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HE slipped the needle through the loop and pulled the thread taut, cutting it just above the knot. Wiping away the remaining blood with a damp cloth, he stopped to admire his handiwork. The stitching was perfect—an immaculately proportioned series of tiny black crosses, wasted on a dead man. William's fastidious post-mortem needlework had been something of a running joke at Oxford, his fellow anatomy students suggesting that he had perhaps missed his calling as a tailor.

The actual insides were another matter entirely. He was sure he had put some of the organs back the wrong way around, and there had seemed to be far too much large intestine when it came time to stuff it all back in. Even now the belly didn't look right. There were lumps where there shouldn't have been, and everything seemed pushed over to one side. Still, at least the stitching was perfect.

He rinsed his hands, as well as the few instruments he had used, then opened the window to let out the smell. It was not a putrid smell—just that unwholesome, meaty odour familiar to butcher's shops, but quite unwelcome in a doctor's surgery.

This was not how he had pictured it, back in his college days when he used to dream of setting up his own private practice. Technically this practice wasn't even his—William was officially employed by Lord Munley as a personal physician, but in the absence of a village doctor the Earl had set him up with a private surgery where he could also treat the local populace at need. But the residents of Munley were a backward lot, preferring their own folk remedies—many of which seemed worse than the ailments they purported to cure—to William's modern, scientific methods. Work was sparse, and at times he felt like the fifth wheel on a carriage. Still, after three years spent at Bethlem he felt that he had earned a rest.

Bethlem Hospital. Some nights he would wake in a cold sweat, thinking he was back there. Bethlem, or Bedlam, was a corruption of 'Bethlehem'. It was one of those strange ironies that Christ's birthplace could share its name with the closest thing to Hell on Earth: Bethlehem Royal Hospital, the notorious London madhouse. A miniature purgatory, full of lost souls wallowing in filth; the air thick with the ever-present reek of stale urine, and the inhuman howls of the caged mad.

Such grand ideas he had had, the wide-eyed, inexperienced young man with the ink still wet on the medical licence he clutched in his hand, and how quickly he had come back down to earth. The career prospects for a graduate without coin or connections had turned out to be very narrow indeed, boiling down to charity work at the London Dispensary or caring for the insane at Bethlem.

They called it a hospital, though in truth it was somewhere between a prison and a circus. The patients were treated like animals, and subjected to all manner of abuse—often sexual in nature—and for a fee of one penny, members of the public were invited to taunt them and laugh at their derangement. William, half gaoler, half ringmaster, hated the place, and his colleagues the more for their inhumanity. Nowhere than Bethlem was the barbarism of mankind more horrifyingly patent.

He sometimes wondered how long he might have lasted. Whether he would have found the courage to break free of his own accord, or else remained there indefinitely; the unending horror gradually sapping his will to live until he was at last put in a cell of his own. But salvation had come—unexpectedly—in the form of a letter from a small estate in the North Riding of Yorkshire, bearing the seal of a man he had known only in passing.

The Earl of Munley was the uncle of one of the Incurable Ward's higher-profile patients, as well as a generous donor to the hospital. Duncan Sinclair had achieved notoriety throughout polite society with the discovery of a dismembered woman in his London townhouse, and it was whispered that only his uncle's popularity at court had saved him from the gallows. William's dealings with Lord Munley had been minimal, and he did not imagine that he had made much of an impression at the time, but two years later when the Earl was looking to hire a physician he had remembered him, and written with an offer of employment.

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