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Tobias Smollett’s medical training in the Boerhaavian tradition helped shape his contributions to debates on luxury, British foreign policy, and public economics. He also invested his medical philosophy with a vast range of political import. This article draws on recent scholarship to outline some of the ways in which medical thought informed the political sensibilities of those writing before Smollett, from Gerard de Malynes and Edward Misselden to William Petty and François Quesnay. Reading Smollett’s novels vis-à-vis his medical and historical works, I analyze the ways in which Smollett deployed his medical philosophy to naturalize his reactionary agenda on issues from Anglo-Scottish fiscal policy to the Seven Years’ War. Attending to Smollett’s revision of the body politic metaphor can help resolve extant scholarly debates concerning Smollett’s axiological orientation.