The Anatomy of Deception

by Lawrence Goldstone, David Ackroyd (Narrated by)

Overview

In the tradition of Caleb Carr’s The Alienist and Matthew Pearl’s The Dante Club, this mesmerizing forensic thriller thrusts the reader into the operating rooms, drawing rooms, and back alleys of 1889 Philadelphia, as a doctor grapples with the principles of scientific process to track a daring killer.

In the morgue of a Philadelphia hospital, physicians uncover the corpse of a beautiful young woman. What they see takes their breath away. Within days, one doctor, Ephraim Carroll, strongly suspects that he knows the woman’s identity. . .and the horrifying events that led to her death. But in this richly atmospheric debut novel – an ingenious blend of history, suspense, and early forensic science – the most compelling chapter is yet to come, as the young doctor is plunged into a maze of murder, secrets, and unimaginable crimes.

Peopled with vibrant real-life characters such as Canadian William Osler, hailed as the Father of Modern Medicine; famed surgeon William Stewart Halsted, who performed the first emergency blood transfusion and invented surgical gloves; and the controversial painter Thomas Eakins, The Anatomy of Deception brings to life a little-known and exciting turning-point in American medical history, when ignorant butchery gave way to intelligent surgery–and a young doctor is forced to confront an agonizing moral choice between exposing a killer, undoing a wrong, and, quite possibly, protecting the future of medicine itself.

Product Details

ISBN-13:	9780739359167
Publisher:	Random House Audio Publishing Group
Publication date:	01/29/2008
Edition description:	Abridged

About the Author

Lawrence Goldstone, with his wife, Nancy, is the author of two critically acclaimed narrative histories of medicine and anatomy. He has written for the Boston Globe, Los Angeles Times, Chicago Tribune, and Miami Herald. He lives in Westport, Connecticut.

Lawrence Goldstone, with his wife, Nancy, is the author of two critically acclaimed narrative histories of medicine and anatomy. He has written for the Boston Globe, Los Angeles Times, Chicago Tribune, and Miami Herald. He lives in Westport, Connecticut.

Read an Excerpt

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. Apprenticing to Newton or Boyle or Leeuwenhoek could not have been more exciting. Others would call Dr. Osler the modern-day Hippocrates, but to me he was simply “the Professor.”

I arrived at the hospital that morning poised for a journey into the unknown, no less than Stanley at the threshold of Zanzibar. In the changing room, I replaced my suit with the trousers, pants, and cap that were provided to the staff. The outfits were faded and blue, with a military air. A persistent rumor had them as leftovers from the late Civil War, and I often wondered if my father had once been dressed in just this way.

I was soon joined by those of my colleagues also invited to observe. There were nine of us that morning, a study in contrast. Some, like me, were experienced physicians; others had just begun internship. Most were products of Philadelphia or other large cities, although I myself had been raised on a small farm in southern Ohio. One of us was even a woman. Mary Simpson had been included at the Professor’s insistence, despite the extreme disapproval of anonymous members of the board of trustees who had been scandalized by such an affront to nature. Two Georges epitomized our differences. Farnshaw, at twenty-one the youngest of our group, had been raised in great wealth and came to study with the Professor after graduation from Harvard; Turk, at twenty-eight the oldest, was the product of an orphanage, and had worked his way through the university unloading merchant vessels on the Philadelphia docks.

We assembled in the staff room and found the Professor already present and in a jaunty mood. William Osler was small, a sprightly man, scarcely five feet five inches, but he moved with such energy, such spring, that he appeared larger. He was already significantly balding, the loss of hair provoking him to pay scrupulous attention to his mustache, which was full and walruslike, perfectly framing his mouth and reaching to the jawline on either side. The backs of both hands bore signs of a recent eruption of verruca necrogenica, anatomist’s warts, a red and raised tubercular infection that gave the skin an appearance of dyed leather. It was a vile condition with which the Professor was regularly afflicted from contact with necrotized flesh, but he blithely treated each new outbreak with oleate of mercury until it receded.

“Well, well, well,” he said, rubbing those reddened hands together, his speech, as whenever he was excited, lapsing into the flat Canadian cant that betrayed his origins, “this will be a fine day, a fine day indeed, eh? I believe there are five cadavers available. Let us not keep them waiting.”

