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On August 13, 1910, Florence Nightingale, British nurse (Crimean War), died at the age of 90. From the article:
"Florence Nightingale
Florence Nightingale (1820-1910), known as “The Lady With the Lamp,” was a British nurse, social reformer and statistician best known as the founder of modern nursing. Her experiences as a nurse during the Crimean War were foundational in her views about sanitation. She established St. Thomas’ Hospital and the Nightingale Training School for Nurses in 1860. Her efforts to reform healthcare greatly influenced the quality of care in the 19 and 20 centuries.
Florence Nightingale: Early Life
Florence Nightingale was born on May 12, 1820, in Florence, Italy to Frances Nightingale and William Shore Nightingale. She was the younger of two children. Nightingale’s affluent British family belonged to elite social circles. Her mother, Frances, hailed from a family of merchants and took pride in socializing with people of prominent social standing. Despite her mother’s interest in social climbing, Florence herself was reportedly awkward in social situations. She preferred to avoid being the center of attention whenever possible. Strong-willed, Florence often butted heads with her mother, whom she viewed as overly controlling. Still, like many daughters, she was eager to please her mother. “I think I am got something more good-natured and complying,” Florence wrote in her own defense, concerning the mother-daughter relationship.
Florence’s father was William Shore Nightingale, a wealthy landowner who had inherited two estates—one at Lea Hurst, Derbyshire, and the other in Hampshire, Embley Park—when Florence was five years old. Florence was raised on the family estate at Lea Hurst, where her father provided her with a classical education, including studies in German, French and Italian.
From a very young age, Florence Nightingale was active in philanthropy, ministering to the ill and poor people in the village neighboring her family’s estate. By the time she was 16 years old, it was clear to her that nursing was her calling. She believed it to be her divine purpose.
When Nightingale approached her parents and told them about her ambitions to become a nurse, they were not pleased. In fact, her parents forbade her to pursue nursing. During the Victorian Era, a young lady of Nightingale’s social stature was expected to marry a man of means—not take up a job that was viewed as lowly menial labor by the upper social classes. When Nightingale was 17 years old, she refused a marriage proposal from a “suitable” gentleman, Richard Monckton Milnes. Nightingale explained her reason for turning him down, saying that while he stimulated her intellectually and romantically, her “moral…active nature…requires satisfaction, and that would not find it in this life.” Determined to pursue her true calling despite her parents’ objections, in 1844, Nightingale enrolled as a nursing student at the Lutheran Hospital of Pastor Fliedner in Kaiserwerth, Germany.
Florence Nightingale and Nursing
In the early 1850s, Nightingale returned to London, where she took a nursing job in a Middlesex hospital for ailing governesses. Her performance there so impressed her employer that Nightingale was promoted to superintendent within just a year of being hired. The position proved challenging as Nightingale grappled with a cholera outbreak and unsanitary conditions conducive to the rapid spread of the disease. Nightingale made it her mission to improve hygiene practices, significantly lowering the death rate at the hospital in the process. The hard work took a toll on her health. She had just barely recovered when the biggest challenge of her nursing career presented itself.
Florence Nightingale and the Crimean War
In October of 1853, the Crimean War broke out. The British Empire was at war against the Russian Empire for control of the Ottoman Empire. Thousands of British soldiers were sent to the Black Sea, where supplies quickly dwindled. By 1854, no fewer than 18,000 soldiers had been admitted into military hospitals.
At the time, there were no female nurses stationed at hospitals in the Crimea. The poor reputation of past female nurses had led the war office to avoid hiring more. But, after the Battle of Alma, England was in an uproar about the neglect of their ill and injured soldiers, who not only lacked sufficient medical attention due to hospitals being horribly understaffed, but also languished in appallingly unsanitary and inhumane conditions.
In late 1854, Nightingale received a letter from Secretary of War Sidney Herbert, asking her to organize a corps of nurses to tend to the sick and fallen soldiers in the Crimea. Nightingale rose to her calling. She quickly assembled a team of 34 nurses from a variety of religious orders and sailed with them to the Crimea just a few days later.
Although they had been warned of the horrid conditions there, nothing could have prepared Nightingale and her nurses for what they saw when they arrived at Scutari, the British base hospital in Constantinople. 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.
The no-nonsense Nightingale quickly set to work. She procured hundreds of scrub brushes and asked the least infirm patients to scrub the inside of the hospital from floor to ceiling. Nightingale herself spent every waking minute caring for the soldiers. In the evenings she moved through the dark hallways carrying a lamp while making her rounds, ministering to patient after patient. The soldiers, who were both moved and comforted by her endless supply of compassion, took to calling her “the Lady with the Lamp.” Others simply called her “the Angel of the Crimea.” Her work reduced the hospital’s death rate by two-thirds.
In additional to vastly improving the sanitary conditions of the hospital, Nightingale created a number of patient services that contributed to improving the quality of their hospital stay. She instituted the creation of an “invalid’s kitchen” where appealing food for patients with special dietary requirements was cooked. She established a laundry so that patients would have clean linens. She also instituted a classroom and a library for patients’ intellectual stimulation and entertainment. Based on her observations in the Crimea, Nightingale wrote Notes on Matters Affecting the Health, Efficiency and Hospital Administration of the British Army, an 830-page report analyzing her experience and proposing reforms for other military hospitals operating under poor conditions. The book would spark a total restructuring of the War Office’s administrative department, including the establishment of a Royal Commission for the Health of the Army in 1857.
Nightingale remained at Scutari for a year and a half. She left in the summer of 1856, once the Crimean conflict was resolved, and returned to her childhood home at Lea Hurst. To her surprise she was met with a hero’s welcome, which the humble nurse did her best to avoid. The Queen rewarded Nightingale’s work by presenting her with an engraved brooch that came to be known as the “Nightingale Jewel” and by granting her a prize of $250,000 from the British government.
Florence Nightingale, Statistician
With the support of Queen Victoria, Nightingale helped create a Royal Commission into the health of the army. It employed leading statisticians of the day, William Farr and John Sutherland, to analyze army mortality data, and what they found was horrifying: 16,000 of the 18,000 deaths were from preventable diseases—not battle. But it was Nightingale’s ability to translate this data into a new visual format that really caused a sensation. Her polar area diagram, now known as a “Nightingale Rose Diagram,” showed how the Sanitary Commission’s work decreased the death rate and made the complicated data accessible to all, inspiring new standards for sanitation in the army and beyond. She became the first female member of the Royal Statistical Society and was named an honorary member of the American Statistical Association.
Florence Nightingale’s Impact on Nursing
Nightingale decided to use the money to further her cause. In 1860, she funded the establishment of St. Thomas’ Hospital, and within it, the Nightingale Training School for Nurses. Nightingale became a figure of public admiration. Poems, songs and plays were written and dedicated in the heroine’s honor. Young women aspired to be like her. Eager to follow her example, even women from the wealthy upper classes started enrolling at the training school. Thanks to Nightingale, nursing was no longer frowned upon by the upper classes; it had, in fact, come to be viewed as an honorable vocation.
While at Scutari, Nightingale had contracted “Crimean fever” and would never fully recover. By the time she was 38 years old, she was homebound and bedridden, and would be so for the remainder of her life. Fiercely determined and dedicated as ever to improving health care and alleviating patients’ suffering, Nightingale continued her work from her bed.
Residing in Mayfair, she remained an authority and advocate of health care reform, interviewing politicians and welcoming distinguished visitors from her bed. In 1859, she published Notes on Hospitals, which focused on how to properly run civilian hospitals.
Throughout the U.S. Civil War, she was frequently consulted about how to best manage field hospitals. Nightingale also served as an authority on public sanitation issues in India for both the military and civilians, although she had never been to India herself.
