This disappointing novel is set in 1889 Philadelphia, the city emerging as a hub of medical advancement. The old methods are giving way to the weight of scientific proof and a new acceptance of antiseptic procedures in surgery, significantly increasing the survival rate of patients. At the core of the profession is William Osler, the Father of Modern Medicine, who teaches the latest surgical innovations to the young physicians under his tutelage. Only recently has it become lawful for medical students to perform autopsies of dead bodies, a critical factor in their improving skills in combating disease.

Ephraim Carroll is an awe-struck student who realizes that Osler is the wave of the future. A star pupil, Carroll is overwhelmed when Osler invites him to leave the city and join the new facility in Boston, Johns Hopkins. Understanding that such a move will make his career, Carroll readily agrees, willing to follow his mentor into the gates of hell in pursuit of knowledge. Unfortunately, he has as yet no idea how that loyalty will be tested and how momentous a decision awaits him.

This wide-eyed, far too naïve country boy in the big city is on the cusp of seeing his aspirations fulfilled until the fateful night he meets upper-class, free-spirited Abigail Benedict. As might be expected, when Miss Benedict requests a favor, Carroll gives her his heart as well as agreeing to do whatever she asks. Introduced to her social circle of outrageous free-thinkers, Ephraim is plunged into a world far beyond his expectations, meeting artist Thomas Eakins and his wife, Abigail’s friends.

Ephraim is to help locate Abigail’s best friend, the daughter of a powerful local family who is supposedly traveling in Italy but has really remained in the city in search of a back-room abortionist. Unwanted pregnancy a scandal in society, the young woman has disappeared; her friends fear for her safety and her life. With his connections to the morgue and a local hospital, Ephraim attempts to trace the woman’s last movements but fears that he has already glimpsed her dead body in preparation for autopsy.

Out of his depth, Carroll turns to the dangerous streets of late-night Philadelphia. Skullduggery and menace lurk, from crowded barrooms to fellow students’ dank accommodations where desperate young women pay for abortions. This is the ugly underbelly of a city fueled by power, a place that overwhelms and frightens Carroll, who carries on for the professed love of Abigail, a lady all too willing to manipulate his naiveté.

Dabbling in the dangers of the streets, Carroll has no idea that his mission will lead him to grave-robbing, the deaths of two other students, and the most difficult moral decision of his career. Caught between pride and stupidity, honor and venality, this rather mediocre man (in a cast of equally one-dimensional characters) has momentary aspirations but eventually faces the harsh truth of his position in the world. The scientific details do not make up for the deficiencies of a novel that fails to produce real emotional depth or a textured mystery, the result a less than riveting tale of foolish love run aground on reality.