This extraordinarily well-researched novel by Lawrence Goldstone is a trifecta winner as a historical study, a medical mystery, and a crime novel. It takes place during the last few years of the 1880s at a time during which modern surgical techniques began to come into their own in spite of considerable controversy. This story centers around five young doctors who are undergoing advanced studies in human anatomy from the historically famous Dr. William Osler, who at the time was the head of Clinical Medicine at the University of Pennsylvania Medical School. 

The young doctors all came to Osler because of his national prominence in promoting modern medical procedures. The plight of patients undergoing serious operations by ill-informed surgeons who were not up to date on the new procedures is amply described by a graphically disturbing portrait of one doctor who nearly butchers his patient. Another background point is made about an earlier botched operation on Ephraim Carroll's father, which caused him to lose his leg. Watching his father suffer made the selection of a career in medicine the proper choice for this idealistic and highly intelligent young man, and twenty years later he is one of the elite group of doctors studying under Osler.

The author also examines society in Philadelphia at that time. The story moves with considerable facility and great literary finesse from the gilded mansions of the rich with their servants and three hour dinners to the dives along the harbor where danger and disease lurk in equal measure. Along the way we are treated to a comprehensive and fascinating portrait of daily life. Reading this book will dissuade anyone that the "good old days" were all that, as life during this era was anything but except for the privileged few, and not even for them if they ran afoul of societal restraints.

The author's selection of this time frame is critical for two reasons. Until just six years before it had been illegal to perform autopsies on the dead. This was only made legal by the passage of the Anatomy Act of 1883. Six years later autopsies on cadavers were still very controversial with the formation of many leagues against "human vivisection" under the guise of protecting "basic human decency." 

The author goes on to suggest that the popularity of the Sherlock Holmes mysteries authored by Conan Doyle, also a physician, had much to do to forge a link between medicine and science. Doyle had created a detective who was so exacting in his methods that forward-thinking medical practitioners were inspired to be equally exacting in their search for the mysteries of the many illnesses plaguing the human body. Needless to say, advances in the knowledge of the human body necessitated rigorous anatomical studies on cadavers.

The background to the writing of this novel is equally fascinating and deserving of an article in its own right. Lawrence Goldstone has co-authored six novels with his wife, Nancy Goldstone, also a prominent author. One night they went out to the movies and saw "The Red Violin" ("Le violon rouge," 1998). Afterwards, Lawrence was inspired by the travels of that violin and wondered if there had ever been a novel which has had such a rich history of former owners. 

His search for an equally prominent novel were initially unsuccessful, but eventually an antiquarian suggested that the works of Michael Servetus (1511 - 1553) might be what he was looking for. Servetus was a highly educated Spaniard who ran afoul of the religious leaders of the day by authoring many tracts arguing against the trinitarian beliefs of Christianity. (He is considered one of the spiritual fathers of the Unitarian Church.) By chance captured in Switzerland, he was tried as a heretic and burned at the stake in 1553 with no support even from the Protestants of that era. 

Nearly all of Servetus's novels were burned as well, but a few have survived on down through the years. While most of his writings were theological, this deeply learned man also wrote a section in one of his tracts about pulmonary circulation, a subject which was unknown at the time. This provided the connection which also makes Servetus respected in the field of medicine. When Goldstone discovered that Dr. William Osler was a bibliophile with a lifelong passion for collecting anything written by Servetus, the seeds for this novel quickly fell into place. 

Dr. William Osler was also an interesting historical figure as a giant of medicine. In spite of his upbringing in the wilderness of Canada, he was a highly educated man coming from a very well educated family. His father was the primary selection for a naturalist to sail around the world on the Beagle, but he turned this opportunity down and Charles Darwin was selected to take his place. 

During his illustrious career, Osler formed a lifelong relationship with Dr. William Halstead, a pioneering surgeon, to the point where he spent his life protecting Halstead's reputation and career from charges of drug usage. Halstead had become addicted to cocaine as a medicinal drug after he self-administered it to test its pain killing properties. Halstead's addiction to cocaine provides a major plot point in this story.

The two doctors practiced in Philadelphia at the time, as did the famous artist, Thomas Eakins, another pivotal character in this novel. Eakins was famous, infamous at the time, for his lifelike paintings of surgical scenes which he rendered on oversized canvases. 

Osler and Halstead went on to become two of the four most famous doctors in the country with their work at Johns Hopkins University in Baltimore, Maryland, after a wealthy Quaker of that name bequeathed the staggering sum of $7 million to fund a medical research center and a hospital to go along with the new university. 

However, this novel takes place before then with Dr. Osler instructing his student doctors at the Blockley Dead House attached to the University of Pennsylvania Hospital. Anatomies were performed to study how diseases affected the human body. Most of the autopsies were done on the indigent who had died without a home or family to claim their remains and provide them with a proper burial. Even then the controversy attending these autopsies was so great that the building caretaker had to be bribed to be out of the building so that the studies could proceed without interruption. 

Ephraim Carroll, a young man originally from Ohio with five years of medical practice in Chicago, was one of five students who had made the effort to study with Dr. Osler. One of the students was a woman, which was highly unusual at the time, and further evidenced Osler's progressive nature. Ephraim, a naturally inquisitive and curious young man, will soon find more than he bargained for when tragic events turn this episode into a dense thicket of questionable morality and self interest. 2008, Random House.