At first, the young man just seemed miserable. Like any student in a strange town, he found it hard to adjust. Basle was one of Switzerland鈥檚 greatest cities. The Rhine flowed through its heart. It had a stupendous red sandstone cathedral, a famous university and plenty of distractions for a young man. There was nothing wrong with Basle 鈥� except that it wasn鈥檛 Berne. And the young man came from Berne. Today he could hop on a train and be home in just over an hour. But in the second half of the 17th century, the journey was long and arduous.
The student鈥檚 health deteriorated. He became anxious and agitated. He suffered bouts of fever. His breathing grew fast and shallow and his heart raced. His doctors feared the worst. But what was this sickness that had brought the youthful scholar to death鈥檚 door? In 1688, a young Swiss doctor diagnosed the deadly disease. It was, he said, nostalgia.
JOHANNES HOFER had heard of young men and women laid low by a terrible longing for home. His fellow Swiss had a name for it, das Heimweh. So did the French 鈥� who noticed that it afflicted young Swiss soldiers serving as mercenaries in France: they called it la maladie du pays. These people wanted to go home so badly that if they couldn鈥檛 they died. But homesickness is just a state of mind: it鈥檚 not fatal. So what exactly had they died from?
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Hofer, a medical student at Basle, searched the medical texts. He found no disease that fitted the bill 鈥� yet it clearly existed. So he gave it a name, listed the symptoms, had a stab at the pathology and outlined a course of treatment. 鈥淚 have called it nostalgia (from nostos, return to one鈥檚 native land, and algos, pain or distress),鈥� he wrote in his thesis in 1688. Over the next two centuries, doctors across Europe and America diagnosed thousands of cases of nostalgia.
According to Hofer, what started out as 鈥渁n affliction of the imagination鈥� could quickly progress to a potentially fatal disease. He knew of two cases that proved the disease was real. The first was the boy from Berne. At first, the student merely pined for home, but soon 鈥渉e fell victim to this disease鈥�. He didn鈥檛 eat. He was anxious, agitated and feverish. His symptoms grew worse. 鈥淭he members of the household, suspecting death鈥檚 approach in a short time, had already taken to uttering public prayers for him,鈥� wrote Hofer.
But he didn鈥檛 die, although it wasn鈥檛 the prayers that saved him. An apothecary called to give the student an enema pointed out that he was homesick 鈥� and, dying or not, it would be best to send him home. At the mention of home, the student perked up. When the servants started to pack, his breathing became easier. By the time the travelling party set out, he was much calmer. 鈥淗e was scarcely some few miles from our city, when all the symptoms already abated to such a great extent, they really relaxed altogether, and he was restored to his whole sane self before he entered Berne,鈥� related Hofer.
The second case, he reckoned, clinched his argument. A young countrywoman who had 鈥渟lipped from a high place鈥� was carried unconscious to hospital, her life hanging in the balance. When she came round she found herself surrounded by 鈥渨rangling and querulous old women鈥� 鈥� and immediately developed a bad case of nostalgia. She wouldn鈥檛 eat. She spat out her medicine. She cried repeatedly that she wanted to go home. She grew so weak the hospital could do no more for her and packed her off home 鈥渨here within a few days she got wholly well, entirely without the aid of medicine鈥�.
Hofer concluded that nostalgia was a disease that afflicted mainly young people, especially those forced to leave home and who found it hard to adjust to strange people and customs. It was possible to diagnose an imminent case: the victim 鈥渨andered about sad鈥�, scorned foreign manners and took umbrage at jokes. If they showed 鈥渃ontinued sadness, meditation only of the Fatherland, disturbed sleep, either wakeful or continuous, decrease of strength, hunger, thirst, senses diminished, and cares or even palpitations of the heart, frequent sighs鈥︹�� then the disease had already taken hold.
Hofer even had an explanation for how a disordered imagination could lead to such serious physical illness. All that yearning disrupted the normal flow of 鈥渁nimal spirits鈥�, vital fluids that mediated between mind and body. Neuroscience was rudimentary in the 17th century, but Hofer believed there was a region deep in the brain where impressions of home lingered. Constantly thinking of home triggered a surge of animal spirits to this part of the brain. The more you thought of home, the more the spirits flowed, eventually enlarging the channels that supplied that part of the brain.
This had two harmful effects. The animal spirits began to flow along the enlarged channels of their own accord, reinforcing the homesickness by triggering memories of people and places. More dangerously, because there was a finite amount of these vital fluids, other parts of the brain were being starved of the stuff. 鈥淭he spirits busied excessively in the brain cannot flow with sufficient supply and proper vigour through the invisible tubes of the nerves to all parts,鈥� explained Hofer. There were not enough spirits to rouse the appetite or persuade the body to digest food. Once patients stopped eating properly and began to weaken, they were well on the way to full-blown nostalgia.
Hofer had a treatment all worked out. In the early stages a purgative would help. More serious cases might require an emetic and bleeding. Opium and other hypnotic draughts could ease the 鈥減erpetual worries鈥�. But always the patient should be given hope of returning home 鈥� when well enough. If too far gone, the only chance of recovery was to send the patient home at once.
Once Hofer had described the disease, doctors began to diagnose cases of nostalgia everywhere. Soon it was a well established medical condition. One doctor found he could diagnose it by listening to the chest, which had 鈥渁 dull sound on one side鈥�. When patients died, the post mortem sometimes revealed changes in the brain, the heart and lungs and even the intestines.
In 1705, Swiss polymath Johann Jakob Scheuchzer, an expert on mountains and meteorology, came up with a new explanation for the sickness. He blamed it on a change in atmospheric pressure. Young mountain folk raised in the rarefied alpine air could be badly affected if they ventured to lower altitudes. The higher pressure compressed their skin and sent blood to the heart and brain, slowing the circulation. Untreated, this could lead to homesickness, which in turn could develop into nostalgia, claimed Scheuchzer. The pressure on the outside could be countered by increasing the pressure inside the body: drinking young wine was supposed to do the trick. But if it didn鈥檛, then the patient had better go home.
The trouble with this explanation was that not all sufferers were mountain people. Nor were they all Swiss. The Russians, the Irish and the Highland Scots were also susceptible. According to one doctor, the skirl of bagpipes was enough to make some Highlanders ill. One group of people did seem more prone to nostalgia than others 鈥� soldiers, especially young and reluctant recruits. When post-revolutionary France raised its first army to fend off its monarchist neighbours, there was an epidemic of nostalgia among young lads dragged from their quiet country villages.
By the middle of the 19th century, nostalgia was becoming a thing of the past. But it had not quite disappeared. The American Civil War saw a revival, with Union soldiers fighting far from home showing the same symptoms Hofer had described years earlier. Between 1861 and 1866, 5213 white Union soldiers were diagnosed with the disease and 58 died. But the end of the civil war saw the end of nostalgia. Doctors and psychiatrists had a whole new list of potential diagnoses 鈥� depression, nervous breakdown, anorexia 鈥� and in the case of soldiers, malingering. Nostalgia was consigned to history.