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Rush explains his plans for travel to Princeton, and the minor ailments he has been suffering. He then describes how he visited a patient who was having a fit of colic, only find she was actually in labor. He expects the affair to give him some trouble, but has neither the constitution nor time to practice midwifery. He rejoices in hearing of the fall of the French monarchy, and expects that it will lead to the removal of all the kings in Europe. A later note was added stating that the letter's signature was given to an autograph seeker.

Rush writes of their exchange of letters, and mentions both of their sons, along with the grandson of President Washington, who is ill with a fever and is being attended by doctors Shippen and Kuhn. He also successfully treats a woman with a locked jaw. He announces his plan to open an African Church, and describes the resulting excitement in the free black community.

Rush takes Julia to task for permitting their son John to have a gun against his expressed wishes. Rush believes John's character is not the correct one for gun ownership, because he lacks gentleness and compassion. Rush requests that Julia not override his dissent, and strengthen their parenting as a result. He announces that he has taken their son Richard to see patients. He is reading John Newton's Cardiphonia. He also is planning to develop a cure for the consumptive cough.

Rush announces that a violent "fever" has broken out in one district of the city, where 12 people have died. If it spreads he plans to have Julia remain at Princeton. He then reports that influenza continues to spread, with violent symptoms that cause him anxiety. He adds that Mr. Wolstonecraft has refused to purchase their property, because he could not support himself by hunting on it. Finally, he notes the arrival of a fellow physician's son from France, who brings disturbing news of the state of affairs, there.

Rush has discovered that a letter containing charges against him has been circulating among physicians. He plans to obtain a copy and publish it. He is inquiring after a house.

Rush outlines the work that will keep him from visiting Julia, after all. He points out that there have been four deaths from fever, so unless there is a frost, she should not return to Philadelphia on the date they agreed upon. He repeats more of the "slander" against him.

Rush points out that he is too weak and busy to ride out to her at Rosehill, but she may come in to town, or he will ride out to spend the next day with her.

Rush outlines their full affection for each other, and makes tentative plans to visit Julia. The closing for the letter has been excised.

Rush challenges Julia to be patient regarding a return to town. He repeats the history of his relationship with his detractors, then returns to praising her as a "great woman" for never asking him to leave the city during the outbreak.

Rush reports having received various letters and items from London, including a medical book. He states that he has had no cases of yellow fever in two days. He uses the rest of the letter to recount fully his second attack of the fever, beginning October 10th. He writes that he expects her return the coming week.