Florence Nightingale (1820-1910)

Florence Nightingales immense achievements are widely recorded, however, the connection to Fibromyalgia and CFS/ME is segregated and often speculated.

Florence Nightingale was born on May 12, 1820 and was named after her place of birth, in Florence, Italy, daughter of Frances and William Shore Nightingale of British descent. She was the younger of two children. Her family returned to England and had a new house built in Lea, Derbyshire, called Lea Hurst. They lived there until 1823, and the family moved on to Hampshire in 1825. However Lea Hurst served as a summer residence for the rest of Florence’s life.

She was a nurse, social reformer and statistician best known as the founder of modern nursing. Her efforts to reform healthcare greatly influenced the quality of care in the 19th and 20th centuries.

From a very young age, Florence Nightingale was active in philanthropy, ministering to the ill and poor people in the village neighbouring her family’s estate. By the time she was 16 years old, it was clear to her that nursing was her calling. She believed it to be her divine purpose. Pursuing a career in nursing was looked down upon by society at that time, especially for someone with an affluent background.

Determined to pursue her true calling despite her parents’ objections, in 1844, Nightingale enrolled as a nursing student at the Lutheran Hospital of Pastor Fliedner in Kaiserwerth, Germany.

In the early 1850’s, Nightingale returned to London, where she took a nursing job in a Middlesex hospital for ailing governesses. Her performance there so impressed her employer that Nightingale was promoted to superintendent within just a year of being hired. The position proved to be challenging as Nightingale grappled with a cholera outbreak and unsanitary conditions conducive to the rapid spread of the disease. Nightingale made it her mission to improve hygiene practices, significantly lowering the death rate at the hospital in the process. The hard work took a toll on her health. She had just barely recovered when the biggest challenge of her nursing career presented itself.

In late 1854, Nightingale received a letter from Secretary of War, Sidney Herbert, asking her to organize a corps of nurses to tend to the sick and fallen soldiers in the Crimean War. Nightingale rose to her calling. She quickly assembled a team of 34 nurses from a variety of religious orders and sailed with them to Crimea just a few days later.

Although they had been warned of the horrid conditions there, nothing could have prepared Nightingale and her nurses for what they saw when they arrived at Scutari, the British base hospital in Constantinople. Due to the appalling conditions, more soldiers were dying from infectious diseases like typhoid and cholera than from injuries incurred in battle. She spent every waking minute caring for the soldiers making her rounds during the night after the medical officers had retired. She thus gained the name of “the Lady with the Lamp.” Based on her observations in Crimea, Nightingale wrote Notes on Matters Affecting the Health, Efficiency and Hospital Administration of the British Army, a 830-page report analyzing her experience and proposing reforms for other military hospitals operating under poor conditions.

Nightingale, one of the most prominent statisticians in history, used her passion for statistics to save the lives of soldiers during the Crimean war, and do ground-breaking work in data visualization that continues to be influential to this day. Her legacy includes not only her extensive use of data as evidence, but she used the pie chart and other visual representations of the data to present her findings. In her most seminal work, which she wrote while bed-bound, she used what we would now call informatics – graphic representational diagrams – to show the transmission of infection and disease, which had a huge impact.

Nightingale remained at Scutari for a year and a half. She left in the summer of 1856, once the Crimean conflict was resolved, and returned to her childhood home at Lea Hurst. To her surprise she was met with a hero’s welcome, which the humble nurse did her best to avoid. The Queen rewarded Nightingale’s work by presenting her with an engraved brooch that came to be known as the “Nightingale Jewel” and by granting her a prize of $250,000 from the British government.

Nightingale decided to use the money to further her cause. In 1860, Nightingale funded the establishment of St. Thomas’ Hospital, and within it, the Nightingale Training School for Nurses. Nightingale became a figure of public admiration. Poems, songs and plays were written and dedicated in the heroine’s honour. Young women aspired to be like her.

While at Scutari, Nightingale collapsed on her 35th birthday. Her diagnosis was “Crimean fever” and she would never fully recover.

