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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 congratulates Jones on his decision to leave Congress, and records his own regrets regarding public service, with particular regard to the funding system and the banks. He now believes American citizens "unfit for and undeserving of liberty."