Warning: the review contains heavy spoilers.
Fever: Death Toll by the author of 4 Hours to Reno is a slow burn adventure where you as part of a wagon train Kingsley Party trying to survive harsh 40 miles track through the desert while battling unforgiving nature, natives, Mythos threats and camp politics.
Investigators would be playing as wagon train members as settlers, gold diggers, missionaries, frontiermen, or anyone else who wants to start a new life on the Western Coast. Unlike many scenarios, investigators have a definite motivation to continue the journey as resources are thin, and there is no turning back. They can rely only on themselves and fellow wagon train members.
While the end destination, Ragtown, is set, there is plenty of group and personal decisions during the journey. For example, as many trains traveling the Carson Trail, the group will experience a shortage of water. Here they will have at least three choices, going to an underground lake, draw water from Paiute controlled spring or move faster to get to the destination before the water runs out.
Another big choice is how to interact with North Paiutes. While they are initially hostile, they are not targeting Kingsley Party specifically. At the same, their attacks on other wagons present ever danger to players. Party can continue their way, hoping that they will able to move without a problem, satisfy North Paiutes or wage full-blown war, raiding their camps, and freeing other settlers leading to multiple losses from both sides.
Interactions with Mythos in most parts are coming organically from challenges presented during the travel and personal choices. Players can access Dreamlands through injecting drugs (and multiple other ways) or safely ignore it. They can appease restless spirits and be left alone. They can pick a side in a conflict between Yig and Shub-Niggurath, fight both of them, or just walk the road of neutrality. Even the climax, the chase/fight with Yig Abomination, may be bypassed by accruing enough favors with Yig believer Ese Ada or performing a ritual.
There is a mystical, even Feverish feel for most Mythos interactions as there often enough ambiguity of what is magic and what is real. Is a creature in a lake a fish, a cryptid, or something else entirely? Are drug-fueled dreams mean anything? Is there any deeper meaning in North Paiute worship? Of course, any ambiguity about the existence of supernatural crushes down with a meeting of 50 feet snake.
The book is well-structured and self-contained, including all the necessary background information as appropriate era equipment, plants, animals, geography, timeline, and local customs. It also includes separate maps for both players and Keepers, which is, for some reason, a rarity among CoC scenarios. While it is still will require some preparation, the Keeper would not need to do their research or create new handouts. For convenience's sake, there are also links between events inside the book, making reading through is a breeze.
The most impressive about the layout is how the author structures event. Each event has defined and highlighted setup, players, and Keeper's goals, NPC directions, consequences, and rewards.
The number of NPCs - all named and having their motivations - may be hard for a Keeper to juggle, especially since most of them are present from the start of the journey as part of the wagon train. The big part of the adventure is interacting with the train members, knowing them better, and, after becoming indeared to them, watching them die.
I must commend the author's effort as every one of them is unique and multi-layered, often hiding their dark secrets behind their exterior.
My personal favorite is Ese Ada, Paiute shaman exiled from his tribe for reluctancy to engage in violence. While firstly presented to investigators as a kindly, almost stereotypical magical Indian, he is later revealed to be deeply troubled with settler incursion and his tribe's going into warpath, so he attempts to carve a new way by worshipping Yig, ready to teach it to anyone who is willing to listen while punishing those who will not. While not intentionally hostile to Kingsley Party, his actions make him a well-hidden and sympathetic antagonist.
Of minor characters, I like a man only known as Irish, who, while acting outwardly as a greedy buffoon, hides his intense intelligence and philosophical mindset.
From a technical standpoint, most named NPCs have their card that can be used by Keepers to keep track of their personality, motivations, and stats. Every wagon also has a handout to show players as they are assumed to have some knowledge about their traveling companions.
It is important to note that while the adventure can be played standalone, the more significant implications of events would be apparent for investigators only in the next chapters, leaving them either unsatisfied or, more likely, begging for more.
I will recommend Fever: Death Toll for all western buffs, especially those who enjoyed the author's 4 Hours to Reno previously, those who enjoy a good story, fair challenge, substantial and rewarding roleplay, and more subtle mystical part of Mythos.
Despite my obvious and glowing praise for the adventure, I would still not recommend it for novice Keepers, those who enjoy heavy and overt Mythos elements and those who prioritize investigation over roleplay.