By the waters of Babylon, there we sat down, yea, we wept, when we remembered Zion [Psalms 137:1].

             Like the fugue states described by Hacking, nostalgia was a 'transient' psychiatric disorder that was recognized and treated for a time and then disappeared [Hacking, 1998]. From the late seventeenth through the late nineteenth centuries, what we might call homesickness was a disorder that doctors and patients took quite seriously. Like shell shock and PTSD a diagnosis of nostalgia could result in a soldier being discharged from the army. Like anorexia nervosa, nostalgia occasionally resulted in death. It was a serious disorder, as long as social and intellectual circumstances provided a lens for seeing it. When those circumstances changed, nostalgia, like hysteria in the late nineteenth century, evaporated. Below are some notes about the history of nostalgia. They are intended to be suggestive, not to explain the strange career of this transient disorder.
         As early as 1569, a Swiss officer reported that one of his cadets had succumbed to homesickness [Anderson, 1984, 156]. Incidents of homesickness were described in medical literature at least as early as the seventeenth century, given different names in various languages--maladie du pays in French, Heimweh in German, el mal de corazón in Spanish. As early as 1634, 44 cases, characterized by deep despair, were described among Spanish conscripts serving in Flanders.
         In 1678 Johannes Hofer [1669-1752] coined the name nostalgia, from Latin roots,  to refer to 'the pain a sick person feels because he is not in his native land, or fears never to see it again' [Rosen, 1975, 30]. This neologism was so successful that people forgot its origin. Moreover, its original technical meaning has been lost as it has entered everyday language. As Starobinski has pointed out, this trajectory was not unique. It also happened with the term 'melancholy' and is perhaps happening with 'schizophenia' [Starobinski, 1966, 96]. At the time, however, Hoffer used the term to refer to  two cases:
         The first was a young man who had come from Bern to Basel to study. After a period of dejection he developed a low grade, continuous fever, anxiety and palpitations. His symptoms worsened and death appeared imminent. When the student heard that plans were being made to send him home, in spite of the gravity of his symptoms, he grew calmer. After several miles on the road from Basel, his complaints abated noticeably, and before reaching Bern he had recovered [Rosen, 1975, 30-1].
         The second was a young peasant woman, who was brought to the hospital, unconscious, after a fall. On waking she refused all food and medication and constantly moaned, "I want to go home." After a few days, despite her weakness, her parents took her home, where she recovered completely [Rosen, 1975, 31]
          Hoffer explained such cases with the psychosomatic theory that nostalgia was a disorder of imagination which could result in death. When one dwelled on  images, such as those of one's native land, the vital spirits, which flowed through the nerve fibers in which  images were stored,  deepened these channels and increased the flow through this region of the brain. As a result there was a decreased flow of vital spirits in other regions of the brain. This resulted in an increased preoccupation with  images of  one's home, as well as an  indifference  towards one's immediate surroundings. The process was self prepetuating. Vital spirits were not available to stimulate appetite or digestion, resulting in a reduction in the quality and quantity of these spirits. As the vital spirits were exhausted, bodily functions weakened and death ensued. [Rosen, 1975, 32].
         While a twentieth century reader might take Hofer's nostalgia as an anticipation of attachment theory, in the eighteenth century it was regarded as a slur [Starobinski, 1966, 98].  J. J. Scheuchzer, perhaps for patriotic reasons,  explained cases of nostalgia with in a purely mechanical way. A Swiss, Scheuchzer tried to combat the theory  that Swiss soldiers in foreign service, suffered from a strange kind of weakness which might even be considered cowardice. In 1705 he argued that when his countrymen descend into lowlands, the delicate fibers of their skin are compressed, their blood is forced into the heart and brain, its circulation is slowed and if the individual's body cannot resist these deleterious effects, anxiety and homesickness supervene [Rosen, 1975,33-34].
         During the eighteenth century nostalgia was generally accepted as a mental illness. William Cullen classified it  as a species of false or defective appetite along with bulimia, polydipsia and satyriasis. In England it was considered a disease of foreigners, particularly the Swiss on foreign service. "In England," Arnold wrote, " whatever may be the partiality to our native land... we know nothing of this passionate aattachment that leads to this sort of Insanity" [Macalpine & Hunter, 1982, 499].
         Although Hofer's initial cases were drawn from civilian practice, during the eighteenth century, attention increasingly focused on the military significance of nostalgia.  For any European country that went to war the recruitment of soldiers on a large scale was a problem. Only hunger would tempt most peasants, who comprised the mass of the European population, to join an army. As a result kidnapping, deception and impressment were used to fill the ranks. Voltaire's Candide, published in 1759, during the Seven Years War, provides a satirical, but apparently not overly exaggerated, depiction of the use of deception to lure a recruit into the Prussian army.  When more enthusiastic volunteers could be found they were usually exiles from other countries. Continental armies, for example, included many Irish and Scottish Catholics  opposed to English rule [Rosen, 1975, 37-8].
 In Britain press gangs provided men for the Royal Navy by seizing seaman returning home from long voyages. Living and working conditions in the Royal Navy were terrible. Cramped quarters, poor scanty food, indescribable sanitary conditions together with severe and rigid discipline were all the impressed men could expect. It is not surprising to find men in such circumstances falling into profound despair, and suffering depression, anxiety and all the other features of nostalgia [Rosen, 1975, 38].
         In 1787 Robert Hamilton [1749-1830] described a case of a soldier suffering from nostalgia, who received sensitive and successful treatment:

