We start off “The World Turned Upside Down” with Roger preaching in the local meeting house, with Jamie and Claire lovingly in attendance as well as the Christies. Things are well and good, but that only lasts until Claire, Bree, Lizzie, and Malva head off to check in with the MacNeills, who missed the service.

The MacNeills are not good. They’re all sick and dying, including young children and a wee baby. The women try to save them but fail, and it’s here we get our first dead baby of the episode, with the MacNeill mother dying immediately after. It’s awful, and it’s going to get worse.

Back in her lab, Claire identifies the sickness as amoebic dysentery. More people get sick, and a lot of people die. At another funeral, Claire feels woozy and Jamie carries her home. We then get a long sequence of Claire being deliriously ill, interspersed with a scene of Malva talking with Jamie about Jamie getting bit by a snake and Malva saying some people think Claire is a witch. We also see a trippy hallucination that Claire has that includes a snake, someone holding a bloody, beating heart in their hands, and a blurry image of Malva touching Jamie’s back while he looks out of the window in her room.

Finally, Claire wakes up, with Roger at her bedside. She finds all her hair gone — Malva and Mrs. Bug cut it off, believing they were helping with the fever. Claire is as mortified as she could be while still feeling half-dead, and Roger says that nothing could make her not beautiful, which is actually very sweet and not as creepy as it sounds.