By the final day of August, the death count is continuing to rise and the heat is oppressive. Grandfather gently teases Mattie about her flirtation with Nathaniel, although she insists that the two of them were just mourning Polly's death. With all the extra money flooding into the business, Grandfather proposes they expand the coffeehouse and start to sell items as well. Mrs. Cook does not like this idea. She thinks they should be cautious and perhaps even leave the city. While the family discusses these ideas, they receive a note from Mrs. Pernilla Ogilvie. Pernilla is a wealthy woman with many children, and Mrs. Cook is hopeful that Mattie might marry Pernilla's son Edward. Therefore, she is very excited when Pernilla invites Mattie and her mother to join them for tea. Mattie is reluctant but agrees to go. She grows more and more impatient as Eliza and her mother fuss over her appearance.
Despite all of these efforts, Mattie and her mother feel shabby and unfashionable when they arrive at the Ogilvie house. Mrs. Ogilvie and her two daughters, Colette and Jeanine, are very wealthy and live in luxury. They are also spoiled and complain about how the outbreak of sickness is inconvenient for them. Mrs. Cook tries to drop hints about the possibility of a match between Edward and Mattie, but Mrs. Ogilvie does not seem to know what she is referring to. Jeanine finally rudely points out that she thinks Edward is too good to marry Mattie, and Mattie and her mother are insulted. Before they can leave, Colette Ogilvie suddenly collapses with fever. Her collapse marks a sudden increase in cases, and more and more individuals are fleeing from Philadelphia if they can afford to. By now, business is getting slower at the coffeehouse and supplies are harder to purchase.
About a week after the Ogilvie tea, Mattie and her grandfather go to Andrew Brown's print shop. Andrew is a friend of Captain Cook, and Mattie's grandfather explains why he thinks it is unnecessary and cowardly for people to be fleeing from the city. However, everyone is worried when Andrew shares that he has heard that thousands of people may die before the epidemic is over. For the first time, Mattie starts to wonder if it might be better to go to the country. She does not like the idea of hard labor on the farm, but she knows that the disease will continue to spread until frost sets in later in the autumn. Just as Mattie and Grandfather arrive at the coffeehouse, they are horrified to see a man bring home Mrs. Cook, unconscious, in a wheelbarrow.
Inside, Mattie, Eliza, and Grandfather put Mrs. Cook to bed, but she is clearly quite ill. A man named Mr. Rowley comes to examine her and says she does not have yellow fever. After he leaves, Eliza and Mattie nurse her mother together, but Eliza eventually needs to return home. She lives with her brother and his family, and she doesn't want them to worry. Since Grandfather has gone out, Mattie is left alone with her sick mother, and during the night, Mrs. Cook becomes much more ill. After doing everything she can, Mattie falls asleep and wakes up to Eliza arriving with Dr. Kerr. Dr. Kerr immediately diagnoses Mrs. Cook with yellow fever. He bleeds her and gives instructions to Eliza on how to nurse her. The doctor suggests that Mattie leave the house to avoid also getting sick. Everyone agrees that it will be best for Mattie and Grandfather to head to the country while Eliza stays behind to nurse Mrs. Cook. Mattie is reluctant to leave her mother but does not have a choice. Within a day, she and her grandfather have hired a place in a wagon heading out of the city. Before Mattie leaves, she receives a gift from Nathaniel: a painting of a vase of flowers.
Despite the rising number of fatalities, many people choose to try to go on with their lives for as long as possible. This trend is reflected in the novel through Captain Cook's desire to expand the business and Mrs. Cook's ongoing attention to Mattie's marriage prospects. Even in dangerous and precarious circumstances, it can create a sense of normalcy to focus on other things, and as Captain Cook notices, the upheaval of an event like the epidemic can actually sometimes create opportunities. Sometimes, plans are also time-sensitive: Mrs. Cook knows that her daughter will likely have a better chance of securing a husband sooner rather than later, so she is torn between forging ahead with her plans and possibly leaving the city to try to avoid the disease.
Mrs. Cook's conflicted values show up in her approach to finding a husband for Mattie. Mrs. Cook chose to defy her own family, follow her heart, and marry someone who is not wealthy. However, when it comes to her own daughter, the pattern basically reverses: Mrs. Cook wants Mattie to marry a wealthy man and have a comfortable life, whereas Mattie dreams of travel and adventure and already has her own idea of whom she might want as a suitor. Up until this point, the conflict between mother and daughter has focused on fairly insignificant disputes over chores and waking up, but the disagreement about the Ogilvie family shows a deeper divide in their values. Mattie is used to female role models who are intelligent, resourceful, and independent because she has grown up around her mother and Eliza; to her, the Ogilvie women seem spoiled and useless.
