“You’ll be gripped by this haunting and atmospheric thriller.” —Tess Gerritsen“Compelling…. [A] top-notch historical page-turner.”—PUBLISHERS WEEKLY, starred review A mesmerizing forensic thriller that thrusts the reader into the operating rooms, drawing rooms, and back alleys of 1889 Philadelphia, as a young doctor grapples with the principles of scientific process to track a daring killerIn the morgue of a Philadelphia hospital, a group of physicians open a coffin and uncover the corpse of a beautiful young woman. What they see takes their breath away. Within days, one of them strongly suspects that he knows the woman’s identity…and the horrifying events that led to her death. But in this richly atmospheric novel–an ingenious blend of history, suspense and early forensic science–the most compelling chapter is yet to come, as young Ephraim Carroll is plunged into a maze of murder, secrets and unimaginable crimes....Dr. Ephraim Carroll came to Philadelphia to study with a leading professor, the brilliant William Osler, believing that he would gain the power to save countless lives. As America hurtles toward a new century, medicine is changing rapidly, in part due to the legalization of autopsy–a crime only a few years before. But Carroll and his mentor are at odds over what they glimpsed that morning in the hospital’s Dead House. And when a second mysterious death is determined to have been a ruthless murder, Carroll can feel the darkness gathering around him–and he ignites an investigation of his own.Soon he is moving between the realm of elite medicine, Philadelphia high society, and a teeming badlands of criminality and sexual depravity along the city’s fetid waterfront. With a wealthy, seductive woman clouding his vision, the controversial artist Thomas Eakins sowing scandal, and the secrets of the nation’s powerful surgeons unraveling around him, Carroll is forced to confront an agonizing moral choice–between exposing a killer, undoing a wrong, and, quite possibly, protecting the future of medicine itself….

Chapter One


At Christmas 1887, fifteen months before this story began, the world was introduced to a fictional character destined for such immeasurable acclaim that he would overwhelm his creator's efforts to be done with him. The essence of this character's appeal was not derring-do, as in the dime novels of Beadle & Adams, but rather in his uncanny ability to unravel a set of data that had stumped lesser men and proceed to a logical and incisive conclusion. He was so coldly rational that he was often compared to a machine, the Analytical Engine of Charles Babbage. His name, of course, was Sherlock Holmes.

To those of us engaged in medical research, however, the remarkable methods of Conan Doyle's consulting detective were not at all revolutionary--they were merely a popularization of the modus operandi we employed in our quotidian efforts to alleviate human misery. The connection of analytic detection to medicine was unmistakable. Doyle himself was a physician, as were both Joseph Bell, widely considered the model for the character, and Oliver Wendell Holmes, the man for whom the detective was named. And while Sherlock Holmes may have trod the back alleys of Victorian London to ply his trade, the scenes of our crimes were no less exotic and often even more grisly.

To make sense of nature's felonies against the human body, you see, physicians are compelled to study not only the living, but also those who have succumbed. Our clues lie in internal organs, blood vessels, skin, hair, and fluids, and we need as much access to these as Holmes needed to footprints, handwriting, or hotel records. It is only through painstaking examination of the data wrung from this evidence that deductions may be made as to what has caused illness and death, which, in turn, aids immeasurably in the care and treatment of those who might still be saved.

As Holmes' popularity soared, it thus became sport among physicians to match wits with the fictional detective, eager to demonstrate that if they applied themselves to murder, theft, and mayhem, they would achieve similarly sterling results. Although for most in the medical field, this exercise was nothing more than a diverting parlor amusement, for me, the game was to be all too real. It started early on a mid-March Thursday in 1889, when I strode through the gate in the high stone wall at the rear of University Hospital in West Philadelphia and entered the Blockley Dead House.

The Dead House, the morgue that served both University Hospital and Philadelphia General, was a squat, solitary brick building, a fetid vault filled with cadavers in various states of putrefaction. The air was thick and still, and heavy drapes were pulled shut day and night. It was a place of spirits, where the tortured souls of hundreds, perhaps thousands, who had died from abuse, disease, want, or ignorance would spend their last moments in the company of the living before they were removed for their solitary rest and placed in the ground forever. I have never been a believer in phantoms, but I could not walk through its door without feeling all of those abbreviated lives pressing down upon me.

But this grim way station was also a place of science. In this incongruous setting, Dr. William Osler, head of Clinical Medicine at the University of Pennsylvania Medical School, forced forward the boundaries of medical knowledge. Although not yet forty, Dr. Osler had transformed the Dead House into perhaps the most exciting and advanced laboratory for the science of morbid anatomy in the entire world. I had given up private practice in Chicago and come East specifically for the chance to work and study with this astounding man....