In the year 1781, while I lay in barracks at Tinmouth in the north of England, a recruit who had lately joined the regiment,...was returned in sick list, with a message from his captain, requesting I would take him into the hospital. He had only been a few months a soldier; was young, handsome, and well-made for the service; but a melancholy hung over his countenance, and wanness preyed on his cheeks. He complained of a universal weakness, but no fixed pain; a noise in his ears, and giddiness of his head....As there were little obvious symptoms of fever, I did not well know what to make of the case...Some weeks passed with little alteration...excepting that he was evidently become more meagre. He scarcely took any nourishment...became indolent...He was put on a course of strengthening medicines; wine was allowed him. All proved ineffectual... He had now been in the hospital three months, and was quite emaciated, and like one in the last stage of consumption...[Macalpine & Hunter, 1982, 499-500]
 On making my morning visit, and inquiring, as usual, of his rest at the nurse, she happened to mention the strong notions he had got in his head, she said, of home, and of his friends. What he was able to speak was constantly on this topic. this i had never heard of before...He had talked in the same style, it seems, less or more, ever since he came into the hospital. I went immediately up to him, and introduced the subject; and form the alacrity with which he resumed it.. I found it a theme which much affected him. He asked me, with earnestness, if I would let him go home. I pointed out to him how unfit he was, form his weakness to undertake such a journey [he was a Welchman] till once he was better; but promised him, assuredly, without farther hesitation, that as soon as he was able he should have six weeks to go home. He vevived at the very thought of it... His apeitite soon mended; and I saw in less than a week, evident signs of revovery...[Macalpine & Hunter, 1982, 499-500].

Eugène L., born in Paris, was sent to a wet nurse in the Amiens area and brought back to his family when he was two years old. the strength of his limbs, the firmness of his flesh, his coloring, the vivacity and gaiety of his character, everything indicated that he had been well cared for and that he was a vigourous child. During the fifteen days that his nurse remained at his side, Eugène continued to enjoy the most robust health; but as soon as she left he became pale, sad and morose. He was unresponsive to the caresses of his parents and refused all the food that had pleased him the most just a few days before.

         Descuret called little Eugène's disturbance "nostalgia from affection." With this label the author emphasized the psychological, or what would have been termed the moral, etiology of the disease. Other physicians placed a greater emphasis on the physical aspects of such maladies. Eugène's first impressions had been in Picardy; it was not only his affection for his nurse but his attachment to the environment around Amiens that had made the return to Paris  a threat to his health. In this case, what descuret called the child's  "memory of the heart" was too faithful to its first oblect. Separation was experienced as violent deprivation [Roth, 1991,7].
 Eugène had been sent to a wet nurse in the countryside, a custom not unusual for a middle-class child in the early nineteenth century, although this does not mean that sending a child away to nurse was uncontroversial during this period. At least since the Enlightenment mothers had been urged to nurse their own children, yet it seems that at least forty percent of children born in Paris in the mid-1800s were placed with rural wet nurses. In the case of Eugène, the child seemed to suffer no ill effects from his two years in the countryside. On the contrary, he was a vigorous two-year-old, a fact that must have made his decline into lethargy even more frightening to his parents [Roth,1991,8].
 