In 1908, at the age of 88, she was conferred the merit of honor by King Edward. In May of 1910, she received a congratulatory message from King George on her 90th birthday.
Florence Nightingale: Death and Legacy
In August 1910, Florence Nightingale fell ill, but seemed to recover and was reportedly in good spirits. A week later, on the evening of Friday, August 12, 1910, she developed an array of troubling symptoms. She died unexpectedly at 2 p.m. the following day, Saturday, August 13, 1910, at her home in London.
Characteristically, she had expressed the desire that her funeral be a quiet and modest affair, despite the public’s desire to honor Nightingale—who tirelessly devoted her life to preventing disease and ensuring safe and compassionate treatment for the poor and the suffering. Respecting her last wishes, her relatives turned down a national funeral. The “Lady with the Lamp” was laid to rest in Hampshire, England.
The Florence Nightingale Museum, which sits at the site of the original Nightingale Training School for Nurses, houses more than 2,000 artifacts commemorating the life and career of the “Angel of the Crimea.” To this day, Florence Nightingale is broadly acknowledged and revered as the pioneer of modern nursing."
"Florence Nightingale
Florence Nightingale (1820-1910), known as “The Lady With the Lamp,” was a British nurse, social reformer and statistician best known as the founder of modern nursing. Her experiences as a nurse during the Crimean War were foundational in her views about sanitation. She established St. Thomas’ Hospital and the Nightingale Training School for Nurses in 1860. Her efforts to reform healthcare greatly influenced the quality of care in the 19 and 20 centuries.
Florence Nightingale: Early Life
Florence Nightingale was born on May 12, 1820, in Florence, Italy to Frances Nightingale and William Shore Nightingale. She was the younger of two children. Nightingale’s affluent British family belonged to elite social circles. Her mother, Frances, hailed from a family of merchants and took pride in socializing with people of prominent social standing. Despite her mother’s interest in social climbing, Florence herself was reportedly awkward in social situations. She preferred to avoid being the center of attention whenever possible. Strong-willed, Florence often butted heads with her mother, whom she viewed as overly controlling. Still, like many daughters, she was eager to please her mother. “I think I am got something more good-natured and complying,” Florence wrote in her own defense, concerning the mother-daughter relationship.
Florence’s father was William Shore Nightingale, a wealthy landowner who had inherited two estates—one at Lea Hurst, Derbyshire, and the other in Hampshire, Embley Park—when Florence was five years old. Florence was raised on the family estate at Lea Hurst, where her father provided her with a classical education, including studies in German, French and Italian.
From a very young age, Florence Nightingale was active in philanthropy, ministering to the ill and poor people in the village neighboring her family’s estate. By the time she was 16 years old, it was clear to her that nursing was her calling. She believed it to be her divine purpose.
When Nightingale approached her parents and told them about her ambitions to become a nurse, they were not pleased. In fact, her parents forbade her to pursue nursing. During the Victorian Era, a young lady of Nightingale’s social stature was expected to marry a man of means—not take up a job that was viewed as lowly menial labor by the upper social classes. When Nightingale was 17 years old, she refused a marriage proposal from a “suitable” gentleman, Richard Monckton Milnes. Nightingale explained her reason for turning him down, saying that while he stimulated her intellectually and romantically, her “moral…active nature…requires satisfaction, and that would not find it in this life.” Determined to pursue her true calling despite her parents’ objections, in 1844, Nightingale enrolled as a nursing student at the Lutheran Hospital of Pastor Fliedner in Kaiserwerth, Germany.
Florence Nightingale and Nursing
In the early 1850s, Nightingale returned to London, where she took a nursing job in a Middlesex hospital for ailing governesses. Her performance there so impressed her employer that Nightingale was promoted to superintendent within just a year of being hired. The position proved challenging as Nightingale grappled with a cholera outbreak and unsanitary conditions conducive to the rapid spread of the disease. Nightingale made it her mission to improve hygiene practices, significantly lowering the death rate at the hospital in the process. The hard work took a toll on her health. She had just barely recovered when the biggest challenge of her nursing career presented itself.
Florence Nightingale and the Crimean War
In October of 1853, the Crimean War broke out. The British Empire was at war against the Russian Empire for control of the Ottoman Empire. Thousands of British soldiers were sent to the Black Sea, where supplies quickly dwindled. By 1854, no fewer than 18,000 soldiers had been admitted into military hospitals.
At the time, there were no female nurses stationed at hospitals in the Crimea. The poor reputation of past female nurses had led the war office to avoid hiring more. But, after the Battle of Alma, England was in an uproar about the neglect of their ill and injured soldiers, who not only lacked sufficient medical attention due to hospitals being horribly understaffed, but also languished in appallingly unsanitary and inhumane conditions.
In late 1854, Nightingale received a letter from Secretary of War Sidney Herbert, asking her to organize a corps of nurses to tend to the sick and fallen soldiers in the Crimea. Nightingale rose to her calling. She quickly assembled a team of 34 nurses from a variety of religious orders and sailed with them to the Crimea just a few days later.
Although they had been warned of the horrid conditions there, nothing could have prepared Nightingale and her nurses for what they saw when they arrived at Scutari, the British base hospital in Constantinople. 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.
The no-nonsense Nightingale quickly set to work. She procured hundreds of scrub brushes and asked the least infirm patients to scrub the inside of the hospital from floor to ceiling. Nightingale herself spent every waking minute caring for the soldiers. In the evenings she moved through the dark hallways carrying a lamp while making her rounds, ministering to patient after patient. The soldiers, who were both moved and comforted by her endless supply of compassion, took to calling her “the Lady with the Lamp.” Others simply called her “the Angel of the Crimea.” Her work reduced the hospital’s death rate by two-thirds.
In additional to vastly improving the sanitary conditions of the hospital, Nightingale created a number of patient services that contributed to improving the quality of their hospital stay. She instituted the creation of an “invalid’s kitchen” where appealing food for patients with special dietary requirements was cooked. She established a laundry so that patients would have clean linens. She also instituted a classroom and a library for patients’ intellectual stimulation and entertainment. Based on her observations in the Crimea, Nightingale wrote Notes on Matters Affecting the Health, Efficiency and Hospital Administration of the British Army, an 830-page report analyzing her experience and proposing reforms for other military hospitals operating under poor conditions. The book would spark a total restructuring of the War Office’s administrative department, including the establishment of a Royal Commission for the Health of the Army in 1857.
Nightingale remained at Scutari for a year and a half. She left in the summer of 1856, once the Crimean conflict was resolved, and returned to her childhood home at Lea Hurst. To her surprise she was met with a hero’s welcome, which the humble nurse did her best to avoid. The Queen rewarded Nightingale’s work by presenting her with an engraved brooch that came to be known as the “Nightingale Jewel” and by granting her a prize of $250,000 from the British government.
Florence Nightingale, Statistician
With the support of Queen Victoria, Nightingale helped create a Royal Commission into the health of the army. It employed leading statisticians of the day, William Farr and John Sutherland, to analyze army mortality data, and what they found was horrifying: 16,000 of the 18,000 deaths were from preventable diseases—not battle. But it was Nightingale’s ability to translate this data into a new visual format that really caused a sensation. Her polar area diagram, now known as a “Nightingale Rose Diagram,” showed how the Sanitary Commission’s work decreased the death rate and made the complicated data accessible to all, inspiring new standards for sanitation in the army and beyond. She became the first female member of the Royal Statistical Society and was named an honorary member of the American Statistical Association.
