- Email: [email protected]
Nostalgia
DISSECTING ROOM
Discarded diagnoses Nostalgia irtually all the young men who responded to the call-up of August, 1914, assumed that they would be home for Christmas. Those who made it were mostly the living casualties: the dead were generally buried near where they fell, in Flanders Fields or elsewhere in military cemeteries close to all the theatres of war. The Victorians had invented the modern Christmas, a time for family, decorations, presents, and eating, with a small dose of piety and good-will. Christmas trees came from Germany, via Prince Albert. Charles Dickens’ A Christmas Carol did not so much describe the modern Christmas as create it. Many of the young survivors, mired in the French mud, would have longed for the Yule log and mulled wine. Their medical officers could have diagnosed as nostalgia the cluster of common symptoms: intense longing for home, with exaggerated feelings about how wonderful it was there, sleeplessness, anxiety, palpitations, functional neurological disturbances, and tachycardia. In fact, few medical men chose to put that label on their young charges, for by World War I, nostalgia was fast losing medical currency. Only the previous year, the eminent Philadelphia neurologist and man of letters, Silas Weir Mitchell, had remarked how rare nostalgia had become, in contrast to its frequency in the American Civil War. Weir Mitchell had not only seen lots of young nostalgics then, he had been keen
V
to differentiate the real disease from feigned illness, or malingering. But the illness, he insisted, was real, “an interesting psychic malady, making men hysteric and incurable except by discharge. Today, aided by German [Austrian] perplexities, we would ask the victim a 121 questions, consult their subconscious mind and their dreams, as to why they wanted to go home and do no better than let them go as helpless”. It should not have taken an advanced student of psychoanalysis to see why they wanted to go home. For more than two centuries, however, nostalgia commanded medical respectability. It was created in the 1688 Basel medical dissertation of Johannes Hofer. Derived from the Greek nostos (return to one’s native land) and algos (pain or distress), nostalgia was for Hofer a disease mainly of young people, especially from isolated areas, forced by circumstance to live abroad. He was aware that, even then, word had got about that the Swiss were especially prone to the disorder. As a good Swiss, Hofer was keen either to dispel the notion, or at least attribute it to positive dimensions of Swiss life, such as the loss of fine milk, nutritious soups, or native freedom. Hofer put a psychological gloss on the condition, but his countryman, J J Scheuchzer, writing in the next century and at a time when the chief Swiss export was not pharmaceuticals but mercenaries, was anxious to deflect the possibility of cowardice among Swiss soldiers. Accordingly, he developed a physiological theory
“A companion is a friend, a guide . . .” The Oxford Illustrated Companion to Medicine Stephen Lock, John M Last, George Dunea, eds. Oxford: Oxford University Press, 2001. Pp 891. £39.50. ISBN 0192629506. “
T
he Companion is not a dictionary, encyclopedia, or treat-yourself manual.” Nor is it a white coat pocket-sized book, or stocking-filler, but a doorstop, something to keep out the drafts, and dip into next to the fire on a winter’s evening. A random selection: Captain Cook apparently had worms, causing thiamin deficiency, leading to “tetchiness” and poor decision-making, contributing to his demise at the hands of the Hawaiians in 1779. He had, however, assured that his sailors received adequate vitamin C. An anonymous artist draws a “device to allow a prematurely buried person to pull a rope and signal a bell above the
2
ground”. Photographs of the graduating medical school class from the University of Adelaide at a 68 year interval, (1924–1992), comment on the increasing proportion of women: one out of 30 (3%) to 65 out of 136 (48%), but do not mentioning the absolute increase in students, the increase in ethnic variety, or that 14 of the women in the 1992 photo are wearing chadars. Such gaps of acuity should not be held against the book, but the four-part index (topic, individual disorders and diseases, people, and general) is a nuisance, and makes it a useless tome for looking up facts to settle debates. However, idle perusal is sometimes
