prior probability

Did Adam Smith’s direct experiences with some of the most celebrated doctors of his age motivate his remark in The Wealth of Nations regarding the “absurd prescriptions” of doctors? How could they not have! From his Oxford and Glasgow days (see, for example, here, here, and here) to the final weeks of his travelling tutor years (see here and here), Smith saw a wide range of home remedies and medical treatments first hand during his lifetime, including tar water, leeches, ipecacuanha, opiates, rhubarb, and bloodletting. These, by our standards, “absurd prescriptions” were what state-of-the-art medical care consisted of in the 18th-century Europe.

But that said, the line between mere quackery and medical cure in Smith’s day was a fuzzy one, especially if Smith’s private letters–such as the ones he postmarked from Glasgow in March and November 1760 and from Compiègne and Paris in August and October 1766–are any guide. In all, three of Smith’s students became seriously ill, and in two of these cases (Duke Henry and Thomas Petty-Fitzmaurice), the patients recovered after receiving the standard prescriptions of the day: bloodletting and leeches. In the other case (Hew Campbell Scott), however, the patient died on Smith’s watch.

I will conclude my three-act medical morality play with Smith’s June 16, 1776, letter to David Hume. (Corr. 161) By way of background, Smith and Hume, two of the most prominent figures of the “Scottish Enlightenment,” were lifelong friends and intellectual collaborators.[1] Hume had fallen ill in 1775,[2] and to alleviate the pain caused by his illness, or perhaps in search of a cure, Hume traveled south to England to “take the waters.”[3] During this final journey before his death (Hume died on August 25, 1776), he visited two great English spa towns–Bath and Buxton[4]–and when Adam Smith got wind of Hume’s hydrotherapy treatments from a mutual acquaintance (Corr. 160), he fired off a letter to his lifelong friend and mentor. Here, Smith pronounces on the efficacy of “Bath Waters” and concludes with a scathing indictment:

“I am very sorry to Learn by Mr Strahan that the Bath Waters have not agreed with you for some time, so well as they appeared to do at first. You have found one Medicine which has agreed with you; travelling and change of air. I would continue, if I was you, during the continuance of the fine Season the constant application of that medicine without troubling myself with any other, and would spend the summer in Sauntering thro all the different corners of England without halting above two or three nights in any one place. If before the month of October you do not find yourself thoroughly re’established, you may then think of changing this cold climate for a better, and of visiting the venerable remains of antient and modern arts that are to be seen about Rome and the Kingdom of Naples. A mineral water is as much a drug as any that comes out of the Apothecaries Shop. It produces the same violent effects upon the Body. It occasions a real disease, tho’ a transitory one, over and above that which nature occasions. If the new disease is not so hostile to the old one as to contribute to expell it, it necessarily weakens the Power which nature might otherwise have to expell it. Change of air and moderate exercise occasion no new disease: they only moderate the hurtful effects of any lingering disease which may be lurking in the constitution; and thereby preserve the body in as good order as it is capable of being during the continuance of that morbid state. They do not weaken, but invigorate, the power of Nature to expel the disease. I reckon it probable that the Bath Waters had never agreed with you, but that the good effects of your journey not being spent when you began to use them, you continued for some time to recover, not by means of them, but in spite of them. Is it probable that the Buxton waters will do you more good? The Prescription supposed most likely to do good is always given first. If it fails, which it does nine times in ten, the second is surely likely to fail ninety nine time in a hundred….” (Corr. 161; my emphases)

[1] See generally Dennis C. Rasmussen, The Infidel and the Professor: David Hume, Adam Smith, and the Friendship That Shaped Modern Thought, (Princeton University Press 2017). Hume was older, having been born in 1711, while Smith was born in 1723. Both luminaries lost their fathers when they were young and were raised by their mothers.

[2] According to Hume’s own account (he had written a brief autobiographical essay titled “My Own Life” a few months before his death), “In spring 1775, I was struck with a disorder in my bowels, which at first gave me no alarm, but has since, as I apprehend it, become mortal and incurable.” Hume 2019 [1776]. Cf. Ernest Campbell Mossner, The Life of David Hume, 2nd edition (Oxford University Press 1980), p. 596: “… so far as the evidence goes, modern medical science might agree that, although cancer of the bowel cannot be ruled out, Hume probably died of chronic ulcerative colitis, following an acute bacillary dysentery.”

[3] Curiously, what began as a medical treatment quickly evolved into a social fad for high society, combining healthcare, high fashion, and matchmaking. See, e.g., Alev Lytle Croutier, Taking the Waters: Spirit, Art, Sensuality (Abbeville Press 1992). See also Veronique Greenwood, “‘Taking the waters’ was the original summer getaway,” Time (July 9, 2026), available here.

[4] See Ernest Campbell Mossner and Ian Simpson Ross (editors). The Correspondence of Adam Smith (Liberty Fund 1987), p. 194 n.3. See also Corr. 160 & Corr. 161.

