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Rush notes that both boys have headaches, but are travelling regardless. He reports on the fever in their neighborhood, listing who has died or left town.

Rush provides a detailed account of the yellow fever epidemic, describing its varied presentation among individuals. He notes that the violence of the fever has caused Philadelphians to mistake it for plague. He points out that common remedies have all failed, but he consults with Dr. Caspar Wistar regarding treatments.

Rush reports that the fever declines daily and that he expects she will be able to return to the city by mid-November. He rode out for the first time in weeks, and found more people in the streets, and those more cheerful. He adds that he is feeling stronger daily.

Rush notes that rain and cold weather have not decreased cases of the fever; 700 have died since 11 October, and 3400 since 1 August. He feels the distress of others all the more because he cannot assist them now. He has discovered further evidence that his sister gave her life to save his. Finally, he notes that his publications are still saving lives.

Rush reports that his practice has fallen off. Disease has left their district and it is well known that he is too weak to see patients. His pupils attend to the poor. He describes his financial situation, then notes how few friends he now has among medical brethren, and how that impacts his future career, since he now cannot consult or operate with them.

Rush reports that only one person has been buried today in the Quaker graveyard, when 5-17 have been regular. He complains of fever treatments used by French physicians.

Rush describes the funerals taking place in the city, and tells Julia that the fever has been particularly fatal to the young. He rejoices that the boys left the city, but hopes they avoid fatigue, heat, and cold, so that they do not excite any portion of the fever they might have carried with them from town. He expresses concern that the city is only at the beginning of the epidemic, but joins Julia in planning to express more gratitude for God's mercies in the future.

Rush briefly notes that the disease spreads, but mortality is not in proportion to the numbers afflicted. His cure is jalap and mercury, taken on the first day of the attack.

Rush's copy of a letter to a Mr. Harris regarding Rush's ability to establish a patent for land in Lewistown.

In this letter to his sister, Rachel, Rush provides details of their sister Rebecca's death, his grief, and the state of their mother's health.