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Rush announces that his final apprentice, John Coxe, has died and that his sister is very ill. There is some rain in the city. He reports that Dr. Wistar has published an account of his recovery that is calculated to undermine Rush's treatments.

Rush reports that his sister is in grave danger and that, by popular demand, physicians have been forced to adopt his treatment for the fever.

Rush records that his case load is increasing, as is his fatigue, but that many of those he treats are out of danger. He reports on the progress of the epidemic in their neighborhood.

Rush defends his taking in Johnny Stall and Ed Fisher, as neither had any other home. His sister, who was at the brink of death, is better, but his mother is now ill and is refusing treatment.

Rush writes that he has seen 100 patients, and that he now saves almost all those he sees within the first day. He notes that some doctors rail against the cure he uses, several of them publishing false information, even though they generally have not visited patients with the fever. He chronicles the fate of several doctors that have contracted the disease. He notes that some of his friends are ashamed to see him once they fall ill. He admonishes her once more to watch the boys closely for signs of infection, for the fever will lie dormant 1 to 16 days following contraction.

Rush notes that his cure is working, but there is a pause in new cases, and that fatalities are now among the poor without access to doctors or respectable people being treated by quacks. He states that if the fever breaks out in Princeton, he will send his assistant John Cox to execute his cure. Once again he documents the health status of his fellow physicians, although he records a rumor that some doctors have ceased seeing patients at all. He then discusses the various treatments that have been used for the fever. In a postscript, he adds that Africans in the city have proven immune to the disease.

Rush tells Julia that the pause is over; he has been called to countless cases. Two more doctors are ill, Dr. Morris has died, and Secretary Hamilton is sick. He describes the support he receives from friends, along with the more serious symptoms of the fever.

Rush points out that though staying in the country helps him forget all that is going on around him, he cannot forget the poor, sick, and dying in the city. Three more persons were admitted to the hospital this day than were admitted in 1793.

Rush announces that yellow fever has broken out throughout the city, but there have been no measures yet to exterminate the disease. Their son Richard plans to move a mattress and books to their farm. Rush notes that a Mr. Thomas has left Philadelphia forever as a result of his debts, and has ruined many young men in the meantime. In a postscript, Rush points out that Capt. Mitchell of the American Army has the fever. Rush is considering leaving and is urging his patients to leave. Rush's signature has been excised.

Rush notes that the fever has increased more in one week than it had in three weeks in 1793 and 1797. He had made plans to leave in 7-10 days when the U. S. Mint was closed, but by the end of the letter announces more immediate plans to remove to Sydenham, which has been prepared for the family and servants. Their son John is arriving via his ship in New Castle. A note was appended to the letter in 1848, saying that the close of the letter was cut out for an autograph seeker.