Florence Nightingale’s Impact on Nursing
Nightingale decided to use the money to further her cause. In 1860, she funded the establishment of St. Thomas’ Hospital, and within it, the Nightingale Training School for Nurses. Nightingale became a figure of public admiration. Poems, songs and plays were written and dedicated in the heroine’s honor. Young women aspired to be like her. Eager to follow her example, even women from the wealthy upper classes started enrolling at the training school. Thanks to Nightingale, nursing was no longer frowned upon by the upper classes; it had, in fact, come to be viewed as an honorable vocation.
While at Scutari, Nightingale had contracted “Crimean fever” and would never fully recover. By the time she was 38 years old, she was homebound and bedridden, and would be so for the remainder of her life. Fiercely determined and dedicated as ever to improving health care and alleviating patients’ suffering, Nightingale continued her work from her bed.
Residing in Mayfair, she remained an authority and advocate of health care reform, interviewing politicians and welcoming distinguished visitors from her bed. In 1859, she published Notes on Hospitals, which focused on how to properly run civilian hospitals.
Throughout the U.S. Civil War, she was frequently consulted about how to best manage field hospitals. Nightingale also served as an authority on public sanitation issues in India for both the military and civilians, although she had never been to India herself.
In 1908, at the age of 88, she was conferred the merit of honor by King Edward. In May of 1910, she received a congratulatory message from King George on her 90th birthday.
Florence Nightingale: Death and Legacy
In August 1910, Florence Nightingale fell ill, but seemed to recover and was reportedly in good spirits. A week later, on the evening of Friday, August 12, 1910, she developed an array of troubling symptoms. She died unexpectedly at 2 p.m. the following day, Saturday, August 13, 1910, at her home in London.
Characteristically, she had expressed the desire that her funeral be a quiet and modest affair, despite the public’s desire to honor Nightingale—who tirelessly devoted her life to preventing disease and ensuring safe and compassionate treatment for the poor and the suffering. Respecting her last wishes, her relatives turned down a national funeral. The “Lady with the Lamp” was laid to rest in Hampshire, England.
The Florence Nightingale Museum, which sits at the site of the original Nightingale Training School for Nurses, houses more than 2,000 artifacts commemorating the life and career of the “Angel of the Crimea.” To this day, Florence Nightingale is broadly acknowledged and revered as the pioneer of modern nursing."
Florence Nightingale
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World History
American Red Cross
Military History
Nurse
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A very good documentary about Florence Nightingale. It tackles her legacy with both positive and negative interpretations. This will be particularly useful f...
Thank you my friend SGT (Join to see) for making us aware that British nurse (Crimean War), Florence Nightingale died at the age of 90 on August 13, 1910.
Florence Nightingale
A very good documentary about Florence Nightingale. It tackles her legacy with both positive and negative interpretations. This will be particularly useful for students of the Crimean War era and for GCSE students working on medicine through time. It is worthwhile to also search for YouTube videos of Mary Seacole
https://www.youtube.com/watch?v=hBVX5s43_Ks
Images
1. 86-year-old Florence Nightingale in bed, 1906.
2. Florence Nightingale surrounded by nursing students London's Nightingale School of Nursing which was founded in 1860 by Florence Nightingale at St Thomas Hospital.
3. Bust of Florence Nightingale, presented to her by the soldiers after the Crimean War
4. Lea Hurst, the summer home of the Nightingale family - annotated
Biographies:
1. florence-nightingale.co.uk/florence-nightingale-biography
2. library.uab.edu/locations/reynolds/collections/florence-nightingale/life
1. Background from {[https://www.florence-nightingale.co.uk/florence-nightingale-biography/]}
Florence Nightingale biography
Famous for being the ‘Lady with the Lamp’ who organised the nursing of sick and wounded soldiers during the Crimean War, Florence Nightingale’s far-sighted ideas and reforms have influenced the very nature of modern healthcare.
Her greatest achievement was to transform nursing into a respectable profession for women and in 1860, she established the first professional training school for nurses, the Nightingale Training School at St Thomas’ Hospital.
…She campaigned tirelessly to improve health standards, publishing over 200 books, reports and pamphlets on hospital planning and organisation which are still widely read and respected today, including her most famous work Notes on Nursing: What It Is and What It Is Not.
Florence’s influence on today’s nursing ranges from her ward designs (known as Nightingale Wards), which were developed in response to her realisation that hospital buildings themselves could affect the health and recovery of patients, through to pioneering infection control measures and the championing of a healthy diet as a key factor for recovery. Florence also believed in the need for specialist midwifery nurses and established a School of Midwifery nursing at King’s College Hospital which became a model for the country.
Florence is also credited with inventing a sort of pie-chart which she called a coxcomb diagramme (to show statistics visually) and was the first woman to be elected to the Royal Statistical Society. She was also the second woman to be awarded the Freedom of the City of London, which she received in 1908.
She inspired the founding of the International Red Cross which still awards the Florence Nightingale Medal for nurses who have given exceptional care to the sick and wounded in war or peace.
Early years
Born in an era when middle-class women were expected to simply make a good marriage and raise a family, Florence sensed a ‘calling’ from God at an early age and believed she was destined to do something greater with her life. As a child, she was very academic and particularly interested in mathematics. Her religion gave her a strong sense of moral duty to help the poor and, over time, she held a growing belief that nursing was her God-given vocation. She was also perhaps set to follow the family tradition of reform mindedness, such as the example set by her maternal grandfather who was an anti-slavery campaigner.
Paid nursing suffered a reputation as a job for poor, often elderly women, and the popular image was one of drunkenness, bad language and a casual attitude to patients. Despite parental concern, she persisted in her ambition, reading anything she could about health and hospitals. Eventually she persuaded them to allow her to take three months’ nursing training at an inspirational hospital and school in Dusseldorf. Aged 33, she then became superintendent of a hospital for ‘gentlewomen’ in Harley Street, London.
The Crimean War
In March 1854, reports flooded in about the dreadful conditions and lack of medical supplies suffered by injured soldiers fighting the Crimean War. The Minister of War, a social acquaintance, invited Florence to oversee the introduction of female nurses into the military hospitals in Turkey. With a party of 38 nurses, Florence arrived in Scutari that November and set about organising the hospitals to improve supplies of food, blankets and beds, as well as the general conditions and cleanliness. The comforting sight of her checking all was well at night earned her the name ‘Lady of the Lamp’, along with the undying respect of the British soldiers.
Reforming spirit
The introduction of female nurses to the military hospitals was deemed an outstanding success, Florence returned to Britain a heroine, and donations poured in to the Nightingale Fund. The money collected enabled Florence to continue her reform of nursing in the civil hospitals of Britain after the war. Determined that the medical mistakes of the two-year long war were never repeated, she vividly communicated the needs for medical reform using statistical charts which showed that more men had died from disease than from their wounds. She then instigated a Royal Commission into the health of the army which led to a large number of improvements and saved the lives of many.
Her attention later turned to the health of the British army in India and she demonstrated that bad drainage, contaminated water, overcrowding and poor ventilation were causing the high death rate. She concluded that the health of the army and the people of India had to go hand in hand and so campaigned to improve the sanitary conditions of the country as a whole.
The Nightingale Training School was established in 1860 using donations from the Nightingale Fund. Its reputation soon spread and Nightingale nurses were requested to start new schools all over the world, including Australia, America and Africa.
Despite often being confined to her sick bed, by what we now believe was a bacterial infection known as brucellosis, Florence continued as a driving force behind the scenes, writing some 13000 letters as part of her campaigns. She met Queen Victoria on many occasions and exchanged correspondence for over thirty years. Florence was awarded the Royal Red Cross in 1883. Then in 1907 she was the first woman to receive the Order of Merit, Britain’s highest civilian decoration.
Florence died aged 90, on 13th August 1910, and was buried alongside the graves of other family members in East Wellow, Hampshire."
