Fifteen-year-old Gustine is a "dress lodger," a young prostitute who rents a beautiful blue dress from her landlord to attract a higher class of clientele. To make sure she earns her fees and to keep her from running off with his fantastical gown, her pimp has set a malevolent old woman, known only as "the Eye," to follow her through the back alleys of Sunderland. By day a potter's assistant, by night a courtesan of the streets, Gustine works to support her fragile only child, born with a remarkable anatomical defect.

Surgeon Henry Chiver is a prisoner of his own past. Implicated in the Burke and Hare killings in Edinburgh, in which beggars were murdered so the corpses could be sold to medical schools, he has come to Sunderland to start a new life. He has a loving fiancé, an influential uncle, and an anatomy school that is chronically short of teaching cadavers.

Doctor and dress lodger come together in the filthy, overgrown East End of Sunderland. Here, during the worst epidemic since the bubonic plague, Gustine secures bodies for the doctor's school, until Henry's greed and his growing obsession with her child challenge her loyalty to him. With cholera bearing down on the city, Gustine must turn to her mortal enemy, the Eye, in her battle for the life and afterlife of her child.