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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 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 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.

Rush notes that John arrived, and they are now at Sydenham. He also reports that he has sold the Chapel farm for $2,500. He describes a new remedy he has developed for yellow fever. The signature has been excised from this letter.

Rush recounts all the improvements he has made for her at Sydenham. He will begin sending the family from town with the warm weather in May or June.

Rush reports that he was driven to Rosehill to visit their son, Ben, and also met neighbors. He figures that two-fifths of all those sent to Bush Hill hospital have died, because his remedies were not used.

Rush describes his parting with their son, James, and announces that Dr. Coxe has been appointed Professor of Chemistry. Includes a letter from Samuel Rush to his mother.

Rush relates how he misses Julia, then describes the activities of their boys. He notes that the weather has been uncommonly cool, which has damaged crops. There has also been an outbreak of yellow fever in the city, but he expects it to be checked by the cool weather. He points out that the "ejection of Mr. Erskine's convention with our government by the British Court" has caused outrage in the city.