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The Bedridden Activist (Part 1)

Posted Feb 18 2011 12:48pm

The signing of the Treaty of Paris on March 30, 1856 meant an end to the bloody Crimean War .   It also meant that Florence Nightingale , the legendary "The Lady of the Lamp", could finally return to England.   Considering her fame, she actually had to travel incognito to avoid any unwanted publicity.  Turning turned down the offer of a naval ship to bring her home directly, Florence Nightingale (traveling under the name of "Miss Smith")  and her aunt took a long overland route which finally brought them, on 220px-Florence_Nightingale_CDV_by_H_Lenthall[1] foot, to their family estate at Lea Hurst on August 7, 1856.  Despite her attempt at privacy, there was no getting away from the fact that Nightingale had become a national heroine.   The "Nightingale Fund" that had been established to fund her overseas hospital was formed into a trust to finance non-sectarian training programs for nurses and midwives throughout the United Kingdom.  Contributions continued rolling in from  veterans, their families, and the general public and Florence Nightingale was overwhelmed by letters begging for financial help.  

She turned down numerous offers from the rich and famous and focused all of her efforts on establishing a new royal commission.  Her experiences in Turkey had demonstrated the need for a thorough investigation of the sanitary conditions in military hospitals.  She had been slow to accept that her own failure in preventing patient infections in her hospital had likely caused numerous deaths (leading to her confrontation with James Barry and other outraged surgeons).   To prevent further deaths, Florence Nightingale spearheaded the forming of the First Royal Commission of the Army.   After meeting with Queen Victoria at Balmoral Castle, she and her supporters lobbied for months before the commission was finally announced.   Once the commission actually began, she worked tirelessly preparing medical statistics (including some pioneering work with pie charts which she developed with the help of statistician William Farr ), interviewing witnesses, and writing many parts of the commission's final report.

Despite Florence Nightingale's tireless work during the months that the commission was in session, her own health began to worsen.    Since many of the symptoms that she described have no precise definition (including "dilation of the heart" and "neurasthenia")  the actual diagnosis remained a mystery during her lifetime   All that was known for certain was that she grew progressively weaker during the months that she worked on the commission although the cause was a matter of speculation.  By 1859, she was almost completely bedridden and remained an invalid for the rest of her life. 

Not that her poor health prevented her from being a tireless crusader.  In addition to publicizing the conclusions of the royal commission report which came out in 1859, she also published Notes on Nursing in that same year.    Quickly becoming an introductory textbook for her newly established school, the slim 136-page volume is now considered a classic in the history of nursing.  Florence Nightingale also threw herself into the establishment of a new royal commission on India (stemming from the Sepoy rebellion of 1857).   Although she offered to go to India herself to aid with relief efforts, she was refused (and her declining health would likely have prevented her from going anyway).   Largely working from her bed, Florence Nightingale and her assistants sent out questionnaires that she had developed to investigate sanitary conditions in various parts of India.  After analyzing the results, she released a ninety-two page paper summarizing her findings which was eventually published as an appendix to the final royal commission report.   Her public advocacy of statistical analysis led to her election to the Royal Statistical Society in 1859 (the first female to be so honoured) and she later became an honorary member of the American Statistical Association as well.

Being a total invalid called for some radical changes in Florence Nightingale's life and working style.  She mainly stayed in her rooms in London and only saw visitors by appointment (and usually one at a time).  That didn't stop her from carrying on a massive correspondence with medical experts, politicians, and policy makers of all kinds (she would have loved email).   She rarely traveled except to visit family or friends at various country homes near London.  While occasional remissions allowed her to leave her sickroom at times and make public appearances, they were relatively rare and she never left England again.  Although she once loved attending art museums and the opera,  all of these activities were eventually cut back so she could focus on her work and her small social circle.  When her mother became ill in 1866, Nightingale went to Embley to care for her but quickly threw herself into a new project examining mortality statistics for several nearby towns.  She also agitated on social reform involving Poor Laws as well as greater rights for women seeking careers outside the home. 

Although Florence Nightingale opposed the Contagious Diseases Act , it was not because she opposed the germ theory of disease (as some critics later argued).  Even though germ theory was not taken seriously before Joseph Lister and Louis Pasteur made the theory acceptable, Nightingale actually pioneered the need for sanitation and antiseptic conditions.  Her opposition to the legislation that was eventually passed stemmed from the intrusive nature of the Act (including mandatory screening of prostitutes for syphilis and detaining infected women).   When the act was passed in 1864, she campaigned for its repeal.  

To be continued

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