2. Background from {[https://library.uab.edu/locations/reynolds/collections/florence-nightingale/life}}
Florence Nightingale was born in 1820 to wealthy English parents traveling in Florence, Italy. Both Florence and her sister were named after the Italian cities in which they were born – her sister Parthenope was born in Naples and given the Greek name for its ancient city. At home in England, the Nightingales divided their time between two houses, Lea Hurst in Derbyshire for the summer and Embley in Hampshire for the winter. The two girls were educated by their father, and Florence, in particular, excelled academically. With regard to the marriage and social life of their daughters, the Nightingales held high expectations. However, Florence had other ideas, because as a teenager in 1837 she received a "divine calling” to do God’s work, which sparked her advocacy of social and health care causes and eventually led her to establish nursing as a distinct profession.
Nursing during the Crimean War
Florence Nightingale is probably most famous for her work during the Crimean War (1854-1856). Responding to unpopular newspaper reports of the horrendous situation in the English war camp hospitals, Secretary of War Sidney Herbert, a personal friend of Nightingale, consented to let her organize and manage a group of female nurses to go to Turkey. On November 4, 1854, Nightingale and 38 nurses arrived in Scutari, the location of the British camp outside Constantinople. The doctors originally did not welcome the incoming female nurses, but as the number of patients escalated, their help was needed in the overcrowded, undersupplied, and unsanitary hospital (4). Under Florence’s leadership, the nurses brought cleanliness, sanitation, nutritious food and comfort to the patients. Nightingale was known for providing the kind of personal care, like writing letters home for soldiers, that comforted them and improved their psychological health. Her group of nurses transformed the hospital into a healthy environment within six months, and as a result, the death rate of patients fell from 40 to 2 percent (5). In 1857, Florence returned home a heroine. It was the soldiers in Crimea that initially named her the "Lady with the Lamp" because of the reassuring sight of her carrying around a lamp to check on the sick and wounded during the night, and the title remained with her (6).
(Thirty-four years to the date (November 4, 1888) after she landed in Scutari for the Battle of Inkermann of the Crimean War, Florence Nightingale wrote a letter to her friend Thomas Gillham Hewlett remembering the heroic nature of soldiers. Click here to view this letter.)
Upon her return from the Crimean War, she devoted the next few years to the Royal Commission investigating health in the British Army. It was her discussions with Queen Victoria on the conditions of the camp hospitals that sparked the commission’s formation. Also, Nightingale's statistical data and analysis strongly influenced the commission's findings, which resulted in great public health advances in the British army (7).
Professional Nursing Pioneer
In 1859, Florence Nightingale’s book Notes on Nursing: What it is, and What it is Not was published. Based on knowledge acquired at school in Kaiserswerth and while nursing the sick during the Crimean War, Notes on Nursing provides a simple but practical discussion of good patient care, along with helpful hints. According to Florence Nightingale, hygiene, sanitation, fresh air, proper lighting, a good diet, warmth, quietness and attentiveness were necessary conditions for hospitals and were to be ensured by trained nurses. Taken for granted today, her commonsense advice helped transform hospitals from death houses to sanctuaries of care. This work quickly became a classic introduction to nursing, and has remained in publication to the present day (8).
During the war a public subscription fund was set up for Florence Nightingale to continue her education of nurses in England, and the Nightingale Training School at St. Thomas’ Hospital opened in 1860. The education of recruits involved a year of practical instruction in the wards, supplemented with courses of lecturing, and followed by two years of work experience in the hospital (9). After graduation, many of the students staffed British hospitals, and others spread the Nightingale education system to other countries.
Through her work and her school, Florence Nightingale is responsible for elevating the profession of nursing to an honorable status. She also wrote about 200 books, pamphlets and reports on hospital, sanitation, and other health-related issues, as well as contributing to the field of statistics (10). Throughout her life she provided advice on a variety of health care issues to associates all over the globe. Though ill and bedridden for much of her later life, Nightingale managed to continue her great work through correspondence.
Endnotes
1. Garrison, Fielding. An introduction to the history of medicine. 4th ed. (Philadelphia & London: W. B. Saunders, Co., 1929), 772.
2. ibid.
3. Porter, Roy. The Cambridge illustrated history of medicine (New York: Cambridge University Press, 1996), 226.
4. Selanders, Louise. "Florence Nightingale." Encyclopedia Britannica Online: Academic Edition {[http://www.britannica.com/EBchecked/topic/415020/Florence-Nightingale]}, Accessed May 5, 2011.
5. Porter, Roy. The Cambridge illustrated history of medicine (New York: Cambridge University Press, 1996), 226.
6. The Florence Nightingale Museum website {[http://www.florence-nightingale.co.uk/]}, Accessed May 5, 2011.
7. Selanders, Louise. "Florence Nightingale." Encyclopedia Britannica Online: Academic Edition {[http://www.britannica.com/EBchecked/topic/415020/Florence-Nightingale]}, Accessed May 5, 2011.
8. ibid.
9. Tooley, Sarah A. The history of nursing in the British Empire (London: S. H. Bousfield & Co., 1906), 96.
10. The Florence Nightingale Museum website {[http://www.florence-nightingale.co.uk/]}, Accessed May 5, 2011.'
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Florence Nightingale
A very good documentary about Florence Nightingale. It tackles her legacy with both positive and negative interpretations. This will be particularly useful for students of the Crimean War era and for GCSE students working on medicine through time. It is worthwhile to also search for YouTube videos of Mary Seacole
https://www.youtube.com/watch?v=hBVX5s43_Ks
Images
1. 86-year-old Florence Nightingale in bed, 1906.
2. Florence Nightingale surrounded by nursing students London's Nightingale School of Nursing which was founded in 1860 by Florence Nightingale at St Thomas Hospital.
3. Bust of Florence Nightingale, presented to her by the soldiers after the Crimean War
4. Lea Hurst, the summer home of the Nightingale family - annotated
Biographies:
1. florence-nightingale.co.uk/florence-nightingale-biography
2. library.uab.edu/locations/reynolds/collections/florence-nightingale/life
1. Background from {[https://www.florence-nightingale.co.uk/florence-nightingale-biography/]}
Florence Nightingale biography
Famous for being the ‘Lady with the Lamp’ who organised the nursing of sick and wounded soldiers during the Crimean War, Florence Nightingale’s far-sighted ideas and reforms have influenced the very nature of modern healthcare.
Her greatest achievement was to transform nursing into a respectable profession for women and in 1860, she established the first professional training school for nurses, the Nightingale Training School at St Thomas’ Hospital.
…She campaigned tirelessly to improve health standards, publishing over 200 books, reports and pamphlets on hospital planning and organisation which are still widely read and respected today, including her most famous work Notes on Nursing: What It Is and What It Is Not.
Florence’s influence on today’s nursing ranges from her ward designs (known as Nightingale Wards), which were developed in response to her realisation that hospital buildings themselves could affect the health and recovery of patients, through to pioneering infection control measures and the championing of a healthy diet as a key factor for recovery. Florence also believed in the need for specialist midwifery nurses and established a School of Midwifery nursing at King’s College Hospital which became a model for the country.
Florence is also credited with inventing a sort of pie-chart which she called a coxcomb diagramme (to show statistics visually) and was the first woman to be elected to the Royal Statistical Society. She was also the second woman to be awarded the Freedom of the City of London, which she received in 1908.
She inspired the founding of the International Red Cross which still awards the Florence Nightingale Medal for nurses who have given exceptional care to the sick and wounded in war or peace.
