Chapter 23

When she awakens the next day, Mattie finds that Eliza already has gone out to minister to the sick and that Mother Smith has come to care for Joseph and the children. Mattie diligently does the housework—cooking, scrubbing, and cleaning—although her efforts largely fail to meet the old woman's exacting standards.

When evening falls, Mother Smith tells the little children a story and then sends them off to bed. The twins retire to their mattress without protest, but Nell climbs into Mattie's lap and falls asleep, sucking her thumb.

As she prepares to leave, Mother Smith warns Mattie not to fall in love with the little girl; she points out that Mattie cannot keep her and that she is only making it harder for Nell by holding her close when in the end, she will inevitably have to give her up to the orphan house. Mother Smith's words weigh heavily upon Mattie throughout the night, and she resolves to take Nell to the orphanage in the morning.

Although she does not seem to agree with the wisdom of the young girl's choice, Eliza accompanies her to the orphan house the next day without comment. During the walk across town, Mattie sternly tells herself that she is doing the right thing, but at the orphanage, she, Eliza, and Nell are greeted by a woman carrying a screaming infant with two crying toddlers clinging to her legs. It is clear that the orphanage has become a "house of last resort," and Mattie is relieved to admit that although the circumstances are far from ideal, Nell is better off with her.

On the walk back to Joseph's house, Mattie notices that they are passing the Oglivies' estate. Eliza tells her that Colette Oglivie, who had been engaged to a young man of high social status, had contracted a severe case of the fever but had recovered. In her delirium, however, she had caused quite a scandal by revealing that she had secretly eloped with her French tutor.

The situation had been made even worse when her sister Jeannine, who had been sweet on the teacher too, had thrown a fit upon learning that Colette was married to him. Mattie knows that it is wrong to laugh at others' misfortunes, but she cannot help but be amused when she pictures the scene in her mind.

The residence of Mr. Peale, the painter, is located a little further along the way, and as they pass the house, Mattie is surprised by a shower of flowers drifting from a surreptitiously opened window. Delightedly, she realizes that they are being scattered by Nathaniel Benson, who has evidently survived the fever outbreak and is still thinking of her.

As conditions in Philadelphia worsen, it is assumed that Mattie and Nell will stay with Joseph and Eliza for the present. Mother Smith is called to help with a family that has just lost their mother, and Joseph, who is regaining his strength, takes over the care of the little children. Mattie accompanies Eliza on her missions of mercy in the city, where the need is never-ending.

Chapter 24

October comes, but there is no lasting break in the sweltering weather. Even though she is no stranger to dealing with the physical filth and horror of the fever, Mattie is unprepared for the heartache and the human toll she encounters on her rounds with Eliza.

In house after house, family units are decimated, and along the waterfront, boarding houses are filled with stricken sailors, terrified of dying alone in a land far from home. The situation is exacerbated by unscrupulous merchants, who seize the opportunity to take advantage of the desperate hordes of the sick. Food and medicine are scarce, and for what little is available, exorbitant prices are exacted.

At the end of one especially grueling day, Eliza urges Mattie to go home ahead of her to get some rest, but she refuses. Eliza, remembering that only a short time ago, the girl had been quite prone to shirk her duties, is impressed with her new-found maturity and dedication and comments admiringly, "Never knew you to look for extra work."

When their errands are done and the two finally do return home, they find the house ominously silent. Joseph sits next to the dying fire with his face in his hands in utter defeat; wordlessly he gestures over to the bedchamber, where the three little children lie in the throes of the fever.

For once Eliza loses her composure and is at a loss as to what to do. She sits by the children and strokes their foreheads helplessly as she struggles to control her anguish. The room is stifling, and as the house is located close to the river, there is no breeze to be had.

Mattie suggests taking the children up to Bush Hill, where there are doctors and "many windows that catch the wind," but Eliza argues that there is no room there. Having learned from the French physicians that openness and fresh air are key to patients' recovery, Mattie thinks hard, and comes up with a  solution—they will take the children to the coffeehouse, where there are "windows and empty rooms, away from the river, away from the worst of the heat."