1. The Narrative of Nervous Bodies in 1800

Thomas Trotter’s A View of the Nervous Temperament

The British physician Thomas Trotter began his literary career in 1777 publishing conventional poetry in Edinburgh Magazine, and he ended it with a collection of verse in 1829.^[1] But by far most of his writing was on medical subjects. He received his M.D. at the University of Edinburgh in 1788, and from 1794–1802 he served as one of four doctors to the British Navy. Admiral Howe named him physician to the Channel Fleet, a particularly important appointment because it gave Trotter full responsibility for health conditions aboard forty warships and supporting boats during the height of the naval war with Revolutionary France. Howe was impressed by the obscure physician’s first book, Observations on the Scurvy (1786), written before he entered medical school. Trotter went on to write a second book on the topic and another on naval medicine in addition to writing on health conditions in coal mines. While a student at Edinburgh, he had written his M.D. thesis on alcoholism and, in 1804, published the first medical text to categorize drinking as a medical condition rather than a moral failing, An Essay on Drunkenness.^[2]

As a naval physician, Trotter observed a direct relationship between the diseases of sailors and the environmental conditions aboard ship. Shortly after his retirement to private practice in Newcastle, he extended the concept of environmental causality to write about the broader English social environment and its relationship to nervous conditions in A View of the Nervous Temperament (1807).^[3] This text stands out in its time as one of the few full-length treatments of that characteristically late Georgian condition, excess sensibility, which Trotter calls the nervous temperament.^[4] The medical ideas he proposes on the subject are not, themselves, so much original or unique as they are exemplary and influential; his study pulls together many different strands of Georgian thinking about the nervous patient and rearticulates them in images that would persist throughout the nineteenth century. The Nervous Temperament also sold well, going through three editions in Britain and becoming the first book on mental medicine ever printed in the United States. Today, medical historians view The Nervous Temperament as the culmination of a series of popular books on nervous disorders by medical writers.^[5]

Trotter, echoing many of his contemporaries, warns that nervous conditions are so widespread in England that they pose a threat to the nation’s commercial greatness and independence. The epidemic, “if not restrained soon, must inevitably sap our physical strength of constitution; make us an easy conquest to our invaders; and ultimately convert us into a nation of slaves and ideots” (NT, xi). Despite their ubiquity, these disorders are notoriously difficult for doctors to read. Hysteria is defined as a protean condition, one that has no reliable signs of its own. As Trotter notes, the symptoms “vary in every constitution” (NT, xv), and so the best he can offer is an impressionistic description of his own, gleaned from practical experience. He calls it a “cursory” list and limits it to only five symptoms, the most consistent indicators of an inconsistent disease. The symptoms of the nervous body are:

An inaptitude to muscular action, or some pain in exerting it; an irksomeness, or dislike to attend to business and the common affairs of life; a selfish desire of engrossing the sympathy and attention of others to the narration of their own sufferings; with fickleness and insteadiness of temper, even to irrascibility; and accompanied more or less with dyspeptic symptoms.

Each of these five symptoms deserves comment, but the one at the center of the list stands apart. For although Trotter otherwise refers to physical sensations, his claim that nervous people are forever demanding “the sympathy and attention of others to the narration of their own sufferings” describes an act of speech. As an act, it differs qualitatively from the other symptoms. An “inaptitude” to action, or a “dislike” for it, indicate constrained or inhibited acts, whereas narration is not only uninhibited but actually in need of constraint. A nervous condition impedes most actions, but it enables the act of speech. The type of speech it generates is remarkable, too, in its specificity. Trotter describes not just any narration but one with an identifiable form, a specific content, and a distinct rhetorical function.

This symptom is far from being an eccentric element in Trotter’s list. Indeed, the idea that nervous disorders can cause one to talk excessively about her or his bodily condition persists today. Such people are still called “hypochondriacs,” the term used for male hysteria in the eighteenth century.^[6] But whereas hypochondria, like all nervous disorders, originally had an endless parade of symptoms, only this particular narrative act has survived to become the primary meaning of the term in current usage.^[7] This observation, first, suggests that this narrative act has had a lengthy and intimate connection with nervous conditions. Second, it allows one to glimpse the centrality of this narrative act in the construction of nervous disorders and thus to see that its appearance within Trotter’s list, far from being idiosyncratic, is a foregone conclusion. It is, to him, so much a matter of common sense that it occurs within his most “cursory” thoughts on what most likely indicates a nervous condition.

Hysteria in Lacanian psychoanalytic theory today is more generally associated with aphasia than with speech and often privileged as an index of the imaginary, which exists outside the symbolic system of language.^[8] But in confronting the physiological premises for pre-Freudian ideas about hysteria, the cultural logic they embody, and the boundaries for the fluid implications that follow from them, strange bodies come into view. The association of hysteria with a compulsion to speak is one of the most foreign, as it is the point on which hysteria in 1800 differs most dramatically from what is meant by hysteria in psychoanalytic discourse.^[9] Yet within the assumptions about nerves as a mechanical entity, this association is unavoidable. As I will argue here, narrative became a central sign of nervous disorder because the nervous body had a narrative structure, and so there was an intrinsic link between nerves and narrative. But to understand why the nervous body was associated with narrative, we need first to understand what that body was like in 1800 and what kind of narrative it contained within it.^[10]

Trotter derives his ideas about the structure of nerves from two founding figures in British neurology, the Scottish physicians William Cullen (1710–1790) and Robert Whytt (1714–1768). In his Observations on the Nature, Causes, and Cure of Those Disorders which Are Commonly Called Nervous, Hypochondriac, or Hysteric (1764), Whytt argues that hysterical maladies are due to the “delicacy and sensibility of the whole nervous system” rather than an imbalance of bodily humours.^[11] Cullen, one of Trotter’s teachers at Edinburgh University, invented the term “neuroses,” defining them as “all those preternatural affections of sense or motion.”^[12] Thus, a neurosis was originally any disturbance in either of the nervous fibers’ two basic functions, the communication of physical sensations to the brain or of the brain’s motor impulses to the body. Physicians of the eighteenth century were uncertain how the fibers actually conveyed these messages, whether through an ethereal fluid that flowed through the nervous tubes or through an exquisite vibration of the fibers. But they took a functional approach to the problem, inferring the presence of a vis nervosa from observations. Whytt thus notes, “But altho’ the minute structure of the nerves, the nature of their fluid, and those conditions on which depend their powers of feeling…lie much beyond our reach; yet we know certainly, that the nerves are endued with feeling…and [I] have thought it better to stop short here, than to amuse myself or others with subtile speculations concerning matters that are involved in the greatest obscurity” (Whytt, Works, n.p. [Preface to Observations, p. 2]). Trotter also draws on an established tradition of medical writing that associated the rise of nervous conditions with the rise of civilization. His greatest indebtedness is to George Cheyne (1671–1743), Samuel Richardson’s physician.^[13] In his popular The English Malady (1733), Cheyne argues that two-thirds of the English aristocracy have fallen prey to a host of nervous conditions, variously called spleen, vapours, lowness of spirits, hysteria, or hypochondria.^[14] In his meliorist view, however, the English malady is a sign not of failure in the character of the English aristocracy but of England’s singular economic success. Too many luxuries, spicy foods, sensual pleasures, and indulgent excesses have degraded the delicate nervous constitution of the upper class. “Nervous Disorders,” he insists, “are the Diseases of the Wealthy” (English Malady, 158). Laborers, in his view, lack the physical fineness in their nervous fibers required to develop nervous disorders: “I seldom ever observed a heavy, dull, earthy, clod-pated Clown, much troubled with nervous Disorders, or at least, not to any eminent Degree; and I scarce believe the thing possible, from the animal oeconomy and the present Laws of Nature” (English Malady, 180, original emphasis). Rather than melancholy, the poor suffer from simple laziness.^[15] Nervous conditions thus became an index of wealth and of the breeding that produced delicate sensibility. It was because of the class-specificity of the disease, as articulated by Cheyne, that nerves became fashionable during the eighteenth century as a sign of social stature or of the acute sensibility associated with the disorder.^[16]

