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 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.
Aside from the health reforms and support for public nursing that were her main causes in life, Florence Nightingale also involved herself in a number of side causes, including economic reform to relieve poverty. She often cajoled legislators into passing legislation that she supported (both in terms of lending her support and threatening unfriendly politicians with adverse publicity if they failed to see things her way). Despite being a public figure, she remained an intensely private person and often preferred to act anonymously whenever possible. Her chronic illness (made her feel old before her time and, in her letters, she often described herself as elderly even at a relatively young age. Being an invalid didn't prevent her from caring for herself though and she often did many of her own household chores.
Florence Nightingale also never accepted payment for her activism and remained dependant on inherited money to support herself. This may have been one of the reasons for her adamant opposition to the registration of nurses (she considered nursing to be a calling rather than a profession). Arguing that nursing required a special aptitude that could not be effectively taught was not a popular position to take. Even after nursing registration became mandatory, she emphasized that nursing was continually evolving and encouraged lifelong learning so that nurses could keep their skills up to date. Her "Nightingale system of education" proved to be popular and she encouraged the founding of nursing schools throughout the British Empire and in the United States.
That wasn't to say that her life was entirely given to public service. She had a longstanding feud with the owner of a pub across the street from her modest home in London. The "disgraceful" behaviour of the pub's patrons and the noise of their antics which continued late into the night was a constant source of vexation for her. Florence Nightingale's status as a public heroine didn't seem to deter the pub-owner and his customers in the least. Her strong Victorian attitudes regarding the evils of alcohol probably didn't help either. She was also an absolute perfectionist and insisted on cleanliness and order in her household and in the various homes and public building that she visited. Despite her strong views on many issues, she remained fiercely loyal to her small circle of family members and friends and often provided financial support when she could. She was also devoted to animal welfare (she owned cats all her life) and many of her surviving letters show her concern about the poor veterinary care available at the time.
By 1900, Florence Nightingale was completely blind and more dependent on her personal staff than ever. When financial problems forced her to "retrench" and let her nurse go, it was a personal blow for her but she managed to live her remaining years in comfort. For the last ten years of her life, she was an almost total invalid with little real writing completed. Her memory had become so poor that she needed to be briefed on any new visitor that she received. The India Office was instructed to stop sending her material in 1906 since she could no longer understand them. When Florence Nightingale died on August 13, 1910, she left behind an amazing legacy of public service and writing (although many of her papers were destroyed at her death as she had requested). While she also left behind instructions that her body be used for medical research, her wishes were ignored and she was buried in her family church in East Wellow. The grave marker simply states, "F.N. Born 12 May 1820, Died 13 August 1910.”
Aside from her achievements, Florence Nightingale also left behind a medical mystery. What was the disease that left her an invalid for much of her life? Given the lack of proper diagnostic tests at the time and the variable nature of her symptoms, many of her later biographers suggested that her illness was largely psychosomatic. Given the number of soldiers in her care who had died as a direct result of her reluctance to recognize the need for proper sanitation (which she freely admitted in her commission work), the theory that her symptoms stemmed from depression became popular for a time. Even up to 1899, the Encyclopedia Britannica article on her stated that "it has never been shown that Florence Nightingale had any organic illness; her invalidism may have been partly neurotic and partly intentional." Her tendency to worsen whenever she experienced emotional turmoil also resulted in accusations of deliberate malingering (she was often referred to as a "strategic invalid").
The current medical consensus seems to be that her symptoms stemmed from a serious attack of brucellosis (also known as "Crimean fever") during her time in Turkey. Believed to be the result of her exposure to infected meat or unsterilized milk, the acute phase of the disease can be marked by severe headaches, anemia, depression, and weakness. Although she recovered enough to carry on her nursing work, the damage left behind by the disease would stay with her for the rest of her life. Considering that brucellosis is still rare in industrialized countries, it's hardly surprising that her condition was never properly diagnosed in her lifetime. There has also been speculation that she suffered from chronic fatigue syndrome or myalgic encephalomyelitis and the Nightingale Research Foundation continues to fund research into those two diseases in her name.
Whatever the actual diagnosis, there is no doubt that Florence Nightingale's ability to carry on her reform work while dealing with such a debilitating disease remains inspirational. The annual International Nurses Day is still celebrated each year on her birthday.