Nursing lore has long maintained that the mysterious illness that sent Florence Nightingale to bed for 30 years after her return from the Crimea was syphilis. At least that’s what many nursing students were told in the 1960s, when my wife was working on her BSN. Syphilis, however, would be difficult to reconcile with the fact that Nightingale was likely celibate her entire life and had not a single sign or symptom typical of that venereal infection.
Even so, Nightingale’s was a decidedly strange illness, one that has stubbornly defied diagnosis since her death on this day 95 years ago. In all likelihood, its seed was sown in 1854, when in her mid-30s, she traveled to Skutari (Uskudar), Turkey to care for British soldiers fighting the Russians in what came to be known as the Crimean War. With a mere 38 nurses, she supervised the care of an all but endless stream of troops wracked by frostbite, gangrene, dysentery, and other diseases crammed into 4 miles of beds not 18 inches apart. Her own quarters were cramped and infested with rodents and vermin. During January and February of her first winter, she saw 3,000 of her patients die, while working 20 hours a day, caring for the severest cases herself. In May of the following year, she developed a near-fatal illness (most likely brucellosis). Although urged to return to England to recuperate, she remained with the Army for 21 months until the last soldier had left for home.
When she finally returned to England, she appeared hardened and aged by illness and exhaustion. She complained of intermittent fever, loss of appetite, fatigue, insomnia, irritability, depression, sciatica, shortness of breath, and palpitations. For nearly three decades, these complaints kept her confined to her room, scarcely ever out of bed. Finally, in her 60s, her symptoms began to dissipate, and the cold, obsessed, and tyrannical workaholic Nightingale had been as an invalid gradually transformed into a gentle matron capable of something close to normal relationships with friends and family. She died non compos mentis at age 90 of “old age and heart failure.”
Since Nightingale’s death, biographers, historians, nurses, and physicians have debated the cause of her strange illness, with some convinced that it had an organic basis and others convinced that her symptoms were the product of a neurosis. It has been suggested that she suffered from “dilation of the heart and neurasthenia;” a “strategic illness” with no physical basis; self-pity manifested as “Victorian melodrama;” and “repressed self-loathing” for her arrogance and ignorance in failing to recognize that the unsanitary condition of her wards was the reason why her army perished. In all likelihood, Nightingale had not one, but four different disorders, all at least loosely inter-related—bipolar personality disorder, Crimean fever (brucellosis), post-traumatic stress disorder (PTSD), and terminal, senile dementia (Alzheimer’s disease).
With regard to PTSD, there is no record of Nightingale ever having spoken or written of flashbacks or recurrent dreams of her Crimean experience. However she had no one with similar experiences or problems in whom she might have confided such thoughts or dreams. She never spoke of her wartime experiences after returning to England. Nor did she ever again personally minister to the sick or wounded, perhaps to avoid situations or activities likely to arouse traumatic Crimean memories. Like many of today’s PTSD sufferers, she isolated herself from social interactions, in her case by punishing herself for almost 30 years with what amounted to virtual self-imposed imprisonment.
Like all wars before and since, Nightingale’s was a hell steeped in the blackness of death, leaving no delight clean and pure, and torturing the minds of those involved long after the fighting ended.
Image Credit: “London – Crimean War Memorial” by Magnus Halsnes. CC BY NC 2.0 via Flickr.