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Rush reports that his practice has fallen off. Disease has left their district and it is well known that he is too weak to see patients. His pupils attend to the poor. He describes his financial situation, then notes how few friends he now has among medical brethren, and how that impacts his future career, since he now cannot consult or operate with them.

Washington acknowledges the receipt of Rush's letter, and regrets the defects of the medical department, as Rush and Gov. Livingston have described them. Washington reports that he has taken measures to have the hospitals inspected and considered regulations regarding them. Includes a separate invitation for Rush to dine with the ?Washington.

Pickering details how the family is no longer able to care for William. He has decided to send William to Rush's hospital in Philadelphia, where he will not be able to escape and might recover. He adds that another son, George, is potentially manifesting the same symptoms as William.

Rush provides a detailed account of his sister's death, describing also the invaluable support she provided to him. He notes that there is a want of cash in the city, and that provisions are costly, and prices high. He adds that many of the committee men who sought to help the poor have now died. He hopes for a change in the weather. The close of the letter is missing.

Rush points out that he has received no letters from Julia. He gains strength but must eat often to avoid becoming "weak and fainty." His patients now hand him a glass of milk or crust of bread as they would hand another a glass of wine. He adds that their servant, Marcus, has been very faithful and that his mother is well, but complains of the high cost of housekeeping.

Rush points out that Julia's letters are now delayed at the Post Office by 2 or 3 days, but her recent letter brought him comfort. He says that he cannot think of the family or the children, but lives in the moment, making himself useful to others. His sister has been buried, and he plans to plant medicinal plants at her grave; his mother is fully recovered.

Rush points out that many people are returning to town; he hopes not too soon, for there are still many who are ill or dying. The rest of the letter is regarding his professional feud with Dr. Wistar over treatment for the fever. Rush is especially offended because Wistar had originally assented to the efficacy of Rush's treatment, then changed his mind.

Rush states that he would rejoice at news of the birth of his niece if he could, but he feels as though he will never feel joy again. The mortality this day is worse than ever. He believes it is now unsafe for her to receive articles of clothing from their house. Also, he would prefer to borrow money from her brother than from a bank at the moment.

Rush notes that the fever has been said to become more mild, but that is not the case, especially if his treatment has not been used. He adds that besides combatting the fever, he has to contend with the "prejudices, fears, & falsehoods" of his fellow physicians. He adds that all are tinged with infection, now. Even his own eyes are tinged a yellow color.

Jefferson notes that he has appointed Dr. Waterhouse to the Marine hospital in Boston, in return for his introducing vaccinations to the country, and describes the political fallout from the appointment. He plans to send his 15-year-old grandson to be with Rush in the Fall. He mentions Dr. Rose, and the impact on an embargo on relations with Europe.