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Rush writes regarding the health of Julia's uncle's family, one of whom is suffering from a stomach disorder. He also notes that Julia's father's health is deteriorating. Her father will accompany him upon his return, to be placed under another physician's care. He requests that Julia have his assistants call upon the parents of children Rush inoculated before his departure, with instructions for their care. He describes the trial of a Dr. Shippen. He mentions that the letter was written in company, in General Green[e?]'s office.

Rush writes that he wishes to share his reading of Paley's moral philosophy with her, because he would enjoy it more that way and it would better qualify her to educate their children. He describes a gathering where he provided beer to a group of laborers, and how affectionate one of them was to his dog, including a reflection of "infinite love which follows the human species." He then comments that their leaving a local congregation has finally been noticed. The signature line for this letter has been excised.

Rush expresses amazement that he remains uninfected by the fever, for he has seen over 100 patients on this date, and 40 people were buried. He states that he does not forget to treat the poor "remembering my dream in the Autumn of 1780." Many doctors have adopted his treatment, but several oppose it, as they oppose his treatment for lockjaw. He remarks that more of the French exiles have come down with the fever. He is now using bloodletting as a tool, since the weather is cooler.

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 explains his plans for travel to Princeton, and the minor ailments he has been suffering. He then describes how he visited a patient who was having a fit of colic, only find she was actually in labor. He expects the affair to give him some trouble, but has neither the constitution nor time to practice midwifery. He rejoices in hearing of the fall of the French monarchy, and expects that it will lead to the removal of all the kings in Europe. A later note was added stating that the letter's signature was given to an autograph seeker.

Rush lists those in the neighborhood who were not his patients that have died. He praises their "black friend," Marcus, for faithfully waiting on him. He has received letters from Europe, among them a letter from Granville Sharp, authorizing him to draw on contributions in London for the African Church of Philadelphia. Among the contributors was the Duke of Grafton. Rush points out that no doctors have inquired after his health, and that their confederacy against him in stronger than ever. The letter's signature has been excised.

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 his cure is working, but there is a pause in new cases, and that fatalities are now among the poor without access to doctors or respectable people being treated by quacks. He states that if the fever breaks out in Princeton, he will send his assistant John Cox to execute his cure. Once again he documents the health status of his fellow physicians, although he records a rumor that some doctors have ceased seeing patients at all. He then discusses the various treatments that have been used for the fever. In a postscript, he adds that Africans in the city have proven immune to the disease.

Rush announces that Dr. Sproat has died, adding, "It is truly distressing to think of the desolation which has followed the footsteps of this man, and of all the Doctors who use Bark- Wine- Laudanum, and hot, or cold Baths in this disorder. It is much more inflammatory than a common Pleurisy, & who ever thought of using those remedies in that disease?" He notes the health of other doctors, and reports that he is now employed again by Mr. Hammond, who had been persuaded against Rush's treatment. He ends noting that Julia's sister has written to urge him to leave the city, a move he feels would be "unwise, and perhaps sinful."

A copy, in an unknown hand, of a letter from Rush to Bayard regarding sentiments expressed in an earlier letter to General John Armstrong. The letter reflects post-revolutionary state politics in Pennsylvania. In the letter, Rush censures his fellow Presbyterians, who refuse to revoke the test laws and to admit amendments to the state constitution. He also condemns the taking over by the Presbyterian dominated state government of the charter of the College of Philadelphia, now the University of Pennsylvania, and refers to the College of Carlisle, or Dickinson College, established in protest to the first action. He regrets the inflammatory remarks and publications made by members of the state's single legislative body, the Council of Censors, and by Joseph Reed and Mr. Smiley, and deplores the character of Henry Osborn and Owen Faris.