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Matilda wakes up to hear people talking over her. The voices discuss death and taking away dead bodies to be buried. Matilda eventually opens her eyes to see beds on either side of her and realizes that the people around her are victims of yellow fever. A woman introduces herself as Mrs. Flagg and explains that she’s been taking care of Matilda and that Grandfather has been waiting for her to wake up. Grandfather does not have yellow fever, but his heart suffered from the heat, which caused his cough. Grandfather explains to Matilda that while she was sick, he tried to find Mother to explain what had happened to them, but Mother wasn’t at the coffeehouse, so he assumes she went to the Ludingtons to join them.
Matilda continues to recover at the hospital. While there, she overhears stories of how the fever has impacted Philadelphia. After a doctor examines Matilda and pronounces that she will recover fully, Matilda is moved into the barn with other recovering patients. She wonders what has happened to Mother and to Nathaniel. A clerk comes to check in on Matilda and says that because her father is dead and they cannot find her mother, Matilda should go to the orphan house. Grandfather refuses to allow the clerk to force Matilda to go to the orphan house and says he will care for her.
Matilda and Grandfather travel back to Philadelphia and are shocked to see how much the city has changed due to the fever. As they walk along, they pass a man dying in the street. Later, Matilda learns that funerals are not taking place due to the fever. Instead, bodies are buried in a mass grave in Potter’s Field.
Matilda’s contraction of yellow fever adds a new level of danger to the Cook family’s troubles, and Grandfather steps up to help, showing the importance of a supportive family to enduring challenges. Matilda’s fever dreams show her deepest fears of helplessness and inadequacy, and they reveal her fear of losing her family. Her recovery offers hope that yellow fever isn’t always a death sentence, but hearing stories of yellow fever affecting all walks of life alters Matilda’s earlier desire to be treated as an adult. Mrs. Bowles suggests Matilda work at the orphanage, but Matilda refuses, claiming she’s just a girl, which shines a light on the shift from Matilda’s previous desire for independence to her new reluctance. Adult responsibilities have overwhelmed Matilda and dulled her excitement about becoming an adult. Yellow fever has turned Philadelphia into a tumultuous and terrifying place, but Matilda does still see that some hope remains in the helpers like those at the Free African Society. Grandfather is out of his element as a soldier but fights by helping wherever he can, such as when he volunteers to be Matilda’s guardian, and Matilda knows being an adult means doing her part, too, whether she is comfortable with it or not.
One of the factors that allows yellow fever to thrive is the failure of doctors to agree on how sick people should be treated. Mr. Rowley, a customer at the coffeehouse with experience helping people with medical problems advises Matilda to let Lucille rest because she is sick but probably doesn’t have yellow fever. However, Dr. Kerr, a doctor, not only disagrees with Mr. Rowley but also chides him for making medical decisions. Dr. Kerr recommends bloodletting, a dangerous but common medical practice of the time that involved drawing blood from a person’s veins with the intention of removing the illness from their body. Doctors eventually realized that bloodletting had no effect on illnesses and was stopped. Without the advantages of modern medicine, Matilda has no other option but to trust Doctor Kerr’s advice. When Matilda contracts yellow fever and wakes up at Brush Hill, another more advanced approach to the disease is revealed by Mrs. Flagg and the French doctors who don’t recommend bloodletting. This contradictory advice about medical treatment, illustrated by the conflicting opinions of medical professionals in the story, added to people’s confusion and helplessness in the face of yellow fever.