The Professor had every right to his enthusiasm. For all of his genius, it was rare he was given the opportunity to conduct a full day’s study in the Dead House. Like most of those who toil to advance human understanding, he was also engaged in a constant battle against human ignorance. Until the Anatomy Act in 1883, just six years earlier, the use of cadavers for teaching purposes was actually a crime. The great anatomist William Smith Forbes of Jefferson Medical College had only narrowly escaped a term in the penitentiary for “despoiling graves.” The liberalization of the law had done little to dispel the revulsion of many in society to the notion of cutting into a dead body, however, and resistance to the Professor’s researches remained strong. Although the more enlightened could occasionally be persuaded to allow Dr. Osler to determine the cause of death of a loved one or friend, for the most part our material was drawn, as it had been for centuries, from society’s most wretched classes.

Even here, however, there was opposition. A number of groups had recently been formed to attempt to end the “ghoulish practice” of dissecting the poor after death. The most prominent and vocal of these was Reverend Squires’ Philadelphia League Against Human Vivisection. Either unaware or unconcerned that “vivisection” referred to the living, Reverend Squires blithely employed innuendo, humbuggery, and outright lies to entice society matrons to support his cause. He then used the money to thrust himself into the public eye, creating an outcry against the postmortem abuse of society’s least fortunate. As a result, although we did not have to compete with wild dogs for the corpse of a convict, as had Vesalius centuries earlier, cadavers available for examination had become increasingly scarce.

Emboldened by the uproar, the official Blockley pathologist, Henri Formad, an eccentric, ill-tempered Russian, had taken to denying Dr. Osler use of the facilities. The Dead House attendant, a gaunt, lumbering creature whom the Professor had dubbed “Cadaverous Charlie,” had soon followed suit. Whereas Formad acted merely out of professional jealousy and spite, Charlie, buoyed by the stipend he had received from the League, refused the Professor access to cadavers out of what he termed, in his broken English, “bazic human decency.”

But Charlie was an enterprising sort, and he had also shown himself willing to accept a second stipend from the Professor to absent himself from the Dead House for hours at a time and leave us to our work. For an additional remuneration, Charlie, as he had done on this occasion, would actually inform the Professor when a promising supply of unclaimed cadavers became available. Dr. Osler seemed unfazed at the necessity of paying for what should have been provided by a grateful citizenry, but I was appalled that so brilliant a scientist was forced to skulk about like a criminal.

At seven-fifteen, when we exited University Hospital to begin our day, I strode quickly to overtake Turk. My colleague was not brilliant, but quick and clever, with an offhand wit I envied. I had made a number of overtures when he joined the staff, but Turk proved to be a man who resisted intimacy, and I had been unable to breach the wall of irony that he threw up around himself. The only member of the staff in whom he had shown any interest was the other George, Farnshaw, his complete opposite. But I continued to find myself drawn to Turk, even though my efforts at friendship were generally rebuffed.

“Five cadavers,” I whispered softly, looking up at him as we crossed the path. Turk was over six feet and quite thin. He had the manner of those who are very tall of leaning down slightly, and it gave him a predatory appearance. “Dr. Osler must think he has unearthed treasure.”

He nodded without turning to face me. “Yes. Treasure soon to go into the ground, instead of coming out of it. I hope he won’t keep us here through the night.” Turk was rumored to be well acquainted with the city’s more disreputable elements, although he was silent as to where and with whom he passed his free evenings.

“It would be time well spent,” I replied.

“You might think an evening elbow-deep in entrails is well spent,” Turk observed grimly. “I prefer the theater.”

At the Dead House, we paused just outside the heavy oak door that had seemingly been installed to prevent the dead from escaping. Pipes and cigarettes were lit. Even those who did not ordinarily take tobacco did so here in an effort to kill the stench. Still, as we entered the building, we were immediately overwhelmed by an ambiance so powerful that it seemed as if we had struck a wall. The first moments were always the most difficult, when eyes teared, breath came in gasps, and stomachs refluxed. These reactions soon passed, however. Human senses have a remarkable ability to adapt quickly to even the most objectionable stimuli.

The autopsy room was two stories high, with a gallery walkway on the second floor and a grimy skylight at the top. When the Professor attracted an especially large group of observers, the overflow stood upstairs, much as medical students in the 1530s had watched Sylvius perform his anatomies from the balcony of the operating theater at the University of Paris.

