Karen Cushman returns to the Middle Ages, the setting for her Newbery Honor book Catherine Called Birdy and her Newbery Award-winning The Midwife's Apprentice, for her fourth novel, Matilda Bone. As with all of Cushman's books, Matilda Bone features a unique and memorable heroine.

Matilda, 14 years old and raised at the manor where her late father was clerk, is left at Blood and Bones Alley where she is to be apprenticed to Red Peg the Bonesetter. She is ill-suited to the job, as her education has been more intellectual than practical. She learned to read and write Latin and Greek from her father, and after his death, the manor priest, Father Leufredus, tutored her in theological matters. (The reader also learns that Matilda's mother abandoned Matilda and her father when the girl was a baby.)

Matilda's talents include petitioning the saints for sympathy; they answer her, almost never quite the way she hopes. She is very good at fasting and lying prone on the floor to pray, and is inventive enough with her spoken Latin to create expressions of frustration such as "Saliva mucusque -- or, "spit and slime."

None of these skills, of course, is particularly useful to Peg, but patience and a degree of firmness are essential to bonesetting, and Peg applies these qualities to the task of shaping Matilda into a proper apprentice.

Slowly, Matilda begins to master her duties, even if she still wishes Father Leufredus would return for her. New people enter her life. Doctor Margery is a woman physician with a quick temper, a curt tongue and a practical competence, and Grizzl Wimplewasher, Peg's friend, is a woman who tries to be cheerful in the face of her crippling ailment. There's another Matilda, called Tildy, a servant in the house of the eminent physician Master Theobald, Nathaniel, the apothecary whose eyesight is failing, and Peg's husband, Tom, a traveling healer. Gradually Matilda starts to understand that there is more to life than waiting for Heaven, such as friends, a home, and work that makes a difference in the world.

As always, Cushman brings alive the sights, sounds and smells of her setting. She injects a great deal of humor into the story, much of it deliciously tongue-in-cheek. Her characters sparkle with life and depth. Matilda's growth is convincing as she learns to turn her focus from within herself to the world around her. Cushman also packs her tale with plenty of medieval medical lore, but she keeps a firm control on the material so that it does not overwhelm the story. Finally, she supplies an author's note that discusses some of her research and highlights the details of the story.

If you're looking for a lively refreshing read with some meat on its bones, Karen Cushman's Matilda Bone may be just the book for you.