Florence’s illness highlights her valour James Le Fanu
The memorial service at Westminster Abbey commemorating Florence Nightingale’s 200th anniversary – planned for last Tuesday, though now postponed until November – is a fitting tribute to her unique contribution to human civilisation in bringing to the care of the sick the inestimable virtues of discipline, attentiveness, compassion and cleanliness.
She has not always been so sympathetically perceived; her character was, until recently, tarnished by her biographers, who portrayed her as a manipulative hysteric feigning ill health to further her ambitions.
She was certainly changed by her experience in the Crimea. On her return in 1856 her friends and family were apparently dismayed at her gaunt appearance, thin and exhausted. Over the following 20 years she was plagued by chronic ill health: weakness, headaches and palpitations interspersed with episodes of excruciating back pain, which left her unable to walk.
“Her indeterminate illness did not give her doctors much to work on,” commented her biographer FB Smith, who judged her symptoms to be psychosomatic, while another, the physician George Pickering, attributed them to “stress-induced neurosis”.
This harsh verdict went unchallenged for many years until 1995 when Dr David Young, principal scientist at the Wellcome Foundation, in a masterly piece of medical detective work, demonstrated it to be quite unfounded. In the months prior to her return Nightingale had been seriously ill with “Crimean fever”, now known to be the bacterial infection brucellosis, contracted by drinking contaminated goat’s milk.
While most recover, for some the bacteria invade the cells of the liver, bone marrow and elsewhere where they persist for many years.
Reviewing the description of Nightingale’s symptoms, Dr Young found them to be “entirely consistent” with this chronic form of brucellosis, particularly in its effects on her nervous system causing her allegedly “psychosomatic” insomnia, low mood and intractable back pain. The judgment on her character is thus precisely the reverse of her biographers, as only a woman of indomitable courage and determination could have overcome decades of debilitating ill health to achieve so much.
Giving voice to issue
The plight of the gentleman whose voice has become much quieter over the past two years has prompted several possible explanations. A couple of readers suggest he should have a hearing test – a bit oddly perhaps, as those with impaired hearing tend to speak loudly to compensate for the difficulty in hearing their own voice.
This, however, is apparently not the case for those with “conductive deafness” – due most commonly to ear wax or fluid in the middle ear (“glue ear”) – as their voice, reverberating within the skull, can sound extremely loud so they try to mitigate it by speaking softly.
Next, former speech therapist Mary Nash-wortham commends breathing exercises focusing on the diaphragm with the intention of increasing the strength and capacity of the lungs and thus the air flow across the vocal cords. Then statins may, if rarely, be responsible as with the gentleman whose always loud voice (“particularly useful as a gun end officer in the Royal Artillery”) diminished markedly in volume after being prescribed them for his “raised” cholesterol. Finally, quieting of the voice may be just a normal feature of ageing or, as Shakespeare put it in his Seven Ages of Man passage from As You Like It, “His big manly voice turning again toward childish treble, pipes and whistles in his sound.”
Back to square one
This week’s medical query comes courtesy of Mr G C from Nottingham troubled by a dry irritation of both nostrils. “From time to time they can be really quite sore,” he writes. An ENT specialist could provide no specific explanation, but suggested a trial of the steroid nasal spray Beconase that unfortunately made matters worse, exacerbating the dryness and causing the nostrils to bleed. He is otherwise well but would be more than grateful for suggestions from others similarly afflicted.
Email medical questions confidentially to Dr James Le Fanu at drjames@ telegraph.co.uk
The harsh verdict on Nightingale’s character went unchallenged for many years