Julia Hamill has sunk her life savings into a 130 year-old- farmhouse in rural Massachusetts where she hopes to recover from her failed marriage. Gardening one afternoon, her spade strikes something soft and unyielding – not a rock, but a human skull. Medical examiner Maura Isles quickly determines that this is no recent burial. The skeleton – that of a woman – dates back to the early 1800s, and forensic evidence indicates foul play. "But too much time has passed," Maura warns Julia. "We may never the whole story of how she died…"

Boston in the 1830s is an age of disease and pestilence – and no one is more aware of this than Norris Marshall, a student at Boston Medical College. Unlike his more prosperous classmates, Norris is a man of modest means, forced to support himself by performing the most disgusting and secretive job of all. Norris is a resurrectionist - a body-snatcher - who procures cadavers from grave robbers in order to further his study of human anatomy. Soon he finds himself hunting a killer known as The West End Reaper, a shadowy figure who flits through graveyards and back alleys, through glittering ball rooms and the luxurious drawing rooms of Boston Brahmins.

Seventeen-year-old seamstress Rose Connolly is the only witness who's seen "The Reaper," a killer whom police believe may be a man of medicine. Despite her impoverished Irish roots, Rose is a cleverer girl than anyone gives her credit for. When The Reaper takes a second victim, and suspicion falls on Norris Marshall, Norris must turn to Rose to prove his innocence.

Together, they will track down the most notorious killer of their time.