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Pickering details how the family is no longer able to care for William. He has decided to send William to Rush's hospital in Philadelphia, where he will not be able to escape and might recover. He adds that another son, George, is potentially manifesting the same symptoms as William.

Pickering describes symptoms for which he would like Rush's treatment advice. Includes Rush's own notes regarding two prescriptions he advised.

Pickering writes regarding his plans for caring for his mentally disturbed son, William, thanking Dr. Rush for his advice. In a postscript, he asks Rush if he should talk to his son about his derangement when he is rational in order to have his cooperation in effecting a cure.