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Dr. Lydia Weston glanced discreetly at her watch. Her patient, Delia Townsend, sat on the examination table. With each deep breath, Mrs. Townsend's corsets creaked in protest. She lifted her chin in stubborn protest as she recited a litany of concerns.

"This fatigue consumes me. After breakfast, I feel ill-suited to do anything. I could lie down and sleep for hours. Perhaps I need a tonic?"

Lydia placed her stethoscope on her desk. Privately she thought that Mrs. Townsend should take some exercise, but she kept this to herself.

She took out her prescription pad and wrote as Mrs. Townsend disappeared behind the chinoiserie screen to dress.

Lydia sighed. She had a stack of patient notes to write before the day was done and Mrs. Townsend's concerns were nothing new. But the patient needed time to fully voice her complaints or else the visit would take twice as long.

An iron tonic would be little more than a placebo, Lydia thought. She had done a thorough exam as she always did: listening to the heart and lungs, palpating the abdomen, noting normal vital signs. An extensive laboratory evaluation had revealed nothing suspicious.

Mrs. Townsend reemerged, elegantly dressed in a cream silk taffeta that pooled at her feet. Lydia knew they were fortunate to have wealthy patients who sought treatment from a "lady doctor"; these patients' ability to pay provided much-needed revenue to support the work of the clinic.

Mrs. Townsend fastened the buttons at the top of her bodice. Her jeweled rings slipped atop gnarled joints, brown age spots mottling the backs of her hands. Lydia could see that her hands shook as she struggled to do up the buttons. No doubt severe arthritis was causing considerable pain. Lydia felt a stab of compassion as she watched the older woman take a deep breath and patiently begin again. Lydia knew wealth conferred no immunity from suffering. Mrs. Townsend's only daughter had died of rheumatic fever the year before and many of her visits stemmed from the void of loss.

Lydia handed over the prescription.

"If you like, you could try a daily tonic. But I would recommend light exercise. Start with a half-hour walk daily. It will make you feel better," she said gently.

"I suppose it can't hurt," Mrs. Townsend admitted. "I would also suggest taking off your corset." Lydia could not resist a chance to dispense this advice. "It is a terrible constriction to the abdominal organs and can impair your breathing."

The remark was greeted with silence. Then Mrs. Townsend ventured, "Well, I don't know. It doesn't seem proper to be without a corset ..."

"Please try it. I will look forward to our next meeting," Lydia said as she ushered Mrs. Townsend out of her office.

The Spruce Street Clinic had been founded by a group of doctors from the Woman's Medical College, fervent idealists who believed that medical care was not the sole province of the rich. It served a thriving working-class community and many of the shopkeepers, seamstresses, and livery drivers that Lydia had treated in the early days were still her loyal patients. Lydia met people from all walks of life, many her own age, who had endured unimaginable trials of sickness and loss.

The building had been a small textile factory, and the industrial flavor was still evident. The knotty pine boards on the floor were burnished to a sheen from countless boots trudging through the rooms in all weather. The former factory floor was divided into exam rooms and a reception hall. The upstairs floor could function as a small hospital ward, with a few beds for those whose conditions required more intense monitoring. There was an airiness to the waiting room, with its high ceilings and large windows. The walls were painted white, adorned with a few bland landscape paintings. It was as if the décor was an afterthought. The simplicity reflected the attitude of its founders: this was a serious place of work and it needed no distraction from the mission it served.

Excerpted from Murder by Degrees by Ritu Mukerji. Copyright © 2023 by Ritu Mukerji. Excerpted by permission of Simon & Schuster. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.