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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.

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.

Rush reports that only one person has been buried today in the Quaker graveyard, when 5-17 have been regular. He complains of fever treatments used by French physicians.

Rush announces he is contemplating moving into a new house before her return and considers a few locations. He adds that his day no grave was opened in the Quaker graveyard and their were no admissions or deaths in the Bush Hill hospital.

Rush has taken measures to purify their house. He points to a new clamor regarding his assertion that yellow fever has been operating in the city. He has been asked to prove that assertion.

In this letter to his sister, Rachel, Rush provides details of their sister Rebecca's death, his grief, and the state of their mother's health.

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 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 has discovered that a letter containing charges against him has been circulating among physicians. He plans to obtain a copy and publish it. He is inquiring after a house.

Rush reports that he was driven to Rosehill to visit their son, Ben, and also met neighbors. He figures that two-fifths of all those sent to Bush Hill hospital have died, because his remedies were not used.

Rush outlines their full affection for each other, and makes tentative plans to visit Julia. The closing for the letter has been excised.

Rush challenges Julia to be patient regarding a return to town. He repeats the history of his relationship with his detractors, then returns to praising her as a "great woman" for never asking him to leave the city during the outbreak.

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 outlines the work that will keep him from visiting Julia, after all. He points out that there have been four deaths from fever, so unless there is a frost, she should not return to Philadelphia on the date they agreed upon. He repeats more of the "slander" against him.

Rush points out that he is too weak and busy to ride out to her at Rosehill, but she may come in to town, or he will ride out to spend the next day with her.

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.

Rush announces that yellow fever has broken out throughout the city, but there have been no measures yet to exterminate the disease. Their son Richard plans to move a mattress and books to their farm. Rush notes that a Mr. Thomas has left Philadelphia forever as a result of his debts, and has ruined many young men in the meantime. In a postscript, Rush points out that Capt. Mitchell of the American Army has the fever. Rush is considering leaving and is urging his patients to leave. Rush's signature has been excised.

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 notes that John arrived, and they are now at Sydenham. He also reports that he has sold the Chapel farm for $2,500. He describes a new remedy he has developed for yellow fever. The signature has been excised from this letter.

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 notes that his pupil is better, and that he is using profuse sweating as part of his treatment for the fever. A later note was appended to the letter stating that Mrs. Rush allowed the signature to be cut away for an autograph.

Rush reports that despite being exposed to the fever daily for two months, he is still healthy. However, he has "felt, mourned, and wept" until he could no longer do so. He reports that poor people chase him down in the street, and that he carries medicine with him in order to do all he can to help them. Free blacks and servants form a large percentage of his patients.

Rush recounts all the improvements he has made for her at Sydenham. He will begin sending the family from town with the warm weather in May or June.

Rush comments on commerce and the work of physicians, and on Philadelphia physicians opposed to use of mercury and bloodletting.

Rush writes a brief note to inform Julia that a friend has failed, physically.

Rush writes that deaths from fever are decreasing, and he will soon end his engagement with city hospital. He outlines activities in the family, and their preparations for her return the following week. The signature to this letter has been excised.

Rush makes treatment recommendations for an undisclosed ailment.

Rush records the benefits of using Kinepox over variolation to inoculate against smallpox.