Early years
Born in an era when middle-class women were expected to simply make a good marriage and raise a family, Florence sensed a ‘calling’ from God at an early age and believed she was destined to do something greater with her life. As a child, she was very academic and particularly interested in mathematics. Her religion gave her a strong sense of moral duty to help the poor and, over time, she held a growing belief that nursing was her God-given vocation. She was also perhaps set to follow the family tradition of reform mindedness, such as the example set by her maternal grandfather who was an anti-slavery campaigner.
Paid nursing suffered a reputation as a job for poor, often elderly women, and the popular image was one of drunkenness, bad language and a casual attitude to patients. Despite parental concern, she persisted in her ambition, reading anything she could about health and hospitals. Eventually she persuaded them to allow her to take three months’ nursing training at an inspirational hospital and school in Dusseldorf. Aged 33, she then became superintendent of a hospital for ‘gentlewomen’ in Harley Street, London.
The Crimean War
In March 1854, reports flooded in about the dreadful conditions and lack of medical supplies suffered by injured soldiers fighting the Crimean War. The Minister of War, a social acquaintance, invited Florence to oversee the introduction of female nurses into the military hospitals in Turkey. With a party of 38 nurses, Florence arrived in Scutari that November and set about organising the hospitals to improve supplies of food, blankets and beds, as well as the general conditions and cleanliness. The comforting sight of her checking all was well at night earned her the name ‘Lady of the Lamp’, along with the undying respect of the British soldiers.
Reforming spirit
The introduction of female nurses to the military hospitals was deemed an outstanding success, Florence returned to Britain a heroine, and donations poured in to the Nightingale Fund. The money collected enabled Florence to continue her reform of nursing in the civil hospitals of Britain after the war. Determined that the medical mistakes of the two-year long war were never repeated, she vividly communicated the needs for medical reform using statistical charts which showed that more men had died from disease than from their wounds. She then instigated a Royal Commission into the health of the army which led to a large number of improvements and saved the lives of many.
Her attention later turned to the health of the British army in India and she demonstrated that bad drainage, contaminated water, overcrowding and poor ventilation were causing the high death rate. She concluded that the health of the army and the people of India had to go hand in hand and so campaigned to improve the sanitary conditions of the country as a whole.
The Nightingale Training School was established in 1860 using donations from the Nightingale Fund. Its reputation soon spread and Nightingale nurses were requested to start new schools all over the world, including Australia, America and Africa.
Despite often being confined to her sick bed, by what we now believe was a bacterial infection known as brucellosis, Florence continued as a driving force behind the scenes, writing some 13000 letters as part of her campaigns. She met Queen Victoria on many occasions and exchanged correspondence for over thirty years. Florence was awarded the Royal Red Cross in 1883. Then in 1907 she was the first woman to receive the Order of Merit, Britain’s highest civilian decoration.
Florence died aged 90, on 13th August 1910, and was buried alongside the graves of other family members in East Wellow, Hampshire."
2. Background from {[https://library.uab.edu/locations/reynolds/collections/florence-nightingale/life}}
Florence Nightingale was born in 1820 to wealthy English parents traveling in Florence, Italy. Both Florence and her sister were named after the Italian cities in which they were born – her sister Parthenope was born in Naples and given the Greek name for its ancient city. At home in England, the Nightingales divided their time between two houses, Lea Hurst in Derbyshire for the summer and Embley in Hampshire for the winter. The two girls were educated by their father, and Florence, in particular, excelled academically. With regard to the marriage and social life of their daughters, the Nightingales held high expectations. However, Florence had other ideas, because as a teenager in 1837 she received a "divine calling” to do God’s work, which sparked her advocacy of social and health care causes and eventually led her to establish nursing as a distinct profession.
Nursing during the Crimean War
Florence Nightingale is probably most famous for her work during the Crimean War (1854-1856). Responding to unpopular newspaper reports of the horrendous situation in the English war camp hospitals, Secretary of War Sidney Herbert, a personal friend of Nightingale, consented to let her organize and manage a group of female nurses to go to Turkey. On November 4, 1854, Nightingale and 38 nurses arrived in Scutari, the location of the British camp outside Constantinople. The doctors originally did not welcome the incoming female nurses, but as the number of patients escalated, their help was needed in the overcrowded, undersupplied, and unsanitary hospital (4). Under Florence’s leadership, the nurses brought cleanliness, sanitation, nutritious food and comfort to the patients. Nightingale was known for providing the kind of personal care, like writing letters home for soldiers, that comforted them and improved their psychological health. Her group of nurses transformed the hospital into a healthy environment within six months, and as a result, the death rate of patients fell from 40 to 2 percent (5). In 1857, Florence returned home a heroine. It was the soldiers in Crimea that initially named her the "Lady with the Lamp" because of the reassuring sight of her carrying around a lamp to check on the sick and wounded during the night, and the title remained with her (6).
(Thirty-four years to the date (November 4, 1888) after she landed in Scutari for the Battle of Inkermann of the Crimean War, Florence Nightingale wrote a letter to her friend Thomas Gillham Hewlett remembering the heroic nature of soldiers. Click here to view this letter.)
Upon her return from the Crimean War, she devoted the next few years to the Royal Commission investigating health in the British Army. It was her discussions with Queen Victoria on the conditions of the camp hospitals that sparked the commission’s formation. Also, Nightingale's statistical data and analysis strongly influenced the commission's findings, which resulted in great public health advances in the British army (7).
Professional Nursing Pioneer
In 1859, Florence Nightingale’s book Notes on Nursing: What it is, and What it is Not was published. Based on knowledge acquired at school in Kaiserswerth and while nursing the sick during the Crimean War, Notes on Nursing provides a simple but practical discussion of good patient care, along with helpful hints. According to Florence Nightingale, hygiene, sanitation, fresh air, proper lighting, a good diet, warmth, quietness and attentiveness were necessary conditions for hospitals and were to be ensured by trained nurses. Taken for granted today, her commonsense advice helped transform hospitals from death houses to sanctuaries of care. This work quickly became a classic introduction to nursing, and has remained in publication to the present day (8).
During the war a public subscription fund was set up for Florence Nightingale to continue her education of nurses in England, and the Nightingale Training School at St. Thomas’ Hospital opened in 1860. The education of recruits involved a year of practical instruction in the wards, supplemented with courses of lecturing, and followed by two years of work experience in the hospital (9). After graduation, many of the students staffed British hospitals, and others spread the Nightingale education system to other countries.
Through her work and her school, Florence Nightingale is responsible for elevating the profession of nursing to an honorable status. She also wrote about 200 books, pamphlets and reports on hospital, sanitation, and other health-related issues, as well as contributing to the field of statistics (10). Throughout her life she provided advice on a variety of health care issues to associates all over the globe. Though ill and bedridden for much of her later life, Nightingale managed to continue her great work through correspondence.
Endnotes
1. Garrison, Fielding. An introduction to the history of medicine. 4th ed. (Philadelphia & London: W. B. Saunders, Co., 1929), 772.
2. ibid.
3. Porter, Roy. The Cambridge illustrated history of medicine (New York: Cambridge University Press, 1996), 226.
4. Selanders, Louise. "Florence Nightingale." Encyclopedia Britannica Online: Academic Edition {[http://www.britannica.com/EBchecked/topic/415020/Florence-Nightingale]}, Accessed May 5, 2011.
5. Porter, Roy. The Cambridge illustrated history of medicine (New York: Cambridge University Press, 1996), 226.
6. The Florence Nightingale Museum website {[http://www.florence-nightingale.co.uk/]}, Accessed May 5, 2011.
7. Selanders, Louise. "Florence Nightingale." Encyclopedia Britannica Online: Academic Edition {[http://www.britannica.com/EBchecked/topic/415020/Florence-Nightingale]}, Accessed May 5, 2011.
8. ibid.
