Francie eagerly anticipates school, but before any child can go to school, he or she must be vaccinated. This ritual brings much consternation to the foreign and uneducated families in Brooklyn. Katie does not go with Neeley and Francie to get their vaccination mostly because she cannot stand the thought of it. Neeley is frightened, and Francie tries to cheer him up by making mud pies with him. When the children show up for the vaccination, their arms are caked in mud. The doctor makes a series of comments to the nurse about how filthy poor families are, and the nurse, a Williamsburg girl now grown up, plays along, not wanting the doctor to know her background. Francie, keen and observant, hears it all and feels thoroughly ashamed. She futilely expects the nurse to act motherly, and defend Francie. The narrator comments that the person who makes it out of the slums "via the boot-strap route" has two choices: to forget his past, or "keep compassion in his heart for those he left behind." This nurse forgot. Aware of the cruelty of his comments, Francie tells the doctor not to say the same things to Neeley. The doctor is taken aback that Francie understood his comments.
Francie's arm becomes infected, and Katie scares her into not scratching it. One night, Francie cannot sleep, afraid that she will die any minute. Johnny comes home and washes her arm, soothing her fears. He wraps it with his own undershirt. That night, Johnny resists Katie's affection in bed, and lies awake in the dark instead.
Francie has great expectations for school, but coming home with a bloody nose the first day is not a good start. She also realizes she will never be teacher's pet, since Miss Briggs likes all the rich children, and consigns the others to the back of the room. The narrator remarks that one would expect unwanted children to band together against a common evil, but instead, the poor children tend to turn against each other.
The school is a brutalizing place, with three times as many children as the facilities can hold. The students are punished brutally. Almost all the teachers are cruel, as the nicer ones get married, or are driven out by the mean ones. During recess, the bullies will not let anyone into the bathroom, and the teachers will not excuse the kids from class. Half of the kids learn to hold it, and half became pants-wetters.
As time goes by, Sissy remains condemned from the Nolan household. She wants to see Francie and Neeley so desperately that she comes by the schoolyard one day, and takes Francie for a soda. Francie is cold, and she shamefully tells Sissy she has wet her pants. Sissy tells Francie that from now on, the teacher will let her leave. The next morning before school, Sissy threatens the teacher, telling her that she is Francie's mother, and her husband is a cop, and Francie has a kidney infection that could lead to death. The teacher excuses Francie to the bathroom from that day forward.
Katie is committed to keeping Sissy away from her house, but when she hears that Sissy has another stillbirth, she feels ashamed of herself, and lets Sissy return.
When children at the school are found to have lice, they are publicly scorned, and the objects of torment from their peers. Katie does not have time for vermin and disease, and scrubs Francie's hair every week, and combs it with kerosene every day. It smells so bad that the other children do not want to hang around her. When a mumps epidemic breaks out, Katie ties garlic around her children's necks. Francie and Neeley never get sick nor have lice. Francie is not affected by her peers' rejection, as she is used to being lonely.
These chapters juxtapose the lives of the poor with the lives of the privileged. Although we have learned much about the Nolan's simple life, these chapters demonstrate how their poverty is viewed by the more affluent members of their community. As a result, the word "shame" appears many times throughout these chapters.
The vaccination story can easily be compared to the story of the girl with the blackboard erasers just a few chapters earlier. Both are moments when Francie loses innocence, and both foreshadow a school experience wrought with shame. The girl who spits in Francie's face represents a smaller version of the cruel doctor. Although Francie feels hurt by the girl, the girl does not have the same power over her that the doctor has. When Francie hears the doctor, she feels as if he could cause her to die. Francie's character also develops through these two experiences. She retreats from the girl in the schoolyard, but when the doctor makes his comments, she stands up for herself, demanding that he not say the same words in front of her brother. The doctor's visit is also an overt issue of class. His wields his power not only from his medical profession, but also from his higher class status.
This event is meant to stand for the larger class issues in the community. The immigrant community is suspicious of the vaccination requirement; it doesn't make sense to the uneducated that a small dose of disease could do anyone any good. Francie's emotional suffering replaces the myth of physical suffering. Although the wound is infected, it is not serious.
The stakes are higher when Francie goes to school. The narrator describes a lower-class mass of children, where poor kids turn on one another, having learned nothing but hateful shame from their teacher. The realism in this chapter makes it all the more powerful. Not just Francie and Neeley, but three thousand kids fight for a few bathroom stalls during recess, and half of them wet their pants because they cannot hold it through the day. This chapter is a more macroscopic view of the impoverished class.
Sissy's entrance back into the novel is consistent with the value system the book espouses. The book does not view Sissy as bad person, and she does not deserve a lifetime worth of condemnation. The narrative, however, does require that she do a good deed to rectify the bad ones. She is not let back into the Nolan house until after she saves Francie from her pants-wetting shame. Although Katie never knows about this, it is a symbolic proof of goodness to the reader.
The short discussion of lice and disease is a way for the author to develop Katie's character, and develop the themes of the book. Katie does not let up when it comes to avoiding lice and mumps even when the teacher tells Francie to keep the kerosene out of her hair. Katie's hardness often results in suffering for Francie in the short term, but builds Francie's character eventually. When in past chapters Francie could not make friends, it was because she talked in Biblical and Shakespearean jargon; now, it is because she has kerosene in her hair. Katie is the cause for both of these situations, but Francie learns how to read and write, and never gets sick. In the meantime, she learns how to be happy with just herself.