Monk is in transition, as his usual private inquiry agent jobs in the city of London, which he knows so well, have dwindled. He's not making enough to support himself or his wife Hester and her clinic for sick and injured street women. So when he's approached by a major ship owner to find a missing cargo of ivory tusks, who promises him a large fee, he feels compelled to accept. While his detecting skills are of use, he knows nothing about life on the Thames, so why did Louvain choose him? And why does Louvain soon bring the ill cast-off mistress of a friend to Hester's clinic? Monk finds help and friendship from a member of the Thames River Police. Margaret, Hester's upper-class friend who both helps in the clinic and approachers her society friends for money, finds two friends who, reluctantly, come to see what Hester and Margaret are doing, and stay to help. A serious illness breaks out among the women in the clinic, one which links her work to Monk's case. The nature of the illness seems a bit far-fetched, but since Perry's research is always impeccable, I have to assume that there were cases during the Victorian period.
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