Lady with the lamp: A pioneer in Statistical Graphics Florence Nightingale Lady with the lamp: A pioneer in Statistical Graphics

Some facts and figures from Wikipedia Born: 12 May 1820 Florence, Tuscany Died: 13 August 1910 Mayfair, London Nationality: British Known for: Pioneering modern nursing Fields: Hospital hygiene and sanitation, statistics

Family and Background: Born to a very wealthy upper class British family Father: William Edward Nightingale Mother: Frances ("Fanny") Nightingale née Smith Sibling: Sister Francis Parthenope Nightingale Verney William's mother was the niece of Peter Nightingale, who willed his estate to him, and he assumed the name and arms of Nightingale. Fanny's father (Florence's maternal grandfather) was the abolitionist and Unitarian William Smith. Humanitarian, Unitarian and Liberal from both sides of the family.

Education Taught at home by her father. He taught his daughters classics, philosophy and modern languages. Unlike other women during that time she was taught Mathematics. Florence excelled in mathematics and science, she loved data. Her love of recording and organizing information was clear from an early age – she documented her extensive shell collection with precisely drawn tables and lists She was always interested in data and graphs

Different from others She recorded detailed notes of population statistics, hospitals and other charitable institutions. In spite of her mother's disapproval, she later received further tuition in mathematics. In 1837, she became convinced God had 'called' her to his service and that she should be a nurse In 1838 she met Mary Clarke, an unconventional woman and became close friends Mary Clarke was an intellectual and encouraged Florence’s ideas about working She traveled extensively and was friends with powerful people like Sidney Herbert and Benjamin Jowett.

Rebellion Being attractive, slim and rich she had many admirers noteworthy among them the poet Milne. At age 24 she wanted to study nursing much to the horror of her family. She visited hospitals around Europe frequently. She turned down Milne’s proposal after a 9 year “courtship” as she felt marriage would interfere with her mission Apparently she turned down Jowett’s proposal as well and he never married.

Breakthrough At age 30, seeing his daughter was unlikely to marry, Florence’s father allowed her to train as a nurse in Germany. Her sister suffered a nervous breakdown in 1852. This forced Florence to return and care for her. Florence became superintendent at a women's hospital in Harley Street in 1853.

Crimean War Crimean war broke out in in 1853 and there were horror stories of British soldiers dying. In 1854 with the help of her friend Sidney Herbert (war secretary) and Mary Clarke she and 38 nurses she had trained reached the British base camp (what is now in Turkey). She realized that the soldiers were dying more from unsanitary conditions rather than from being wounded. She realized reform was necessary and she knew that while people may not believe her, data would be her powerful ally.

Lady with the lamp Florence Nightingale worked hard to bring more sanitary conditions and make the hospital more efficient. But still death toll rose sharply. Her dedication for the sick soon became well known and across Britain there were many Florence “fans”. She became well-know as “the lady with the lamp”. But she realized that just nursing wasn’t enough. She realized that the hospital was built on a sewer and the drinking water was contaminated. She knew that to make changes she had to use her old friend: data.

Lady with the data Using her fame Florence met with one of her biggest fans, Queen Victoria. She persuaded the government to set up a Royal Commission into the health of the army. Leading statistician William Farr and John Sutherland of the Sanitary Commission helped her analyze vast amounts of complex army data. The truth she uncovered was shocking – 16,000 of the 18,000 deaths were not due to battle wounds but to preventable diseases, spread by poor sanitation.

Graphical Summary Florence realized that data by itself wouldn’t help her case, she started finding ways to summarize data using graphical methods. The pie-chart had been introduced by Playfair in 1801. Quetelet had started using statistics (which at that point was mainly used in astronomy) in social sciences. Florence looked at these pioneers’ work. To summarize the deaths in the Crimean war she used an innovative graphical summary called Coxcombs.

Rose Diagram Rather than lists or tables, she represented the death toll in a revolutionary way. Her ‘rose diagram’ showed a sharp decrease in fatalities following the work of the Sanitary Commission – it fell by 99% in a single year. The diagram was so easy to understand it was widely republished and the public understood the army’s failings and the urgent need for change. In light of Florence’s work, new army medical, sanitary science and statistics departments were established to improve healthcare

Her books and reports Appendix 72 of the report of the Royal Commission that Nightingale organized after the war, published in 1858. Mortality of the British Army (1858), a private edition by Nightingale A Contribution to the Sanitary History of the British Army (1859).  Notes on Matters Affecting the Health of the British Army (1858).  England and Her Soldiers (1859) by Harriet Martineau.  Nightingale encouraged Martineau to write this book about the war and gave her copies of the graphics used in No. 3.

Pages from the Mortality of the British Army

Some quotes from Florence Nightingale: I attribute my success to this - I never gave or took any excuse. How very little can be done under the spirit of fear. It may seem a strange principle to enunciate as the very first requirement in a hospital that it should do the sick no harm.

Fight for sanitary conditions Nightingale took her fight for sanitary after the war to India and rallied for soldiers to have better sanitary conditions there. Nightingale made a comprehensive statistical study of sanitary conditions in Indian rural life She was the leading figure in the introduction of improved medical care and public health service in India. In 1858 and 1859, she successfully lobbied for the establishment of a Royal Commission into the Indian situation. Two years later, she provided a report to the commission, which completed its own study in 1863. "After 10 years of sanitary reform, in 1873, Nightingale reported that mortality among the soldiers in India had declined from 69 to 18 per 1,000".

Nightingale’s contribution Her contribution to nursing is well-known She contributed to the theory and techniques used in modern nursing She rallied for training of nurses and wrote books on the subject

Nightingale’s contribution to Statistics Florence Nightingale was not the first one to use statistical graphics Her contribution was that she used statistical graphics to rally for change. She believed in data based decisions and wanted everybody to understand her data and came up with simple graphics She was the first woman to be elected to the Royal Statistical Society She was the first female member of the American Statistical Association. There is so much talk about “data based decisions” these days. She was the pioneer of this idea.