The room itself contained three large postmortem tables, the tops of which were soapstone, the legs iron. Shallow channels were cut into each tabletop, leading to a drain covered by a brass grating in the middle, which allowed the fluids released during the examinations to be discharged. The drain led to a ventilating shaft, which extended down into the floor and out of the building to a ditch in the rear that was regularly sprinkled with calcium oxide — quicklime.

A set of drawers with a zinc top was set against one wall, holding bottles of fixatives, sponges, basins, enameled dishes, empty bottles, and museum jars. Next to the drawers sat a capacious sink and, adjacent to the sink, a table held the scales used for the weighing of organs. A crude, high, red-painted desk stood on the other side of the room, upon which rested the book for recording autopsy findings. During each procedure, the Professor provided a steady stream of dictation and one of the students took down the information. Dr. Osler reviewed the notes at the conclusion of each postmortem to ensure that the record was complete and accurate. A coat rack abutted the desk and held aprons and gowns, next to a case on the wall housing autopsy instruments.

Beyond the sink, a doorway led into the mortuary, which contained a bank of cast-iron ice chests that could accommodate sixteen bodies. Charlie was responsible for maintaining the ice, which, even in early spring, required regular changing. A rear door led out to a gravel path where bodies and ice were received, and where wagons of undertakers took the remains away. Occasionally, simple services for the dead were conducted within the mortuary itself.

On the second floor, four rooms were set aside for study and research. It was here that we performed urine analysis, prepared culture media, and examined slides. One of the rooms was a small library and record storage area.

The Dead House held not only the deceased from the two hospitals, but also the bodies of paupers, criminals, and any unidentified, unclaimed corpse encountered within the city limits by the Philadelphia Police Department. Today’s subjects represented a typically diverse assortment. The five chests holding cadavers available for autopsy had been marked by Charlie with white chalk; he had also left a scrawled note detailing the particulars of each case. The Professor could choose from a carpenter who had succumbed to a respiratory disorder in the hospital, a male Negro and a young woman found dead in the streets, an elderly woman who had probably died of stomach cancer, and a Chinaman with a gunshot wound.

“Quite a bounty, eh?” he exulted, a wide smile disappearing under the ends of his mustache. “Who shall be first?” He moved to the nearest chest. “Let’s start with our carpenter.” He opened the top to reveal a bald man of about forty, heavily muscled about the arms. Three of us lifted him out of the ice onto a wheeled table and rolled him into the autopsy room.

After the carpenter had been transferred to a postmortem table, the Professor assigned tasks. “Who’ll take notes?” he asked. “Turk . . . no, you observe. Corrigan. You get the chore.” Corrigan, a stocky, goggle-eyed, bandy-legged young man from South Philadelphia, was eerily reminiscent of a bulldog. He possessed the talent to be a first-rate physician but his dedication was suspect. He had taken notes just two weeks before, and assigning him the tedious chore again so soon was the Professor’s way of chiding him to greater application.

As Corrigan sulked off toward the desk, Turk cast a grin his way. “Be sure to form your letters clearly,” he called.

The Professor laughed and the rest of us chuckled as well. He rarely tolerated sarcasm in anyone else, but seemed to give Turk extra latitude. Perhaps he admired, as I did, Turk’s rise from poverty. “Simpson,” the Professor went on, “you will handle weights and measures, and Carroll will assist.”

Simpson and I were almost always given the most responsible tasks. I was senior in experience, with almost five years in practice, and Simpson was without question the most devoted and hardworking young physician I had ever encountered. Fully cognizant of the risk the Professor had taken in including her on the staff, she seemed determined to leave not a scintilla of doubt that his decision had been the correct one. She was a square-faced, slightly thickset woman, three years my junior. Her speech, while lacking the lilt of the upper classes, was precise and well enunciated, indicating good schooling and, I assumed, an upbringing to match.

When we had all taken our places, the Professor doffed his coat, donned a heavy apron, removed the appropriate implements from the cabinet, and strode to the body. The jauntiness he had exhibited earlier had vanished, replaced by self-assured professionalism.

“We have here what you all can see is a large, powerfully built man, who the note says is German by extraction and was a carpenter by trade. He was admitted to the ward Wednesday last complaining of a cough and swelled feet. Chest measured eighty centimeters, with two-to-five centimeter expansion. Both sides functioned equally, percussion over lungs was normal, and there was nothing special on auscultation.