She was eventually diagnosed as having brucellosis, a bacterial infection that is transmitted through milk from infected cows and is similar to tuberculosis. Doctors found this confusing because she shouldn’t have been capable of working insane hours with the disease. After she returned from the Crimean War she still complained of: loss of appetite, unrelenting pain, intermittent fever, fatigue, insomnia, irritability, nervousness, depression, sciatica, shortness of breath, and palpitations. After her attacks, she had to limit the amount of stimulation around her so she didn’t experience sensory overload. She couldn’t listen to music because she found it “nerve-wracking.” Going on a drive brought too many sensations and left her fatigued and out of breath.

There are all sorts of (male) doctors since who have tried to diagnose Florence. Many of them claim she faked her symptoms and was a “malingerer.” Some people thought she had a mental illness such as bipolar disorder because her moods were up and down. These people disregarded that she had severe physical symptoms as well as mental ones. It’s probable that sexism played a part in how her illness was viewed then and now.

By the time she was 38 years old, she was homebound and bedridden, and would be so for the remainder of her life. Fiercely determined and dedicated as ever to improving health care and alleviating patients’ suffering, Nightingale continued her work from her bed. She continued to learn more about infectious diseases to improve nursing education and hospital administration and to publish over 200 books, reports and articles on theses matters..

Barbara Keddy, BSc.N., M.A., Ph.D., Professor Emerita, School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada. A fellow Fibromite and CFS/ME sufferer was also keen to look into why Florence Nightingale is linked with Fibromyalgia and discusses that ‘A person interested in Ms. Nightingale’s life would read about how after she returned from the war in the Crimea where she was faced with the deplorable conditions, she took to her bed, often refusing visitors, with ailments that were invisible and a condition that was without a name.’

Residing in Mayfair, she remained an authority and advocate of health care reform, interviewing politicians and welcoming distinguished visitors from her bed. In 1859, she published Notes on Hospitals, which focused on how to properly run civilian hospitals. Despite her constant pain and fatigue, she did not shirk responsibilities and needed to let the world know the value of the profession of nursing. This became her ‘major achievement that raised nursing to the level of a respectable profession for women’.

Throughout the U.S. Civil War, she was frequently consulted about how to best manage field hospitals. Nightingale also served as an authority on public sanitation issues in India for both the military and civilians, although she had never been to India herself.

On many websites it seems that the link between Florence Nightingale and Fibromyalgia is just speculation. However, Kevin White, MD, Phd justifies Florence’s ‘meticulous note-taking’. In ‘her very own diary, in which she documented the chronic widespread pain, fatigue and mental cloudiness she suffered over the last 40 or so years of her life.’

In the 1870s, Florence worked with the government to push for legislation to significantly improve sanitation. Florence inspired Red Cross founder Henry Dunant. She went on to directly influence the setting up of the British Red Cross in 1870.

In 1883, Nightingale was awarded the first Royal Red Cross by Queen Victoria. She was the first woman inducted into the Order of Merit in 1907.

In 1908, at the age of 88, she was conferred the merit of honor by King Edward. In May of 1910, she received a congratulatory message from King George on her 90th birthday.

“There is no part of my life, upon which I can look back without pain”, Florence Nightingale

In August 1910, Florence Nightingale fell ill, but seemed to recover and was reportedly in good spirits. A week later, on the evening of Friday, August 12, 1910, she developed an array of troubling symptoms. She died unexpectedly at 2 p.m. the following day, Saturday, August 13, 1910, at her home in London.

Characteristically, she had expressed the desire that her funeral be a quiet and modest affair, despite the public’s desire to honor Nightingale—who tirelessly devoted her life to preventing disease and ensuring safe and compassionate treatment for the poor and the suffering. Respecting her last wishes, her relatives turned down a national funeral. She was laid to rest in Hampshire, England.

The Florence Nightingale Museum, which sits at the site of the original Nightingale Training School for Nurses, houses more than 2,000 artifacts commemorating the life and career of the “Angel of the Crimea.” To this day, Florence Nightingale is broadly acknowledged and revered as the pioneer of modern nursing.