Florence Nightingale: Innovator in Statistics and Data Presentation

Florence Nightingale: Innovator in Statistics and Data Presentation

Timothy Taylor 12/05/2020 10
Florence Nightingale: Innovator in Statistics and Data Presentation
I learned as a child about Florence Nightingale (1820-1910) as the founder of the modern profession of nursing and probably the single person who did the most to make it socially acceptable for women from middle - and upper-class background to become nurses. Her name became eponymous: referring to someone as "Florence Nightingale" was a way of saying that the person was a perfect nurse.

For more than a century, the International Committee of the Red Cross has given an award in her name for "exceptional courage and devotion to the wounded, sick or disabled or to civilian victims of a conflict or disaster" or "exemplary services or a creative and pioneering spirit in the areas of public health or nursing education."

What I had not learned about Nightingale as a child was that she was also an early innovator in applying statistical analysis to health data, and in the graphic presentation of data.  Indeed, she was the first female member of Britain's Royal Statistical Society / Noel-Ann Bradshaw provides a nice overview of this story in "Florence Nightingale (1820–1910): An Unexpected Master of Data," in Patterns magazine (May 2020). 

Nightingale's work in statistics and data followed after her legendary work in the Crimean War. (For background here, I draw on the article about Nightingale from the History.com editors, updated April 17, 2020.)  When she arrived at the main British base hospital in Constantinople in 1854, she found that the "hospital sat on top of a large cesspool, which contaminated the water and the hospital building itself. Patients lay on in their own excrement on stretchers strewn throughout the hallways. Rodents and bugs scurried past them. The most basic supplies, such as bandages and soap, grew increasingly scarce as the number of ill and wounded steadily increased. Even water needed to be rationed. More soldiers were dying from infectious diseases like typhoid and cholera than from injuries incurred in battle."

Nightingale dramatically revamped hygiene, food, laundry, and nursing practices. The hospital's death rate fell by two-thirds. Upon her return to England in 1856, she was greeted as a hero. She wrote an 830-page report, "Notes on Matters Affecting the Health, Efficiency and Hospital Administration of the British Army." Queen Victoria supported her in establishing Royal Commission for the Health of the Army in 1857. where she worked with leading statisticians of the day. 

Bradshaw presents several examples of Nightingale's data presentations. For example, Bradshaw writes: 

She became fascinated that the mortality rate among soldiers stationed at home was higher than the mortality rate of ordinary British men, despite soldiers being healthier at the start of their careers. She used data to examine the cause, concluding that the problem was poor sanitation and over-crowding of military barracks, encampments, and hospitals that exacerbated the spread of disease. She drew many graphs depicting this, including Figure 1, which shows five circles filled with hexagons representing the space between people. The first three circles show how closely packed the army would be in the Quartermaster General’s camp plans, while the last two circles show how densely packed the inner city of London currently was and the population of London in general. This comparison made it obvious to anyone that the Quartermaster General’s proposition for encampment was going to be problematic given how unhealthy densely populated areas of London were.

Florence Nightingale: Innovator in Statistics and Data Presentation
 
Here's another example, from Bradshaw:

She [Nightingale] went on to forecast the efficiency of the army if the soldiers were as healthy as the rest of the men in the UK. This graph was way ahead of its time (Figure 2). On the left she displayed the current situation, showing the effectiveness of the British Army in terms of the numbers who were ill, invalided, etc. On the right she graphed the potential effectiveness of the army if the soldiers were as healthy as the general male population. By forecasting this potential effectiveness, she emphasized how the army at rest were experiencing higher degrees of mortality that the general male population. 
 
Perhaps the most famous of Nightingale's figures was sometimes called the "rose" diagram. Each wedge represents death sin a month. The red part of the wedge is deaths from wounds; the blue par is deaths from infectious disease; and the total is deaths from all causes. The circle on the right is April 1854 to March 1855, while the circle on the left is the following year from April 1855 to March 1856. 
  
Florence Nightingale: Innovator in Statistics and Data Presentation
 

Exercises like these also made Nightingale an outspoken advocate for improved and regularized methods of collecting health statistics--a lesson which is self-evidently still being learned today during the coronavirus pandemic. 

I should be clear that Nightingale's work in statistics and data presentation has been well-known for a long time--just not by me. Indeed, there is an award given to a prominent female statistician every other year by the Committee of Presidents of Statistical Societies and Caucus for Women in Statistics called the Florence Nightingale David Award. F.N. David's (1909-1993) parents were friends with the nurse, and named their daughter after her. David did her doctoral research with Karl Pearson in the 1930s, and then spent most of of her professional career at University College in London,  University of California, Riverside, and University of California, Berkeley.

If history of data display is holding some perhaps unexpected appeal for you, you might also be interested in "William Playfair: Inventor of the Bar Graph, Line Graph, and Bar Chart" (August 9, 2017). 

A version of this article first appeared on Conversable Economist.

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  • Ellan Wicks

    In a time like this... we need more people like her. We need Florence Nightingales.

  • Ron Hoogan

    Florence was the first one to receive the order of the merit

  • Terry Johnson

    An amazing nurse and such an inspiration to all other nurses

  • Joe Pisani

    Good article

  • Elliott Arnold

    Love it !!

  • Greg Kennedy

    She is a smart woman

  • Paul Clint

    I highly respect nurses, because they are the first ones to see any patient whether it be in the hospital, emergency room, or a doctor's office, and they're the ones who do an initial diagnosis.

  • Wayne Hillier

    To every single nurse, thank you for your undying sacrifice, your phenomenal service, and your unwavering dedication in helping those who are in great need of help.

  • Kevin Murray

    This was a great article.

  • Paul Haynes

    Very interesting.

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Timothy Taylor

Global Economy Expert

Timothy Taylor is an American economist. He is managing editor of the Journal of Economic Perspectives, a quarterly academic journal produced at Macalester College and published by the American Economic Association. Taylor received his Bachelor of Arts degree from Haverford College and a master's degree in economics from Stanford University. At Stanford, he was winner of the award for excellent teaching in a large class (more than 30 students) given by the Associated Students of Stanford University. At Minnesota, he was named a Distinguished Lecturer by the Department of Economics and voted Teacher of the Year by the master's degree students at the Hubert H. Humphrey Institute of Public Affairs. Taylor has been a guest speaker for groups of teachers of high school economics, visiting diplomats from eastern Europe, talk-radio shows, and community groups. From 1989 to 1997, Professor Taylor wrote an economics opinion column for the San Jose Mercury-News. He has published multiple lectures on economics through The Teaching Company. With Rudolph Penner and Isabel Sawhill, he is co-author of Updating America's Social Contract (2000), whose first chapter provided an early radical centrist perspective, "An Agenda for the Radical Middle". Taylor is also the author of The Instant Economist: Everything You Need to Know About How the Economy Works, published by the Penguin Group in 2012. The fourth edition of Taylor's Principles of Economics textbook was published by Textbook Media in 2017.

   

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