After medical school in Philadelphia, Dr. Julia Lewis is one of Britain's first woman physicians. In 1866, that's still so unusual that Scotland Yard Inspector Richard Tennant is appalled when Dr. Lewis, and not her grandfather, shows up to help at his crime scene. Although this is her first crime scene, Dr. Lewis capably handles the gruesome murder. It's only the first of several, as a serial killer taunts Tennant with handwritten notes. Tennant, his team, and Dr. Lewis attempt to connect the victims through lifestyles and workhouses. As the working-class and poverty-stricken people of London suffer from cholera and typhus, and Dr. Lewis tries to help them, she gets closer and closer to a murderer who is watching. Although she doesn't fit the killer's M.O., a twisted mind can find its own pattern. While Scotland Yard looks in other directions, Julia's guesses about a troubled childhood are the clues that ultimately lead to a surprising villain, one too close for comfort.