of nostalgia, whereby living at low altitudes caused nostalgia among the Swiss, their bodies being used to the lower (but more refined) atmospheric pressures of the Alps. Other commentators suggested the highland Scots were also especially prone to the condition, for the same reasons. For all Scheuchzer’s efforts, nostalgia remained mainly a psychiatric disorder, associated above all with young soldiers and sailors. Napoleon’s surgeon-inchief, Dominique-Jean Larrey, was particularly concerned with its effects on French troops, attributing the disorder to cold, humid climates, and the usual medical suspects, idleness, venery, and onanism (see Lancet 2001; 358: 1020). It could be fatal, he warned, and doctors diagnosed it as the source of dozens of deaths in the American Civil War. What was called crowd poisoning increased susceptibility, as young men brought up on clean air were housed in crowded camps; urban lads fared better. As Weir Mitchell shrewdly concluded, in the early 20th century, nostalgia was not so much discarded as psychoanalysed. It also changed its primary meaning, from a longing relating to place (home) to one concerned with temps perdu. As a preventive, Robert Burton’s antidote for melancholy is still worth a try: “Be not solitary; be not idle”. And, this Christmas, if you can manage only one of Burton’s injunctions, make sure it’s the first. Happy Holidays. Bill Bynum Wellcome Trust Centre for the History of Medicine, University College London, London NW1 1AD, UK
rewarded. There is a delightful entry on zombification with at least three reasonable explanations for the condition: bereaved relatives mistakenly identifying a mentally ill stranger; sorcerers opening tombs and occasionally coming across corpses in “a schizophreniform state of extreme passivity”; or an unidentified neuromuscular toxin given to induce catalepsy, followed by secret retrieval, and revival, of the body. Despite the astonishingly poor quality of some of the illustrations, and the quibbles between contributors and editors on subjects such as the relative merits of boxing as a sport, The Oxford Illustrated Companion to Medicine is an entertaining read, and could round out the education or spur the interest of a keen medical student. Laragh Gollogly The Lancet, London, UK
THE LANCET • Vol 358 • December 22/29, 2001
For personal use. Only reproduce with permission from The Lancet Publishing Group.
Discarded diagnoses Nostalgia irtually all the young men who responded to the call-up of August, 1914, assumed that they would be home for Christmas. Those who made it were mostly the living casualties: the dead were generally buried near where they fell, in Flanders Fields or elsewhere in military cemeteries close to all the theatres of war. The Victorians had invented the modern Christmas, a time for family, decorations, presents, and eating, with a small dose of piety and good-will. Christmas trees came from Germany, via Prince Albert. Charles Dickens’ A Christmas Carol did not so much describe the modern Christmas as create it. Many of the young survivors, mired in the French mud, would have longed for the Yule log and mulled wine. Their medical officers could have diagnosed as nostalgia the cluster of common symptoms: intense longing for home, with exaggerated feelings about how wonderful it was there, sleeplessness, anxiety, palpitations, functional neurological disturbances, and tachycardia. In fact, few medical men chose to put that label on their young charges, for by World War I, nostalgia was fast losing medical currency. Only the previous year, the eminent Philadelphia neurologist and man of letters, Silas Weir Mitchell, had remarked how rare nostalgia had become, in contrast to its frequency in the American Civil War. Weir Mitchell had not only seen lots of young nostalgics then, he had been keen
V
to differentiate the real disease from feigned illness, or malingering. But the illness, he insisted, was real, “an interesting psychic malady, making men hysteric and incurable except by discharge. Today, aided by German [Austrian] perplexities, we would ask the victim a 121 questions, consult their subconscious mind and their dreams, as to why they wanted to go home and do no better than let them go as helpless”. It should not have taken an advanced student of psychoanalysis to see why they wanted to go home. For more than two centuries, however, nostalgia commanded medical respectability. It was created in the 1688 Basel medical dissertation of Johannes Hofer. Derived from the Greek nostos (return to one’s native land) and algos (pain or distress), nostalgia was for Hofer a disease mainly of young people, especially from isolated areas, forced by circumstance to live abroad. He was aware that, even then, word had got about that the Swiss were especially prone to the disorder. As a good Swiss, Hofer was keen either to dispel the notion, or at least attribute it to positive dimensions of Swiss life, such as the loss of fine milk, nutritious soups, or native freedom. Hofer put a psychological gloss on the condition, but his countryman, J J Scheuchzer, writing in the next century and at a time when the chief Swiss export was not pharmaceuticals but mercenaries, was anxious to deflect the possibility of cowardice among Swiss soldiers. Accordingly, he developed a physiological theory
