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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 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 tells Julia that the pause is over; he has been called to countless cases. Two more doctors are ill, Dr. Morris has died, and Secretary Hamilton is sick. He describes the support he receives from friends, along with the more serious symptoms of the fever.

Rush points out that though staying in the country helps him forget all that is going on around him, he cannot forget the poor, sick, and dying in the city. Three more persons were admitted to the hospital this day than were admitted in 1793.

Rush reports that the fever declines daily and that he expects she will be able to return to the city by mid-November. He rode out for the first time in weeks, and found more people in the streets, and those more cheerful. He adds that he is feeling stronger daily.

McHenry details reforms required within the Army's medical department and makes recommendations for restructuring of general and regimental hospitals, controlling fraud in the commissaries, increasing the numbers of nurses and surgeons, and improving the distribution of medicine.

Greene writes of his support for Rush's recommendations regarding best methods for preserving the health of the Army. He suggests they print a pamphlet on the topic, to make adoption of the recommendations more likely. He comments on Congress' regulation of hospitals.

Pickering notes that he sent Yellow Fever medicine developed by Dr. Conrad G. Bölke to the Board of Health, but is only now sending along copies of his letters from Bölke and the United States consul at Hamburg, Joseph Pitcairn, with instructions regarding the medicine's use.

Pickering writes regarding his plans for caring for his mentally disturbed son, William, thanking Dr. Rush for his advice. In a postscript, he asks Rush if he should talk to his son about his derangement when he is rational in order to have his cooperation in effecting a cure.

Rush writes most likely to Dr. Basil G. Middleton, (c. 1740-1818), a former surgeon with Virginia forces in the Revolutionary War, now living in London. Rush discusses personal and medical matters, touching on College of Philadelphia medical school classes and enrollment, and comments on the unconcluded treaty with England and the American political system.