The Romantic-era epidemic that Trotter describes is thus an aristocratic disease whose class boundaries have been redrawn.^[17] In Cheyne’s era nerves were “little known among the inferior orders,” Trotter notes, but in 1800 they “are by no means limited to the rich” (NT, xvii). Indeed, Britain’s consumption of luxuries has grown to such an extent that now “nervous disorders…may be justly reckoned two thirds of the whole, with which civilized society is afflicted” (NT, xvii, original emphasis).^[18] Because of the sedentary nature of their occupations, bankers, vendors, and investors from the rising commercial and bureaucratic branches of the middle class now “make up the bulk of hypochondriacs in this country” (NT, 43). Their daughters and wives are victimized by misguided social conventions that keep them confined indoors reading passion-inflaming novels. Because of the widespread availability of tea, tobacco, opium, and especially alcohol, even the working class has become susceptible.^[19] But Trotter’s concern with laborers is limited; he holds that their physical activity keeps their bodies strong enough to resist the worst effects of debauch. Conditions endemic to poverty, such as starvation and exhaustion, pose a danger, he acknowledges, but one that does not compare in significance to the infinitely more dangerous diseases of wealth: “[A]ll the diseases which are caused by hard labour, poverty, and want, are much easier of cure, than those which arise from indolence, luxury, and debauch. A constitution that has been weakened by subtraction of nourishment, may soon have its energies restored by suitable regimen, diet, and medicine: but the frame that has been wasted of its vital powers by excessive stimuli and debilitating pleasures, has seldom or never been brought to its former strength” (NT, 47–48). At the opposite extreme from poverty, we are told, “to be born a prince, is to be the most unfortunate of mankind,” for of all individuals, he most lacks the hardiness to endure the dangers of excess and simultaneously is “exposed to greater temptations” than others (NT, 221). Like Cheyne, Trotter remains concerned with the diseases of wealth. His interest in the working class is always contingent on the danger it poses to the health of his middle- and upper-class audience. Thus, he warns readers to beware the condition of a wet nurse, who might communicate her debility to their delicate children.^[20]

This expansion of the epidemic across class lines necessitated a revision in the traditional method of diagnosing nervous diseases. Interpreting psychological disorders had always presented a major difficulty for the physician because of the indefiniteness of their signs. Robert Burton, in 1621, writes, “The tower of Babel never yielded such confusion of tongues, as the chaos of melancholy doth variety of symptoms.”^[21] A century later, Whytt is still able to observe that the label of nervous disorders, “having been commonly given to many symptoms seemingly different, and very obscure in their nature, has often made it to be said, that physicians have bestowed the character of nervous, on all those disorders whose nature and causes they were ignorant of” (Whytt, Works, n.p. [Preface to Observations, 1]). Whytt explains this confusion by contending that nervous diseases are by definition imitative of other diseases. As he conceives it, the nervous system touches all the organs of the body, so any disruption of the nerves affects the performance of one or more of the bodily organs. A nervous disorder might impair the function of the intestines and present itself to the outside observer as dyspepsia or constipation. Or it might appear in the lungs as congestion, in the heart as an elevated pulse, as typhus, or as delirium. Nervous disorders “imitate the symptoms of almost all other diseases,” writes Whytt; “the shapes of Proteus, or the colours of the chamaeleon, are not more numerous and inconstant” (Works, 530). Trotter agrees: “In the body we observe symptoms, that counterfeit every other disease” (NT, 289). Thus the “migratory power which these affections possess, of traversing every part of the body, is the inscrutable idiosyncracy of the NERVOUS TEMPERAMENT (the difficulty, perhaps the impossibility, of fixing a certain criterion by which nervous disorders may be distinguished from all others” (Works, 528).

Like his predecessors, Trotter uses the concept of predisposition to tame the protean shape of nervous disorders. As he notes, the irregularity of their symptoms must lead the investigator to look elsewhere: “A methodical history of these diseases, at least a narrative of the symptoms as they appear in succession, is almost impossible. They assume such variety in form and manner in different persons, that we look in vain for regular order. The only thing certain and peculiar in their character, is predisposition” (NT, 166). This prior susceptibility that constitutes the nervous temperament, not the manifest disease itself, is the subject of Trotter’s book. This temperament is an invisible first stage in a two-stage disease model. In the first stage, a hidden temperament is first formed and creates a predisposition to nervous disorders. In the second stage, an actual disorder, such as hysteria or hypochondria, is manifested. The temperament is itself created by exposure to the same kinds of events that, when continued, will later aggravate it into a manifest disorder; the danger lies in repeated exposure to a broad class of causes rather than to a single catastrophic event. As Trotter notes, “Many of these causes, of both the mental and corporeal class, act for a length of time before they bring forth actual disease; but this mode of operation would seem to happen only where there was no predisposition. They may therefore be said first to create predisposition, and when this is sufficiently done, a train of symptoms appears which constitutes real disease” (NT, 196–97).

