James eventually departs naval service to become a medical student, accompanied by Gummer, who by now has become his manservant. His studies over, he searches out Munro, who has settled in Bath with a young pretty wife. James moves in with the married couple and proceeds to establish their medical practice as the most sought in the city. The surgeons' wealth expands in accordance with their increasing popularity among the aristocracy. This period of prosperity proves fleeting, however, because Munro's wife Agnes soon falls for James. The extramarital affair drives Munro to suicide, which in turn causes both Agnes and James to be ostracised. With his practice snubbed and his clinic periodically falling prey to vandalism by the city's outraged denizens, James opts to participate in a race among other English doctors to inoculate Empress Catherine of Russia. Against the odds, he fails to win the race, having been waylaid by a snowstorm and abandoned by Gummer. James falls into a stupor and loses his sanity. James is subsequently shipped back from Saint Petersburg and incarcerated in Bedlam, where he is subjected to many beatings. It is during this time that he discovers sensation, feeling both pain and pleasure. Reception Critics praised Miller's evocative prose, thorough research and precise pacing. Sarah Broadhurst in a review for Love Reading stated that the book was a "very skilful, densely written, complicated novel" and stated that it was "challenging and intelligent, it is a rewarding read." Publishers Weekly called the novel "inventive", "steeped with specific details" and "beautifully controlled". In a review for The Independent, Josie Barnard praised the tone of the novel, stating "Ambivalence is one of Miller's strengths. He enfolds the reader in the present tense and wields his writing style as coolly and precisely as a scalpel." and also praised his descriptions of the 18th century, stating that "Miller's evocation of the period is thorough. Many of his sentences speak paragraphs, his paragraph pages. Ingenious Pain is a book that gives visceral pleasure.", calling the novel as a whole "sensational". It was again reviewed by The Independent a year later by Lilian Pizzichini who opined that Millers "understanding of contemporary mores is thorough, the period detail precisely evoked, and his characters come alive with flashes of humour and compassion." Patrick Mcgrath writing for the New York Times was particularly effusive in his praise, calling the novel "peculiar", "colorful" and "complicated";