' entries, addition of cross-references, several layers of copy-editing, and much else. Late at night, going through the text yet one more time, I began to lament that after the project was over, I'd have put in as much work as if I'd co-edited a real medical guide, but still not have the credentials to edit one!
    Yet even then, we weren't finished. John Coulthart had agreed to do the design of the book. John is one of the world's best book designers, his work for Savoy legendary in the United Kingdom. He's a very visual designer who, when necessary, will combine elements of graphic novel design into his books. We thought he'd be ideal to add illustrations, fake covers of prior editions, and anything else we'd need to make the Guide authentic.
    So it shouldn't have come as any surprise that the first e-mail John sent to us once he started on the project was "I'm determined to find or create an illustration for every disease in the book." Mark and I had thought that there might be a few illustrations, but had no idea that John would become as obsessed with the Guide on the graphic side as we had on the editorial side.
    Soon John was sending us pages with "bloodstains" grayscaled over the page numbers, a number of mockup pages of disease entries with stunning accompanying illustrations, a table of contents that looked like a medical chart, and a series of stunning fake covers. Not only was he creating an amazing look-and-feel for the book, he went ahead and wrote his own disease, "Printer's Evil," which is one of the highlights of the book.
    "The challenges of working on the disease guide were myriad," John would say later. "Not least of which was working on fleshing out my own ideas while incorporating yours and Mark's."

    I can't say it wasn't without strife. There were a lot of late nights emailing back and forth on esoteric points that I'm sure most readers won't even think about. I wouldn't call it an argument per se -- more that both editors and the designer loved the project so much that over time the project changed yet again, metamorphosing through graphic element, the captions to photos and book covers, into something even better than it had been before.
    The moment I knew I personally had gone around the bend on the project, succumbing to Diseasemaker's Croup, occurred on what we all call "The Borges Entry." A New Orleans writer had created a disease called "The Malady of Ghostly Cities" that didn't fit the rest of the Guide. In this disease, people turn into whole cities in barren, remote locales, their essence contained in libraries in the heart of the cities. The entry was good we had to find a way to include it. So we decided that Dr. Lambshead had met Borges during his travels, and influenced Borges to produce a little-known book of metaphysical diseases, only available in an Argentine version, in Spanish.
    One night, well into pre-production, I realized, with a certainty that bordered on madness, that we needed not only the English translation from the Spanish, but the original Spanish version as well. I quickly sent out an e-mail to John and Mark, who, to their credit, took it in stride, and we soon had contacted Gabriel Mesa, a Spanish-speaking lawyer in New York City. Gabriel was kind enough to go along with it all without asking "Are you all crazy?" Within a few weeks, we had the "original" Spanish version of Ballingrud's disease. We also had John's incredibly creative covers of the Argentine edition, and a subsequent cheap English-language paperback of The Book of Metaphysical Diseases that mysteriously had not included Dr. Ballingrud's contribution.
    Meanwhile, new text had to be created every so often to replace old captions or to make the whole concept more plausible. Sometimes it was a bio note for Lambshead himself -- who Mark and I were too close to for us to write it ourselves -- and sometimes it was a bit of introductory text for a disease from the "Autopsy" section (examples from prior editions).
    In such cases, we bounced ideas off of Stepan and John, and also brought in Michael Cisco, a New York City-based writer who specializes in bizarre Burroughs-meets-Beckett work.
    Slowly, the Guide took shape. After more than four months of pre-production, the Beast, as I think we had all come to call it, was ready to be sent to the printer for production of bound galleys. (All through this time, Mark was fine-tuning the excellent Web site he had created for the Guide, to help trigger pre-orders: www.lambsheadguide.com.)

    Of course, at this point, the fear set in. Looking over the finalized layout, with titles of diseases like "Motile Snarcoma," "Extreme Exostosis," and "Bone Leprosy," I think both Mark and I thought, "Oh my god—we've just sent a 320-page book to press that may be the weirdest anthology ever produced in the history of English literature!"
    Was it all commercial suicide? Was it the biggest folly since the French built a palace in the shape of a huge elephant?
    Luckily, that has not turned out to be the case. We waited on pins and needles for the initial pre-pub reviews, and were rewarded with some glowing notices:

Publishers Weekly: "An often amazing book. Sure to delight the discerning reader!"

The Complete Review: "A lot of care has been put into this volume, and it is a fun book to make one's way through. Fun and cleverness can be found at every turn. Enjoyable!"

San Francisco Bay Guardian: "This anthology is so demented and funny it must be read to be believed!"

    Fast-forward to three years later and the Guide has been published by Pan Macmillan in the British Commonwealth (with the trade paperback out this month) and by Bantam Books in the United States, with great success for both editions. It has also been republished in Greece by Oxy Publishing. It has been a finalist for the Hugo Award, World Fantasy Award, British Fantasy Award, International Horror Guild Award, Bram Stoker Award, and several others. Readers worldwide have emailed or written to tell us how much they enjoyed the Guide. Writers who scoffed at the project initially have sheepishly approached us to make sure they're invited to whatever's next. Not everyone has liked the Guide, but it has provoked a strong response one way or the other.
    "I still can't believe it's taken off like this," one contributor, Jeffrey Ford, told us. "Who could have guessed?" Not me.
    Most satisfying of all, however, have been the group readings. From London to Minneapolis, New York City to Atlanta, the Lambshead group readings at bookstores have taken on a kind of cult status.
    Often appearing in lab coats and sporting Bunsen burners, beakers, and odd medical instruments, our intrepid readers have gotten into the spirit of the proceedings to the point that passersby are often seen to do a double take, unsure if they're listening to something real or fictional.
    Highlights for me have included Jay Caselberg and Stepan Chapman inhabiting their roles so thoroughly that medical arguments have broken out during readings. Or, at one bookstore, being approached by someone with a knee problem.
    "I'm not a real doctor," I told him.
    "Well, you might not be a specialist in knees, but surely you can help me, doctor."
    "I'm not a real doctor."
    "Yes, but..."
    And so on and so forth. Several of the readings attained that lofty height usually reserved for "performance art."

    Now, least anyone think the Guide makes fun of the ill, I should point out that several of the diseases in the Guide are serious, for balance, and because we are sensitive to the issue. We've been very happy to see the great reaction from medical personnel, too, for whom a book like this is a welcome relief from daily stress. Our biggest fans have been people who've had to spend time in hospitals or doctor's offices; the humor really rings true to them.
    The success of the project, though, has been due to, as Mark puts it, "taking it seriously. Without our totally committing to the idea of the personage of Dr. Lambshead, the funny bits wouldn't be quite as funny." (Our only regret? After spending literally hundreds and hundreds of hours putting the anthology together, we can't really enjoy it the way a first-time reader will be able to enjoy it.)
    Sometimes people ask me why we did this anthology. The answer, really, is because it's imaginative and it involves an advance sense of play. Because we think it will delight readers, and make them think at the same time.
    Besides, Dr. Lambshead made us do it.