This hidden temperament also can be inherited. When a mother or father is in the second stage and actively suffering from a nervous disorder, the acquired temperament of the parent will be inscribed on the body of the child, who is born with an inherited nervous temperament and so is predisposed to the protean host of nervous disorders. It is in this manner that the nervous temperament has become, by 1800, an integral part of the British “constitution,” according to Trotter. This inherited condition resembles Cheyne’s theory of blue-blood aristocratic sensibility, but it is more closely related to the acquired condition. It extends into the next generation what was acquired in the first. And so the middle-class nervous temperament always originates in social factors rather than in some “naturally” predisposing condition in the body, such as the innate delicacy of the aristocracy. But by allowing for the function of inheritance within the structure of the temperament, Trotter is able to extend the class range of the condition yet retain its traditionally aristocratic characteristics. The specific predisposing factors, however, can no longer be restricted to the narrow range of experiences and inherited sensibilities unique to an idle aristocracy. Trotter’s explanation of the specific conditions within the middle class—primarily their sedentary occupations and confinement indoors—that eventually create the predisposition is the central object, and the central accomplishment, of A View of the Nervous Temperament.

Although the predisposition is hidden, those conditions that create it are readily accessible to the physician. Thus, Trotter insists on a type of social realism in the practice of medicine: “Early habits, pursuits in life, modes of living, moral character, preceding diseases, amusements, professions, seasons, climate, &c. must all be taken into the account” (NT, 208). Through such a broad knowledge of the individual’s circumstances and personal and family history, the doctor can gauge the likelihood that the patient’s complaint represents a given disease or its nervous counterfeit. The division of labor in modern society, he argues, generates unique body types; each occupation produces “a different species of being” (NT, 31). Because bodies literally embody their social role, the first step in the proper interpretation of the body is to place it in its social context to establish the body type:

The physician of a cultivated understanding, who knows how to appreciate the resources of his art…would not confound the complaint of the slim soft-fibred man-milliner, with that of the firm and brawny ploughman; nor would he mistake the nervous cramp of the delicate lady, for the inflammatory pleurisy of a nut-brown country girl. If both expressed pain on the same spot or organ, he would, in consideration of original temperament, along with the concourse of symptoms, resolve into first principles what belonged to each constitution; and thus analyze the morbid phenomena, so as to give a degree of certainty to his indications of cure, and a decision to his practice, that would insure success, if the disease was at all remediable.

Because nervous disorders imitate all others, bodies must be resolved into their different constitutions as a means of establishing whether symptoms represent established disorders or their nervous doubles. Thus, identical signs in two different bodies do not have the same meaning; the sign of nervous disorder in the urban “lady” means a simple cold in the rustic “girl,” whose active life in the open air rules out the presence of a nervous disease. The same rationale marks his distinction between the plowman and the milliner. The ambiguity of nervous symptoms is thus resolved by interpreting the individual physical body as a product of its role in society, using information on occupation and parentage as the primary criterion in determining the presence of a nervous predisposition.

Trotter represents the effects of the nervous temperament in his different images of the sensible and insensible body. Both occur under various guises and in changed circumstances, but throughout his discussion they take two paradigmatic forms, each of which needs to be considered separately. The first is the urban female, “where the sensibility trembles at every breath” (NT, 36).

The female body in modern society has become, as Trotter terms it, “a subject for medical disquisition” (NT, 49). Hysteria began as a disease-construct specific to women, and its name was taken from the Greek word for uterus, “hystera.” But in the eighteenth century, when the body became redefined in terms of its nervous system rather than Galenic humors, hysteria became one among many recognized nervous disorders and less frequently was viewed as intrinsically connected to the uterus.^[22] Nonetheless, the new nervous medicine continued to associate the female body with a greater susceptibility to nervous disorders by ascribing to it a nervous system more impressionable than that of the male body. Whytt explains, in his Observations, that in women “the nervous system is generally more movable than in men,” and it is because of this hyperacuity that women “are more subject to nervous complaints, and have them in a higher degree” (Works, 540). Trotter inherits this assumption and makes it conform to his theory of predisposition. In terms of the two-stage model of the temperament, the female body, because of its “greater delicacy and sensibility than [that of] the male” (NT, 49), is naturally in the first stage and is never free of the nervous temperament. Male bodies, by contrast, are naturally born without the temperament. “Hence the diseases of which we now treat, are in a manner the inheritance of the fair sex” (NT, 51–52), the bodies of which are always predisposed to the protean horde of nervous disorders. When to its intrinsic sensibility is superadded the “preposterous customs of fashionable life” (NT,[cf1] 52), the female body rapidly succumbs to the multiform disabilities of the nerves: “[T]he modern system of education, for the fair sex, has been to refine on this tenderness of frame, and to induce a debility of body, from the cradle upwards” (NT, 49). In consequence, he laments, “these diseases, from innate delicacy of frame, fall mostly on the fair sex” (NT, 249). The nervous temperament is thus indivisible from the female body; it forms a constituent part of Trotter’s gender construct.

His attitude toward this female body is two-sided. In his argument against the “modern system of education” for females, he takes the position that women are victimized at an early age by the very practices intended to protect female delicacy from harm. Against enforced inactivity, he argues that the young girl should be allowed to run “with her brother, to partake of his sports, and to exercise herself with equal freedom” (NT, 50). Because of her inherent predisposition, she is even more in need of this exercise than her brother. It is sadly misguided, thus, that “we indulge our boys to yoke their go-carts, and to ride on long rods, while little miss must have her more delicate limbs crampt by sitting the whole day dressing a doll” (NT, 50–51). Yet the female body, though victimized by confinement, is also the contagious source of the nervous epidemic; the nervous mother, in her debility, infects her offspring with a constitutional nervous temperament. Trotter quotes Deuteronomy (38:56) for emphasis:

“The tender and delicate woman among you, which would not venture to set the sole of her foot upon the ground, for delicateness and tenderness, her eye shall be evil towards the husband of her bosom, and towards her son, and towards her daughter.”

No text in scripture, or any other book, ever conveyed a more just censure on the indiscreet conduct of a parent to the offspring. From having injured her own frame by refinements in living, the mother thus sows the seeds of disease in the constitutions of her children: hence a weak body, delicate nerves, and their consequence, a sickly existence, become hereditary.

Instead of being a passive victim of its condition, the female body thus represents the active principle of contagion. More significant than the mere fact of its activity is the way in which it acts. The disease it “sows” in the frame of its children, that “weak body” with its “delicate nerves,” is the essential sensibility that Trotter defines as a constituent part of the female body. So he argues, ultimately, that the female body not only spreads disease but spreads the particular disease of femininity by reproducing its female nerves. In his analysis, it is this specifically female contagion that threatens England.^[23]

