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In August of 1793, 14-year-old Matilda “Mattie” Cook is awakened by her mother, Lucille Cook. She’s late for work at the coffeehouse because their serving girl Polly has died from a fever. Mattie reluctantly gets up and helps out in the coffeehouse with her friend Eliza, who feeds her breakfast before sending her outside to tend to the garden. While she’s working in the garden she daydreams about running businesses someday and meeting Nathaniel Benson, who she likes. But then Mother interrupts again to tell Mattie that Polly has died suddenly of a fever.

Mattie takes over Polly’s duties in the coffeehouse, hearing her beloved Grandfather debate with customers about rumors of a yellow fever outbreak in the city. A couple of weeks later, many have died from the fever, but Grandfather argues that it’s nothing to be concerned about. One day, a neighborhood aristocrat invites Mattie and Lucille to tea. Mattie hates Pernilla’s snobby daughters Colette and Jeannine, and doesn’t share Lucille’s desire that she marry an Ogilvie son because they’re snobs who don’t appreciate her love for books or her passion for social justice work at the Cook Coffeehouse. However, she reluctantly goes along when Lucille insists that it’ll be good for business if she meets wealthy men like them. Just as Jeannine is picking a fight by insulting the Cook Coffeehouse while Colette collapses from yellow fever right next to them…

People in Philadelphia are starting to get sick because of the fever. Many people leave the city, including President Washington and other important politicians. Mattie’s grandfather continues to believe that there is nothing to worry about, but one day he sees Lucille being dropped off at their coffeehouse—she looks very sick.

A girl named Mattie spends the night with her sick mother. The mother begs her to leave so that she won’t get sick, but Mattie refuses and instead stays there to take care of her mom. She regrets their past arguments and feels like she has failed in taking after her strong-willed mother. The next day, a doctor diagnoses Lucille with yellow fever and bleeds her as a remedy. Grandfather agrees that he and Mattie should flee to the country while Eliza stays behind to take care of Lucille. They hitch a ride with a farmer who offers them food for the journey. When they are just 10 miles outside of Philadelphia, however, their wagon is stopped by guards who tell them that people from outlying towns aren’t allowed through because there’s an outbreak of yellow fever nearby. Because it looks suspicious for him to cough, Grandfather isn’t allowed through either. He decides that he’ll stay behind while Mattie goes on ahead without him.

When Mattie realizes that her grandfather is sick, she does her best to help him. She remembers how to find water and berries so they can survive. When she goes looking for food at neighboring farms, however, she gets lost and becomes ill herself. Later on, the nurse tells her that Grandfather brought her to Bush Hill Hospital where French doctors are better equipped than American ones with yellow fever knowledge.

Mattie recovers from her illness and decides to go home with Grandfather. When they get there, they find Philadelphia in a state of panic. The streets are filled with corpses, businesses have been abandoned, and thieves are taking advantage of the situation by preying on the vulnerable. Even their coffeehouse has been broken into, so Mattie urges Grandfather to rest while she cobbles together meals for them from what’s left of their garden. It’s too dangerous to venture into the city in search of food because it would be too risky and she doesn’t want him to overexert himself due his frail health.

Fever 1793 Book Summary, by Laurie Halse Anderson