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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.

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.

Rush provides a detailed account of his sister's death, describing also the invaluable support she provided to him. He notes that there is a want of cash in the city, and that provisions are costly, and prices high. He adds that many of the committee men who sought to help the poor have now died. He hopes for a change in the weather. The close of the letter is missing.