The suggestion that the nervous temperament is a female contagion is made explicit in Trotter’s images of contaminated males who are literally being transformed into females. Clerks, merchants, and vendors, for example, are debilitated by the sedentary nature of their employment, and they are infected by the female clients with whom they associate each day. Trotter claims these males thus suffer peculiar “degeneracies in corporeal structure,” which he describes as follows: “These persons are commonly pale and sallow, soft-fibred, and of a slender make. Not a few of them behind the counter, approach in external form towards the female constitution; and they seem to borrow from their fair customers an effeminacy of manners, and a smallness of voice, that sometimes make their sex doubtful” (NT, 41). As nervous disorders imitate other diseases, they also mask themselves in changed social mannerisms. Society itself becomes a form of nervous masquerade as males discard their supposedly natural gender roles, adopting those of the female. Male nervous personalities undergo a similar transformation. In business, such men are “indecisive, unsteady, and impracticable. Their friendships are often puerlish, and their resentments unmanly” (NT, 163). In government, the emotionalism of a nervous legislator can endanger the state: “Every plan he devised, would partake of the mood he happened to be in at the moment” (NT, 161). The common characteristic in these nervous men is a mercurial inconstancy—variously called fickleness, changeability, or a “wavering and capricious principle of action”—which is a hallmark of female gender stereotypes in eighteenth-century thought (NT, 163).^[24]

The uncontaminated male body is absent from Trotter’s representation of the present, and the author describes this opposite of the nervous female paradigm as belonging to the distant past of ancestral Britain’s tribal life. Drawing on Gibbon’s account of Tacitus, Trotter devotes a full chapter to describing the historical transformation of the human body.^[25] The savage tribe’s constant exposure to the elements hardened their bodies and dulled their susceptibility to dangerous sense impressions. This leads Trotter to the conclusion that “insensibility or passive content of mind, are the inheritance of the untutored savage” (NT, 29). This inheritance, because it forms the exact reverse of the sensibility that is “the inheritance of the fair sex,” suggests that Trotter’s primitive world was primarily a masculine one, even as his contemporary world is feminine. Thus, the ancestors had “large limbs and muscular form” (NT, 21). As gender roles in Trotter’s day blur sexual differences toward varieties of feminization, the earlier savage state blurred them toward the male: “It was part of the matrimonial contract,” he writes, “for the wife to share with the husband his labours and dangers; and to be his companion in peace and war” (NT, 22). Trotter’s image of the savage female body is a significantly masculinized one in the gendered terms of Trotter’s day; it is characterized by physical strength, vigor, and stamina as well as stature. In this way he constructs an overall historical narrative that tells the basic story of the decline of the healthy and therefore male body and the rise of the sick and female body.^[26]

These two paradigms of the insensible and sensible body establish a fundamental antagonism between bodily health and the basic capacity for feeling. Trotter claims that the savage’s insensibility was accompanied by a remarkable “health and vigor of body” and total freedom from “bodily disorder” (NT, 20). Thus, he reflects, “if his enjoyments are limited, his cares, his pains, and his diseases are also few” (NT, 29). This absence of enjoyment was not due to any lack of beauty in nature, which Trotter frequently praises. Instead, Trotter’s point is that insensibility dampens the feelings of pleasure as well as pain. This absence of all feeling, both “enjoyments” and “cares,” was the guarantor of the savage’s perennial good health. Thus, health is predicated on an inability to feel. At the opposite extreme, civilized bodies of both sexes quickly develop a feminine sensibility, which, we are told, “disposes alike to more acute pain, as to more exquisite pleasure” (NT, 25). From the earliest age, the child’s body in civilized society is sensitized by a stimulation that makes it alive to all sensual delights: “He is no sooner brought into the world, than he is taught to admire every thing that dazzles, glitters, or makes a noise” (NT, 221). But this same urban body is simultaneously weakened by luxury and its physical confinement, becoming thus both physically weak and sensitive to sensation. Sensibility and illness combine in the civilized body as intimately as insensibility and health combine in the savage. In Trotter’s model of nervous function, then, feeling itself endangers health. To be capable of feeling pleasure is to be unavoidably exposed to the dangers of pain.

By medicalizing sensibility, Trotter sacrifices the positive qualities associated with the ability to perceive sensations at the beginning of the nineteenth century. For although it poses a peril to the body, sensibility is equally a necessity for the individual. The nervous system, as the site at which sensations enter the mind and motor impulses move outward, is also the medium between the individual and the world. Being insensible implies a type of individual isolation, a lack of sympathy for others, and it is this absent capacity by which Trotter defines the savage.^[27] The savage’s nervous system “was fully excited for all the movements of vital energy” (NT, 27). It was not inert; his mechanical sensations were functioning well, as they would have to be for adept hunters and warriors. What remained absent was a theoretically higher level of functioning, the excess of sensation that generates the capability to experience “higher” sentiments or those “elevated” feelings associated with refinement, as well as the despair that forms their unavoidable shadow.^[28] There was no artistry or inventiveness in the savage’s most un-Athenian world, and Trotter consistently regulates any implication in his description that there might have been an aesthetic component to it. There were martial tournaments, for example, but even these dramas “were only kinds of palaestrae for exercising the body so as to enure it to martial fatigues” (NT, 23); they served a purely functional end, rather than including displays of color or artistry. As Foucault has noted, “On one hand, nervous sufferers are the most irritable, that is, have the most sensibility: tenuousness of fiber, delicacy of organism; but they also have an easily impressionable soul, an unquiet heart, too strong a sympathy for what happens around them…. From now on one fell ill from too much feeling; one suffered from an excessive solidarity with all the beings around one.”^[29]

It is precisely because the nervous temperament implies qualities in excess of mechanical sensation that the condition of sensibility embraces at once the body’s greatest triumph and its most abject failure. For, as Trotter acknowledges, although the nervous temperament is the cause of Britain’s degeneration, it is also the seat of sympathetic understanding: “On the other hand, the nervous temperament is often found to be the soil of numerous virtues: the noblest feelings are cherished here. Sensibility to excess marks the constitution; and affliction cannot address it without meeting its sympathy. It is this degree of feeling, that too often makes it the sport and victim of passion. It loves and hates beyond bound. Hence those corroding sorrows, which sometimes overtake the most tender of all attachments, and which ultimately bring the possessor to the grave” (NT, 164). The conflict between what are simultaneously the “noblest feelings” and feelings “beyond bound” is unresolved (and unresolvable) in Trotter’s pristine encapsulation of the paradox of sensibility. Virtue and despair thus join hands in a bodily condition where to feel “tender attachments” is also to suffer under the most “corroding sorrows.” It is this problematic body represented by the nervous female, rather than the absent body of the healthy male, that Trotter faces in the present.

