Thursday, August 4, 2011

Florence Nightingale

Florence Nightingale (1820 - 1910), who died 100 years ago, is well-known as a heroic nurse during the Crimean War. What is less well-known is her remarkable ability as a statistician and her use of these mathematical skills to influence people in authority and bring about real social change.

When Nightingale arrived in the military base in Scutari (now near Istanbul, Turkey) in 1854, the wounded soldiers were being badly cared for by over-worked medical staff, hygiene was being completely neglected and medicines were in short supply. In short, the camp was overcrowded, unventilated and squalid, with sewers leaking through the walls of the hospital and running across the floor.

16000 British soldiers died from disease in the war (another 2000 from wounds and 2000 in battle) and Nightingale was spurred into action by the squalor she had witnessed and the unnecessary loss of life.

But there was resistance to change from all in authority. Many, even in the scientific community, did not believe in sanitation as a way to improve the care of wounded soldiers. Moreover, many in the establishment didn't care about the well-being of soldiers anyway, considering them almost as low as animals.

Nightingale's use of statistical diagrams was, over time, to change all of this. She recorded the deaths in the camp meticulously and subsequently prepared diagrams based on her data. She is credited with developing a form of the pie chart (shown above) now known as the polar area diagram, or sometimes the "Nightingale Rose Diagram".

The right-hand side of the diagram shows a period of terrible loss of life at Scutari. The area of the blue sectors represents the number of deaths from preventable disease. The left-hand side shows the effects some of the changes had brought about very quickly.

This use of eye-catching graphs was highly innovative. Previously, statistics had been a study of numbers and the data were almost exclusively published in long tables. Indeed, Nightingale gained help from the statistician William Farr, but he originally disapproved of her diagrams.

After the war, Florence Nightingale began campaigning tirelessly. She leaked her report to 100 influential people to try to get information into the public domain. She gained an audience with Queen Victoria and members of the British government. Public support was behind her and the pressure for change was building.

She knew she had a limited time with those in authority and her report needed to show that poor hygiene was unmistakably the cause of death of thousands of men. Her diagram must be so eye-catching as to seize attention immediately. It seemed to work. Eventually the government approved publication of her report.

Slowly, the army adopted sanitary science, statistical medicine, and decent levels of nutrition for soldiers on the battlefield. Army medical practice changed beyond recognition.

What makes Florence Nightingale's achievements all the more remarkable is that, from 1857 onwards, she was largely bed-ridden, due to illness and depression. She influenced many other social reformers, who caught on to the idea of using graphs to convey their message and influence those in authority.

And another legacy of this extraordinary woman's work must be that campaigners in all fields know that to appeal to minds, they must first appeal to the eye.
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Witch of Stitches said...

Most interesting. While I knew that Florence was influential in care of the sick and injured as well as making sanitary conditions more important, I had no idea she was a statistician and used this information for her cause. Even more interesting is that she lived such a long life, accomplished so much, yet suffered from depression.

Sarah Ettritch said...

I had no idea; I only knew about her nursing accomplishments. Thanks for teaching me something new.