The interaction with the Ogilvie family shows the impact of social class at this point in history, as well as how class can intersect with the outbreak of disease. The Ogilvie family can initially pretend that the outbreak of disease is merely an inconvenience, and they believe their money and privilege will insulate them from any danger. The Ogilvie sisters are blatantly rude to Mattie and her mother because to them, money made from a business like a coffeehouse (as opposed to inherited and derived from land ownership) connotes lower social value. While Mattie may be frustrated by her mother, she is also protective of her, and so she is hurt and defensive by virtue of the way they are treated. This tense moment is interrupted by Colette's collapse, which symbolizes how the disease is now bigger than everyday conflicts. It also shows that the idea that the wealthy will be safe from the fever is misguided. For the Ogilvies, Mattie, and Mattie's mother, this moment is a stark reminder that no one is really safe, no matter where they live nor how much money they might have.
The growth of Mattie's own fear is revealed by her beginning to wonder if she should go to the countryside. Mattie is young and healthy, and it would be easy for her to feel invincible. She initially is not frightened of the fever, but as the cases continue to increase, Mattie starts to doubt her initial confidence. It is also becoming clear that Philadelphia likely faces months of disease and death. In 1793, it was not understood that yellow fever was transmitted by mosquitos, but people had observed that outbreaks seemed to stop when the weather got colder (and the mosquito population died out). As historian Michael Oldstone explains, the population was also being explicitly encouraged to get out of the crowded city: "Dr. Benjamin Rush, one of the leading physicians of the time, advised everyone who could to leave the city, to travel into the countryside where the air was clear: 'There is only one way to prevent the disease—fly from it'” (pg. 93). Before anyone in the Cook family can reach a decision, they experience the shock of what everyone tries to believe won't happen to them: an outbreak within their family.
Mrs. Cook falling ill is a surprising and dramatic plot twist because she has not been depicted as a vulnerable or fragile character. As an elderly man, Captain Cook seems like he would have been much more likely to fall ill. By showing the strong and resilient Mrs. Cook catching the fever, Anderson shows that anyone could contract this terrible disease. This plot development is also significant because it sheds new light on the relationship between Mattie and her mother. There have been moments of tension between them, but Mattie is terrified at the idea of losing her mother. In fact, Mattie nursing her mother alone is a major milestone in her growth as a character. At this time, hospitals were not common—in fact, they were sometimes more dangerous than being at home due to poor quality of care and lax hygiene standards. Moreover, doctors were limited in how much help they offered. As historian John McNeil explains, "For 250 years, victims of yellow fever expected scant help from the medical profession. Indeed, many prudent sufferers from the disease made a point of keeping their distance from doctors" (pg. 68).
Instead, most people would be nursed at home by family members, usually women. Eliza is a competent and experienced nurse from years of caring for others, but Mattie has not yet had to step into this role. Nursing her mother symbolizes that she will now have to begin to shoulder more adult relationships and that the parent-child relationship is going to reverse, leaving Mattie in the position of caregiving and responsibility.
While Mattie bravely steps into the role of nurse, her mother's illness is still a terrifying experience. Anderson depicts Mrs. Cook's illness and the initial treatment of blood-letting in graphic and unflinching detail. This choice shows the harsh reality of what happened as thousands of people suffered and died, often cared for by individuals with no formal medical or nursing training. In fact, Mrs. Cook's illness shows that during times of epidemic, medical professionals can be incompetent and even unscrupulous. The first medical professional cannot even correctly diagnose Mrs. Cook, perhaps because he has an incentive not to increase the number of cases. The second doctor diagnoses her correctly and prescribes blood-letting, a treatment that was believed to be effective at the time but is now known to be useless and even dangerous.
The dangerously contagious nature of the fever creates additional stress and trauma during Mrs. Cook's illness. Her only priority is to ensure her daughter doesn't fall ill, even if that means being left alone at a time when she is still seriously ill. Fortunately, the close relationship between Mrs. Cook and Eliza means that Eliza is willing to continue to nurse her friend and employer. Leaving the city for the unknowns of a journey to the country would be stressful for Mattie under any circumstances, but she is now fleeing the city and leaving her mother behind while she is seriously ill. Ironically, Mattie had initially found her stable and secure life to be boring and stifling, but she is now plunged into chaos and uncertainty.