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Rush describes how he has been forced to limit the number of patients he sees, and the reactions of those whose treatment he declines. He also describes how many of those who become infected are abandoned. He mentions that there is fear of famine in the city.

Rush says that distress increases in Philadelphia, and names several friends and one doctor who have died.

Rush announces that he is well, but has a sore throat from his treatment. He saw 25 patients by carriage; then 25 more, mostly poor people, at home, but was still forced to turn away 38 others. Their house continues as a hospital. He says that his professional detractors are increasing their persecution of him.

Rush enumerates the close family friends that are ill or have died, and notes that only one doctor who continues to follow his treatment.

Rush announces that his pupil, Johnny Stall, has died. He mentions that citizens universally exhibit symptoms of the fever, but that the poor suffer the most. He hopes the weather will change.

Rush announces that another of his assistants, Alston, has died. He admits to extreme weakness, but otherwise is in good health. He points out that bleeders, doctors, apothecaries, and nurses are becoming scarce, as are the medical necessities used to treat the fever.

Rush says he has been spending time treating and putting up medicines for the poor. He hopes rain and frost will follow to weaken the contagion. He points out that many have died because they mistake their symptoms for a common fever. He notes that now even the African Americans are succumbing in large numbers.

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.