Martin tells four people of the sighting: his editor, McIlvaine; his fiancée, Emily Tisdale; the family pastor, Dr. Grimshaw; and a college friend, Harry Wheelwright.

From Wheelwright, McIlvaine learns that he and Martin secretly opened Augustus's grave and found a child buried there instead of the old man.

From Sarah, McIlvaine learns that Augustus was diagnosed with a terminal blood disease and that with the assistance of his secretary, Eustace Simmons, he entered a private hospital said to be near Saranac Lake in upstate New York and run by a Dr. Sartorius.

Sartorius, a brilliant and innovative Army surgeon during the Civil War, has invented treatments that were then unknown to medicine: blood transfusions, dialysis, bone marrow transplants and others.

With the assistance of the corrupt Tweed Ring, which runs New York (and with which several of the old men are connected), Sartorius has built a secret sanitarium in which he is free to experiment and administer his treatments without any supervision.

When Donne discovers the location of the sanitarium in a municipal waterworks installation outside the city, he stages a police raid.

The first-person narrator presents a very negative image of the city he lives in – and he shows the readers an authentic view on the New York in 1871.

The novel was less successful than Doctorow' previous works Billy Bathgate (1989) and Ragtime (1975), but like them it combines history with fiction.

[1] In 1984 Doctorow had previously written a story about the Croton Aqueduct titled "Waterworks" which is featured in the collection Lives of the Poets.