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.