Debate During the 1820s and 1830s
         During the early decades of the nineteenth century, and especially in the 1820s and 1830s, there was an impotant increase in medical writings on nostalgia, and the disease attracted considerable medical attention, discussion and intervention. Although not many medical writings concentrated on nostalgia as a childhood illness, almost all identified the origins of the disease in the first affective connections to people and places in the child's world. Doctors believed that attachment to one's earliest memories was so frequently the core of this disorder because the first impressions on the brain were permanent. Eugène's attachment to his lost nurse renderd him morose, pale and unresponsive to any pleasures his parents could provide. In the nineteenth century these signs were suggestive of melancholia. Nostalgia was distinguished from melancholia by the specificity of its object, and rapidity with which it developed. As a disorder that was considered to be potentially fatal, doctors looked for  postmortem changes in patients who died from nostalgia. Finding such changes on occasion gave support to the view that emotional states can result in organic changes. [Roth, 1991,9].
         Forgetting could be protection against nostalgia, but no doctor thought it wise to forget one's origins completely. How could physicians understand this desease, which seemed to be the result of "our finest natural sentiments," but which could spred to others and be fatal?"

         By the 1850s nostalgia was losing its status as a particular disease and coming to be seen rather as a symptom or stage of a pathological process. It was considered as a form of melancholia and a predisposing condition among suicides. This was not surprising, the psychiatrist Brierre de Boismont argued in 1856, "if one considers the mass of strangers who come to seek their fortune in Paris, and who so frequently find only poverty, isolation and despair."  After coming to Paris from Brittany, the heroine of Balzac's Pierrette, for example, suffers from nostalgia, leading finally to death from consumption [Rosen, 1975, 43-4].

A Revival in the American Civil War
         While nostalgia was in decline as a diagnostic category in the mid-nineteenth century, it experienced a revival in the American Civil War. After insanity, nostalgia was  the second major disgnostic category used in the Civil War era to describe what we would think of today as a stress disorder. The official records of noninfectious diseases in the federal army during this war reveal 5,213 cases of and 58 deaths from nostalgia among white troops from May 1861 to June 30 1866. The record for 'colored troops' reveals 334 cases of nostalgia and 16 deaths [Anderson, 1984, 157].
  In A Manual of Instructions for Enlisting and Discharging Soldiers the Union Army instructed medical officers that:
Nostalgia is a form of mental disease which comes more frequently under the observation of the military surgeon… Considered as a mental disease,-- and there can be no doubt that the primary phenomena of this state are mental,-- it belongs to the class Melancholia. The extreme mental depression and the unconquerable longing for home soon produce a state of cachexy, loss of appetite, derangement of the assimilative functions, and, finally, disease of the abdominal viscera,-- in fact, the objective phenomena of the typhoid state… As Nostalgia is not unfrequently fatal, it is a ground for discharge if sufficiently decided and pronounced [Dean, 1997, 129]

         Early in 1863, assistant surgeon general Dr. Dewitt C. Peters also described nostalgia as a 'species of melancholy.' He then elaborated on the symptoms:

'First, great mental dejection, loss of appetite, indifference to external influences, irregular action of the bowels, and slight hectic fever. as the disease progresses it is attended by hysterical weeping, a dull pain in the head, throbbing of the temporal arteries, anxious expression of the face, watchfulness, incontinence of urine, spermatorrhea, increased hectic fever, and a general wasting of all the vital powers. The disease may terminate in resolution, or run on into cerebral derangement, typhoid fever, or any epidemic prevailing in the immediate vicinity and frequently with fatal results [Anderson, 1984, 157].'

