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Ami McKay's first bestselling novel was a trove of period ephemera, her own narrative playing off juicy snippets from newspapers, magazine ads and herbalist lore. It was a winning formula that she continues to favour in a new novel that also shares thematic territory with The Birth House.

This time, she examines power imbalances between the sexes through the prism of the so-called virgin cure for syphilis, an insidious 19th-century myth with no socio-economic boundaries and a trail of human wreckage: If the thought of a wealthy older man procuring sex with a girl weren't repugnant enough, there is the real and present danger that she could die from it. It was, and still is in some parts of Africa, where the myth endures as a cure for AIDS, a uniquely female tragedy.

Enter Moth. She is female, part Gypsy and born into abject poverty in 1871 Manhattan, so her prospects are dim. Still, the 12-year-old, given her name by her capricious and since-decamped father, shares a lumpy straw mattress in a tenement with her fortune-telling Mama and dreams of a life she glimpses through windows in the neighbourhoods north of Houston.

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It's not that Moth is blind to her fate – Mama hints broadly that their salvation hinges on Moth's successful appointment as a maid to the wealthy – but Moth figures on 13. Thirteen, and she'll find her own way. Mama, streetwise but self-indulgent, nursing a broken heart with bottles of Dr. Godfrey's cordial, has other plans. One summer night, Moth is awakened and sold away.

There's more than a shading of Dickensian cruelty in Moth's stay at the Wentworth household, and she endures it with heartbreaking resolve to support her mother. When she finally escapes, her discovery that her mother has deserted their home is all the more harrowing. As in all good fairy tales, the orphaning marks the beginning of the real story: Lower Manhattan is the heart of darkness for a motherless girl of no means. "Girls sold matches and pins, then flowers and hot corn, and then themselves," she tells us. "The most valuable thing a girl possessed was hidden between her legs, waiting to be sold to the highest bidder."

On the mean streets, she sleeps on a rooftop in a barrel with mouldy burlap bags for warmth, begging pennies and fending off attacks from guttersnipes and lecherous men. You'll feel the grime under your fingernails. Rats move inside Moth's straw mattress, clods of horse dung fuel barrel fires, and she passes time guessing whether what's squirming in garbage bins is rat, cat or baby. When the snow melts in spring, the streets of the slum run with "a vile slop of chicken innards, bits of wet newsprint and stale dung." There are rag pickers, bloodsuckers, oyster stabbers and Dick the Ratter. McKay's ability to make Moth's slum experience visceral is testament to her meticulous research and storytelling prowess.

But if Moth is vulnerable, she is also wily. "It was inevitable that I should part with my innocence," she says, having been recruited as a prostitute-in-training within days, "but at least under Miss Everett's roof I hoped I might get a chance to give it up for a fair price." At the Infant School, Miss Everett is madam to a handful of girls whose maidenheads she will sell at a premium to wealthy men. It's worth noting that 18th-century slang for female genitalia included "commodity" and "Eve's custom house," but what has been most prized through the centuries is the unbroken hymen, long linked (unreliably) to a young woman's purity.

Like Camilla Gibb, who brought a novelistic spotlight to female genital mutilation in Sweetness in the Belly, McKay depicts the prospect of Moth's imminent, premature and life-threatening deflowering – even as she plays Blind Man's Bluff, wonders about a first kiss and sleeps with a childhood doll – in all of its stomach-churning villainy. Through it all, Moth is graceful, resilient and guided by a sound moral compass.

The threat is real and the stakes high, but McKay may love her character too much at times, bestowing on her an innocence that sometimes seems out of place with her hardscrabble experience and the equanimity that allows her to survive rather than despair, not to mention a host of lucky breaks. But it's hard to blame her. Moth's lot in life is undeserved and her longings universal. You'll hope that she escapes with her dignity and her health, and you'll want her to feel safe, have comfort and be loved. In spite of the odds stacked against her, she deserves it.

Christine Fischer Guy is a Toronto writer. An excerpt from her new novel, Moose, which deals with another bacterial scourge (tuberculosis), will appear in an upcoming issue of Descant.

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