4.5 Stars
This is a powerful, well-researched book, and a sequel to The Ways of All Flesh. On the surface, it is a gripping, historical medical mystery, but it is much more than that. Set in Edinburgh, 1850, it details medical practices of that time and is based on some real-life historical characters. This atmospheric story highlights the squalid, unhygienic, dangerous lot of the poor, high infant mortality, infectious diseases, and inept policing procedures in a Victorian-era city teeming with criminality.


Conservative medical practices, jealousies and rivalries among ambitious doctors, their reluctance to accept innovative new practices and a denial that deadly germs could be spread due to lack of sanitation prevailed. What stood out for me was social restrictions imposed on women and the lack of feminist advocates.

This works well as a standalone novel, but reading the first gives one a deeper understanding of recurring characters. Sarah had worked as a housemaid, but her keen intelligence, observations, and her study of medical texts while serving in the home of a prominent doctor, made this independent woman a valued assistant to her employer, Dr. James Simpson, renowned for his discovery of chloroform to alleviate pain during surgery. Even Sarah’s competent role as a medical assistant was frowned upon by society including other doctors and most patients. A woman doctor would not only be unacceptable, but unthinkable.

Will Raven had been apprenticed to Dr. Simpson. He had formed romantic feelings towards Sarah, but in his arrogance rejected marriage to her, feeling that she was below his social status, and such a marriage would impede his ambition to become a successful doctor.

Dr. Will Raven has now completed his medical requirements and has been expanding his knowledge by travelling to centres in Europe for a year, gaining insight from physicians and medical lecturers in cities he visited. Although he rejected marriage with Sarah, he still has feelings for her and is anxious to resume their relationship. He is anticipating a position as a doctor with his mentor, Dr. Simpson on his return to Edinburgh. To his chagrin, he learns that Sarah is now Dr. Simpson’s trusted assistant, but that she married during his absence. He is stunned to discover that her new husband is not only a doctor but a man who encourages his wife’s career in the medical field.

Dr. Simpson, having made a name for himself for his discovery of chloroform, is now having his reputation tarnished. He is finding himself unjustly accused of malpractice, causing the death of another doctor’s wife following surgery he performed. Sarah approaches Dr. Will Raven for help in restoring Dr. Simpson’s good reputation. Will is reluctant to work with Sarah in any capacity, being heartsick and jealous of her position as a doctor’s wife and her ongoing work as a medical assistant. Later, he relents, and they try to get to the cause of the rumours and put an end to them.

Meanwhile, there is a mysterious new illness that no one can diagnose and cure. It affects entire families killing all those afflicted over a period of time. Will regards this as an opportunity for fame and fortune. He hopes to find a cause and cure for this communicable new epidemic which he thinks will carry his name. Sarah suspects that a cunning serial killer is behind these deaths, arguing with Will that it is not a disease. Will finally realizes that the more vigilant Sarah is correct and that they now have a difficult, relentless task of solving this crime. Will takes a major step in his personal outlook as his arrogance diminishes.

As their relationship develops, I expected a different ending after all the twists and revelations. I was surprised and gratified by the next step in Sarah’s heroic story. I am anticipating a sequel focusing on the same main characters.
Thanks to NetGalley and Canongate Books for this impressive novel in return for an honest review. Highly recommended.