Florence Nightingale: The passionate statistician

Fascinating. A big part of her success was after the Crimean War, reporting what went wrong, from a health perspective. [Link]

When Nightingale returned from the war, she was obsessed with a sense of failure, even though the public adored her. Despite her efforts, thousands of men had died needlessly during the war from illnesses they acquired in the hospital. “Oh, my poor men who endured so patiently,” she wrote to a friend, “I feel I have been such a bad mother to you, to come home and leave you lying in your Crimean graves, 73 percent in eight regiments during six months from disease alone.” Without widespread changes in Army procedures, the same disaster could occur again, she worried.

So she began a campaign for reform. She persuaded Queen Victoria to appoint a Royal Commission on the Army medical department, and she herself wrote an 830-page report. Her stories, she decided, weren’t enough. She turned to William Farr, who had recently invented the field of medical statistics, to help her identify the reasons for the calamity and the necessary policy changes. He advised her, “We do not want impressions, we want facts.”

Under Farr’s tutelage, Nightingale compiled vast tables of statistics about how many people had died, where and why. Many of her findings shocked her. For example, she discovered that in peacetime, soldiers in England died at twice the rate of civilians — even though they were young men in their primes. The problem with the military health service, she realized, extended far beyond a few terrible hospitals during a war.

Furthermore, the statistics changed Nightingale’s understanding of the problems in Turkey. Lack of sanitation, she realized, had been the principal reason for most of the deaths, not inadequate food and supplies as she had previously thought. Deaths from disease began to fall only in March 1855, after a Sanitary Commission arrived in Turkey. They did what she could not do alone: They flushed the sewers, removed putrid animal carcasses that were blocking the water supply, replaced rotten floors and improved ventilation. Almost immediately, the mortality rate dropped from 52 percent to 20 percent.

As impressive as her statistics were, Nightingale worried that Queen Victoria’s eyes would glaze over as she scanned the tables. So Nightingale devised clever ways of presenting the information in charts. Statistics had been presented using graphics only a few times previously, and perhaps never to persuade people of the need for social change. In doing so, she ignored the express advice of her mentor, Farr. “You complain that your report would be dry,” he wrote to her. “The dryer [sic] the better. Statistics should be the dryest [sic] of all reading.”

Nightingale’s best-known graphic has come to be known as a “coxcomb.” It is a variation on the familiar modern pie graph, showing the number of deaths each month and their causes.

Animated version of the graphs.