Monk and Hester are now married, and beginning to build their life together, each having to make adjustments in preferences and considerations. As expected, there are some tense moments: Monk mustn't try to lay down the law, or force Hester into the role of a subservient wife, if he wants them to be happy, and she must also allow him to retain some pride and decision-making.
There continues to be medical and nursing history. Anaesthetic is now more commonplace, changing surgery for the surgeons as well as the patients. Hester, along with Florence Nightingale, is still trying to improve conditions at the hospitals and to train nurses to a higher standard, to make them skilled professionals rather than untrained, drunken cleaners. Nightingale is regarded, sentimentally, as a lady sweeping genteely through a ward at night, soothing fevered brows - rather as she is now - but is in the process of setting up her own training school (something which actually occurred in 1860, at St. Thomas' Hospital). Unfortunately Hester's hospital is not as forward-thinking.
The social issue Anne Perry focuses upon here is that of veterans: those who fought in earlier wars, and the many who are now old and poor, unable to afford the medicines they need or to go to hospital. Used and discarded, these valiant soldiers who fought at Waterloo and Trafalgar are now the vulnerable in society, and yet hospital administrators and doctors seem to discount them, leaving only a handful of people and some dedicated nurses to try to help them.
The mystery, of course, is murder, with the answer in long-buried history. Monk, Hester and Rathbone require all their skill and co-operation if they are to save their clients - if their clients are as innocent as they believe - and when the answer is finally revealed, it is the unthinkable.