The difference between these two bodies rests on their opposite relationships to narrative. Trotter defines sensibility and its nervous consequences by explaining that “the living body possesses the faculty, if I may so call it, of receiving impressions, and retaining them, even to the hazard of its destruction” (NT, 199). The hazard of nervous disorders is caused by the problem of retained impressions. In Trotter’s nervous physiology, healthy nerves receive and transmit impressions without ill effect, operating as transparent media between the subject and the world. But the nervous body “retains, or records as it may be termed, all the effects of vicious indulgence” (NT, 211). These retained impressions produce a physical record of the past that is “hoarded as it were in the structure of [the body’s] nerves” (NT, 210). Thus, as a physical condition, the nervous temperament consists in a new receptivity to impressions that are incorporated into the fibers of the nerves, taking on a new materiality as they become permanently etched in the body rather than passing through as transient sensations. This process of retention, however, cannot continue indefinitely, for it is limited by the finite capacity of the nerves; eventually they “accumulate the quantum of predisposition, and a nervous fit, or a bilious attack, is the immediate consequence of every new trouble of mind, and of every recent debauch of the body. Thus the habit may become so completely nervous…that the faculties of the soul will be worn out, and fatuity takes place; and the body will be so enervated as to be in a state of constant pain, tremor or convulsion” (NT, 211). The essential quality of the nervous temperament, thus, is that it destroys the body’s assumed ability to resist the ill-effects of impressions. It creates an overly inscribable body, one that is too easily written upon by the stimulus of its day-to-day experience.

These gradually accumulated impressions create a narrative within the nervous body that details its interaction with the larger social order. Within each nervous body lies the story of the social conditions that created it and, having created it, compel it to act out its nervous fit. This narrative is also a history of its own production, a somatic bildungsroman that tells the story of how it came into being, of how this particular body came to have a story to tell. Trotter’s medical text on the genesis of nervous disorders is thus a critical treatise on how and why these nervous narratives originate.

Trotter’s two paradigmatic bodies thus have essentially opposite relationships to this nervous narrative. The nervous female body contains a narrative within the fibers of its nerves. That narrative details the body’s interaction with the social world around it, and so within each nervous body lies the story of the social conditions that created it. The non-nervous male body, certainly, has a history, but it is not pressed into its material structure, waiting to come forth at a moment of crisis. The nervous female body, however, possesses a constitutive relationship to narrative. It has a story to tell, whereas the healthy male body has none. In the medical view, nervous disorders as well as narrative itself are inextricably bound up with the female body and with the feminization of the non-narrative male body. To assert, then, as this medical writer does in his brief list of nervous symptoms, that a particular narrative act is symptomatic of nervous disease is to presuppose the narrative structure of the disease. He is saying that, having acquired the body with a story to tell, the nervous sufferer characteristically tells it.

When this body tells its story, it is going to tell it in a recognizable form, that of “engrossing the sympathy and attention of others to the narration of [its] own suffering.” And, because of its association with the female body, this form is unavoidably gendered female. In this nervous narrative, the speaker pleads for the listener’s sympathy and so will appear blameless or essentially victimized. She narrates her own sufferings, describing in the first person the events in the past that produced her nervous condition. It is a retelling of the narrative in the body; the narrator tells the story of how she acquired the body with a story to tell, of how she came into being as a narrator. This is also a self-canceling narrative, because the narrator’s authority to speak is compromised by the nervous disease that the story reveals. To a trained ear, the form of this narrative immediately identifies the speaker as a medical object, not an authentic speaking subject. It demands treatment, not attention: a house in the country, fresh air, and energetic horse rides are the proper response. If it is heard in the prescribed manner, as a type of hypochondriacal speech, we know that this narrative asks only to be made to disappear, regardless of what it might say. And it will disappear, of its own accord, as the nervous narrator is recuperated to the realm of health and silence. Because she has acquired the body with a story to tell, the nervous narrator is disqualified from telling it.

That authority shifts to the practitioner. His minute attention to the individuality of the nervous body allows him to represent, in the third person, the narrative that has been written on its nerves and produces its disease. From the vantage point of the practitioner, the new nervous body is a body in need of his narration. And his job as a nervous doctor is to tell the story his feminized patient has been disqualified from telling.

Trotter’s brief list of symptoms reflects the new social reality of 1800. Defining as a medical condition a “dislike to attend to business and the common affairs of life,” for example, is a way of naturalizing the new importance the middle class attached to efficiency and routine. Trotter’s nervous temperament is a middle-class disease, as he points out, and his configuration of its symptoms tends to reflect the concerns of his own newly important class by medicalizing behaviors that contradict its values. He also defines the specific conditions that are responsible for the new epidemic within the day-to-day experience of this class. These social conditions have changed since the day of Cheyne and have brought into being this new nervous body. So Trotter’s construction of the epidemic has two separate aspects to it: the naturalizing of middle-class values and a critique of middle-class social reality.

We can see his ideological assumptions at work in his most frequent complaint about modern life, the lack of physical activity caused by sedentary occupations. Nervous diseases “are chiefly the offspring of a life of sloth and inactivity” (NT, 156). Thus he lists as the first of his five nervous symptoms an “inaptitude to muscular action, or some pain in exerting it.” This physical passivity forms an important trope in his litany of conditions contributing to the present, debilitated state of the physical body. Prior to Trotter, inactivity was commonly used to explain the mental maladies of the aristocracy. But because Trotter is concerned with the middle class, his focus on the ill effects of inactivity involves a criticism of middle-class forms of property that do not require productive activity. When Trotter argues that inactivity leads to “the most confirmed habits of nervous affection,” he explains that “[s]uch cases are chiefly to be seen among people enjoying easy fortunes, who had formerly been active, but are now without any of those urgent motives which preserve energy of mind, so conducive to health” (NT, 246). Their former activity indicates that these sufferers are not perennially idle aristocrats but successful entrepreneurs who have found a way to invest safely their ample fortunes. Trotter in fact makes this suggestion explicit, and his comment emphasizes the relationship between the condition of possessing an “easy fortune” and the social effect of commercial investments: “The public funds of this country are one great cause of those torpid habits of living; where the security of property is so compleat, that any care about its safety is needless. A vast capital is by this means unproductive of any thing to the public, but is a source of bad health to its owner. All interprize is thus checked among a large part of the community, who become victims to diseased feelings, and to those kindred glooms which prey on still life” (NT, 246–47).

