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Rush congratulates Greene on his successes in North Carolina, then recommends that he move from Rhode Island to South Carolina, which is more active in manners and government and would suit him better. He then comments upon the country's need for Confederation and for a national character built upon something more than resentment of Great Britain.

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 reports having received various letters and items from London, including a medical book. He states that he has had no cases of yellow fever in two days. He uses the rest of the letter to recount fully his second attack of the fever, beginning October 10th. He writes that he expects her return the coming week.

Rush details several patients' responses to treatment, or lack thereof, and includes consideration of the impact of psychological influences on recovery. He notes that the days grow colder, but they need rain. He has returned to his notes on yellow fever taken during his apprenticeship in 1762.

Rush records a visit from physicians who have quietly sought to prove the effectiveness of his mercury treatment by using it to treat the poor. He asks Julia to join him in reading Psalm 103 and praising God for his protection. He expects to take charge of the hospital shortly.

Rush notes the health of several doctors and points out that St. Paul's Church has offered prayers twice a week since the fever began. He is not seeing patients, but is spending his time reading and making notes on the epidemic. He describes his melancholy when he contemplates the state of the city and those he has lost.

Rush states that he receives many inquiries each day from country practitioners, and there is a high cost personally and in postage to answering each letter, so he is publishing an account of the fever, including preventatives and remedies. He reports that he is seeing 40-50 patients a day, and notes the progress in the cases.

Rush notes that the efficacy of his cures is now proven, and that his directions for treating and preventing the disease will be published in the newspapers. He adds that he is in surprisingly good health, since his meals now consist only of milk and vegetables, and water.

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 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.