(Continued from yesterday’s post)

Adam Smith’s next direct experience with doctors would occur in October 1766 in Paris. Duke Henry’s younger brother, Hew Campbell Scott (pictured below), contracted some kind of illness in the City of Light. Although Hew would obtain the best medical care he could have possibly received in 18th-century Paris, the intellectual and cultural epicenter of the 18th-century Age of Enlightenment, his sickness was so severe that it would take his life in a matter of days.

For his part, Adam Smith–who, after all, was responsible for the health and safety of his teenage pupils as their travelling tutor–had once again consulted the best doctors he could find, including his friend the royal physician François Quesnay as well as Richard Gem (1717–c.1800), the doctor assigned to the British embassy in Paris (Armbruster 2019, p. 131), and Théodore Tronchin (1709–1781), the famed physician, Professor Emeritus of Medicine at the Academy of Geneva, who had opened a medical practice in Paris. (See Corr. 97.) But how good would this medical care have been by our modern medical standards?

In the first part of a lengthy letter (dated 15 October 1766) addressed to Duke Henry’s sister (Lady Frances), Smith describes Hew’s ailment in gruesome detail as well as the specific treatments prescribed by his doctors–everything from “ippcuana” to “a very gentle opiat” to “fifteen grains of Rhubarb”:

“On Monday morning Dr Gem observed some degree of fever in Mr Scott’s pulse which he had thought entirely free of it for some days before. Mr Quenay observed the same thing. His vomitings, however, and Purgings continued with great violence all day, notwithstanding a dose of ipp[eca]cuana which they had given him in the morning. His fever seemed to go off almost entirely in the evening, and they gave him, what they had given for two days before, a very gentle opiat to quiet his stomach and to give him a little rest in the night time. Yesterday morning Dr Gem imagined he felt more quickness in his pulse than he had ever done before; this, however, soon subsided and his pulse returned to a degree of frequency that was not much beyond its natural state. He was all day much freer from vomitings than he had been for some days before, and his purgings seemed to be no greater than what might be expected from fifteen grains of Rhubarb which they had given him the night before and that morning: from one to about three o’clock afternoon I thought I observed some alterations in his speech, and an extraordinary hurry and confusion in his Ideas.” (Corr. 97)

Were any the three treatments described in the passage above–the “dose of ipp[eca]cuana”; the “very gentle opiate”; and the “15 grains of rhubarb”–“absurd prescriptions”? Where do we draw the line between pseudo-scientific quackery and legitimate cures? Let’s start with the “dose of ippcuana.” (Corr. 97) Quackery or cure? Ipecac, short for ipecacuanha (Kang & Pederson, p. 22), was first brought to Europe in the 1600s and was used for centuries as an expectorant to clear chest congestion as well as an emetic to induce vomiting. Ipecac is still available today, but it straddles the line between legitimate treatment and medical quackery, for “modern toxicologists know it doesn’t reliably decrease the absorption of toxins, and half the time, it doesn’t even make you throw up.”[1] In other words, given these even odds, deciding whether ipecac is a cure or a quack remedy is no different than a coin toss.

What about the “very gentle opiate”? As it happens, opiates have a long and storied history going back to ancient times.[2] Today, opium tincture (a liquid solution) is used to treat severe cases of diarrhea.[3] But whether opiates are an “absurd prescription” or a legitimate one depend on whether the known benefits of the drug (euphoria and drowsiness) outweigh the known side-effects, including addiction and death![4] Given these risks, Smith is at pains to reassure Lady Frances–i.e. Duke Henry’s sister to whom Smith’s letter is addressed–that a “gentle opiat” was prescribed.

That leaves the “fifteen grains of Rhubarb.” Quackery or cure? According to Clifford Foust (1992), who literally wrote the book on rhubarb, at the time rhubarb was “a popular and expensive drug” (Foust 1992, p. 156) that was widely prescribed as a laxative and cathartic.[5] Rhubarb is also one of the most ancient and important herbs in traditional Chinese medicine (Xiang et al. 2020), and the dried rhubarb root is still used as a short-term stimulant laxative.[6] According to Foust (1992, p. 142), however, 15 grains was a “light dosage,” so again, determining which side of the quackery-cure line rhubarb falls on is an open question.