“After admission, he grew steadily worse, spending most of his time sitting up in bed to ease his breathing. Cough became hacking with expectoration of a bright red color and like currant jelly, dyspnea increasing. Feet became increasingly edematous, expectoration bloody, dyspnea exaggerated. Three nights ago, he became almost insensible with a highly weakened pulse. He was briefly roused with stimulants, but died late Tuesday.”

The Professor grasped the anatomist’s scalpel, larger and heavier than its surgical cousin. “We shall begin by opening the thorax.” Starting at each armpit, the Professor made a deep incision diagonally downward, so that they met at the sternum. He worked smoothly and quickly, the lines straight and true like a draftsman’s. There was a soft hiss as gases were released from the body, and the smell became almost overpowering. Each of us tried to remain stoic, but only the Professor seemed genuinely immune to the stench.

From this juncture, the Professor made a third incision down through the abdominal wall to just above the pubic bone, bypassing the umbilicus, leaving a Y-shaped cut. He then peeled back a fold of skin to either side of the rib cage and one over the face. The carpenter had been dead for thirty-six hours. That, combined with lying in the ice, kept the flow of blood minimal, although it was sufficient to cover the Professor’s hands and wrists. What fluid did escape, I quickly sponged into the channels of the autopsy table.

While the Professor rinsed his hands after the skin had been cleared, I grasped a set of rib cutters, which resembled large garden pruning clippers. I cut through the ribs at the far side of both lungs, just under the skin fold, each snap of the cutters making the sound of a breaking twig. When the ribs were free, the Professor removed the anterior chest wall to expose the organs underneath. From here, most anatomists used the Rokitansky method, extracting all the organs simultaneously after cutting off their connections to the body, but the Professor, although he had studied with Rokitansky at the Allgemeine Krankenhaus in Vienna, preferred the Virchow technique, removing the organs one at a time. Of course, he had studied with Virchow as well.

“The body presents the appearance of a man dead of heart disease,” he began, as Corrigan entered the data into a journal. “There is a small amount of fluid in the abdomen.” Using a siphon, I drew off additional fluid in the lining over the lungs and heart, placing each in a graduated cylinder, which Simpson measured and noted.

“In the right pleura, sixty ounces of clear serum, thirty ounces in the left, and eight ounces in the pericardium,” she reported. The Professor then severed the coronary arteries, freeing the heart, which Simpson removed from the chest cavity and placed on the scale.

“Heart is large,” she said. “Seven hundred ten grams.” The heart was brought to an examining table and the Professor lanced it open. He spoke continuously as he cut, unmindful of the blood and other sera that once more drenched his bare hands, Corrigan scribbling furiously to get it all down.

“Right chamber distended with large, jellylike clots. Ventricle dilated, measuring twelve centimeters from pulmonary ring to apex. Tricuspid orifice dilated fifteen centimeters in circumference. Segments of heart healthy, pulmonary valves normal. Left auricle large and contains blood, with clots. Left ventricle dilated and contains gelatinous clots. Those about the trabecula”—he indicated the partition that separates auricle from ventricle — “are colorless.”

The Professor instructed Simpson to measure each chamber and the connecting valves, with the measurements then recorded in the journal. He noted where muscles were fibroid or pale in color or valves thickened at the edges. When the examination of the heart was complete, it was left on the table and the Professor removed each lung, one hand at the top, the other at the bottom, and repeated the dissection process. He observed that in both were large spots of apoplexy — hemorrhaging — and the anterior borders were emphysematous. Tissue sections presented coarse appearance of brown atrophy. After the lungs, he examined the bowels, kidneys — on which there were several cysts — liver, and spleen.

The next step was to remove the brain, a delicate operation that only the most skilled anatomist could perform without mishap. Unfixed brain tissue has the consistency of gelatin and is notoriously difficult to handle. It had taken me months, but I finally mastered the technique and was now the only member of the staff to whom the Professor would delegate the task. After my first success, Turk had proclaimed me “Lord of the Runny Eggs.”

