Florence Nightingale


From a letter from cousin Bob McDonald:

FN had "Crimean Fever" and then developed "Brucellosis".... There was an article written about her in a British medical journal and I have the reference. Apparently, this was a chronic disease and may have contributed to her longstanding withdrawal.

The incubation period varies from 5 days to several months (average, 2 wk). Symptoms vary, especially in the early stages. Onset may be sudden and acute, with chills and fever, severe headache, pains, malaise, and occasionally diarrheal or it may be insidious, with mild prodromal malaise, muscular pain, headache, and pain in the back of the neck, followed by a rise in evening temperature. The total WBC count usually is normal or reduced, with a relative or absolute lymphocytosis. As the disease progresses, the temperature increases to 40 or 41° C (104 or 105° F), then subsides gradually to normal or near-normal In the morning, when profuse sweating occurs.

Typically, the intermittent fever persists for 1 to 5 wk, followed by a 2- to 14-day remission with symptoms greatly diminished or absent; the febrile phase then recurs. Sometimes this pattern occurs only once; occasionally, however, subacute or chronic brucellosis ensues, with repeated febrile waves (undulations) and remissions recurring over months or years. In some patients, fever may be only transient.

After the initial phase, constipation usually is pronounced; anorexia, weight loss, abdominal pain, joint pain, headache, backache, weakness, irritability, insomnia, mental depression, and emotional instability occur. Splenomegaly appears, and lymph nodes may be slightly or moderately enlarged; hepatomegaly may be present in up to 50% of patients.

Patients with acute, uncomplicated brucellosis usually recover in 2 to 3 wk. Complications are rare but include SBE, meningitis, encephalitis, neuritis, orchitis, cholecystitis, hepatic suppuration, and bone lesions. Chronic disease usually results in prolonged ill health, but the disease is rarely fatal.

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