This is a remarkable novel, especially for a second book by such a young author, remarkable in large part for its accuracy as historical fiction. As she relates in notes following the end of the narrative, Ms. Perry has done her research in the history of medicine, especially the history of 19th century surgery and tuberculosis. The author is also a student of late Victorian social progressivism and sexual mores, both of which figure prominently in the novel. Of the many tensions that pullulate in this story, the one between starkly naked (big city) Science and fervently believed (small village) Faith predominates with several novel-of-ideas discussions between Will and Cora, the two intellectuals in love - the former advocating for God, the latter an apostle of Science, most recently that of Darwin. The author offers the following synopsis: "An atheist, Darwinist, progressive widow comes down to the Blackwater Estuary, determined to find out what this monster is — and while she's there, she meets a man of the cloth who is determined to protect his flock from the hysteria and the terror that surround them." (Ref. 1) Their conversations are polite but vigorous and reflect the late 19th century stances prevalent then in Christian faith and natural history. They and the disputes between Will and Luke concerning the role of medicine, especially the aggressive treatment Luke proposes for Stella's tuberculosis, involve first and foremost the proper authority of faith vis-a´-vis the hegemony of science, which is becoming theoretically and practically dominant as the 20th century approaches.  

In addition to the dialogue between non-medical science and religion that informs the cognitive approaches Cora and William bring to the mystery of the Essex Serpent, the sexual mores of late Victorian upperclass Englanders receives the attention of the author and reader. In truth, there is little if any discussion about their romantic affair in person or in some of the many letters that punctuate the novel, but Ms. Perry has invested the ethos of the characters of her novel with what I feel is an aspect of Lawrentian love familiar to readers of his novel Women in Love, i.e., a freedom to love without preconceived social boundaries or rules. This love is akin to a deeply felt friendship, with the membrane between the two a highly porous one. Whether it be Martha and Cora, Martha and Edward, Luke and Spencer, Will and Cora, or even Martha and Spencer, the distinction between love and a steadfast friendship is often one without a difference. (Indeed, the author dances close to a notion of same-sex friendship that approximates homosexual love - but one without explicit or overt physicality.) Friendship is the silent savior in this novel, quietly and ubiquitously rescuing relationships.  Indeed, the epigraph is a quotation from Montaigne's essay "On Friendship".  Friendship in The Essex Serpent, and its characters' belief in its virtues and powers, is versatile, forgiving, civilized, flexible, generous and, ultimately, redemptive. If this description seems to mirror that of religious faith, it is likely no coincidence, although perhaps one not intended by the author. 

Although not ostensibly a "medical" novel - Luke plays a relatively minor part - this novel gently and, except for the tuberculosis, subtly yields medical humanities fruits on every page. The Essex Serpent explores many themes of interest to users of this database: the history of surgery, especially innovative life-saving emergency pericardial surgery; the power of the unknown in generating irrational fear that grips an entire community, testing its inhabitants' faith and their pastor's ability to keep it intact; the relation of health to poverty and subsistence housing in London; disability put to service of begging; the psychological response (including suicidal intentions) of a wounded healer to a devastating injury; and the psychological world of children.  The medical centerpiece of the novel, however, is tuberculosis.
  
Tuberculosis: Stella, who can ill afford any weight loss or systemic illness (described as "no bigger than a fairy and twice as pretty" - page 51), burns with an intensity like her name, Latin for "star". This emotional and physical (fever, rapid heartbeat) energy soon becomes what Stella has known all along it to be (she murmurs to herself,""'Captain among these men of death'")- a paraphrase of John Bunyan's famous description of tuberculosis as "the captain of all these men of death" (Ref.3).  In the novel tuberculosis is called by its 19th century name, "phthisis", Greek for "decay", "emaciation", or "waning" (when referred to the moon), but reserved in medical nomenclature for the inexorably progressive wasting of untreated pulmonary tuberculosis, replete with the hemoptysis (coughing up blood), weight loss, fever  and, an unusual feature of Stella's illness, mental aberrations, especially euphoria, known as "spes phthisica" (from Latin for "consumptive hope"), a controversial notion that pulmonary tuberculosis was sometimes associated with real or imagined heightened creative energy. (Refs. 4,5)  As Stella loses energy, she becomes obsessed with all things and objects and materials blue. She keeps a diary we are allowed to read on occasion in a blue journal with blue ink, an often  mystical journal that reads at times like that of Saint Teresa of Ávila.  Her illness seems to parallel the course of the Essex Serpent mystery - is there one or not? is it a physical object, a sea monster, or just a malevolent curse upon the village for unknown transgressions?

It is a thrill to read such a well plotted tale with adroit characterizations that never feel false or forced and delineated in a prose style one can only call smooth but not purple, articulate almost to the point of poetry but not glib. This author leaves the reader excited to read the next sentence, comfortably at ease that one will not be disappointed in that expectation. Stella is described as "serene in her blue cotton dressing-gown: with the light behind her she'd shame a stained-glass saint." (page 273) In September, "Skeins of geese unravel over the estuary, and cobwebs dress the gorse in silk." (page 305)  The blurbs on the back of the dust cover compare her to Bronte, Dickens and Hilary Mantel . She reminds me of John Irving, the consummate story teller, although one who cannot resist having her fun with names. The surgeon who opposes the will of Will, the minister, is Luke, the only physician of Jesus's apostles. Stella burns like a star. Frankie, aka Francis, who at times seems an almost saintly yet apostate monk, drives splinters into his palms (page 399) at the highly dramatic climax of the Essex Serpent mystery, recreating the stigmata of St Francis. Will must struggle with the freedom of his will and adulterous desire for Cora in opposition to his faith which should mandate subjugation of that will. And, finally, Naomi Banks's father's missing boat and Will's self-perceived moment of grace share the name Grace. Whether one is interested in the various clinical manifestations of Mycobacterium tuberculosis hominis in the pre-antibiotic era, or coastal life of southeastern England in the 1880's, or what intelligent, civilized Englishmen and Englishwomen sound like when ardently debating the cause of Science and its perceived assault on Faith with the latter's defenders - for almost no reason at all except to be charmed by prose in the hands of a stylistic artist - one should read The Essex Serpent. In the Author's Notes at the end are her history of medicine resources that will be of interest to readers.