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Rush points out that he has received no letters from Julia. He gains strength but must eat often to avoid becoming "weak and fainty." His patients now hand him a glass of milk or crust of bread as they would hand another a glass of wine. He adds that their servant, Marcus, has been very faithful and that his mother is well, but complains of the high cost of housekeeping.

Rush lists those in the neighborhood who were not his patients that have died. He praises their "black friend," Marcus, for faithfully waiting on him. He has received letters from Europe, among them a letter from Granville Sharp, authorizing him to draw on contributions in London for the African Church of Philadelphia. Among the contributors was the Duke of Grafton. Rush points out that no doctors have inquired after his health, and that their confederacy against him in stronger than ever. The letter's signature has been excised.

Rush announces that Dr. Sproat has died, adding, "It is truly distressing to think of the desolation which has followed the footsteps of this man, and of all the Doctors who use Bark- Wine- Laudanum, and hot, or cold Baths in this disorder. It is much more inflammatory than a common Pleurisy, & who ever thought of using those remedies in that disease?" He notes the health of other doctors, and reports that he is now employed again by Mr. Hammond, who had been persuaded against Rush's treatment. He ends noting that Julia's sister has written to urge him to leave the city, a move he feels would be "unwise, and perhaps sinful."

Rush details several patients' responses to treatment, or lack thereof, and includes consideration of the impact of psychological influences on recovery. He notes that the days grow colder, but they need rain. He has returned to his notes on yellow fever taken during his apprenticeship in 1762.

Rush points out that Julia's letters are now delayed at the Post Office by 2 or 3 days, but her recent letter brought him comfort. He says that he cannot think of the family or the children, but lives in the moment, making himself useful to others. His sister has been buried, and he plans to plant medicinal plants at her grave; his mother is fully recovered.

Rush announces he is contemplating moving into a new house before her return and considers a few locations. He adds that his day no grave was opened in the Quaker graveyard and their were no admissions or deaths in the Bush Hill hospital.

Rush has taken measures to purify their house. He points to a new clamor regarding his assertion that yellow fever has been operating in the city. He has been asked to prove that assertion.

Rush records a visit from physicians who have quietly sought to prove the effectiveness of his mercury treatment by using it to treat the poor. He asks Julia to join him in reading Psalm 103 and praising God for his protection. He expects to take charge of the hospital shortly.

Rush notes the health of several doctors and points out that St. Paul's Church has offered prayers twice a week since the fever began. He is not seeing patients, but is spending his time reading and making notes on the epidemic. He describes his melancholy when he contemplates the state of the city and those he has lost.

Rush points out that many people are returning to town; he hopes not too soon, for there are still many who are ill or dying. The rest of the letter is regarding his professional feud with Dr. Wistar over treatment for the fever. Rush is especially offended because Wistar had originally assented to the efficacy of Rush's treatment, then changed his mind.