I made a transverse incision at the back of the head from ear to ear across the brain stem, then separated the scalp from the underlying skull and pulled it forward. After utilizing a bone saw to score the calvaria — the cap of bone at the top of the skull — I employed a skull chisel, known as a “Virchow skull-breaker,” to remove it. I then moved with great care to gently lift the brain out of the cranial vault. My hands were soaked with perspiration and my clothes clung to me in the still air, making delicate movement laborious. I managed to remove the brain, which, as Turk had so aptly noted, felt like a mass of undercooked eggs, and placed it in a large jar of formalin fixative. After soaking for a moment, the brain tissue coagulated and was removed to a table and sliced for examination.

“The brain, as we would have expected,” said the Professor after taking some cross sections, “presents nothing abnormal. The arteries at the base are opaque, but not rigid.”

The remainder of the autopsy went quickly. The intestines were opened with an enterotome, a large specialized pair of shears. The major blood vessels were examined, but nothing further of interest was discovered.

When the examination was completed, ninety minutes after we began, the Professor washed his hands in the sink and then returned to the table. “Well, not too much question of what did this fellow in, eh?”

Those of us familiar with the Professor’s teaching methods knew not to answer too hastily, but Farnshaw, four months removed from Harvard, rashly offered, “No, sir. Hypertrophy.” Farnshaw was tall, like Turk, with a smooth, clean-shaven face, and the innocence that is the inevitable result of an upbringing in which wealth is utilized to insulate life’s many pitfalls. So ingenuous was Farnshaw, however, that it was impossible not to feel affection for him. That he constantly stumbled in his barefaced attempts to prove himself worthy of our professional respect endeared him to us all the more. He was not, it must be said, a bad doctor, simply unseasoned, like newly hewn poplar.

“Indeed,” replied the Professor. “An enlarged heart. Now, Farnshaw, this chap entered the hospital in relatively decent shape. Some coughing, but no evidence of advanced disease. What might have been done for him to prevent this unfortunate result?”

“Digitalis,” replied Farnshaw triumphantly. My gaze met Simpson’s for a moment and her eyes rolled upward. Digitalis, derived from the otherwise poisonous purple foxglove, was known to strengthen contraction of the heart muscle, slow the heart rate, and help eliminate fluid from body tissues. It had been popular for a century and was prescribed by almost every physician in the nation for almost every heart problem. Every physician except the Professor, that is.

“Simpson,” said the Professor, “you do not seem to agree.”

“No, sir,” she answered, coughing slightly from being caught in the act. “I do not see how digitalis would have alleviated the symptoms or provided a cure.”

“What then, Simpson?”

Simpson considered this for a moment but finally admitted that she could think of no treatment that would have been effective. Such a response might have been treated harshly by many who taught medicine — doctors were supposed to have a response for everything — but the Professor preferred no answer to an incorrect one, and so merely nodded and moved on.

“How about you, Turk?”

“Perhaps showing him Farnshaw’s fee would have shocked him back to health,” Turk replied.

“Ha! Quite right, Turk.” The Professor chortled. “That is one aspect of medical education that Harvard does not ignore.” He turned to the unfortunate Bostonian. Farnshaw’s face had gone a deeper red than his hair. “Digitalis would no more have prolonged this man’s life, Dr. Farnshaw, than would standing on his head. There was nothing we could have done for this man short of manufacturing him a new heart.”

The Professor began to pace about the room, the fingers of his right hand tapping into his left. “All we know here, Farnshaw, is that we don’t know. We have permutated disparate pieces of data, but can come to no definitive conclusion. This patient died with all the symptoms of chronic coronary valve disease, but we find no affection of the valves and only moderate arterial degeneration. The kidneys are not especially fibroid and there was not sufficient pulmonary distress to account for the hypertrophy and dilation of the heart.”

The Professor returned to his place at the center of the table and gestured at the cadaver, hand opened, palm up. “So what do we do, Farnshaw, when faced with a mystery?”

As so often occurs in youth, Farnshaw’s reckless enthusiasm had been supplanted by abashed reticence.

“After we have recorded each bit of data, no matter how seemingly inconsequential or tangential to the case,” expounded the Professor, now addressing all of us, “we form hypotheses and then pursue and test each one without prejudice or preconception until it is disproved. We distrust coincidence.

