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Matilda and Grandfather bring Mother to her bed. Grandfather insists that she has just been overcome with heat and needs to rest. Mr. Rowley, a coffeehouse customer who is not a doctor but has treated illnesses before, examines her and determines that she’s not suffering from yellow fever. That night, Matilda is left alone to care for Mother. Mother feels ill all night and vomits up blood. Mother’s illness worsens, and she yells at Matilda to leave so that she doesn’t get sick too.
The next morning, Eliza has brought a doctor, Dr. Kerr, who examines Mother. Dr. Kerr diagnoses her with yellow fever and says that Mr. Rowley is an impostor. Dr. Kerr says that Mother must be bled in order to let the fever leave her body. He then suggests that Matilda leave the city to avoid the illness. Grandfather and Matilda make plans to go to the Ludingtons’. Eliza gives Matilda a package she found by the door. The package contains flowers and a note from Nathaniel Benson to Matilda saying his teacher’s family is insisting they all stay inside and that he hopes she stays well. Matilda and Grandfather say goodbye to Eliza and leave Philadelphia on a wagon with a farmer and his wife.
Grandfather has a coughing fit while in the wagon. The farmer warns that he will not have anyone with yellow fever in his wagon, but Matilda assures him that Grandfather is fine. Matilda and Grandfather fall asleep, and when Matilda wakes up, four men on horses have stopped the wagon. At first, she and the farmers fear that the men are robbers. However, the men are just monitoring who comes through their town as they don’t want visitors spreading the illness. A doctor examines the farmer and his wife while Matilda tries to wake Grandfather. When Grandfather wakes up, he begins coughing again, and the doctor insists that he must be sick and should go back to Philadelphia. The farmer and his wife leave Matilda and Grandfather behind on the road, miles from Philadelphia.
Matilda and Grandfather rest under a tree. Matilda finds a stream to fill their canteen with water and berries for them to eat. She makes a plan that after they rest and eat, they will make their way back to Philadelphia. Grandfather, weak and ill, admits to being foolish. Matilda understands that she now must take charge.
Matilda wakes up and makes sure Grandfather’s heart is still beating. She goes back to the stream to cool off and tries to catch fish by making a net out of her petticoat but fails. She brings more water and berries back to Grandfather and then sets out to look for a farm that might give them food. However, every farmer she meets turns her away as they are scared of catching the fever. On her way back to Grandfather, Matilda begins feeling disoriented and then collapses.
Matilda gets a taste of being an adult as roles are reversed and she must care for her mother and grandfather. The epidemic offers Matilda the freedom of adulthood, but it’s not what she imagined. In caring for her sick mother, she gains insight into Lucille’s thoughts. Despite slipping in and out of consciousness, Lucille shows she still cares more for Matilda’s well-being than her own by demanding Matilda leave so she doesn’t fall ill. Matilda obeys only to watch her grandfather fall ill on their journey away from Philadelphia. Not until this point does Grandfather, overcome with illness and no longer able to deny the truth, admit to being a fool for not preparing for the epidemic. This moment was foreshadowed, but the realization signifies a turning point because denial is no longer possible. Action is mandatory and Matilda is the only one with the ability to act. She quickly recalls Grandfather's soldiering lessons and procures sustenance, showing she’s ready for the challenge. She forms a plan to get Grandfather back to Philadelphia, but because of his illness, he can’t guide her. Matilda alone must care for her sick Grandfather outdoors without a single person willing to help.
There is a lot of symbolism in Grandfather and Matilda’s journey out of the city. Mosquitoes viciously attack Matilda and Grandfather in the farmer’s wagon, just as mosquitoes have attacked before every illness thus far in the book. The men who stop the wagon to inspect for sick people embody the alienation of Philadelphia at the time. The city relies heavily on its suburban neighbors as exemplified in the various vendors of the marketplace. So, the inspection of every wagon fleeing Philadelphia adds to the sense of isolation and helplessness among city residents. Even as Grandfather lies weak in the grass, fearful farmers shut themselves in their homes at the sight of Matilda, showing how the epidemic has bred intense fear which isolates people from getting the help they need. Everywhere Matilda turns on this journey, she meets dangers and responsibilities bigger than she has ever had to face.