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Adams sends her condolences to Rush, and confides her own concern about her daughter's struggles with breast cancer.

Rush writes regarding the health of Julia's uncle's family, one of whom is suffering from a stomach disorder. He also notes that Julia's father's health is deteriorating. Her father will accompany him upon his return, to be placed under another physician's care. He requests that Julia have his assistants call upon the parents of children Rush inoculated before his departure, with instructions for their care. He describes the trial of a Dr. Shippen. He mentions that the letter was written in company, in General Green[e?]'s office.

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 writes a brief note to inform Julia that a friend has failed, physically.

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 writes regarding shipment arrangements for materials Julia has requested. He notes that a new tenant has taken possession of their farm. He inquires regarding Julia's health, they comments on the difficulty of separation from her. Rush's signature has been removed from the letter.

Rush writes that he expects their friend, Dr. Hall, to marry soon. He also writes of his activities with his boys. More particularly, his son John accompanied him on rounds at the hospital and showed no emotion while witnessing an operation. Rush also described in detail their visit to a mentally disturbed patient. He is pleased that John has expressed a desire to become a physician.

Rush writes about solitude, and how he misses having his wife and family to impart his thoughts and ideas to immediately.