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Rush writes of their exchange of letters, and mentions both of their sons, along with the grandson of President Washington, who is ill with a fever and is being attended by doctors Shippen and Kuhn. He also successfully treats a woman with a locked jaw. He announces his plan to open an African Church, and describes the resulting excitement in the free black community.

Rush takes Julia to task for permitting their son John to have a gun against his expressed wishes. Rush believes John's character is not the correct one for gun ownership, because he lacks gentleness and compassion. Rush requests that Julia not override his dissent, and strengthen their parenting as a result. He announces that he has taken their son Richard to see patients. He is reading John Newton's Cardiphonia. He also is planning to develop a cure for the consumptive cough.

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 writes to his son regarding his education. He expects him to study Latin and arithmetic, and stresses that he needs to pay more attention to his spelling.

Rush writes to Thornton regarding his opposition to capital punishment, and encloses copies of a his pamphlet on the matter, of which Thronton had approved. Rush also discusses his birthplace, Byberry, where Thornton resides.

Rush announces that a violent "fever" has broken out in one district of the city, where 12 people have died. If it spreads he plans to have Julia remain at Princeton. He then reports that influenza continues to spread, with violent symptoms that cause him anxiety. He adds that Mr. Wolstonecraft has refused to purchase their property, because he could not support himself by hunting on it. Finally, he notes the arrival of a fellow physician's son from France, who brings disturbing news of the state of affairs, there.

Rush updates Julia on the alarming spread of the fever. He reports that the College of Physicians has met to consult on how to stop the spread of disease and to draw up instructions for that purpose. These directions will be handed to the mayor. He asks her to stay in New Jersey with the children, and to pray for his protection, although he takes all precautions possible. He plans to confine his boys to the house for their protection.

Rush states that the boys are so apprehensive about contracting the fever from his clothes that he has decided to send them to Trenton. He asks her to have them read something useful, because he is worried about possible habits of idleness. He notes that the directions from the College of Physicians are to be published tomorrow, but worries that the fever will not subside before October's heavy rains and frost. His postscript provides instructions on how to protect the boys.

Rush notes that both boys have headaches, but are travelling regardless. He reports on the fever in their neighborhood, listing who has died or left town.

Rush provides a detailed account of the yellow fever epidemic, describing its varied presentation among individuals. He notes that the violence of the fever has caused Philadelphians to mistake it for plague. He points out that common remedies have all failed, but he consults with Dr. Caspar Wistar regarding treatments.

Rush describes the funerals taking place in the city, and tells Julia that the fever has been particularly fatal to the young. He rejoices that the boys left the city, but hopes they avoid fatigue, heat, and cold, so that they do not excite any portion of the fever they might have carried with them from town. He expresses concern that the city is only at the beginning of the epidemic, but joins Julia in planning to express more gratitude for God's mercies in the future.

Rush records that his case load is increasing, as is his fatigue, but that many of those he treats are out of danger. He reports on the progress of the epidemic in their neighborhood.

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.

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 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 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 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 writes that he is preparing for the "awful duties of the day," as yesterday exceeded any of the preceding days in distress and death, and two more physicians are ill.

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.

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 seeks to reassure his wife that he is fully recovered and well cared for. He notes the numbers of those who oppose his treatments that have now left the city. He adds that it is cold, and that he hopes this will check the fever.

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 says that distress increases in Philadelphia, and names several friends and one doctor who have died.

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 enumerates the close family friends that are ill or have died, and notes that only one doctor who continues to follow his treatment.

Rush announces that his pupil, Johnny Stall, has died. He mentions that citizens universally exhibit symptoms of the fever, but that the poor suffer the most. He hopes the weather will change.

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 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.

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 reports that his sister is in grave danger and that, by popular demand, physicians have been forced to adopt his treatment for 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 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 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 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 reports that he has had a relapse of the fever, but is still seeing patients as he can. He adds that the poor, children, and servants have been hardest hit by the fever. Nursing wages are now $4 a day. The signature for the letter has been excised.

Rush asks that Julia and the children mourn his sister's death, as he is doing. He is unable to see patients because of continued weakness.

Rush announces that the publication about the fever has been well received by the citizens. He updates Julia on the condition of several patients.

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 reports that the women who waited before sending for him to treat their fever have now died. His meals are now public, and he describes his diet. He notes that some doctors have been adding bark and laudanum to his new remedies. He plans to publish to expose their ignorance.

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 is confined to his house, and has been prescribing based on the reports of his pupils. He remains weak, but otherwise healthy. He finds it strange when men write to propose business or contractual dealings at this point in time. Part of the final page of the letter is missing.

Rush informs Julia that he has been thinking more of the children than he has in weeks and describes a dream he has had about her. He inquires after the new baby. He plans to ride out to the countryside to repair his health and later reports feeling stronger. He lists the conditions of those among their acquaintances.

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 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 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."

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 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.

Rush notes that rain and cold weather have not decreased cases of the fever; 700 have died since 11 October, and 3400 since 1 August. He feels the distress of others all the more because he cannot assist them now. He has discovered further evidence that his sister gave her life to save his. Finally, he notes that his publications are still saving lives.