Butcher is the harrowing story based on authentic historical documents, we follow the career of Dr Silas Weir, “Father of Gyno-Psychiatry” as he ascends from professional anonymity to national renown. Humiliated by a procedure gone terribly wrong, Weir is forced to take a position at the New Jersey Asylum for Female Lunatics, where he reigns. There, he is allowed to continue his practice, unchecked for decades, making a name for himself by focusing on women who have been neglected by the state – women he subjects to the most grotesque modes of experimentation. As he begins to establish himself a pioneer of nineteenth-century surgery. Weir’s ambition is fuelled by his obsessive fascination with a young Irish indentured servant named Bright, who become not only Weir’s primary experimental subject, but also the agent of his destruction.

Joyce Carol Oates’s latest novel inspired by the lives and work of three 19th- century physicians: gynaecologist J Marion Sims, neurologist Silas Weir Mitchell and Henry Cotton director of the New Jersey Lunatic Asylum from 1907 to 1930.

Sims’s ghost, often known as the father of modern gynaecology,  who was performing barbaric experimental surgeries  conducted without consent and without pain relief on ensalved Black women and children.  Early 1850s when her fictional protagonist Dr Silas Aloysius Weir arrives at a fictional New Jersey State Asylum for female Lunatics, and quickly promoted to director, a position he then holds for the next 30 years. The women at the asylum have their  own name for him – “the Red-Handed Butcher”.

Most action takes place within the institution more prison-cum-zoo than hospital. The most damaged inmates  are kept like beasts, in streamlined cages indentured servants  til for years to secure their freedom. An occasional private patient  her fate decided by handshakes between Weir and her husband or father is the Butcher’s to do with as he wishes.

A clitoridectomy is deployed to quieten a defiant daughter. The cure for a gentlewoman’s hysteria is six weeks strapped in the “Chair of Tranquility” – “ a horror of swaddling & suffocation” being  force-fed fat like a goose. Weir has also a Wishlist of experiments so cruel that they would rival those performed by Josef Mengele at Auschwitz.

The text is presented as a biography comprised of divers voices. Compiled and edited by the physician’s eldest son Jonathan after Weir’s death. Jonathan calls himself Weir’s most crusading chronicler & heir, even as he knows that his book will court scandal. Although he likes to think they’re very different men, with very different values, his own sense of righteousness and self-belief can be just as blinding as his father’s.

The recollections of those who knew Weir as a gauche youth in Chestnut Hill, Pennsylvania, with hints of megalomania. Chronicle of Physician’s life n where Oates reveals how a man all but devoid of talent, intelligence or empathy is nevertheless allowed to wield absolute control.

Brigit –  a mute Irish girl who becomes one of Weir’s first patients and is thereafter a favourite assistant in his laboratory is allowed to give her own account. Weir  regards his pioneering practice and Christian magnanimity describing female genitalia, loathsome in design, function & aesthetics, as he puts it, the vagina in particular  that veritable hell-hole of filth- requiring steely nerves of any surgeon bold enough to behold its “hellish spectacle”.

Narrated by Silas Weir’s eldest son, who has repudiated his father’s brutal legacy. Joyce Carol Oates’s  spellbinding, Butcher is a unique blend of fiction and fact, a nightmare voyage through the darkest regions of the American psyche conjoined, in its startling conclusion, with unexpected romance.

Butcher by Joyce Carol Oates, Fourth Estate £16.99, Knopf $30, 352 pages.