It is the sweltering summer of 1896, and serious industrial accidents amongst the overworked, underpaid employees of the local brewery are on the rise, partly due to the fact that they are slaking their thirst while on the job. Eleanor is appalled to learn of their working conditions, but finds she must hold her tongue because the Thrift's chief benefactor, wealthy widow Alice Costigan, is not only the brewery's owner, but has also caught the eye of her father, Robert.Finn O'Neill suddenly returns from America, passing through London on his way to a six-week lecture tour on the Continent. Eleanor finds herself drawn to him just as much as before but, though he, too, claims to want to cement their relationship, there is a small political difficulty back in Chicago, where Finn's boss, Dr. Fraser, has ambitions to marry his 18-year-old daughter, Emmaline, to Dr. O'Neill.

Robert has been invited by wealthy Alice Costigan to her country house for a shooting party. He has high hopes of furthering his personal relationship with his hostess, but soon discovers that he has a rival for her affections, in the person of eminent Harley Street physician Aubrey Savier.During Robert's absence, Finn O'Neill returns to London for one day on his return route to America, and Eleanor invites him to stay the night. In the morning, they agree to marry upon his return next June.After returning to London, Alice stops by the Bramwells' house to return Robert's watch, which he had left behind. But her infant nephew Theo is clearly ill, and when Robert diagnoses an interseseption of the bowel he advises immediate surgery. Alice, however, is averse to the idea (her late husband had died ""under the knife"") and calls in Aubrey Savier, who suggests inflation of the bowel as an alternative. Next day, however, little Theo is worse than before and Robert, now with Eleanor's support,

Fed up with endless self-sacrifice and hoping to improve life for the family he has been neglecting, Joe Marsham has decided to accept the much better-paid position in Edinburgh he has been offered. But then he discovers a secret that his wife has been concealing from him (and which he would have noticed for himself if she hadn't been avoiding marital relations since the death of their infant son George, two years ago): she has developed breast cancer. Despite the utterly pessimistic assessment of Harley Street specialist Professor Osborne, he asks Eleanor and Robert to perform the necessary surgery on his wife--but is it already too late? She urges him to remain in London for the sake of their three daughters, if she should die.

It is June 1897 and Queen Victoria's Diamond Jubilee celebration will be held in a few days, on the 22nd. The Thrift plans a party, but Eleanor is far more excited by the prospect of Finn O'Neill's return from America, so that they can at long last formalise their engagement. When he arrives, however, he brings with him something that Eleanor neither expects nor is pleased about. However, at the Thrift there is worse to contend with when a battered wife and her injured husband are both admitted and, as a result, a murder occurs.

Eleanor has fled to the country and so Robert finds himself temporarily in charge of the Thrift. At Alice Costigan's suggestion, and against the advice of Dr. Marsham, he hires a young trainee, Charlotte Adler. Her first assignment is to make a detailed inventory of the infirmary, from which Dr. Marsham discovers that bed-linen and, more seriously, opium, is going missing. Young Sidney Bentley is the obvious suspect and, despite his protestations of innocence, is summarily dismissed.Meanwhile, Ethel has her hands full at home with her aged and rapidly declining mother. When the kindly shopkeeper from across the street, Mr. Collard, offers to help, she refuses to let him in--probably because she has had to tie her mother up to keep her from wandering about. When Charlotte stops by with some flowers while nurse Carr is out, she discovers Till Carr tied up and drugged with opium, and the truth comes out.

Eleanor retreats to the country to recover from the emotional blow dealt her by Dr. O'Neill. She is hosted by old friends from medical-school days, the Kilshaws, whose outwardly blissful existence begins to appear to be concealing a disturbing secret. Their efforts to fix Eleanor up with a possible suitor, Mr. Jameson, is acutely embarrassing, but then comes a distraction with an outbreak of measles at the local school. The local schoolmaster, Mr. Herne, seems harsh and callous, but in the end proves a sound man.Sarah Mole, who is doubling as the Kilshaw's nursery maid and Mr. Herne's assistant, finds she can no longer conceal the fact that she is five months pregnant, but will not name the father. She is shunned by the entire village, but when she miscarries and Eleanor brings her to the Kilshaw home for care, she blurts out her secret to Eleanor. Seeing that Sarah cannot stay in the village, Eleanor decides to take her to London and find her a place training to be a nurse.

Robert has decided to open a Harley Street practice, to which end he borrows the necessary capital through his friend George Talbot, who arranges a very reasonable rate of interest from his banker father-in-law. Unfortunately, that is not the only interest involved, as Robert quickly finds himself having to fend off (without offending) his friend George's wife (and the banker's daughter), Laura. At the party celebrating Robert's new venture, he proposes to Alice Costigan, and she accepts him. Getting Laura Talbot to accept these circumstances is another matter.At the Thrift, Sidney Bentley seems smitten with a young burn patient named Florence. But despite Joe Marsham's encouragement, Sidney's bashfulness seems certain to prevent any relationship developing.

When Dr. Finn O'Neill returns once again to London, he is famed for his pioneering work with immunization. As a human being, however, he has not improved at all. He sees no reason why he should avoid the Bramwells despite his shameful treatment of Eleanor, and even tries to resume their former relationship, even with his young wife ill in the same room.Robert, who has never liked Dr. O'Neill, suspects that Emmaline O'Neill's mysterious and increasingly serious illness may in fact be the result of some unspeakable experiment being carried out by the ambitious Dr. Finn to further his own career. A clandestine visit to the Irish doctor's laboratory reveals a damaging truth with which Robert could end O'Neill's career.As Alice and Robert's wedding draws near, Kate becomes convinced that her job is not safe, since Alice will be bringing her own domestic staff.

There is joy in the air as Robert Bramwell and Alice Costigan prepare to wed. Unfortunately for Eleanor, her father's impending move to Alice's sumptuous Kew residence also means that he will be withdrawing their support of the Thrift, threatening not only her livelihood, but also her developing relationship with Joe Marsham.