Present day: Julia Hamill has made a horrifying discovery on the grounds of her new home in rural Massachusetts: a skull buried in the rocky soil–human, female, and, according to the trained eye of Boston medical examiner Maura Isles, scarred with the unmistakable marks of murder. But whoever this nameless woman was, and whatever befell her, is knowledge lost to another time. . . .

Boston, 1830: In order to pay for his education, Norris Marshall, a talented but penniless student at Boston Medical College, has joined the ranks of local “resurrectionists”–those who plunder graveyards and harvest the dead for sale on the black market. Yet even this ghoulish commerce pales beside the shocking murder of a nurse found mutilated on the university hospital grounds. And when a distinguished doctor meets the same grisly fate, Norris finds that trafficking in the illicit cadaver trade has made him a prime suspect.

To prove his innocence, Norris must track down the only witness to have glimpsed the killer: Rose Connolly, a beautiful seamstress from the Boston slums who fears she may be the next victim. Joined by a sardonic, keenly intelligent young man named Oliver Wendell Holmes, Norris and Rose comb the city–from its grim cemeteries and autopsy suites to its glittering mansions and centers of Brahmin power–on the trail of a maniacal fiend who lurks where least expected . . . and who waits for his next lethal opportunity.