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Case Reports

Florence Nightingale's fever

BMJ 1995; 311 doi: (Published 23 December 1995) Cite this as: BMJ 1995;311:1697
  1. D A B Young, formerly principal scientist, Wellcome Foundationa
  1. a23 Hillcrest, Downham Market, Norfolk PE38 9ND

    It is a sad irony that Florence Nightingale (1820-1910), the founder of modern nursing, who made such important contributions to public health through her advocacy of sanitation, statistics, and common sense, should also be remembered as history's most famous invalid and possibly as its most successful malingerer. After her return from the Crimean war hospitals in 1856 she suffered several bouts of illness, and both she and her friends, medical and lay, thought she was dying. From August 1857, when she suffered her first major attack, until 1880 she was an invalid, spending much of her waking hours confined to a couch. An attack at Christmas 1861 left her unable to walk and she remained bedridden for six years.

    The nature of the illness that afflicted this precise, energetic, and inquiring woman was not understood then, nor has it been satisfactorily elucidated since. After her death medical opinion favoured the diagnosis of neurasthenia,1 an obsolete term denoting a symptom complex now associated with psychosomatic illness; retrospective diagnoses propose such a condition.2 3 This seems eminently reasonable from a review of the signs and symptoms of her illness: weakness, headache, nausea at the sight of food, breathlessness, tachycardia, palpitations, and precordial pain; furthermore, earlier in life she had a somewhat neurotic disposition.

    Cope believed that after her superhuman efforts in both the Crimean war and the campaign for medical reform of the army (1856-7) Florence collapsed with a “stress” induced neurosis, but he was unable to explain why she did not recover.2 Such a difficulty does not arise with Pickering's diagnosis of an anxiety neurosis resulting from Florence's unresolved conflict with her mother and her sister,3 since such a neurosis will, if left untreated, often continue indefinitely. Nevertheless, this diagnosis has grave deficiencies. Firstly, Florence's sister Parthenope …

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