         Other factors were also considered. A military surgeon, J. Theodore Calhoun argued that, 'the very existence of nostalgia, presupposes a state of mental depression, extremely favorable to the contraction of the disease' [Anderson, 1984, 158]. Some saw nostalgia as the result of what was called 'crowd poisoning.' According to this view men from the country were more susceptible to nostalgia because of their early life in the pure atmosphere of fresh air and sunlight. Those coming from the city were not as easily affected by the 'poisonous effluvia' generated by crowded camps [Anderson, 1984, 1957-8]
         Dealing with cases of nostalgia was an important concern for  miliatary doctors during the Civil War. One tactic was to accuse soldiers suffering from nostalgia of moral turpitude and a lack of patriotism and courage. Some argued that a generous furlough policy might be useful. Others thought that idleness provoked 'home sickness.' They insisted that if  a soldier were ' hard at work all day,...he will have a relish for his rations, and will sleep soundly all night, having little time to think of home'. Battle activity and preparation for battle were also seen as curing many individuals.  Calhoun insisted that the 'Battle of Chancellorsville cured ... [a whole] regiment [of nostalgia] and it has since enjoyed as good health as any in the division' [Anderson, 1984, 160-1].

         During the American Civil War nostalgia was not only a diagnosis made by doctors but a way that soldiers thought about the mental deterioration of their comrades. In a letter describing prisoners of war one soldier, for example, wrote, "They  became homesick and disheartened. They lost all interest in everything, and would sit in the same attitude hour after hour day after day, with their backs against the wall and their gaze fixed on the floor at my feet... they were dying of nostalgia." Or as another soldier wrote, "Homesickness, the most pitiless monster that ever hung about a human heart, killed them. It killed as many in our army as did the bullets of the enemy" [Dean, 1997,129].
         Terror struck soldiers, in large numbers, claimed to suffer from nostalgia. During an evacuation by boat authorities noted that "it was found impossible to prevent the flocking on board of many whose only complaint was nostalgia [Dean, 1997,130]. Soldiers who wanted to avoid combat were tempted to fake nostalgia, claiming to their commanders and doctors that they suffered from being so far away from home. However these malingerers were betrayed by their complaints: true nostalgics would conceal their disease, withdrawing into lethargy without disclosing the origins of their suffering [Roth, 1991, 13]
          Although reports of nostalgia went up in the second year of the war, reaching 2,057 cases and 12 deaths in the year ending June 30 1863. After 1863 the number of cases  declined [Anderson, 1984, 157]. A number of explanations for the waning of this diagnosis might be suggested. It has been suggested that a change in the type of men selected for service or a more realistic view of the duration of the war may have been responsible for the decline in number of cases [Anderson, 1984, 157].  Another possibility is that the meaning of nostalgia changed and came to be viewed as a sign of weakness. As a letter from a veteran put it, "These new fellers ARE GENERALLY a homesick set. The toughening process affects them rather severely" [Dean, 1997, 130].

The Disappearance of  Nostalgia
         By the 1870s interest in nostalgia as a medical category had all but vanished. Those who saw it as disappearing saw this as the result of progress. As one author declared, "Le mal de pays, already rare in our time, is destined to disappear before the progress of hygiene and civilization." Perhaps  better education had made people  "more capable of struggling against this disease." Or, perhaps, the development of steam engines, regular mail and telegraph lines prevented people from being so completely separated from home [Roth, 1991, 19-20].
         In 1875   Charles Lasègue, by contrast, argued that it was impossible to say whether there was a decline in the incidence of the disease because nostalgia had never signified a "pathological unity" in the first place. As a member of the young profession of psychiatry he argued that the army doctors responsible for much of the writing on nostalgia were not real experts on "troubles intellecutels." "The asylums of convalescents, …he wrote, "are a homeland for no one, and yet how many sick people have found a cure there?"[Roth, 1991, 21]
         As nostalgia was being eliminated as a medical concern in the 1870s, psychiatrists were beginning to direct their attention toward hysteria. While Lasègue had complained that hysteria was the "waste paper basket of medicine where one throws otherwise unemployed symptoms," he had spent years working to clarify the use of that diagnosis. As interest in nostalgia declined, Lasègue's colleague and rival Jean Martin Charcot began to focus the attention of French psychiatry on hysteria. If nostalgia was erased by the developents of industrialization and centralization, these same aspects of historical change were said to be responsible for the exhaustion of the nerves defined as neurasthenia [Roth, 1991, 22-3].
         Nonetheless most saw the decline of this serious disease was a good thing, but some lamented the loss of the feelings for home that gave rise to the illness [Roth, 1991, 29-30]. Of course the phenomenon of nostalgia did not disappear with its demedicalization. [Roth, 1991, 7].