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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 Greene on his successes in North Carolina, then recommends that he move from Rhode Island to South Carolina, which is more active in manners and government and would suit him better. He then comments upon the country's need for Confederation and for a national character built upon something more than resentment of Great Britain.

Rush congratulates the unnamed recipient on his recent appointment in the army, and makes note of the support of France and Spain in America's revolutionary cause, along with other Mediterranean countries. He mentions that the army expects to check any advance of General Howe into Philadelphia, whose appearance would cause a panic. He notes that his opposition to Pennsylvania's current government has cost him his seat in Congress, but that he had planned to join the army in any case.