At the age of 37, Nightingale collapsed in her London home and for three decades rarely strayed from couch or bed, complaining of a wide and puzzling variety of symptoms ranging from pain in her spine to “recurrent spasms of the heart.”

Then, when she was 68, her affliction suddenly and mysteriously lifted.

Over the years, historians and medical experts have puzzled over what turned the famous medical reformer into an even more famous recluse, proposing everything from chronic lead poisoning to post-traumatic stress disorder to Malta fever, a bacterial infection.

Yesterday, more than 200 doctors, medical students and armchair historians packed Davidge Hall at the University of Maryland School of Medicine to listen to a new theory. Katherine Wisner, a psychiatrist at the University of Pittsburgh School of Medicine, argues that Nightingale suffered from bipolar disorder.

The forum, sponsored by the medical school and the Veterans Affairs Maryland Health Care System, is part of an annual conference. In the past, guest experts have retrospectively diagnosed the ills of luminaries such as Edgar Allan Poe (rabies), Beethoven (syphilis), and Alexander the Great (typhoid fever).

The idea, said Philip Mackowiak, the VA’s medical director and conference coordinator, is not just to have fun, but also “to teach problem-solving techniques and principles of medicine.”

The case of Nightingale, he said, was hard to pass up. “She’s a woman who basically went to bed for 30 years and then got up. I’ve never heard of anybody with that kind of illness,” he said.

To find clues to Nightingale’s illness, Wisner spent six months poring over her voluminous correspondence and diary entries. She also discussed the case with a psychopharmacologist and a nurse.

Nightingale’s chronic medical troubles—and her fame—began during the Crimean War. In 1854, the 34-year-old British army nurse was dispatched to Scutari, Turkey, to tend to troops suffering from cholera, typhus, typhoid and gangrene.

The conditions of the British military hospitals shocked her. Drinking water was foul, and a typical meal, she wrote, was often rancid. Thousands of her patients died.

But the ones who survived wrote letters home about Nightingale. Soon, The Times of London started to publish articles that made her an international celebrity. Poet Henry Wadsworth Longfellow described her as the “lady with a lamp,” tending sick soldiers. Others wrote songs, carved woodcuts and made china figurines in her honor.

In May 1855, Nightingale suddenly felt tremendous fatigue and “as bad an attack of fever as I have seen,” her physician reported. The symptoms lasted for two weeks. Afterward, Nightingale was so weak that she was unable to speak above a whisper or feed herself. Doctors judged it to be “Crimean fever.”

When Nightingale returned to England, her troubles continued. She complained of persistent insomnia, irritability, nervousness and depression. She felt ill when she saw food and exhibited an excessive fear of failure. In September 1857, she collapsed and declared herself an invalid, withdrawing to her house for the next 30 years.

Over the years, historians and others have tried to explain her illness. In 1995, a British scientist argued that Nightingale’s Crimean fever and subsequent health troubles stemmed from a case of brucellosis, a bacterial infection common among farmers, butchers and stockmen

Wisner argued that brucellosis does not account for Nightingale’s severe mood swings or her extraordinary productivity.

Despite Nightingale’s isolation at home, she established the first modern nursing school and wrote 200 reports and books, including the first nursing textbook.

“If you just focus on the war, you miss all kinds of things,” Wisner said. “She was a sick person before that.”

In Nightingale’s diaries and letters, Wisner also detected signs of mental illness. When Nightingale was 16, she reported having a mystic experience in which God spoke to her. Also, her writings showed signs of depression. “Oh, God, let me die,” Nightingale once wrote.

Adding to the mystery is that Nightingale’s symptoms disappeared nearly as suddenly as they began. When she was 68, her depression lifted, and she suddenly felt well enough to leave her room. Nightingale died in her sleep at age 90.

The sudden disappearance of Nightingale’s afflictions “stumped me until about two days ago,” Wisner said. But then she recalled research showing that the number of people who experience symptoms of depression and mania plummets as they reach their 60s.

She said it is easier to find evidence of Nightingale’s depressed episodes than to find evidence of her manic ones. But Wisner said bipolar disorder in women is often that way: long periods of depression with short bursts of mania.
“The manic periods . . . allow for extreme productivity, creativity and insight that go beyond what would normally be possible,” Wisner concluded.