Florence Nightingale (1820 1010) By Noel-Ann Bradshaw, University of Greenwich

Florence Nightingale (1820 – 1010)
By Noel-Ann Bradshaw, University of Greenwich
Florence Nightingale is known to many people as a pioneer of nursing – the “Lady with the Lamp” who comforted wounded soldiers during the Crimean war. She had a profound effect on the practice of nursing, but you may not realise that it was through her use of statistics that she was able to establish the need for change which lead to a massive improvement in the nursing conditions in military hospitals.
Nightingale was born in 1820, and was named Florence after the place of her birth. She was initially taught by a governess but, after finding out that she passionate about learning mathematics, her parents grudgingly and allowed her to be tutored in the subject. This was very unusual for this period and indeed her parents, who desired her purely to get married, wondered “What use were mathematics to a married woman?” and urged her to study more appropriate subjects such as “history or philosophy, natural or moral”. It is probable that one of her mathematical tutors was the eminent mathematician James Joseph Sylvester.
Nightingale was a very intelligent young woman with a strong Christian faith and a keen sense of social justice. She tutored children in mathematics before entering the nursing profession in 1850. She seems to have taken her responsibilities as tutor very seriously as can be seen from some of her lesson plans which are held by the British Museum.
Nightingale also taught poor children at the Ragged School in Westminster. The experience opened her eyes to poverty. She had strong views about education and longed to make it accessible to all but she continually came up against people’s disapproval. She said: “If only education could be conducted without reference to what people think or do not think but only to abstract right and wrong, what a difference it would make!”
Having eventually been allowed to train as a nurse she was asked to go to Turkey in 1854 to oversee the introduction of nurses to the medical hospitals over there. Her position was entitled Superintendent of the Female Nursing Establishment of the English General Hospitals in Turkey.
During her time there she collected large amounts of medical data and organised a record keeping system. She then used this data to calculate the mortality rate in the hospitals. She showed that if sanitary conditions improved then the mortality rate would decrease.
Indeed by February 1855 the mortality rate had dropped from 60% to 42.7% and later that year it dropped further to just 2.2%. Nightingale presented her data in Polar Area diagrams or Coxcombs as she called them. They looked a bit similar to pie charts

in that each diagram contained a number of coloured wedges measured from the centre as a common point. Each wedge was split into sections representing deaths from contagious diseases, wounds and other causes. These were coloured blue, red and black respectively and were drawn in proportion.

From these diagrams, it was easy to see that by far the largest cause of death were contagious diseases such as cholera and typhus. Nightingale realised that if you could prevent the spread of these diseases you would lower the mortality rate. So by putting into practice new regimes for sanitation and avoiding cross contamination she did indeed do this. Such a dramatic decrease in the number of deaths had a significant effect on the war. Had the mortality rate continued to rise, and it would have done had it not been for Nightingale’s intervention, then it is likely that the whole of the British army would have been wiped out by disease alone.
On her return to London after the war she used her hospital statistics to press the case for sanitary reform in all military hospitals, since she realised that these poor conditions were not just present on the field. She calculated that soldiers aged 20-35 during peacetime suffered twice the mortality rate of civilians. She gained the attentions of Queen Victoria and the Prime Minister Lord Palmerstone, and was granted an official enquiry which led to the establishment of the Royal Commission on the Health of the Army.
She became the first woman to be elected as a fellow of the Royal Statistical Society in 1858. Her passion for education and training also motivated her to open the Nightingale Training School and Home for Nurses based at St Thomas' Hospital in

London.
Nightingale used statistics to make a major contribution to healthcare and as a result many lives were saved. She also appreciated the importance of presenting statistical information in appropriate visual form so that the right conclusions can be drawn. In both these respects she addressed issues that remain of major importance today.