prior probability

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 paper, by contrast, will focuses 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).

1. The Public Database of World Predictions (hat tip: Alex Tabarrok)
2. A computational framework for evaluating an edge-integrated, multi-ramp construction model of the Great Pyramid of Giza (via Nature)
3. AI extinction resignation sparks false-flag conspiracy claims (via The Telegraph)
4. Game Theory (Open Access textbook with 165 solved exercises; via arXiv)
5. Posner v. Tullock: Diverging Paths in the Economic Analysis of the Law (via RHETM)
6. The Kid Who Could Count to Ten (Excerpt from 1968 Soviet animated film; via Twitter)

Check out this post by ‘Air Genius’ Gary Leff: “Terrorists Attacked Our Freedoms on 9/11–Then Washington Spent 25 Years Taking More of Them Away“. Today, air-travel passengers in the U.S. are less safe (see here, for example) AND less free than ever before. PS: Call me crazy, but teetotalers and war-mongers George W. Bush (Iraq) and Donald J. Trump (Iran) should be in jail right now for leading us into two protracted wars under false pretenses.

My most recent paper “Adam Smith in the City of Light” (with Alain Alcouffe) was recently published in volume 15 of the Adam Smith Review. (Here is a link to an ungated preprint of my paper.)

One (“The Social Reckoning“) is about Mark Zuckerberg’s response to a Wall Street Journal investigative report known as the Facebook files; the other (“You Can See Everything“) is about disgraced Theranos founder and convicted felon Elizabeth Holmes. The theatrical release dates of these productions are 9 and 16 October; teasers below:

PS: “Musk” does not make my short-list as that movie is almost four hours long!