Virginia Chief Medical Examiner Kay Scarpetta has a bloody puzzle on her hands: five headless, limbless cadavers in Ireland, plus four similar victims in a landfill back home.

That's what the panicked public thinks, thanks to a local TV reporter who got the leaked news from Scarpetta's rival, Investigator Percy Ring.

[1] Central to the plot is the case of Janet Parker, the last person known to have died of smallpox, which she contracted in 1978 due to a lab accident in Birmingham, England, after the disease was eradicated in the wild.

Cornwell makes the villain a junior employee of the lab at the time who was made a scapegoat for the accident and whose career was blighted as a result.

The emergency response is complicated by a Federal budget freeze, when all "non-essential" government employees are sent home.