Hew temporarily recovered, for Smith reports that his pupil “was entirely free from sickness and vomiting” and that “[t]he Physicians [Quesnay and Gem] were both much pleased with his situation and imagined that all the violence of his disorder was over”:

“This disagreeable symptom, however, soon went off, so as to have me uncertain whether I had not fancy’d it from my own apprehensions; His pulse continuing all the while, tho’ a little feverish, extremely gentle and moderate. In the evening he appeared easier than he had been for some days before: They gave him no opiat that night and he Passed it very easily notwithstanding. This morning he ordered himself to be taken out of bed at eight o’clock and sit up to Eleven. He was entirely free from sickness and vomiting; his pulse had very little quickness; and his purging was no greater than what was to be expected from the fifteen grains of Rhubarb he had taken this morning and the night before. The Physicians were both much pleased with his situation and imagined that all the violence of his disorder was over. Quenay said that he had been at a loss before but he now knew what to do. I thought I might venture to go to my Bankers to get some money which, tho I had much occasion for it, I had put off doing for eight days before in order not to leave him. Dr Gem undertook to sit by him till I should return. I stayed out about an hour happy to imagine that all my anxiety was likely to be at an end.” (Corr. 97)

Whether Hew recovered because of or in spite of his treatments is hard to say. But his recovery was short-lived, and when his health deteriorated further, it was time to let the blood flow. Smith writes: “Upon my return I found him quite delirious, and that too with no very violent fever. I immediately sent for Quenai who ordered him instantly to be blooded.” (Corr. 97)

Towards the end of his letter to Lady Frances, Smith reports that he decided to get a third opinion due to the mistaken predictions or flawed diagnoses of Hew’s doctors: “Tho’ I have entire confidence in the skill of the Physicians [Quesnay and Gem] that have hitherto attended him, notwithstanding they have been mistaken in their predictions, I have thought proper to call in Tronchin, who will attend him for the future along with them.” (Corr. 97; my emphasis) By the end of the week, however, Hew would be dead,[7]

Alas, whether the “absurd prescriptions” of Hew’s doctors contributed to his death is impossible to say. (To be continued…)

[1] Kang & Pederson, p. 22.

[2] Ibid., pp. 63-64.

[3] Mayo Clinic (n.d.).

[4] Cf. Kang & Pederson, p. 63: “Within half an hour of consuming [raw opium], you feel euphoric and drowsy, while even your most excruciating pain is numbed away. Sounds wonderful, right? Just wait for the side effects: itchy skin, constipation, nausea, and dangerously slow breathing. Oh, also crippling addiction. And death.”

[5] See generally Foust 1992, Ch. 7.

[6] Cf. Kindermann 2025: “Unsurprisingly, given its history as a laxative, one of the biggest properties of rhubarb is its high fiber content. What’s more, it also has a high tannin content, which means it also has anti-diarrheal properties. While rhubarb could still be considered an herbal remedy for constipation (it is sometimes sold in powdered form at natural food stores), these two properties together mean it should only be used as a temporary solution, with the guidance of a qualified doctor.”

[7] In his next letter to Lady Frances (dated 19 October 1766; see Corr. 98), Smith writes: “It is my misfortune to be under the necessity of acquainting you of the most terrible calamity that has befallen us. Mr Scott dyed this Evening at seven o’clock.”

Act III: Compiègne and Paris (1766) [Parts I and II are available here, here, and here]

Adam Smith’s next first-hand experience with medical quackery occurs during the last part of his travels in France. By way of background, Smith had accompanied Henry Scott, the 3d Duke of Buccleuch (pictured below), who was born in 1746, along with Hew Campbell Scott, the duke’s younger brother (by one year), on their “grand tour” of Europe in the mid-1760s. Smith was travelling in his capacity as their tutor and overseas guardian, and at some point, Smith and his private pupils must have secured an invitation to visit the royal hunting park at Compiègne, France, for that is where Smith and his two pupils found themselves in August of 1766.

It was here, in Compiègne, that the young duke became violently ill. Although Smith describes this ailment as a “slight fever” in a lengthy letter (dated 26 August 1766) addressed to the duke’s stepfather, Charles Townshend:

“It is, you may believe, with the greatest concern that I find myself obliged to give you an account of a slight fever from which the Duke of Buccleugh is not yet entirely recovered, tho’ it is this day very much abated.” (Corr. 94; punctuation and spelling in the original)

Next, Adam Smith describes how the young duke had contracted what the travelling tutor describes as a “slight fever”:

“He came here to see the camp and to hunt with the King and the Court. On Thursday last he returned from hunting about seven at night very hungry, and eat heartily of a cold supper, with a vast quantity of sallad, and drank some cold punch after it. This supper, it seems, disagreed with him. He had no appetite next day, but appeared well and hearty as usual. He found himself uneasy in the field, and returned home before the rest of the company. He dined with my Lord George Lennox, and, as he tells me eat heartily. He found himself very much fatigued after dinner, and threw himself upon his servant’s bed. He slept there about an hour, awaked about eight at night in a good deal of disorder. He vomited, but not enough to relieve him. I found his pulse extremely quick; he went to bed immediately and drank some vinegar whey, quite confident that a night’s rest and a sweat, his usual remedy, would relieve him. He slept little that night but sweat profusely. The moment I saw him next day (Sunday) I was sure he had a fever, and begged of him to send for a physician. He refused a long time, but at last, upon seeing me uneasy, consented. (Corr. 94; punctuation and spelling in the original)