9. Tooley, Sarah A. The history of nursing in the British Empire (London: S. H. Bousfield & Co., 1906), 96.
10. The Florence Nightingale Museum website {[http://www.florence-nightingale.co.uk/]}, Accessed May 5, 2011.'
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Florence Nightingale - The Lady with the Lamp
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Florence Nightingale - The Lady with the Lamp
https://www.youtube.com/watch?v=E-97fnUAbyo
Images
1. Florence Nightingale
2. Florence Nightingale photograph by Goodman
3. Florence Nightingale as team leader taking care of sick and injured in Crimean war
4. Letter written written by Florence Nightingale to a Mrs. James on September 20, 1853, about patient admittance, payment, demographics and lengths of stay
Background from {[https://www.agnesscott.edu/lriddle/women/nitegale.htm]}
Written by Cynthia Audain, Class of 1998 (Agnes Scott College)
Florence Nightingale is most remembered as a pioneer of nursing and a reformer of hospital sanitation methods. For most of her ninety years, Nightingale pushed for reform of the British military health-care system and with that the profession of nursing started to gain the respect it deserved. Unknown to many, however, was her use of new techniques of statistical analysis, such as during the Crimean War when she plotted the incidence of preventable deaths in the military. She developed the "polar-area diagram" to dramatize the needless deaths caused by unsanitary conditions and the need for reform. With her analysis, Florence Nightingale revolutionized the idea that social phenomena could be objectively measured and subjected to mathematical analysis. She was an innovator in the collection, tabulation, interpretation, and graphical display of descriptive statistics.
Florence Nightingale's two greatest life achievements--pioneering of nursing and the reform of hospitals--were amazing considering that most Victorian women of her age group did not attend universities or pursue professional careers. It was her father, William Nightingale, who believed women, especially his children, should get an education. So Nightingale and her sister learned Italian, Latin, Greek, history, and mathematics. She in particular received excellent early preparation in mathematics from her father and aunt, and some references also claim she was tutored in mathematics by James Sylvester (although there seems to be no documentary evidence of this). In 1854, after a year as a unpaid superintendent of a London "establishment for gentlewomen during illness," the Secretary of War, Sidney Herbert, recruited Nightingale and 38 nurses for service in Scutari during the Crimean War.
During Nightingale's time at Scutari, she collected data and systematized record-keeping practices. Nightingale was able to use the data as a tool for improving city and military hospitals. Nightingale's calculations of the mortality rate showed that with an improvement of sanitary methods, deaths would decrease. In February, 1855, the mortality rate at the hospital was 42.7 percent of the cases treated (Cohen 131). When Nightingale's sanitary reform was implemented, the mortality rate declined. Nightingale took her statistical data and represented them graphically. She invented polar-area charts, where the statistic being represented is proportional to the area of a wedge in a circular diagram (Cohen 133).
As Nightingale demonstrated, statistics provided an organized way of learning and lead to improvements in medical and surgical practices. She also developed a Model Hospital Statistical Form for hospitals to collect and generate consistent data and statistics. She became a Fellow of the Royal Statistical Society in 1858 and an honorary member of the American Statistical Association in 1874. Karl Pearson acknowledged Nighingale as a "prophetess" in the development of applied statistics.
Mathematical Education in the Life of Florence Nightingale
By Sally Lipsey
Reprinted with permission of the author from the Newsletter of the Association for Women in Mathematics, Vol. 23, No.4 (July/August 1993), 11-12.
In 1840, Florence Nightingale begged her parents "to let her study mathematics instead of doing worsted work and practicing quadrilles." Her mother "did not approve, home duties were not to be neglected for mathematics." She assumed that her daughter's destiny was marriage, "and what use were mathematics to a married woman?" Her father, who loved math and had communicated that love to his daughter, nevertheless urged her to study more appropriate subjects (for a woman), "history or philosophy, natural or moral." Florence expressed her preference for mathematics by saying, "I don't think I shall succeed so well in anything that requires quickness as in what requires only work." [1] Her parents finally granted permission. Years later, her mathematical approach saved the British army at Scutari during the Crimean war and provided the data that led to hospital reforms. [2]
Only after long emotional battles was Florence permitted to have tutors in mathematics. (One of her tutors was J.J. Sylvester.) She learned arithmetic, geometry, algebra, and before her involvement with nursing, spent her time tutoring children in these subjects. In the British Museum, one can read lesson plans in her handwriting (including story problems based on the lives of the children she was tutoring) for teaching arithmetic and geometry. She includes reminders to tell pupil teachers "to write notes of all the lessons they will give through the next week--the must never give them unprepared--of what they will say..tell them you prepare yourself." [3]
Her lesson plans show concern about the education of girls. "Girls' arithmetic has been neglected--their geography should be made arithmetical." She made notes to ask such questions as:
How high is the reindeer? Are you as high? How high are you? 3 feet--how much is that? a yard-- are you a quadruped? How far is the topmost point of Europe from the Equator? How far do you come to school? Two miles-- now, if you were to walk two geographical miles a day, how long should you be walking to the equator? [4]
Clearly, she espoused teaching by questioning. In later years, when she wrote on nursing, she expressed the hope that the memory of Socrates would help her with the art of questioning, so that "those who read may learn not of me but of themselves."
Florence Nightingale's interest in mathematics extended beyond the subject matter itself, as shown in letters to her sweetheart during 1846. For example, in May she wrote, "There is a most lovely character given of D'Alembert's the great mathematician's lightheartedness..It says that it is the exclusive privilege of the exact science, to enjoy everyday some new truth which comes to reward one's work." Again, in August: "The loss of power of the high priest...the inconsiderate 'following of the leader' of the people, are everyday feelings in our hearts, just as is the jealousy, which brought under a different system of police, Abel to the grave." Her letters show her sense of humor. In September after attending a political speech, she wrote: "I have invented a new system of Logarithms (finding the capacities of arithmetic not sufficiently extensive) to count the number of times 'Imperial Majesty' occurs in the speech...." [6]
Nightingale helped to promote what was then a revolutionary idea (and a religious one for her) that social phenomena could be objectively measured and subjected to mathematical analysis. Her work with medical statistics was so impressive that she was elected (in 1858) to membership in the Statistical Society of England. One of the pioneers in the graphic method of presentation of data, she invented colorful polar-area diagrams to dramatize medical data. [7] Although other methods of persuasion had failed, her statistical approach convinced military authorities, Parliament, and Queen Victoria to carry out her proposed hospital reforms.
During the American Civil War, Nightingale was a consultant on army health to the United States government. She also responded to a British war office request for advice on army medical care in Canada. Her mathematical activities included ascertaining "the average speed of transport by sledge" and calculating "the time required to transport the sick over the immense distances of Canada."
Florence Nightingale was a feminist, of course. It is amusing to see that she dedicated Introductory Notes on Lying in Institutions to the shade of Socrates' mother. She fought for the privilege of studying math, for the right to be a nurse, and for every woman's right "to bring the best that she has, whatever that is to the work of God's world... to do the thing that is good, whether it is 'suitable for a woman' or not." She cautioned against extremism, "which urges women to do all that men do...merely because men do it, and without regard to whether this is the best that women can do." [5] She was a true mathematician in her love for reasoning, always questioning assumptions and taking great care in the process of reaching conclusions.
Notes
Woodham-Smith, C., Florence Nightingale. new York: Atheneum. p. 37.
Pickering, G. Creative Malady. New York: Oxford University Press, 1974. p. 100.
Nightingale Papers, Vol. X. British Museum Additional Manuscript #43402, 1850. pp84-89.
ibid. p. 85.
Nightingale, F., Introductory Notes on Lying-in Institutions. London: Longmans, Green, 1871. Dedication.