Trotter formulates a direct causal association between the investment in “public funds,” or government stock, and the sedentary habits that generate the nervous temperament. Once alerted to the implicit criticism of “unproductive” uses of capital within his references to “sedentary” habits, one rapidly perceives that his argument against the dangers of “civilization” is specifically aimed at a credit society’s commercial investments, which make this idleness possible. As we have seen, Trotter reserves his greatest opprobrium—and the greatest degree of effeminization—for “men of business.” In that class he includes “[a]ll those employed in the public offices of government, and in the houses of trading companies and banks” (NT, 43)—that is, those most closely associated with the stock market and capital investment, or more generally the commercial and bureaucratic branches of the middle class. This segment of the middle class, in particular, has inherited the mantle of the English malady from the young lords of George Cheyne’s day. Instead of aristocrats, Trotter tells us, in “this age, when riches are so generally diffused,” men of business now “make up the bulk of hypochondriacs in this country” (NT, 43). In the middle class, the figure of the sedentary, successful man enjoying his “easy fortune” is repeatedly discussed: “When he comes to retire he is of all men the least satisfied; for his easy circumstances become the root of all his evils; and from having no longer any motive for action, he falls a certain prey to low spirits” (NT, 42–43). What matters in the ideological underpinnings of this observation, ultimately, is the social arrangement that makes that “easy retirement” possible for a man whose new independence comes not from land but from successfully invested capital.^[30]

The consequences of such a secure means of wealth on the national character are disastrous. Surveying Britain of 1805 and its response to the imminent danger of French invasion, Trotter describes a nation lost in the delusions of its own hypochondriacal fears. Whereas early Britons repelled invaders with a calm spirit of self-reliance, modern, effeminized Britons instead have “projected the inundation of Essex, and hoarded up the current gold coin, as tokens of being afraid of the French. These alarms are to be considered as so many symptoms of a nervous temperament appearing in our national character” (NT, 147). Given his years of naval experience, Trotter is as certain of the groundlessness of such fears as he is about their source: “[A]t this moment she has a navy capable of fighting the whole fleets of Europe united; yet she trembles at a flotilla of cock-boats. It is that puddle of corruption, the Stock Exchange; that Delphi of Plutus, where stock-brokers pay their vows, and expound prophecies, that has filled the nation with degenerate fears, apprehension, and hypochondriacism” (NT, 147). Thus, Trotter blames the system of public credit, the stock market, and commercial investment generally for the rising disorders that are effeminizing the “national character” through the nervous diathesis.

In a broader sense, the “effeminizing” threat to society posed by commercial exchange lies in its redefinition of relations within that society. Commerce transforms relations between otherwise independent individuals into mutually dependent relationships, and Trotter loathes this transformation. His indictment of “commercial society” draws heavily on a coherent tradition of eighteenth-century political rhetoric, recently elaborated by J.G.A. Pocock.^[31] This oppositional tradition raised an ideal of agrarian independence against the corrupting relations of commercial exchange. It relied on a resurrection of the patriot-citizen ideal of the Greek polis, in which land enables the individual to become an independent, and therefore virtuous, civic actor. This oppositional discourse originated in response to the Financial Revolution of the 1690s, when the government instituted the national debt and financed the country’s political operation through an offering of public stock. Pocock points out that this new system of public credit “transformed the relations between government and citizens, and by implication those between all citizens and all subjects, into relations between debtors and creditors” (Virtue, 110). An elaborate system of patronage, or favoritism in appointments, arose between the government and its creditors, who wielded a new influence in the control of preferments, so that the entire government was seen as operating through a web of mutual dependencies that destroyed self-sufficiency and created instead a nation ruled by corruption.

This commercial creation of dependent relations was not limited to the operation of public stock but included, by association, trade in general. As Pocock notes, “The merchant became involved in the indictment of capitalism, and the credit society became known as the ‘commercial’ society, because it was observed that there was a fairly obvious relation between trade and credit” (Virtue, 110). Commerce transformed isolated and self-reliant societies, such as those of Trotter’s ancestral ideal, into societies that now depended on others for their economic well-being. In Trotter’s idealized past, “when commerce has made no progress,” each localized group was self-reliant because each was isolated from “intercourse with its neighbours” (NT, 25, 143). But commerce between groups erodes their capacity for independent action: “A commercial people merely, can never be an independent nation. They owe to foreigners the consumption of their manufactures; and when these chuse to do without them, or to buy them elsewhere, such a people must become bankrupts in finance” (NT, 150). Buying and selling thus produce mutually dependent relations, and it is this dependency that Trotter views with the greatest alarm, associating it with the effeminization of British society.

Trotter does not offer a coherent scheme of social relations to replace those of the effeminized commercial society. But his remedy implies a retreat from exchange-value to a social order founded on use-value. He advocates a direction away from the stock exchange and back toward rural life. Cheyne had been obligated to defend himself for adopting a similar course, which led to the accusation that he “advis’d People to turn Monks, to run into Desarts, and to live on Roots, Herbs, and wild Fruits; in fine, that I was at Bottom a mere Leveller” (English Malady, ii). Rather than prescribing an actual return to a life of nuts and berries, Trotter generalizes that the “lesson is only so far in point, as it tends to confirm general truths…or to illustrate a precept by showing an example” (NT, 233). Yet the “simplified mode of living” that Trotter recommends as an anodyne for the disease of civilization promises to renew health in the face of contemporary hysteria, and it aims to do so by implicitly reforming society’s property relations, eliminating “unproductive” forms of labor involved solely in commercial exchange and favoring the “productive” labor represented by the farm. Trotter’s solution to the nervous temperament consists of a modified return to the agrarian life of the past, with an emphasis on “simplicity of living and manners” (NT, xi). Thus, his specific remedies always entail altered economic relations. Ideally, the businessman or artisan and his family must move “from the city to the village,” where they will begin anew as gentleman farmers (NT, 245). He endorses a new society to promote a scheme “to regenerate the physical strength of the country, by recalling mankind to agricultural life…. No man who possesses the smallest spark of love for his country, but must with full success to the undertaking” (NT, 149–50). Where such a removal is not possible, he recommends intermediate steps, such as daily rides into the country “beyond the effluvium of smoke and mud” and extended vacations there (NT, 248). But where an agrarian way of life is impossible, Trotter is pessimistic; for “the town-bred female”—more in need of an energetic country life than the male, yet more restricted in her options—he advises, “[i]f she cannot look to a country residence, her situation must be pitiable” (NT, 249). Against the commercial dependencies symbolized by the rise of the city, he thus prescribes a return to the limited intercourse of agrarian independence.

This dichotomy between the healthy virtue of agrarian independence and the avaricious patronage of urban politics permeates Trotter’s text. The healthy masculine savage is also a paradigm for the modern agrarian individual, rendered self-sufficient (and thus masculine) by virtue of his land. The modern female, we have already seen, is closely allied to the urban man of business. His contamination by her femininity is a dramatization of the dependent relations in which he is placed by the process of commercial exchange and by his dependency on the good will of the buyers and sellers with whom he deals.

Trotter’s political rhetoric was a conventional part of the ongoing debate between competing elements of the middle class. The standard commercial response to claims about the corrupting effects of commerce on social virtue, first articulated by writers such as Addison and Defoe, was to transform commerce into the primary source of social good.^[32] According to this point of view, commercial intercourse destroys the isolation of societies by bringing them into closer communication with one another. Rather than creating servile dependency, commerce leads to an increased understanding between individuals and between societies, thus enlarging the scope of social sympathy. It progressively expands a society’s knowledge of the world. “Refinement” and “manners,” far from the transient “fashionability” Trotter complains about, represent an accumulation of social wisdom that distinguishes civilized people from their ancestors, who are conceived as unsocialized barbarians rather than as the noble savages of Trotter’s mythology. Thus, when Trotter claims that nervous diseases “receive a stronger tincture from the manners of the age, than any others” or that they “increase in proportion to the deviation from simplicity of living,” his rejection of “manners” and endorsement of “simplicity” is a criticism aimed at the heart of the ideology of eighteenth-century commerce.

