Florence Nightingale: Statistician?

Brilliance | Dec. 15, 2017

Most people know of Florence Nightingale as "the lady with the lamp"; a famous nurse who tirelessly aided sick and wounded soldiers in the 1800s. But what most people don't know is that she wielded a much greater influence with her pen than with her candle. Florence Nightingale was a trailblazing statistician who used her knack for numbers and data visualization to literally save lives.

The Story You Know

As a child, Nightingale was thirsty for knowledge. Her father fueled that fire by guiding her education, leading her to read the great philosophers, engage in social and political discourse, and read and write five languages at a young age. In her late teens, she felt a "calling from God" to reduce human suffering, and decided she wanted to go into nursing. Despite her well-to-do family's belief that nursing was beneath her, she trained as a nurse and eventually became the superintendent at a London hospital. Within a year, she had improved nursing care, working conditions, and efficiency, and started setting her sights on training nurses instead.

But in 1853, everything changed for Europe. The Turkish (and British-backed) Ottoman Empire declared war on Russia, triggering the start of the Crimean War. Soon, newspapers were reporting that the military hospitals were in shameful condition, with ineffective staff and inadequate supplies. Nightingale happened to be friends with Liz Herbert, the wife of British secretary of state Sidney Herbert, and wrote to her asking if Sidney would let her lead a private expedition to help out in the military hospitals. Coincidentally, Sidney was sending a letter at the same time asking Nightingale to do just that. Once the confusion had settled, Nightingale gathered a party of 38 women and arrived at the Barrack Hospital in Scutari in November 1854.

The conditions, as reported, were awful. The space was filthy, the overcrowding was terrible, and even basic supplies were hard to come by. What's worse, five days after she arrived, injured soldiers from two more battles arrived and completely overwhelmed the hospital. Nightingale got to work delegating, getting the rooms cleaned, laundry cleaned, and, most importantly, the patients cared for: she made sure that every patient was bathed, clothed, fed, and given psychological support.

The Story You Don't

But if the facility was bad, the recordkeeping was worse. "Even the number of deaths was not accurately recorded," wrote Edwin W. Kopf later in the Publications of the American Statistical Association. "The three separate registers then maintained gave each a totally different account of the deaths among the military forces."

While her staff cleaned rooms, Nightingale cleaned up the records. She established a new system of recording each patient's principle illness and the hospital's mortality data — and in the process, realized conditions were even worse than she thought. In the first seven months of the war, 60 percent of soldiers died from disease alone. She had to do something. "I stand at the altar of murdered men," she wrote in her private notes, "and while I live, I fight their cause."

But just because the facts are on your side doesn't mean you'll have an easy time convincing government officials to do anything about it. That's what led to Nightingale's most lasting legacy: her infographics. More than a century before data visualization became trendy, Nightingale invented the "Coxcomb"— an extra-fancy pie chart that data scientists still use to this day. After dividing a circle into the 12 months of the year, she used proportion and color coding to illustrate not only how that month's mortality rate compared to the others, but how much of that mortality rate was due to unsanitary conditions compared to battle wounds. It turned piles of boring data into a vivid symbol that showed readers exactly what the numbers meant.

That chart and others illustrated an 850-page report that she presented to the British government. That led them to institute big reforms in the military medical system. It also led others to institute the Nightingale Fund, which Nightingale used to establish the Nightingale School of Nursing in London. There, she established evidence-based nursing training, and wrote a book on nursing that's still being published today.

All this, and it's a wonder we remember Nightingale as the tireless nurse roaming the hospital wards as the "lady with the lamp." Writes science professor Alan Finkel, "She ought to be the Lady with the Logarithm. She saved far more lives by her grasp of numbers than by her gift for nursing. And she put data at the heart of healthcare as we know it today."

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