What Smith is describing in this passage sounds like a stomach illness, perhaps some form of food poisoning. Moreover, the duke’s ailment was severe enough that Smith ended up chasing down three different doctors to attend to and treat the duke’s malady: “Quenay” or François Quesnay (1694-1774), physician to the French royal court; “Senac” or Jean–Baptiste Senac (1693-1770), premier physician to Louis XV from 1752; and “De la Saone” or Joseph-Marie-François de Lassone (1717-1778), appointed the First Physician to the Queen of France, Marie Leszczyńska (wife of Louis XV), in 1751. In Smith’s words:

I sent for Quenay, first ordinary physician to the King. He sent me word he was ill. I then sent for Senac; he was ill likewise. I went to Quenay myself to beg that, notwithstanding his illness, which was not dangerous, he would come to see the Duke. He told me he was an old infirm man, whose attendance could not be depended on, and advised me, as his friend, to depend upon De la Saone, first physician to the Queen. I went to De la Saone, who was gone out and was not expected home till late that night. I returned to Quenay, who followed me immediately to the Duke. It was by this time seven at night. The Duke was in the same profuse sweat which he had been in all day and all the preceding night.” (Corr. 94; punctuation and spelling in the original)

Today, doctors would treat such a severe case of stomach flu with “oral rehydration solutions,” such as Pedialyte, Naturalyte, Infalyte, or CeraLyte. But in Smith’s day, bloodletting was the most likely course of action:

“In this situation Quenay declared that it was improper to do anything till the sweat should be over. He only ordered him some cooling ptisane drink. Quenay’s illness made it impossible for him to return next day (Monday) and De la Saone has waited on the Duke ever since, to my entire satisfaction. On Monday he found the Duke’s fever so moderate that he judged it unnecessary to bleed him. . . . To–day, Wednesday, upon finding some little extraordinary heat upon the Duke’s skin in the morning, he proposed ordering a small quantity of blood to be taken from him at two o’clock. But upon returning at that hour he found him so very cool and easy, that he judged it unnecessary.” (Corr. 94; punctuation, including the ellipsis, and spelling in the original)

Next, Smith acknowledges just how routine the practice of bloodletting was in his day, for in the very next sentence he makes the following offhand but revealing remark: “When a French physician judges bleeding unnecessary, you may be sure that the fever is not very violent.” (Corr. 94) Alas, the young duke was not to be spared this gruesome treatment, after all. By all accounts, bloodletting was a “cure-all,” so when Smith wrote a second letter to Duke Henry’s stepfather the very next day (27 August 1766), he describes how the duke’s doctors ended up taking “three moderate tea cupfuls of blood”:

“I resume the history of the Dukes illness from the moment in which I left it of yesterday. I had scarce sealed up my Letter when de la Saone came into the Room. He found that the fever was somewhat increased since the time that he had seen him before which was at two o’clock afternoon. Its paroxysme is always from about seven in the evening till about twelve or one in the morning. He thought that a gentle bleeding would diminish this paroxysme which had entirely broke his rest the night before. He ordered accordingly three moderate tea cupfuls of blood to be taken from him, which was accordingly done at eight at night.” (Corr. 95; punctuation and spelling in the original)

In fact, the duke’s doctors shed “a little more blood” from Duke Henry’s veins, for Smith concludes his letter by describing how “[t]he extreme good success of last night[’]s bleeding” inclined them to repeat their bloodletting procedure a second time:

“The extreme good success of last nights bleeding inclines them to take a little more blood from the Duke, provided the fever increases as usual towards seven or eight at night. Senac is more formal than la Saone who is one of the most engaging men I ever saw; In his reasonings and Judgements, however, Senac is one of the clearest, distinctest and most rational Physicians I ever saw. La Saone is not less so.

“Since I wrote the above la Saone has been to see the Duke. He finds him so easy that he imagines it will be unnecessary to bleed him to night. He is to return, however, at eight o’clock in order to decide that point along with Senac.” (Corr. 95; punctuation, spelling, and paragraph indent in the original)

Fortunately for Duke Henry–and for Adam Smith, who, after all, was responsible for the young duke’s health safety as his travelling tutor–no more of the young duke’s blood was let. But the fact that this gruesome treatment was entertained at all shows us how primitive, by modern medical standards, the practice of medicine was in Smith’s day: quackery was the rule rather than the exception in 18th-century Europe. Alas, Smith’s next direct experience with quackery, which would occur just a few weeks later in Paris, would take a deadly turn. (To be continued…)

(Continued from yesterday’s post)

Adam Smith’s private pupil at Glasgow, Thomas Petty-Fitzmaurice, became ill yet again in the fall of 1760. In a letter (dated November 11, 1760) to Fitzmaurice’s father, Lord Shelburne, Smith writes:

“Mr Fitzmaurice being at present indisposed with sore eyes I write this letter to make his apology to your Lordship and to Lady Shelburne for his not having written so regularly of late as usual. He got cold at Inveraray [a small coastal town in Argyll and Bute, Scotland, located on the western shore of Loch Fyne], the effect of which was to make the scurvy on his face strike in and fall upon his eyes. They were, he tells me, ill there, and have been so ever since his return. These three days he has been confined to a dark room. Had he taken proper care of them immediately upon his return, they probably would have given him less trouble. But his manliness hinders him from being so careful of his person, or as attentive to the first beginning of Disorder as I would wish him. The inflammation is in the ball of one of his eyes.” [1]

Next, Smith reassures Lord Shelburne that his son underwent medical treatment and is now “free from all pain.” The treatment? Leeches! Smith writes: “By the application of Leeches it [the eye-inflammation] is this day a good deal reduced and he is free from all pain.” [2]

As it happens, leeches are still prescribed by doctors today! As Lydia Kang and Nate Pederson (2017, p. 220) explain, “After reconstructive surgeries for delicate, small areas such as fingers, ears, and nose tips, leeches can gently decompress tissues engorged with blood, and by doing so, improve blood flow and the survival rate of those tissues.” [3] But in Smith’s day, leeches were prescribed far more frequently and for a wider variety of ailments. In fact, according to Kang and Pederson (p. 212), leeches and bloodletting were two sides of the same medical coin:

“Leeches and bloodletting were believed to accomplish the same goal–relieving the body ‘congested’ of blood and inflammation. By bleeding away the “bad” blood, you could potentially bleed away the problem. Any problem. The reasons for leeching were many, including venereal diseases, brain inflammation, epilepsy, hysteria, organ disease, and tuberculosis.” [4]

But if leeching and bloodletting accomplish the same goal, why would a doctor in Smith’s day use a slimy creature instead of a metal projectile to let the blood flow? In a word, pain-relief. A leech bite, according to Kang and Pederson (2017, p. 213), is “relatively painless”:

“Unlike lancets, fleams, or bladed scarificators [i.e. the sharp tools of the bloodletting trade], a leech bite was relatively painless, thanks to its saliva. A genius concoction of chemicals; leech spit thoughtfully contains anesthetics to keep its host comfy and unaware ….” [5]

In the case of Petty-Fitzmaurice, the bloodletting and blood-sucking worked. Doctors removed some of Petty-Fitzmaurice’s blood on the two occasions he fell ill, and the patient recovered both times. [6] But one of Smith’s future pupils would not be so lucky. For his part, Smith would witness many more bloodlettings during tail end of his travelling-tutor years in France–with fatal consequences.

Nota bene: I will resume my series on “Adam Smith and the absurd prescriptions of doctors” on Monday (21 September).

[1] Corr. 52

[2] Ibid.

[3] Kang & Pederson 2017, p. 220. Kang and Pederson devote an entire chapter of their history of quackery to leeches. See ibid., pp. 211-220. See also this 2017 report about a Polish immigrant who opened his own leech medical practice in Greenpoint, New Jersey.

[4] Ibid., p. 212.

[5] Ibid., p. 213.

[6] In Smith’s last known letter to Lord Shelburne (also dated Nov. 11, 1760), Smith writes: “Mr Fitzmaurices eyes are much better. He has been abroad, yesterday to take the air in a Post Chaise, today to attend his Classes. He is still, however, obliged to wear a piece of Black Silk over them and cannot yet venture to use them.” Corr. 53.

Act II: Glasgow College (1760) [*]

The next direct evidence of Smith’s encounters with the “absurd prescriptions” of doctors are two pieces of private correspondence–one dated March 10, 1760 (Corr. 45); the other, Nov. 11, 1760 (Corr. 52)–both of which are addressed to “Lord Shelburne.” [1] At the time, Adam Smith was a professor at the University of Glasgow as well as a private tutor to Lord Shelburne’s son, Thomas Petty-Fitzmaurice. [2] The first time the young aristocrat became ill during his studies in Glasgow, Smith describes his illness as a “slight fever” in a letter addressed to his pupil’s father:

“I think it my Duty to inform your Lordship that Mr. Fitzmaurice has been for some days past ill of a slight fever, from which, however, he never appeared to be in the least danger and from which I hope he is now in a fair way of recovery.” [3]

This supposed “slight fever,” however, was serious enough for Smith to call a doctor and for the doctor to perform a bloodletting:

“He [Thomas Petty-Fitzmaurice] was seized with it [“a slight fever”] on Wednesday last. I missed him that forenoon from the Class, which I had never done before and upon my return to my own house, I found him lying upon his bed and complaining of a headache. I immediately sent for a Physician who ordered him to be blooded. He was a good deal relieved by the bleeding, but became very feverish that evening. He continued so all next day but the day following found himself greatly relieved in consequence of a sweat and a sound Sleep.” [4]

