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Death is present, but Conquest appears stupidly often.
Book of Rev isn't the only way, there is also a few more ways like the famous Sharp Plug + Pyromaniac + Dr fetus, epic fetus, or ipecac + The wafer (this one is optional) + monster manual
Book of Rev first floor, still gotta go all the way to the Womb, and chances are that you'll not get all bandages or meat cubes.
Then you have to deal with the huge problem that is Conquest which means no Death. If you get Conquest, you have to reset entire run and try again and get all the bandages and cubes again.
In the way i said, you dont have to go all the way to the womb, you dont have to worry about getting Conquest, you dont have to worry about not getting all bandages/cubes (You'll get it eventually with the manual)
I believe that some person said there was roughly a 0.01 chance of getting it with book of rev on first floor and getting the same cubes/bandages every floor, etc
It was just a matter of moments
lol For real now, there is a guide BoIR on how to get both SMB and BG. Lemme see if I can link it or whatever.
Edit: See if this helps
http://steamcommunity.com/sharedfiles/filedetails/?id=346411111
Btw, third time got damn Conquest. That's not fun, you know. Using any of methods mentioned above requires a lot of luck. In my current run, i've got Epic Fetus and Habit, but i will be very lucky to unlock it this way, since there were no signs of Pyromaniac or Monser Manual so far (i'm in Depth II at the moment).
Well, it looks, Conquest got all chances of appearance of all another alternative bosses, since i have never seen triachnid, gish and chad aside of boss rush (except first one, i've never seen him at all).
The issue is solely actually getting all four normal horsemen in a single run.
This is not my case at all.
Maybe you broke Rebirth with some kind of weird magic. Or maybe i'm just crazy. Or am i? I am. Or am i? I am-
I'll shut up now.
But yeah, all meat or all bandages per run.