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.