Before proceeding any further, notice how Smith attributes his pupil’s recovery not so much to the bloodletting procedure but to “sweat” and “sound Sleep.” In addition, it turns out that Smith ended up calling on not just one doctor but on two medical men, for Smith concludes his letter thus:

“I have the greatest trust in the two Medical Gentlemen who waited upon him, Dr. Black and Mr. Hamilton. They are both with him at least five times a day. They never have suspected the least danger from this ailment which they now think is over, and it is contrary to both their opinions that I give your Lordship the trouble of this alarm.” [5]

Although Smith confirms Petty-Fitzmaurice’s speedy and complete recovery two days later (March 12, 1760) in his next letter to Lord Shelburne, his sickness-prone pupil suffered yet another medical relapse requiring yet another medical visitation just a few days letter. In his next letter (dated March 17, 1760) to Lord Shelburn, Smith writes:

“I expected that Mr. Fitzmaurice would have been able to have acquainted your Lordship by this Post of the entire reestablishment of his health. An accident, however, has prevented this from taking place as soon as I expected. I never saw any body appear to recover faster than he did on Friday and Saturday last. On Saturday, particularly, he was surprisingly well and went to bed about 8 o’clock, in appearance, in as good health as it is possible for anybody to have, who had so lately recovered of a fever. On Sunday morning he was seized with a purging which continued all that day, raised his pulse and seemed to threaten a return of his fever. The Doctor assured me that this would in all proba[bility] prove a final crisis, that his former bleeding at the nose had not been so plentiful as he could have wished and that he had always suspected that something of this kind might happen: And I remember, indeed, that after the bleeding of his nose had stopped the Dr. told him that it would probably bleed again that night, which, however, did not happen and is the only prediction of his in this disease that has not in some degree been fulfilled…. I write this at 8 o’clock at night. Tho’ much exhausted by the Disorder of yesterday, he is quite cool and easy and free from every symptom of fever. This slight fit, I hope, tho it has retarded, will ensure his future recovery.” [6]

Two days later (March 19, 1760), Smith confirms yet again that his private pupil “has been quite free from all feverish symptoms since Monday last, and begins now to recover his strength very fast ….” (Corr. 49), but in closing his letter Smith mentions in passing that his pupil at some point had to undergo yet another bloodletting: “He was only once blooded and the rest of his cure has been wrought by a dark, quiet room and great plenty of lemonade made of warm barley water.” (Ibid.; my emphasis)

Why does Adam Smith mention this gory treatment in passing, almost as a mere afterthought? Most likely because bloodletting was so common in Smith’s day–the 18th-century equivalent of taking two aspirins today. Even after William Harvey first proposed his blood-circulation theory in the 1600s, bloodletting was a medical “cure-all” used to treat almost any and every ailment imaginable, including insanity, [7] and bloodletting occupied such a prominent place in the annals of medical history because most doctors, even in Smith’s day, still subscribed to the now-debunked humoral theory of disease, a long-standing and entrenched mental medical paradigm going back to the days of Hippocrates. [8]

Alas, Smith’s sickly student would fall ill yet again in the fall, resulting in another round of letters from Smith to Shelburne. This time around, Petty-Fitzmaurice would suffer an eye infection, and this time his doctor would prescribe leeches! (To be continued…)

[*] For Act I, see my previous post.

[1] The Lord Shelburne that Smith is corresponding with is identified as the “1st Earl of Shelburne” in Mossner & Ross 1987, p. 29 n.1 (Corr. 29), and the 1st Earl of Shelburne was John Petty Fitzmaurice (1706–1761). See Lundy 2019

[2] Cf. Mossner & Ross 1987, p. 26 n.2: “Hon. Thomas Petty-Fitzmaurice (1742–93) of Llewenny Hall, Denb., Wales; educ. Eton; matriculated at Glasgow, 1759; St. Mary Hall, Oxford, 1761; called to the English Bar, 1768; M.P. 1762–80. In 1779, he set up as a linen merchant and established a bleaching factory at Llewenny, Wales, because his Irish estates were unproductive. He was reported to have lived on ‘the most intimate terms with Johnson, Hawkesworth and Garrick’ (Gentleman’s Magazine, 1793, 1053).”

[3] Corr. 45.

[4] Ibid.

[5] Ibid.

[6] Corr. 48.

[7] See generally Kang & Pederson 2017, pp. 129-139.

[8] See, e.g., ibid., p. 5.