Sensibility plays a central role in this commercial ideal as a product of the progressive refinement of the individual’s capacity to feel. It represents the remaking of the individual personality by the accumulated improvements in social organization made possible by the rise of commerce. Thus, Trotter’s medicalization of sensibility as the nervous temperament at its most fundamental level makes pathological what are otherwise seen as the beneficial effects of marketplace dynamics on social development. Sensibility is indivisible from coffee, opium, tobacco, tea, spice, and other “luxuries,” which both cause nervous disorders and function as metonyms for commercial trade and commercial social values. It is for this reason, Trotter claims, that the “produce” of Britain’s trade “only tends to weaken her manly character, and overwhelm her with nervous infirmities” (NT, 144).

Because Trotter was himself a middle-class professional, his critique of middle-class values cannot be disinterested. The medical profession in 1800 was still emerging from the patronage system of eighteenth-century medicine, in which doctors were servile dependents of their aristocratic patients. Though major professional reform would not be instituted until the 1830s, Trotter was one of the earlier voices to argue for it; he wanted to end medicine’s dependence on wealthy clients and to establish an independent social basis for medicine’s professional authority.

Few biographical details are available, and most of those are supplied only by his own writing, but it appears that Trotter himself was victimized by the system of government patronage at the time he was writing The Nervous Temperament.^[33] His appointment as physician to the Channel Fleet by Admiral Howe in 1794 brought the obscure young doctor into a demanding, high-profile position, and his efforts were noticed. In 1802, at the age of forty-two, he retired early after injuring himself climbing aboard ship. Despite his accomplishments, testimonials on his behalf, and the service-related nature of his disability, his pension was only half what his colleagues received, the minimum of £200 per year. Trotter was convinced that the parsimonious award, inadequate to live on, was the result of professional jealousy by the other naval physicians and their patrons, who resented his success and his evidently high reputation (Sea Weeds, xix). Nor was this an unwarranted assumption. His Edinburgh degree placed him outside the institutional structure of power in the British medical profession, as virtually all political authority within the Royal College of Physicians was held and jealously guarded by graduates of Oxford or Cambridge, despite the fact that medical education at Edinburgh was clearly superior to that of Oxbridge.^[34] Because he was an outsider, Trotter appears to have made serious enemies by gaining Howe’s appointment and improving his reputation, and Howe’s death in 1802 left Trotter vulnerable.^[35] It is certain that Trotter was excluded from the increase in pensions awarded to ship’s doctors shortly after his retirement and that his appeals for a redress of his grievance were first ignored and then dismissed in 1805 and again in 1808. Thus, his remarks on patronage and nervous disorders in The Nervous Temperament, written in 1805, have a timely autobiographical resonance: “Some of the severest instances of these diseases, which have come under my care, were in officers: men endued with acute sensibility of mind, of fine parts, and with high notions of honour. They had been long tantalized by promises of promotion, and lived to see unworthy favourites put over their heads. Similar cases are too often met with among other conditions of life; where worth, virtue, and talents, must give place to wealth, servility, and intrigue” (NT, 88–89).

Having been on the losing end of the system of political patronage in medicine, Trotter is uncompromising in describing its adverse effects on the profession as a whole.^[36] He establishes a melodramatic rivalry between the physician of a “manly spirit and dignified independence” and his avaricious counterpart, “the gossiping physician” or “wheedling apothecary” (NT, vii, 232). Trotter’s battle with degeneration in the profession is a substantial element of his treatise.^[37] It is the opening subject of the book’s dedication and appears more than fifteen times during the course of his text. Degenerate doctors cater to their patients’ hypochondriacal ailments rather than adopting an independent and medically principled position. Such doctors contribute to the spread of nervous disorders, rather than curing them, by subjecting patients too frequently to courses of physic that weaken their constitutions; opium and mercury, in particular, create a nervous temperament where it does not yet exist. In a world of “the poor, sick, and lame,” Trotter complains, the “physician and apothecary are seen gliding in their chariots, with retinues sometimes not much like men who are conversant with human affliction, and enriched by the luxuries and vices of their fellow mortals” (NT, 145).

His description of degenerate, sycophantic doctors bears a close resemblance to that of the “men of business,” particularly in their exaggerated effeminacy and in the author’s palpable sense of disgust: “A man who carries for ever on his face the sleek simper of artful insignificance; who has a bow and a smile ready for every person that addresses him, will be very apt to accommodate his prescription to a fashionable folly” (NT, 313). As eloquent and dissembling as his business counterparts, the avaricious doctor is a vendor of physic and a dependent on the good opinion of his patron-clients. His engagement in commerce thus leads him away from principled self-reliance and moral virtue.

The primary market for medical care in Trotter’s time was still among the wealthiest part of the population.^[38] For a physician or surgeon to sustain a full-time private practice without resorting to farming on the side or writing books (as Tobias Smollett did), pleasing his querulous and often powerful patients was essential. In the relationship between practitioner and patient, the latter frequently held the balance of power over the former, who was the patient’s social inferior and so was expected to accommodate the treatment to his or her desire for a particular remedy or favorite physic.^[39] Nowhere was the subservient role of the practitioner more evident than in the treatment of nervous disorders, where the clientele was historically drawn from the wealthy and the protean disorder impossible to identify. As Trotter acknowledges, “This branch of medical practice has commonly been reckoned one of the most lucrative; for the subjects of it are generally found among the affluent” (NT, 231). When the only evidence for a nervous complaint is the patient’s testimony of some discomfort, a difficulty sleeping, anxiousness, or lethargy, the medical attendant is wholly dependent on the patient’s report to make the diagnosis.

Trotter’s placement of that same patient narrative at the center of his list of nervous symptoms is thus part of a professional strategy to minimize the patient’s authority within the new doctor/patient relationship, and his definition of the doctor as narrator is the necessary counterpart to that goal. His construction of middle-class hysteria is part of the ongoing campaign to professionalize medicine. He writes that the purpose of his book is “to familiarize the junior members of the profession with the genius of nervous disorders” (NT, x). In this process of educating members of the profession, he aims to alter the professional relationship between patient and doctor by contributing to an elite basis of specialized knowledge on which the practitioner can claim an independent basis of authority.^[40] He would have physicians be as independent as any idealized landholder, beholden to none and none to him, and therefore able to act with perfect, uncompromised virtue. He thus seeks to rescue the physician from the cesspool of patronage and from the influence of his feminized patients and so establish him as an independent civic actor in the model of the agrarian ideal of virtue.

