Hi,
Maria Alexandrovna suffered from tuberculosis and was prone to influenza and pneumonia; all of which doomed her to live in Russia.
At the beginning of her time there in the 1840's and 50's, she seemed healthy and active. She headed the Russian Red Cross and encouraged her husband in liberal thinking and freeing the Serfs.
She did found and operate schools and hospitals and orphanages in Russia; so she did accomplish much during her healthy years. These works were continued by her daughter and daughters-in-law......
But after 1860 and the last of her many pregnancies, she slowly went downhill and lived mostly in Southern Italy and the French Riviera.
She was pretty much a recluse during her later times in Russia and was seldom seen in public.
Her eldest son, Nicholas, also had TB and died in Nice in 1865.
Maria died in 1880.
Larry