Sunday, May 4, 2003

  Florence Nightingale, founder of modern nursing, was mentally ill, a psychiatrist said yesterday at a University of Maryland School of Medicine conference in Baltimore.
  “It is my opinion that Florence Nightingale suffered from bipolar disorder, a mental illness characterized by alternating highs and lows,” said Dr. Katherine Wisner, professor of psychiatry and obstetrics/gynecology at the University of Pittsburgh Medical Center, who addressed the conference.
  “Florence heard voices and experienced a number of severe depressive episodes in her teens and early twenties — symptoms consistent with the onset of bipolar disorder,” said Dr. Wisner, who specializes in mood disorders.
  Bipolar disorder, previously known as manic-depressive disorder or manic depression, is a mental condition in which periods of deep depression alternate with periods of hyperactivity and uncontrolled elation, or mania.
  Dr. Wisner presented her diagnosis at this year’s clinicopathologic conference (CPC), co-sponsored by the University of Maryland medical school and the Veterans Affairs Maryland Health Care System.
  During a CPC, the case history of an unnamed patient, who turns out to be a historic figure, is presented to an experienced clinician for discussion in an academic setting. In past years, the patients diagnosed included Edgar Allan Poe and Wolfgang Amadeus Mozart.
  “This method teaches medical students and residents how to properly diagnose difficult or challenging cases,” said Dr. Philip A. Mackowiak, professor and vice chairman of the Department of Medicine at the University of Maryland and director of medical care at the VA Maryland Health Care System.
  Dr. Mackowiak selected Dr. Wisner to do the Nightingale diagnosis, which she completed over several months.
  For her research, Dr. Wisner analyzed many letters written by Nightingale, said Larry Roberts, spokesman for the University of Maryland School of Medicine.
  Florence Nightingale made great strides in health care reform in the 19th century in spite of a lifelong illness that kept her bedridden for decades. It has long been believed her medical problems resulted from a bacterial infection she contracted while serving as a nurse in the Crimean War.
  The World Book Encyclopedia says she caught “Crimean fever” during a visit to the front lines and almost died. The reference book also says the “strain of overwork and her Crimean illness injured her health, and she became a semi-invalid and seldom left her rooms” for the next 40 years.
  According to the CPC case study, Nightingale experienced extreme fever and fatigue. “Her condition fluctuated between satisfactory and critical. Her mind wandered, and she was unable to concentrate. Over the next year, she complained of spinal pain, insomnia, nervousness and depression,” the case study said.
  Nightingale’s symptoms have most often been attributed to an infection known as chronic brucellosis.
  “She may very well have contracted the infection in the Crimean War,” Dr. Wisnersaid . “But that illness alone does not account for her severe mood swings, or the fact that she could be so incredibly productive and so sick at the same time.”
  Despite being isolated in her room for four decades, Nightingale established the first modern nursing school and wrote 200 reports and books, including the first nursing textbook. She was also among the first to apply statistics to the study of public health and is credited with inventing the pie chart.
  Nightingale said she heard the voice of God speak to her when she was a teenager, telling her she had a special mission in life. She felt this mission had something to do with helping other people.
  Her wealthy British family opposed her interest in studying health and blocked her from working in a hospital. But on her own, she entered the Institution of Deaconesses, a school for training nurses in Germany. At age 33, she became superintendent of a women’s hospital in London.
  Nightingale became a national heroine as a result of the improved hygiene and better food she brought British soldiers in the Crimea, which meant a lower death toll.
  She was the first woman to receive the British Order of Merit.

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