But this rhetoric of dependence and independence directly conflicts with the larger goal of professional reform. For professional independence depends on a base of specialized knowledge, not land. Establishing independence for the physician means accumulating knowledge and progressively refining techniques, processes that presume a network of social intercourse. Trotter draws on the ideas of his predecessors Cheyne, Whytt, and Cullen; he quotes from Tacitus, Horace, Virgil, the Bible, Shakespeare, and Goldsmith; and he cites contemporary medical and historical texts, borrowing their ideas in a perfect example of how commerce promotes the accumulation of knowledge and progressively refines social wisdom.

The social function of Trotter’s book is to establish a knowledge base for professional independence. But by thus participating in the exchange of ideas and the process of refinement that make up the central defense of the commercial ideology, Trotter symbolically elevates commerce into a necessary virtue. Even as he attacks commercial values, his attack serves a professional function that endorses the commercial ideal. His protest against the effects of commercial exchange is ultimately a reassertion of commerce’s progressive underpinnings. As the voice of the new medical professional, Trotter relies on the ideology of commerce to supply him with the authority to criticize the diseases of commerce.

Indeed, the nervous doctor does more than just rely, in an abstract or formal sense, on the virtues of commerce. He makes its offspring, sensibility, the central element of medical work. The physical body, he explains, is a site of mystery and infinite subtlety. Its material truth can never be fully known “without overstepping the bounds which divine Providence has prescribed for the ingenuity of mankind” (NT, 142). Thus, to be empirically effective, medicine must rely on more ephemeral qualities in the physician, qualities that few possess and that exceed the quantitative sum of rational knowledge: “Nature has endowed so few minds with that superior intelligence of being equal to this task, that we cannot be surprized when told, that medicine is still in many respects ‘a conjectural art’” (NT, 142).^[41] He insists on the need for practitioners to develop a most refined sensitivity to exquisitely subtle sense perceptions in order, for example, to judge the internal condition by signs in the patient’s face: “Persons accustomed to study the variations of feature in the human countenance, such as physicians, sometimes acquire a wonderful expertness in developing the passions. This physiognomonic experience is of great utility to the practice of medicine: it is the gift of genius; and in this respect, the physician like the poet, may be said to be, ‘nascitur non fit’ (NT, 81–82). This “wonderful expertness,” this “gift of genius,” is the essential quality of the physician, distinguishing between the true artiste and mere mechanical imitators. “The want of this eminent quality of intellect, makes the laborious plodder a dangerous visitor at the sick bed, particularly to the nervous patient: nature refuses to draw her veil aside to a clumsy observer; who, being denied access to her mysteries, is very apt to pervert the purpose of what she discovers” (NT, 82). Wanting to avoid self-incrimination, Trotter refuses to brand this ineffable attribute “sensibility,” yet the two are indistinguishable. Sensibility, thus, is not simply advisable in the physician; it is, in fact, the central ingredient in his interpretive work.

Trotter’s construction of the nervous temperament transforms the work of the physician from what it had been in Cheyne’s day. Cheyne insisted that the presence of a nervous temperament was discernible in immediate bodily signs; abnormally fragile hair suggested weak nervous fibers, for example. He carefully listed the essential physical qualities—skin color, texture, complexion, muscle tone—that could guide the physician in distinguishing a disease from its nervous double, all empirically observable qualities (English Malady, 99–105). Trotter, however, insists that such stable signs are misleading. The physician must see through the deceptive appearances of present signs into their past, and he must see through the surface of signs to a deeper level of hidden significance within the present moment. The epistemological problem posed by the nervous temperament demands the development of uniquely acute observational powers in the doctor. Hence, the epidemic of nervous disorders, which transforms the male body into that of the female, requires that the physician become feminized in order to combat the disease of feminization. It is precisely because of the ubiquity and ambiguity of the nervous temperament that the doctor must rely on the same nervous temperament he seeks to cure in his patient. Thus, Trotter’s construction of the disease makes his own implication within it inevitable. In his inconstant—one might say “fickle” or “capricious”—wavering between the fear and praise of sensibility, Trotter becomes himself an example of the nervous temperament at work, and his text ultimately mimics the very disorder it claims to describe.

Although the simultaneous insistence on the physician’s sensibility and the medicalizing of it as the nervous temperament are in conflict, they nonetheless work hand in hand in advancing the medical profession’s social authority. Trotter’s text claims to be responding to an epidemic of nervous disorders in British social life. It seeks to convince the reader of the existence outside the text of the nervous disorders it describes by organizing particular events and sequences of events, incorporating them into its own model of nervous function and social decay. But by relabeling as “nervous” events that otherwise would not be seen as such, the text creates a new social perception of these events as diseased. That is, A View of the Nervous Temperament argues for a “re-viewing” of the world. Where effeminate mannerisms in men, for example, were previously seen as a matter of manners and social bearing, among Trotter’s readership they become medicalized as a nervous disorder. The Nervous Temperament is not simply responding to events outside of its text. It is in fact creating, in the minds of its readers and thus in social life, the disease it pretends to react against.

Trotter creates the phenomenon of a nervous epidemic and then uses it to justify medicine’s existence as an independent profession. The epidemic creates a new social role for the physician; society now needs his “expertise” to rid it of the disorder he has “discovered” in its midst. And so Trotter’s professional project cannot be restricted to establishing a new mode of treatment for disease, which then becomes the source of professional authority. It extends to creating the epidemic his new treatment will remedy.

In the history of mental medicine, disease constructs are frequently designed to expand the boundaries of professional authority, and in this respect the nervous temperament differs little from Esquirol’s monomania in the first half of the nineteenth century or Charcot’s reworking of hysteria at the century’s end.^[42] However, in Trotter’s case this pattern is further complicated because the physician’s “expertise” is intimately related to the disease he creates. The central ingredient in the physician’s work is the same sensibility, or nervous condition, he seeks to cure in the world. In effect, then, Trotter creates a belief in the nervous temperament as an empirical reality but simultaneously elicits an acknowledgment, through the back door, of the related phenomenon that becomes the essential skill of the physician. The reality of that “wonderful expertness,” which exists somehow in the nebulous sphere of excess knowledge and sensation, cannot well be denied in a world where its shadow looms in every nook and cranny of human behavior as the protean nervous disorder. Thus, there are two distinct but related elements to medicine in Trotter’s text. The first, discussed earlier in its relationship to commerce, is based on the accumulation and exchange of knowledge and its role in the professionalization of medicine. Here the text tries to advance the development of medicine as a science. The second element, which enters on the coattails of science, is its justification of medicine as an art. In the best Romantic tradition, Trotter is “creating the taste by which he is to be enjoyed.”^[43] He does so by creating a need for his expertise as well as a belief in the empirical reality of his own refined sensibility.

Notes