Florence Nightengale (1820-1910)

Florence Nightengale is mostly known for her radical innovations in nursing care. She was a pioneer in nursing and a reformer of hospital sanitation methods. Besides being a nurse, reformer, and humanitarian, Nightengale was a statistician. S he would use new techniques of statistical analysis and apply them to her life’s work. Biographer, Sir Edward Tirook, called her the "Passionate Statistician".

Florence Nightengale was born in Florence, Italy on May 12, 1820. She was named after the city she was born in. She was raised mostly in Derbyshire, England. Most Victorian women of her age group did not attend universities or pursue careers. H er father, William Nightengale, however, believed women should get an education. Both Florence and her sister received a thorough classical education from their father. She especially received an excellent education in mathematics from her father and au nt and from James Sylvestor, her math tutor. Besides math, she was well educated in history, economics, astronomy, science, philosophy, and multiple languages. Her mother taught her social skills and leadership qualities.

Florence became disenchanted with the upper class lifestyle she was born into. When she was young she would care for sick and injured pets. Later she would care for servants who were ill. In 1837, Florence said she heard the voice of God tell he r she had a mission. At the time she did not know what it was. Later she would discover her mission.

In 1849, she went abroad to study the European hospital system. One year later, she began training at the Institute of Saint Vincent de Paul in Alexandria, Egypt. She then studied at the Institute for Protestant Deaconesses at Kaiserworth, German y. In 1853, she became superintendent of the Hospital for Invalid Gentlewomen in London. She volunteered her services in 1854 in the Scutari after the Crimean War broke out. The minister of war proposed that she assume direction of all nursing operatio ns at the war front. Through her efforts, the mortality rates among the sick and wounded was greatly reduced. After the war, in 1869, Nightengale founded the Nightengale School Home for Nurses at Saint Thomas’s Hospital in London, marking the beginning of professional education in nursing. Nightengale did much to reform the health and living conditions of the British army, the sanitary conditions and administration of hospitals, and the nursing profession.

While nursing was her profession and what she was most known for, Florence used statistics to achieve her reforms. During the Crimean War, she collected data and systemized record-keeping practices. She used the data for improving hospital condit ions. Her calculations of the mortality rate showed that an improvement in sanitary conditions would lead to a decrease in deaths. Nightengale took her statistical data and represented them with graphical diagrams, which were an innovation in statistics at the time. She invented polar-area charts, where the statistic being represented is proportional to the area of a wedge in a circular diagram. The graphical illustrations portrayed, by means of shaded or colored squares, circles and wedges, (1) the de aths due to preventable causes in the hospitals during the Crimean War and (2) the rate of mortality in the British Army at home.

Florence had a flair for collecting, arranging, and presenting facts and figures. She became aware that mortality statistics should be age-specific and that crude death rates can be misleading. In 1850, there was no scientific system of tabulatin g or reporting mortality or morbidity statistics. When Nightengale arrived at Scutari in 1854, no proper records were being kept. She introduced a system of recording the sickness and mortality data of the military hospitals. The system allowed her to be able to plead her case successfully. For further reforms, she made proposals for standardizing and improving the collection and recording of health statistics. She shares credit for this with her adviser William Farr. Farr brought a scientific appro ach to vital statistics.

There was much opposition to the reforms proposed by Nightengale. Her most effective weapon was the presentation of sound statistical data. She showed, for example, the "those who fell before Sebastopol by disease were above seven times the number who fell by the enemy." The opposition could not respond to her statistics and publication of the statistics led to public outcry.

Her study of the data in the Crimea convinced her that many of the deaths in hospitals did not need to occur. The results of her personal studies of army medical statistics were in a report titled "Notes Affecting the Health, Efficiency and H ospital Administration of the British Army." Her "Notes" made a profound impression, showing the causes of failure and a means by which the country could best provide for the health of its troops in future wars.

When she returned from the Crimea, she directed her attention to hospital statistics, as an aide to administration of institutions for the care of the sick. She found a lack of scientific coordination. With the help of Dr. Farr and other physicians, she made a standard list of diseases and a set of model hospital statistical forms.

Her skill in using the statistical method in army sanitation reform led to her election in 1858 to fellowship in the Royal Statistical Society. In 1874, the American Statistical Association elected her an honorary member. Nightengale was instrume ntal in the founding of a statistical department in the army.

Nightengale used statistical methods to study the questions relating to the possible removal of St. Thomas’ Hospital to provide room for a railroad. She showed the probable effect upon patients to the removal of the hospital to the several possibl e sites suggested.

Nightengale had proposed gathering statistics during the census to help her sanitary reform. She wanted to enumerate the sick and gather complete data on the housing of the population. She said "The connection between the health and the dwel lings of the population is one of the most important that exists."

She believed that social and moral sciences are in method and substance statistical sciences. She was profoundly influenced by the studies of Adolphe Quetelet in moral statistics. Nightengale learned a lot from Quetelet about the science and art of describing society in terms of numbers. She learned the methods, goals, and results of inquiry into social facts and forces.

In 1891 Nightengale founded at Oxford a Professorship in Applied Statistics. At this time she relinquished active interest in the progress of statistics because of failing physical health.

Nightengale’s sympathy for the sick and distressed was coupled with a genius for determining the forces which make for disease and suffering. She did this through extensive gathering of data and through analysis of the statistics. In a time when the collecting, editing, and presentation of data was not commonplace like it is today and when prejudices against women were prevalent, Nightengale’s accomplishments were truly remarkable. Florence once said "To understand God’s thoughts, we must s tudy statistics, for these are the measure of His purpose."

http://bemorecreative.com/one/180.htm

http://www.internurse.com/flo.htm

http://www.netsrq.com/~dbois/nighting.html

http://www.scottlan.edu/lriddle/women/nitegale.htm

Kopf, Edwin W. "Florence Nightingale as Statistician." Studies in the History of

Statistics and Probability. New York: Macmillan Publishing Co., Inc. 1977.

Read, Campbell B. "Florence Nightingale." Encyclopedia of Statistical Sciences.

New York: John Wiley & Sons. 1986.