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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 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 refers to the tremendous opposition fellow physicians have given him regarding his cures, and Dr. Kuhn's publications have done the most harm. Rush announces that he has used his methods to cure his own attack of the fever.

Rush states that he is sending his assistants out to his patients, and will now visit the most serious cases. He updates her on those in the neighborhood who have not survived.

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 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 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 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 briefly notes that the disease spreads, but mortality is not in proportion to the numbers afflicted. His cure is jalap and mercury, taken on the first day of the attack.

Pascalis acknowledges receipt of two essays. He states that he has not yet had the opportunity to read Dr. Rush's treatise on the diseases of the mind, but that he plans to write a review of it.