“In this case,” the Professor continued, “there is evidence that circumstances that tend to produce and maintain a high degree of tension in the arterial system may lead to hypertrophy and dilation. Here, we have a subject whose occupation often involved intense exertion, and who had no history of syphilis, so it may be possible to connect his habits to the life of the disease. Still, as we cannot definitively account for the hypertrophy, we will simply chronicle the evidence so that we may compare it to similar instances in the future and seek correlations that may lead us to solve this riddle.”

“Not a very satisfying conclusion,” remarked Turk.

“On the contrary,” replied the Professor. “We have discovered a case whose particulars do not correspond to accepted data, an illness or condition from which this man died that is not yet recorded in the literature. What I see here, Turk, is an opportunity, and hardly unsatisfying.”

“Of course, Doctor,” said Turk. “As you say.”

“You are a good doctor, Turk, but I’m not sure that research is your métier,” observed the Professor. “Perhaps you and Farnshaw should join in private practice. That way you may partake of those legendary Harvard fees.”

Farnshaw again reddened, but Turk guffawed. “An excellent suggestion,” he replied cheerily.

We all grinned, grateful for the break as the Professor strode over to check Corrigan’s notes. As Simpson and I made to deposit tissue samples in specimen jars and return the removed organs to the body, I noticed her eyes on me, but her gaze flitted quickly away. For a time, Charlie had been responsible for putting things back in what order he could, and then stitching up the cadavers before burial. But Charlie, who had been known to tipple the alcohol in the specimen jars, was not always reliable. On one occasion, some months ago, a male cadaver ordered exhumed because of suspicion of foul play was found by Formad to have three livers. We now performed the chore ourselves.

After all was in order and the carpenter had been returned to the ice chest, the Professor moved to the next subject that Charlie had marked for him. This was the male Negro.

Following the same procedure, it soon became apparent from an extensively cirrhotic liver that the man had died of alcohol poisoning. The case was undistinguished except the Professor declared that the condition of the left lung was extraordinary. “I have never seen an organ so infiltrated with bloody serum.” The fluid had a uniform purplish red, viscous appearance. The Professor was at a loss to account for it, except to hypothesize that the subject, under the influence of drink, had gone to sleep coiled on his left side so that, while he was senseless, his gradually weakened heart propelled feeble charges into the pulmonary artery. By hypostasis, an increasing volume had reached the left lung until a state of extreme congestive edema was produced.

For our third specimen, the Professor chose the elderly woman with stomach cancer. Her case was equally unremarkable and, when we had finished with her, it was only two o’clock. “Well,” said the Professor eagerly, “it looks as if we’ll have time for another.”

As the rest of the group returned the dead woman to the ice, I remained in the dissecting room to wipe down the table more thoroughly. When I got to the mortuary door, the Professor was standing at the chest that held the girl found dead on the streets of unknown causes.

“A bit of a mystery here, eh?” he said, and swung open the lid.

Only because I was standing away did I notice Turk’s reaction. For an instant, his body stiffened and his gaze froze on the cadaver. I stepped in hastily to see what had caused his reaction, and got a brief glimpse of a young, light-haired woman of perhaps twenty years of age. Although she had been dead for some days, she looked nothing like the street urchins we generally encountered. She had a beautiful figure and what seemed to have been clear, unblemished skin, marred only with distinct bruising to the upper left arm and milder trauma at the lower abdomen. As I leaned forward for a closer look, the Professor slammed the lid shut. The crack of metal on metal reverberated through the room.

“I’ve changed my mind,” he said quickly. He took a deep breath and then smiled stiffly. “We’ve been at this for quite some time. No need to overdo, eh?”

Turk had recovered his equilibrium, but remained staring, his brow furrowed, at the closed cover of the chest.

Editorial Reviews

"You’ll be gripped by this haunting and atmospheric thriller." –Tess Gerritsen

"Compelling…. [A] top-notch historical page-turner." –Publishers Weekly, starred review

"What makes his book so fascinating is the attention to the medical procedures and innovations of the time ... Readers who enjoy Anne Perry’s and Caleb Carr’s psychological thrillers will welcome Goldstone’s brooding, paranoiac addition to the genre." –Booklist

"Colorful and highly informative....Evokes the evolving medical profession and the art world in late-nineteenth-century America." –USA Today

"An intriguing tale of death and dishonesty." –London Free Press

"A clever and entertaining tale...set in the surgical theatres and medical research halls of late-nineteenth-century Philadelphia and Baltimore." –Los Angeles Times Book Review

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