Act I: Balliol College, Oxford (1744) [*]

Adam Smith was enrolled in Balliol College at Oxford University from July 1740 until August 1746. During his Oxford years, the young scholar wrote to his mother on several occasions.[1] Although most of these letters are mundane,[2] two of them are worth taking a closer look at, for Smith self-diagnoses–not once, but twice!–a peculiar health condition: “laziness”! In one letter (dated 29 November 1743), for example, Smith informs his mother, “I am just recovered of a violent fit of laziness, which has confined me to my elbow-chair these three months.”[3] And in the other relevant letter (dated 2 July 1744), Smith explains to his mother why he has not gotten around to writing her more often:

“I am quite inexcusable for not writing to you oftener. I think of you every day, but always defer writing till the post is just going, and then sometimes business or company, but oftener laziness, hinders me. Tar water is a remedy very much in vogue here at present for almost all diseases. It has perfectly cured me of an inveterate scurvy and shaking in the head. I wish you’d try it. I fancy it might be of service to you.” (Corr. 6)

Today, “tar water” is an almost-forgotten footnote in the ignoble history of quackery,[4] but at the time, this potion was believed by many to be a panacea capable of curing or alleviating a staggering list of ailments, including asthma, gout, indigestion, smallpox, and even ulcers.[5] For his part, the young Adam Smith not only recommends this folksy home remedy to his mother; he also claims it has already cured him of at least two other maladies: “inveterate scurvy and shaking in the head.” But what was tar water, how did Smith discover this cure-all, and did it really work?

Tar water was a medicinal liquid consisting of pine tar mixed with water,[6] and this elixir may have come to Smith’s attention via the buzz generated by the Anglo-Irish philosopher George Berkeley’s final major philosophical work, Siris: A Chain of Philosophical Reflexions and Inquiries Concerning the Virtues of Tar-Water,[7] which was first published in London in April 1744 and the cover of which is pictured below.[8] Among other things, Bishop Berkeley’s treatise on tar water recommends that pine tar be stirred for three or four minutes with an equal quantity of water, that the mixture be allowed to stand for 48 hours, and after this time has elapsed, that the separated water be drawn off and consumed at the rate of one half-pint night and morning “on an empty stomach.”[9]

Alas, Adam Smith’s early encounter with quackery produced mixed results: he claimed tar water had cured him of his “inveterate scurvy and shaking in the head,” but by his own admission, this foul-smelling concoction was unable to counteract his recurring bouts of “laziness”; otherwise (one presumes), he would have written to his mother more often! In any case, although Smith’s biography thus far contains some evidence of his willingness to experiment with at least one popular pseudo-medical remedy (tar water), direct evidence of Smith’s skepticism toward doctors–or toward the medical profession more generally–is still lacking. In the meantime, Smith’s first direct encounter with the “absurd prescriptions” of doctors will occur during his college professor days in Glasgow.

[*] For my Prologue, see my previous post.

[1] See letters nos. 2, 3, 4, 5, and 6 in The Correspondence of Adam Smith.

[2] In one undated letter from Oxford to his mother, for example, Smith writes: “Dear Mother I have but just time to tell you that I am well.” (Corr. 2) And in another letter (this one dated 23 October 1741), Smith requests an article of clothing: “In my last Letter I desir’d you to send me some Stocking’s, the sooner you send ’em the better.” (Corr. 3)

[3] Corr. 5; my emphasis. As an aside, my colleague and friend Sarah Skwire points out the “delightfully paradoxical” nature of Smith’s peculiar phrasing (“a violent fit of laziness”) in her contribution to the “Smith at 300” symposium issue of the Journal of the History of Economic Thought. See Sarah Skwire, “Smith at 300: a violent fit of laziness,” Journal of the History of Economic Thought, Vol. 43, No. 2 (2023), pp.182-183.

[4] See, e.g., Eric Jameson, The Natural History of Quackery (1961), pp. 31-33. Curiously, Lydia Kang and Nate Pederson’s more recent survey of medical quackery, which I featured in my previous post, omits tar water. See Kang & Pederson, Quackery: A Brief History of the Worst Ways to Cure Everything (2017).

[5] See generally Scott Breuninger, “A panacea for the nation: Berkeley’s tar-water and Irish domestic development,” Études irlandaises, Vol. 34, No. 2 (2009), pp. 29-41.

[6] Ibid.

[7] See George Berkeley, Siris: A Chain of Philosophical Reflexions and Inquiries Concerning the Virtues of Tar-Water. Dublin and London (1747) [1744]. Available online: https://archive.org/details/sirischainofphil00berkiala/page/n3/mode/2up

[8] According to Ernest Campbell Mossner and Ian Simpson Ross (1987, p. 3 n.2; Corr. 6), Bishop Berkeley’s treatise on tar water caused “an immediate sensation”: “George Berkeley’s Philosophical Reflexions and Inquiries Concerning the Virtues of Tar-Water (later prefixed by the title Siris) was first published in London in April 1744, and caused an immediate sensation. A correspondent of the Archbishop of York commented in June: ‘it is impossible to write a letter now without tincturing the ink with tar-water. This is the common topic of discourse, both among the rich and poor, high and low; and the Bishop of Cloyne has made it as fashionable as going to Vauxhall or Ranelagh.’ The Archbishop replied that he thought it a defect in Berkeley’s recommendation that he had made it a ‘catholicon’ (Letters from . . . Dr. Thomas Herring to William Duncombe, London, 1777).”

