James Le Fanu

‘For every problem there is a solution: neat, plausible and wrong’. H.L.Mencken

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What bugged Florence Nightingale?

THE drawback of spending time in exotic places is the possibility of contracting some exotic disease, requiring a panoply of tests on one’s return to determine which malevolent organism might be responsible. A family doctor from the north-west of England spent a month working in Saudi Arabia: “It was great – five-star luxury, trips to the desert, and the skin-diving in the Red Sea was divine,” he reports in the doctors’ journal Medical Monitor.

A fortnight after his return, however, he felt unwell with a high temperature, and ended up in hospital. “During the night I developed rigors. The chills came first, then I was cold, very cold, and I covered myself with blankets. The shakes followed. The morning found me caked in sweat." His consultant ordered a “complete battery of tests”, and everyone sat back to await the results. “A week passed and the rigors continued, but no diagnosis was made. The consultant went off on holiday, and I was left to the mercy of his registrar, who wanted to do a liver biopsy.” The patient dissuaded him from doing this, suggesting instead that the registrar might contact the hospital in Saudi Arabia to find out if anyone else had gone down with a mysterious ailment.

“I was in my second week of hospitalisation and had lost 22lbs in weight when the diagnosis finally arrived. Brucellosis was prevalent in Jeddah and I had attended the delivery of a febrile Bedouin woman. The midwife, the nurse and myself had all caught brucellosis from her. A quick course of tetracycline cured the rigors, but it was six months before I regained my weight and previous state of health.”

One wonders how many of those intrepid founders of the Empire must have returned to a life of chronic ill-health, whose cause was never identified and for which there was no treatment.

This reflection is prompted by the news this week that the Nightingale School of Nursing at St Thomas’s Hospital has finally closed its doors. The tradition of nurse-training established by Florence Nightingale has been one of Britain’s most substantial contributions to Western civilisation, bringing to the care of the sick the inestimable virtues of discipline, attentiveness, compassion and cleanliness.

And yet the reputation of this extraordinary woman has always been tarnished with the charge of hypocrisy. While her public life was devoted to humanitarian ends, in private she was regarded as cold, tyrannical and a malingerer. Following her return from the Crimea, Florence Nightingale took to her bed for 20 years. “Her indeterminate illness did not give her doctors much to work on,” observed the historian F. B. Smith. “It remains indisputable that whenever Miss Nightingale announced herself to be ill, she was busy.”

But in a masterly piece of medical detective work, the former principal scientist at the Wellcome Foundation, David Young, has shown this cruel verdict to be quite unfounded.

Soon after arriving in the Crimea, Florence Nightingale was struck down by “as bad an attack of fever as I have ever seen”, wrote the Chief Medical Officer, Dr Anderson. Her recovery was slow, and three months later she was described as being “white-faced, extremely weak and looking much older than her age". Her “Crimean Fever” is now known to have been none other than brucellosis. It is caused by the bacterium Brucella Melitensis, which gains entry to the body through the tissues of the mouth and pharynx, and spreads through the bloodstream, causing rigors and debility.

Following the acute illness, Brucella can remain in the body, causing recurring symptoms over many years. Reviewing the description of Florence Nightingale’s symptoms in the years after she returned to England, Dr Young has found them to be “entirely consistent” with this chronic form of brucellosis, punctuated by acute relapses every few years. The weakness and pain that forced her to take to her bed was almost certainly because the nerves of her lower spine were affected. This has been described as “one of the most incapacitating and painful maladies that can affect man”, and which, in Miss Nightingale’s case, could only be relieved by injections of opium. Nor was that the total of her misfortunes, because chronic brucellosis may also cause sleeplessness, depression, palpitations and nervous tremors, precisely the sort of symptoms that have been cited as evidence that her illness was neurotic.

“After the age of 60, Miss Nightingale’s depression – the last symptom of her Brucellosis – lifted,” writes Dr Young. “Gone was the cold, obsessed tyrant who rejected as inadequate the devoted services of her closest allies. As her character blossomed into benevolence, this thin, emaciated woman became a dignified, stout old lady with a good-humoured face.”

In the absence of antibiotics, her physicians could do nothing to relieve her suffering other than recommend rest. She followed this advice for 20 years, and nothing in her life has generated more censure.

It occurs to me, having re-read Lytton Strachey’s biographical portrayal in Eminent Victorians and knowing now the scale of the physical distress that dogged her life, that Florence Nightingale’s public achievements were not merely extraordinary but super-human.