Letters. British Museum Additional Manuscript #46176. 1846.
References
Cohen, I.B., "Florence Nightingale," Scientific American. March 1984, pp. 128-136.
Cohen, I. B. "Florence Nightingale," Scientific American, 250 (March 1984),128-137.
Cohen, I.B. The Triumph of Numbers: How Counting Shaped Modern Life, W. H. Norton, 2006. Chapter 9 is devoted to Florence Nightingale. [Read excerpts from Google Book Search]
Sandra Stinnett. "Women in Statistics: Sesquicentennial Activities," The American Statistician, May 1990, Vol 44, No. 2, 74-80.
Kopf, E.W. "Florence Nightingale as a Statistician," J. Amer. Statist. Assoc., 15 (1916), 388-404.
Nuttall, P. "The Passionate Statistician," Nursing Times, 28 (1983), 25- 27.
Grier, M.R. "Florence Nightingale and Statistics," Res. Nurse Health, 1 (1978), 91-109.
Lipsey, Sally. "Mathematical Education in the Life of Florence Nightingale," Newsletter of the Association for Women in Mathematics, Vol 23, Number 4 (July-August 1993), 11-12.
Wadsworth Jr., Harrison, Kenneth Stephens and A. Blanton Godfrey, Modern Methods for Quality Control and Improvement, Wiley & Sons, 1986. Discusses the history of graphical methods in quality control and F. Nightingale's contributions.
Florence Nightingale Museum website
Biography at the MacTutor History of Mathematics Archive
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https://www.youtube.com/watch?v=E-97fnUAbyo
Images
1. Florence Nightingale
2. Florence Nightingale photograph by Goodman
3. Florence Nightingale as team leader taking care of sick and injured in Crimean war
4. Letter written written by Florence Nightingale to a Mrs. James on September 20, 1853, about patient admittance, payment, demographics and lengths of stay
Background from {[https://www.agnesscott.edu/lriddle/women/nitegale.htm]}
Written by Cynthia Audain, Class of 1998 (Agnes Scott College)
Florence Nightingale is most remembered as a pioneer of nursing and a reformer of hospital sanitation methods. For most of her ninety years, Nightingale pushed for reform of the British military health-care system and with that the profession of nursing started to gain the respect it deserved. Unknown to many, however, was her use of new techniques of statistical analysis, such as during the Crimean War when she plotted the incidence of preventable deaths in the military. She developed the "polar-area diagram" to dramatize the needless deaths caused by unsanitary conditions and the need for reform. With her analysis, Florence Nightingale revolutionized the idea that social phenomena could be objectively measured and subjected to mathematical analysis. She was an innovator in the collection, tabulation, interpretation, and graphical display of descriptive statistics.
Florence Nightingale's two greatest life achievements--pioneering of nursing and the reform of hospitals--were amazing considering that most Victorian women of her age group did not attend universities or pursue professional careers. It was her father, William Nightingale, who believed women, especially his children, should get an education. So Nightingale and her sister learned Italian, Latin, Greek, history, and mathematics. She in particular received excellent early preparation in mathematics from her father and aunt, and some references also claim she was tutored in mathematics by James Sylvester (although there seems to be no documentary evidence of this). In 1854, after a year as a unpaid superintendent of a London "establishment for gentlewomen during illness," the Secretary of War, Sidney Herbert, recruited Nightingale and 38 nurses for service in Scutari during the Crimean War.
During Nightingale's time at Scutari, she collected data and systematized record-keeping practices. Nightingale was able to use the data as a tool for improving city and military hospitals. Nightingale's calculations of the mortality rate showed that with an improvement of sanitary methods, deaths would decrease. In February, 1855, the mortality rate at the hospital was 42.7 percent of the cases treated (Cohen 131). When Nightingale's sanitary reform was implemented, the mortality rate declined. Nightingale took her statistical data and represented them graphically. She invented polar-area charts, where the statistic being represented is proportional to the area of a wedge in a circular diagram (Cohen 133).
As Nightingale demonstrated, statistics provided an organized way of learning and lead to improvements in medical and surgical practices. She also developed a Model Hospital Statistical Form for hospitals to collect and generate consistent data and statistics. She became a Fellow of the Royal Statistical Society in 1858 and an honorary member of the American Statistical Association in 1874. Karl Pearson acknowledged Nighingale as a "prophetess" in the development of applied statistics.
Mathematical Education in the Life of Florence Nightingale
By Sally Lipsey
Reprinted with permission of the author from the Newsletter of the Association for Women in Mathematics, Vol. 23, No.4 (July/August 1993), 11-12.
In 1840, Florence Nightingale begged her parents "to let her study mathematics instead of doing worsted work and practicing quadrilles." Her mother "did not approve, home duties were not to be neglected for mathematics." She assumed that her daughter's destiny was marriage, "and what use were mathematics to a married woman?" Her father, who loved math and had communicated that love to his daughter, nevertheless urged her to study more appropriate subjects (for a woman), "history or philosophy, natural or moral." Florence expressed her preference for mathematics by saying, "I don't think I shall succeed so well in anything that requires quickness as in what requires only work." [1] Her parents finally granted permission. Years later, her mathematical approach saved the British army at Scutari during the Crimean war and provided the data that led to hospital reforms. [2]
Only after long emotional battles was Florence permitted to have tutors in mathematics. (One of her tutors was J.J. Sylvester.) She learned arithmetic, geometry, algebra, and before her involvement with nursing, spent her time tutoring children in these subjects. In the British Museum, one can read lesson plans in her handwriting (including story problems based on the lives of the children she was tutoring) for teaching arithmetic and geometry. She includes reminders to tell pupil teachers "to write notes of all the lessons they will give through the next week--the must never give them unprepared--of what they will say..tell them you prepare yourself." [3]
Her lesson plans show concern about the education of girls. "Girls' arithmetic has been neglected--their geography should be made arithmetical." She made notes to ask such questions as:
How high is the reindeer? Are you as high? How high are you? 3 feet--how much is that? a yard-- are you a quadruped? How far is the topmost point of Europe from the Equator? How far do you come to school? Two miles-- now, if you were to walk two geographical miles a day, how long should you be walking to the equator? [4]
Clearly, she espoused teaching by questioning. In later years, when she wrote on nursing, she expressed the hope that the memory of Socrates would help her with the art of questioning, so that "those who read may learn not of me but of themselves."
Florence Nightingale's interest in mathematics extended beyond the subject matter itself, as shown in letters to her sweetheart during 1846. For example, in May she wrote, "There is a most lovely character given of D'Alembert's the great mathematician's lightheartedness..It says that it is the exclusive privilege of the exact science, to enjoy everyday some new truth which comes to reward one's work." Again, in August: "The loss of power of the high priest...the inconsiderate 'following of the leader' of the people, are everyday feelings in our hearts, just as is the jealousy, which brought under a different system of police, Abel to the grave." Her letters show her sense of humor. In September after attending a political speech, she wrote: "I have invented a new system of Logarithms (finding the capacities of arithmetic not sufficiently extensive) to count the number of times 'Imperial Majesty' occurs in the speech...." [6]
Nightingale helped to promote what was then a revolutionary idea (and a religious one for her) that social phenomena could be objectively measured and subjected to mathematical analysis. Her work with medical statistics was so impressive that she was elected (in 1858) to membership in the Statistical Society of England. One of the pioneers in the graphic method of presentation of data, she invented colorful polar-area diagrams to dramatize medical data. [7] Although other methods of persuasion had failed, her statistical approach convinced military authorities, Parliament, and Queen Victoria to carry out her proposed hospital reforms.