[9] Berkeley, op. cit., pp. 4-5.

By my count, the word “absurd” appears 36 times in Adam Smith’s Wealth of Nations, but for me the most memorable use of this word is when Smith refers to “the absurd prescriptions” of doctors in Book II, Chapter 3 of his magnum opus. Here, Smith draws a direct analogy between two types of health systems, micro and macro, so to speak: i.e. the health of any given solitary individual (micro) and the financial health of an entire nation (macro):

“The uniform, constant, and uninterrupted effort of every man to better his condition, the principle from which public and national, as well as private opulence is originally derived, is frequently powerful enough to maintain the natural progress of things towards improvement, in spite both of the extravagance of government and of the greatest errors of administration. Like the unknown principle of animal life, it frequently restores health and vigour to the constitution, in spite, not only of the disease, but of the absurd prescriptions of the doctor.” (WN, II.iii.31, p. 343)

In addition, a few months after the publication of his magnum opus in March of 1776, Smith doubles down on his medical skepticism in a private letter (dated June 16, 1776) to David Hume: “The [medical] Prescription supposed most likely to do good is always given first. If it fails, which it does nine times in ten, the second is surely likely to fail ninety nine time in a hundred.” (Corr. 161) What I therefore wish to explore further are the origins of Smith’s medical skepticism. Specifically, when he observes in public that a man might often regain his health in spite “of the absurd prescriptions of the doctor” or likewise comments in private to a close friend that such prescriptions will fail “nine times in ten,” is Smith writing from personal experience?

Some of Adam Smith’s biographers (see, e.g., Buchan 2006, pp. 6, 23-25, 87; Ross 2010, pp. 70-71) assert that the Scottish scholar was a hypochondriac. My work, by contrast, will focus instead on Smith’s documented encounters with the doctors and medical treatments of his day. I will therefore structure my next set of blog posts as a three-act 18th-century medical morality play, with each “act” corresponding in chronological order to a different medical practice that Adam Smith encountered during his lifetime:

1. Act I explores one form of quackery that Smith himself fell for during his student years at Balliol College, Oxford: tar water. The young Smith was so sold on this miracle remedy that he recommends it to his mother in a letter dated 2 July 1744 (Corr. 6).
2. Act II takes place in Glasgow, where one of Smith’s most sickness-prone private pupils (the young aristocrat Thomas Petty-Fitzmaurice) will suffer various ailments, including an eye infection that is treated with leeches!
3. Act III occurs across the English Channel during the tail end of Adam Smith’s grand tour in France as a travelling tutor to the 3d Duke of Buccleuch and the duke’s younger brother, Hew Campbell Scott. Both would fall seriously ill and be subjected to bloodletting; one would perish. Were the doctors to blame?

My epilogue concludes my medical morality play with Smith’s June 16, 1776, letter to David Hume and with a Smithian anomaly of sorts. Although Adam Smith defends some forms of aggressive government regulation in Book II of The Wealth of Nations and calls for the provision of universal public education in Book V (a radical idea at the time!), he is decidedly pro-market and anti-regulation when it comes to doctors and medicine.

As an aside, what Smith calls the “absurd prescriptions” of doctors has a long and colorful history. See generally Lydia Kang and Nate Pederson’s 2017 book Quackery: A Brief History of the Worst Ways to Cure Everything.

Starting tomorrow (16 Sep), I will begin sharing the details of two new scholarly projects that I have been working on these past few weeks. One of my projects explores Adam Smith’s own personal experiences with doctors and the health practices of his day, including such quack remedies as tar water and the practice of bloodletting. (I will also survey Smith’s hard-core free-market views on medical education. See especially letter #143 in The Correspondence of Adam Smith; Mossner & Ross 1987, pp. 173-179). My other project builds on the previous work of Anderson, Shughart, & Tollison (1985), who pointed me to an archive preserved on microfilm containing over 1,100 pieces of correspondence signed by Adam Smith in his capacity as as commissioner of Scottish customs. I will thus be doing a deep dive into Smith’s work as a customs official during the last 12 years of his life. In the meantime, I will continue the painstaking process of transcribing the contents of this archive.

WORKS CITED

Gary M. Anderson, William F. Shughart II, and Robert D. Tollison, “Adam Smith in the Customhouse”, Journal of Political Economy, Vol. 93, No. 4 (1985), pp. 740-759.

Ernest Campbell Mossner and Ian Simpson Ross (editors). The Correspondence of Adam Smith. Indianapolis: Liberty Fund (1987).

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