Jennifer Donnelly tackles 20th-century London in her newest panoramic novel, over 700 pages of drama, social consciousness and thwarted love as Doctor India Selwyn Jones turns her back on family fortune and expectations to devote her life to alleviating the suffering of the poor.

India’s dream is to open a free women’s clinic in one of the most destitute areas of London, but female physicians are barely tolerated in an era when suffragettes have yet to capture the vote. India is passionate about women’s issues, an unpopular position for a doctor at the beginning of her career.

The newly-minted physician chafes under her boss’s treatment of women, their suffering of little interest to him. India is a woman who sees things in black and white, untested but determined to change the world.

Although her cousin, Wish, and sister, Maud, support India’s ambitions, she refuses contact with a disapproving mother who would have her daughter married and settled. India’s mother bribes the girl’s intended, Freddie Lytton, with a substantial dowry, knowing India would never agree to such an arrangement.

Lytton has a grand ambition of his own: a seat in the House of Parliament. To that end, he fashions himself a champion of the people, assuring India they can accomplish great things together. In her naiveté, India assumes Freddie is a good man, but nothing could be farther from the truth, a lesson India will face in due time.

On her mission to transform poverty-stricken of Whitechapel, India makes the acquaintance of the infamous Sid Malone, a local crime boss. Like oil and water, the two are instantly incompatible. The rigid India cannot accept help from a man who makes his living from crime; she has reform on her mind, Sid as her unwilling target. Of course, fate has other plans for the pair.

With the London slums as a background for her tale, the author constructs a hopeless triangle: India, Freddie Lytton and Sid Malone. The devious Freddie is determined to see the end of Malone and marry India for her fortune and will do whatever it takes to accomplish his goal. Malone, a decent man drawn into a terrible life, is torn by his affection for the rigid India and the hope of starting over elsewhere.

Thanks to Lytton’s machinations, Sid and India’s future is doomed as the drama moves from London to Africa and finally, Point Reyes in northern California. Mixing class and characters, the desperation of the poor and the luxury of the entitled, the novel has a Dickensian feel, posh versus poverty, with a dash of dastardly deeds and a damsel in distress, suffering for the loss of her true love.

The plot twists and turns, a serpentine stew of misadventures and small treacheries, the evil Freddie a truly stereotypical villain. But this author is an optimist - her long-suffering characters receive their just rewards, wrongdoers punished, and the world set right by the final page. I would like to have seen a bit more nuance, although a plethora of cliffhangers is likely to keep some readers turning pages.