“A companion is a friend, a guide . . .” The Oxford Illustrated Companion to Medicine Stephen Lock, John M Last, George Dunea, eds. Oxford: Oxford University Press, 2001. Pp 891. £39.50. ISBN 0192629506. “
T
he Companion is not a dictionary, encyclopedia, or treat-yourself manual.” Nor is it a white coat pocket-sized book, or stocking-filler, but a doorstop, something to keep out the drafts, and dip into next to the fire on a winter’s evening. A random selection: Captain Cook apparently had worms, causing thiamin deficiency, leading to “tetchiness” and poor decision-making, contributing to his demise at the hands of the Hawaiians in 1779. He had, however, assured that his sailors received adequate vitamin C. An anonymous artist draws a “device to allow a prematurely buried person to pull a rope and signal a bell above the
2
ground”. Photographs of the graduating medical school class from the University of Adelaide at a 68 year interval, (1924–1992), comment on the increasing proportion of women: one out of 30 (3%) to 65 out of 136 (48%), but do not mentioning the absolute increase in students, the increase in ethnic variety, or that 14 of the women in the 1992 photo are wearing chadars. Such gaps of acuity should not be held against the book, but the four-part index (topic, individual disorders and diseases, people, and general) is a nuisance, and makes it a useless tome for looking up facts to settle debates. However, idle perusal is sometimes
of nostalgia, whereby living at low altitudes caused nostalgia among the Swiss, their bodies being used to the lower (but more refined) atmospheric pressures of the Alps. Other commentators suggested the highland Scots were also especially prone to the condition, for the same reasons. For all Scheuchzer’s efforts, nostalgia remained mainly a psychiatric disorder, associated above all with young soldiers and sailors. Napoleon’s surgeon-inchief, Dominique-Jean Larrey, was particularly concerned with its effects on French troops, attributing the disorder to cold, humid climates, and the usual medical suspects, idleness, venery, and onanism (see Lancet 2001; 358: 1020). It could be fatal, he warned, and doctors diagnosed it as the source of dozens of deaths in the American Civil War. What was called crowd poisoning increased susceptibility, as young men brought up on clean air were housed in crowded camps; urban lads fared better. As Weir Mitchell shrewdly concluded, in the early 20th century, nostalgia was not so much discarded as psychoanalysed. It also changed its primary meaning, from a longing relating to place (home) to one concerned with temps perdu. As a preventive, Robert Burton’s antidote for melancholy is still worth a try: “Be not solitary; be not idle”. And, this Christmas, if you can manage only one of Burton’s injunctions, make sure it’s the first. Happy Holidays. Bill Bynum Wellcome Trust Centre for the History of Medicine, University College London, London NW1 1AD, UK
rewarded. There is a delightful entry on zombification with at least three reasonable explanations for the condition: bereaved relatives mistakenly identifying a mentally ill stranger; sorcerers opening tombs and occasionally coming across corpses in “a schizophreniform state of extreme passivity”; or an unidentified neuromuscular toxin given to induce catalepsy, followed by secret retrieval, and revival, of the body. Despite the astonishingly poor quality of some of the illustrations, and the quibbles between contributors and editors on subjects such as the relative merits of boxing as a sport, The Oxford Illustrated Companion to Medicine is an entertaining read, and could round out the education or spur the interest of a keen medical student. Laragh Gollogly The Lancet, London, UK
THE LANCET • Vol 358 • December 22/29, 2001
For personal use. Only reproduce with permission from The Lancet Publishing Group.