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Rush writes that deaths from fever are decreasing, and he will soon end his engagement with city hospital. He outlines activities in the family, and their preparations for her return the following week. The signature to this letter has been excised.

Rush reports that despite being exposed to the fever daily for two months, he is still healthy. However, he has "felt, mourned, and wept" until he could no longer do so. He reports that poor people chase him down in the street, and that he carries medicine with him in order to do all he can to help them. Free blacks and servants form a large percentage of his patients.

Rush informs Julia that he has been thinking more of the children than he has in weeks and describes a dream he has had about her. He inquires after the new baby. He plans to ride out to the countryside to repair his health and later reports feeling stronger. He lists the conditions of those among their acquaintances.

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 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.

Rush reports mortality is very great, and chiefly among the poor and servants. He adds that nearly 2000 people have died since the beginning of the fever. His own fever has returned and confined him to his house.

Rush is confined to his house, and has been prescribing based on the reports of his pupils. He remains weak, but otherwise healthy. He finds it strange when men write to propose business or contractual dealings at this point in time. Part of the final page of the letter is missing.