Although it comes nowhere near the modern graphic gut-curdling horrors of, say, Hannibal Lecter, the book is notable for its outspoken 'grossness', all explainable when one takes into account that it involves a medical school with the characteristic blasé attitude of surgeons and students toward physical mutilation and deformity -- trepanning in jest. Like the Philo Vance novels of S.S. Van Dine, the book is riddled with learned footnotes relating to the occult and medical anomalies, probably much out-dated (although that is not for me to say). For example, there is an absurd premise that a blood donor with the 'second sight' can suffer vicariously the tribulations of someone who has received his blood (especially an amputee, who is already sensitized to feeling missing parts). This can reach high levels of pretentiousness*, but it is an effective technique used in many books of the period to disguise improbabilities. The reader does get the impression, however, of awful and occult manifestations and insanity in a small and parochial agricultural town whose only distinction is a large hospital and medical research school. One cannot fault the author for his effective and atmospheric mood of menace, even if the attempt to render the Down East dialect is irritating.
* An example: "Histoire Générale et Particulière des Anomalies de l'Organisation chez l'Homme et les Animaux; etc. des Monstruosités, des variétés et des vices de conformation, ou Traité de Tératologie, par M. Isidore Geoffory Saint-Hilaire. Paris: J.B. Ballière, Libraire de l'Académie Royale de Médecine, 1837. (The volume referred to above is the "Atlas" containing twenty engraved plates and a table of contents.)" Much ado about nothing, eh?