Heather Beatty's study of nerve doctors and their patients admirably fills some significant gaps in our knowledge about late eighteenth-century British culture and the medical profession. Pointing out that previous investigations of the topic have tended to rely on evidence from literary texts and private writings of the period's celebrities, Beatty presents a wealth of new information and perspectives drawn from less well-known medical publications and, more important, the private correspondence of the period's physicians.

Beatty's argument offers important corrections and refinements of conventional views about nervous diseases in the eighteenth century. Laying the groundwork for her argument, Beatty notes in chapter 1 that physicians for centuries lamented the difficulties of precisely defining and successfully treating nervous diseases; these difficulties in turn created skepticism about nervous patients and their doctors, hence the prevailing attitude that people complaining of bad nerves were self-absorbed hypochondriacs and the physicians who treated them were self-promoting quacks. Beatty then demonstrates in chapter 2 that nerve doctors were not a homogeneous group; yes, they included the quacks frequently satirized in the literature of the period, but they also included serious, ethical medical professionals and respectable practitioners. Chapter 3 then addresses the stereotypes about patients. Quoting evidence from consultation letters between physicians and patients, correspondence between nationally recognized medical professors such as William Cullen and local physicians seeking the advice of those more celebrated nerve doctors, and academic treatises aimed at medical professionals rather than the reading public, Beatty points out that contrary to the impressions created by portraits in novels and periodicals, nervous disorders were not merely fashionable affectations of the social elite to whom mercenary doctors pandered. Instead, these diseases, sources of real suffering for the poor and rich alike, were taken seriously by well-trained, well-intentioned physicians acting on the best evidence and theories available to them. In chapter 4, Beatty demonstrates patients' willingness to undergo rigorous regimens and ingest noxious concoctions, further evidence from the correspondence that those patients and their physicians took nervous diseases seriously. Chapter 5 focuses on the plausible but perhaps overstated claim that attitudes about nervous diseases shifted “radically” toward the end of the century (141). Undoubtedly, Beatty is right to argue that in the final decades of the eighteenth century, both medical and popular writings leaned more toward condemnation of nervous patients' self-indulgence and lack of fortitude than toward praise for the intellectual and emotional refinement figured by delicate nerves, but one can also see such criticisms of luxury and indolence in earlier writings by physicians such as Thomas Sydenham and George Cheyne. Perhaps it would be more accurate to say that ambivalence about nervous disorders existed from the late seventeenth century onward, though there may have been increasing anxiety in the late eighteenth century because—as Beatty points out—writers feared two consequences of the alleged spread of nervous diseases: on the one hand, the growing incidence of nervous diseases among the laboring poor threatened social distinctions considered necessary to the orderly functioning of society, and on the other, an enervated upper class would be too weak to stem the tide of violence threatened by the French Revolution and Napoleon.

The bibliography and endnotes demonstrate Beatty's extensive reading and archival research, create a useful context for her argument, and provide ample leads for readers who wish to delve further into the topic. The reader is offered a comprehensive list of secondary sources, as well as important manuscript and printed primary sources from the period, and Beatty regularly acknowledges significant work already done in this area, especially publications by Roy Porter, G. S. Rousseau, and Guenter B. Risse.

Beatty is careful to help readers make connections from beginning to end. The introduction lays out the topic and main points of each of the five chapters, and each chapter ends with a summary of its main points and a preview of the next chapter. The epilogue begins with a review of the main lines of Beatty's argument and concludes with a glance at the continuing presence of nervous disorders in medical texts and the popular consciousness in the nineteenth and early twentieth centuries. Particularly interesting is her point that later American physicians claimed “neurasthenia” to be a new, distinctively American affliction, though its symptoms mirrored those described by late eighteenth-century British nerve doctors. Perhaps Beatty is a bit too careful to help readers navigate her argument, since her approach creates repetition that some readers might find unnecessary, but no reader will finish the book feeling uncertain about the main points of Beatty's argument, and it is an important argument for historians and literary critics interested in the reality behind the popular representations of nervous disorders in late eighteenth-century Britain.

Beatty's book opens up new ways to think about the medical and cultural significance of nervousness in late eighteenth-century Britain. Her comments on the moralizing tones of nerve doctors' prescriptions point to important connections between the rise of modern medicine and the decline of traditional religious beliefs. Her emphasis on the disparity between writers' claims about the rising epidemic of nervous disease and evidence to the contrary (drawn from hospital records) gives the sense that the tendency to embrace media constructs as reality is not a particularly recent phenomenon. Finally, Beatty's emphasis on the reciprocal relationship between medicine and culture—medical theories and judgments of nervous disease both shaping and being shaped by cultural attitudes—is not new to students of the history and literature of eighteenth-century Britain, but it is a useful reminder that we should be wary of accepting simple binary oppositions involving causes and effects, signifieds and signifiers, or reality and its representations.