In 1688 a young Swiss milkmaid clambered over a rocky outcrop. She was halfway up an Alpine slope when she slipped and tumbled down several feet. Seriously injured, she was carried away to hospital in the nearby town where she lay, unconscious, for days. Physicians plied her with remedies and performed surgeries, and gradually she healed. Once physically better, however, she awoke and sat straight up in her hospital  bed. Realising that she was no longer in the mountain village of her birth, homesickness took hold. She spat out her foods and medicines and wailed, ‘Ich will Heim; ich will Heim’ (‘I want to go home; I want to go home’). She would say nothing else, turning listlessly to the wall. Eventually her parents came to collect her. Almost immediately her mood and condition improved and, after just a few days back in her own home, she returned to full fitness, entirely without the aid of further medical care. 

The young woman’s condition had only just received a name. This milkmaid was one of the first people in the world to be diagnosed with nostalgia, a term coined by the doctor Johannes Hofer. While today nostalgia is a relatively benign longing for a bygone era, for Hofer it was a sickness acquired by a yearning for a distant place. Born in 1669, Hofer left his home in modern-day Germany to attend university in Basel, graduating in 1688. His final thesis was a dissertation on nostalgia, or homesickness. Having first identified the disorder among Swiss mercenary soldiers, Hofer was moved by the stories of afflicted youths who (unless rapidly returned to their native land) ‘met their last days on foreign shores’, and devoted his studies to their mysterious ailment, which he called la maladie du pays. As he saw it, nostalgia was a kind of pathological patriotic love, an intense and dangerous homesickness (or das Heimweh in Hofer’s native German). It was an illness associated with being uprooted, a sickness of displacement, a kind of sadness or depression that arose from the desire to return to one’s home.

Hofer was concerned that this dangerous, even fatal, disease had not yet received sufficient attention from medical experts. He endeavoured to describe and detail the condition, and to identify its causes, characteristics and possible cures. Symptoms ranged from continued sadness, thinking only of the fatherland, disturbed sleep, either ‘wakeful or continuous’, ‘stupidity of the mind’ and a low tolerance for cruel jokes or even the slightest injustice, to depleted strength, diminished sight or hearing, fevers and a lack of interest in food or drink. It was these last two symptoms that most often led to the patient’s eventual death.

Victims of nostalgia, as Hofer identified, were primarily young people and adolescents sent to alien lands, regions and cities. He was very clear about the malady’s prognosis: it was potentially fatal, particularly if left untreated. To heal a stricken nostalgic, he prescribed an unspecific combination of dietary adjustment, warm baths and a change of circumstances. Only very rarely did he recommend more extreme treatments, such as bloodletting and purgatives. In such cases, patients should ingest mercury or arsenic, and leeches could be applied to veins. He also included recreational therapies such as outdoor exercise and pleasant conversation, especially in nostalgia’s early stages. If these methods failed and the disease advanced, then nostalgia could only be resolved by a return to the victim’s homeland. If this was not possible – for example, if the patient was conscripted to an army or under employment as a domestic servant – then the outlook was grim. In such cases, the malady was incurable, if not deadly.

Hofer might well have been the first to name and diagnose nostalgia, but he was certainly not the last. In the early decades of the 18th century, various Swiss doctors embellished Hofer’s theories of nostalgia. In 1710 Thomas Zwinger added a story about a sweet Swiss melody which produced pathological homesickness in anyone who heard it. ‘Kühe-Reyen’, a milking song played on the horn of an Alpine herdsman as he drove his animals, was thought to be such a trigger, and its impact so debilitating on the armed forces, that its playing among Swiss mercenaries was punishable by death in many European armies.

Nostalgia, then, seemed peculiarly Swiss – it was first identified by Swiss doctors and foreigners remarked on the disease’s unusual prevalence in the mountainous country. One German doctor even blamed the famed Alpine air, suggesting that the Swiss were so acclimatised to their home atmosphere that it made them unable to breathe properly in other places. Albrecht von Haller, a doctor from Bern, thought that nostalgia was an unfortunate side effect of rapid changes in altitude. He recommended an unusual, if logical, cure: sufferers from the sickness should be put in tall towers so that they might be elevated again to almost Alpine heights.

It is tempting to diagnose those who died from nostalgia in early modern Europe with modern medical conditions. Did they succumb to scurvy, malnutrition, heart disease, malaria, depression, anorexia, or psychosis? But the answers to these questions are unknowable. We have no bodies to examine and, even if we did, depression leaves no sign in bones or mummified flesh. Diseases are also mutable; they reflect the societies they infect.

Indeed, as the centuries marched on, nostalgia changed. At first, it began to affect all highlanders, irrespective of their nationality. But it soon stopped being confined to those who lived in mountainous regions altogether. It became even more deadly and ever more closely studied. It was particularly common in the United States, France and European colonies. During the American Civil War, more than 5,000 soldiers were stricken with nostalgia. As the 19th century drew to a close, nostalgia’s grip on the medical imagination slowly waned. But it took until the early 20th century for the malady to claim its final victim. The last person to be diagnosed with and die from nostalgia was an American soldier fighting on the Western Front in 1918.

This version of nostalgia – one that posed a serious threat to people’s health and survival – is very different from the one we live with today. Nostalgia no longer affects the body, just the mind. We no longer call it a malady of memory or attempt to treat nostalgic patients with brisk walks and bloodletting, and it is no longer a fatal diagnosis. Yet it still carries its own emotional baggage and remains a scapegoat for a range of perceived social, cultural and political sins. It is still an explanation – in all sorts of circumstances – for what a critic might see as wayward or irrational acts or beliefs. Indeed, while nostalgia no longer kills, it remains, strangely, a kind of pathology. A diagnosis to levy at your enemies; a malignancy that requires excision.

Agnes Arnold-Forster is the author of Nostalgia: A History of a Dangerous Emotion (Picador, 2024).