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In an analogue of 1800s London, Harriet Smith, fifteen years old, lives at St Dymphna’s Hospital for the insane. She was taken in by the sweet-natured but scatter-brained inventor Mr Cogley after her mother was committed. She lives there happily enough under the guidance of Mr Cogley and motherly Nurse Florence.

On an errand to supply her cat’s insatiable appetite for pickled herring, she meets the frog-faced and awkward apothecary Aloysius Brown and confides in him about her mother’s delusions – Arabella Smith believes that her younger child, Johnny, was kidnapped by the fairies and spirited away into the sewers.

But Mr Cogley’s reaction to Harriet’s new friend is unexpected – he accuses the pair of conspiring with his old rival Professor Skelton to steal his latest invention, and casts them out into the corridors of the asylum. Many of the inmates are little worse than eccentric, but others are actively dangerous – particularly on the night of the full moon...

What follows is a frantic mission through the corridors of the asylum, the back rooms of the Unnatural History Museum and the sewers of London to rescue Johnny and end the day with all their arms and legs still on.