During the American Civil War, Nightingale was a consultant on army health to the United States government. She also responded to a British war office request for advice on army medical care in Canada. Her mathematical activities included ascertaining "the average speed of transport by sledge" and calculating "the time required to transport the sick over the immense distances of Canada."
Florence Nightingale was a feminist, of course. It is amusing to see that she dedicated Introductory Notes on Lying in Institutions to the shade of Socrates' mother. She fought for the privilege of studying math, for the right to be a nurse, and for every woman's right "to bring the best that she has, whatever that is to the work of God's world... to do the thing that is good, whether it is 'suitable for a woman' or not." She cautioned against extremism, "which urges women to do all that men do...merely because men do it, and without regard to whether this is the best that women can do." [5] She was a true mathematician in her love for reasoning, always questioning assumptions and taking great care in the process of reaching conclusions.
Notes
Woodham-Smith, C., Florence Nightingale. new York: Atheneum. p. 37.
Pickering, G. Creative Malady. New York: Oxford University Press, 1974. p. 100.
Nightingale Papers, Vol. X. British Museum Additional Manuscript #43402, 1850. pp84-89.
ibid. p. 85.
Nightingale, F., Introductory Notes on Lying-in Institutions. London: Longmans, Green, 1871. Dedication.
Letters. British Museum Additional Manuscript #46176. 1846.
References
Cohen, I.B., "Florence Nightingale," Scientific American. March 1984, pp. 128-136.
Cohen, I. B. "Florence Nightingale," Scientific American, 250 (March 1984),128-137.
Cohen, I.B. The Triumph of Numbers: How Counting Shaped Modern Life, W. H. Norton, 2006. Chapter 9 is devoted to Florence Nightingale. [Read excerpts from Google Book Search]
Sandra Stinnett. "Women in Statistics: Sesquicentennial Activities," The American Statistician, May 1990, Vol 44, No. 2, 74-80.
Kopf, E.W. "Florence Nightingale as a Statistician," J. Amer. Statist. Assoc., 15 (1916), 388-404.
Nuttall, P. "The Passionate Statistician," Nursing Times, 28 (1983), 25- 27.
Grier, M.R. "Florence Nightingale and Statistics," Res. Nurse Health, 1 (1978), 91-109.
Lipsey, Sally. "Mathematical Education in the Life of Florence Nightingale," Newsletter of the Association for Women in Mathematics, Vol 23, Number 4 (July-August 1993), 11-12.
Wadsworth Jr., Harrison, Kenneth Stephens and A. Blanton Godfrey, Modern Methods for Quality Control and Improvement, Wiley & Sons, 1986. Discusses the history of graphical methods in quality control and F. Nightingale's contributions.
Florence Nightingale Museum website
Biography at the MacTutor History of Mathematics Archive
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Florence Nightingale, what can you say the lady had the work ethic of a thousand men, good or bad she was a great lady.
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(Rare!) Voice of Florence Nightingale (1890)
Another rare, Historical voice recording. Florence Nightingale(1820.5.12 - 1910.8.13), known as "The Lady with the Lamp" and a pioneering nurse, writer, and ...
(Rare!) Voice of Florence Nightingale (1890)
https://www.youtube.com/watch?v=ax3B4gRQNU4
Images:
1. Florence Nightingale’s ‘Rose Diagram’ a statistical graphic illustrating the causes of mortality in the army.
2. Title page from Notes on Nursing, the first book by Florence Nightingale
3. Florence Nightingale and Mr Bracebridge at Cathcart's Hill burial ground. Tinted lithograph after William Simpson. Published P. & D. Colnaghi & Co., London
4. Florence Nightingale's horse drawn hearse carrying her remains to be buried
5. Florence Nightingale's family tomb
Background from {[http://journal.sciencemuseum.ac.uk/browse/issue-05/a-statistical-campaign/]}
A statistical campaign: Florence Nightingale and Harriet Martineau’s England and her Soldiers
This article was written by Iris Veysey
03-15-2016 Cite as 10.15180; 160504
Abstract
This essay is an account of the making of England and her Soldiers (1859) by Harriet Martineau and Florence Nightingale. The book is a literary account of the Crimean War, written by Martineau and based on Nightingale’s statistical studies of mortality during the conflict. Nightingale was passionate about statistics and healthcare. Whilst working as a nurse in the Crimea, she witnessed thousands of soldiers die of infectious diseases that might have been prevented with proper sanitation. After the war, she launched a campaign to convince the British government to make permanent reforms to military healthcare, compiling a dataset on mortality in the Crimea. She worked with the government’s Royal Commission investigating healthcare during the war, but also worked privately with Martineau to publicise her findings. Martineau and Nightingale grasped that the lay reader was more receptive to statistical information in a literary format than in dense statistical reports. As such, Nightingale’s data was interwoven with Martineau’s text. The pair illustrated their book with Nightingale’s ‘Rose Diagram’, a statistical graphic which simply illustrated the rate of mortality.
Introduction
‘This book is not a work of invention. It is no fancy-piece...’
Harriet Martineau, England and her Soldiers, 1859
In 1859, the writer Harriet Martineau and the statistician Florence Nightingale published a little-known book called England and her Soldiers. A literary account of the Crimean War which marries Martineau’s text with Nightingale’s statistical studies, the book was intended to inform the public of gross failings in military health care provision during the conflict. Perhaps most significantly, the pair illustrated their argument with Nightingale’s ‘Rose Diagram’, a statistical graphic which demonstrates that the primary cause of death amongst soldiers was infectious disease, not injury incurred in battle. As Martineau firmly asserts in the preface, England and her Soldiers is no ‘work of invention’ (Martineau, 1859, p 5); rather, it is a serious endeavour to campaign for better military health care.
Nightingale believed diagrams to be a vital means of communicating statistics to non-specialist audiences, writing, ‘diagrams are of great utility for illustrating certain questions of vital statistics by conveying ideas on the subject through the eye, which cannot be so readily grasped when contained in figures’ (Nightingale, 1858). In the ‘Rose Diagram’ – also known as the ‘Coxcomb’ or ‘Wedges’ (Small, 2010, p 1) – twelve wedges, one for each month of the year, are arranged around a point. The area of each wedge, measured from the central point, corresponds to the number of mortalities that month, with a larger wedge indicating a higher rate of mortality. Each wedge is further divided into blocks of colour, which represent the causes of mortality. Blue indicates death from contagious disease, red indicates death from wounds, and black represents any other cause of death. The diagram on the right shows that in the year 1854–1855, when sanitation was poor, disease was the most common cause of death. The diagram on the left shows that in the year 1855–1856, after sanitation was improved, death by disease was drastically reduced.
Nightingale’s ‘Rose Diagram’, and its deployment in England and her Soldiers, remains a prime example of the way complex statistics can be communicated simply in visual formats. Indeed, a copy of England and her Soldiers (generously lent by the Florence Nightingale Museum) will be displayed in the Science Museum’s new Mathematics Gallery, which opens later this year.[1] This essay explores the making of Martineau and Nightingale’s book, from its basis in Nightingale’s experience during the Crimean War, to its publication and distribution. Beginning with an account of Nightingale’s early life and career, it continues to her time in the Crimea, describing the events which led her to produce England and her Soldiers. The women’s collaboration, and their methodological approach to communicating the facts of the war to the general public, are then explored in the latter half of the essay.
Florence Nightingale and the Crimean War
By the time war broke out in 1853, Nightingale was an accomplished statistician and experienced nursing administrator. Born into an upper-middle class family with liberal-humanitarian views, Nightingale was raised in privilege. She and her sister, Parthenope, were educated to university level at home by their father, who taught them mathematics, Latin and Greek. Outside of their studies, the sisters were introduced to a wide range of intellectuals by their parents, including the mathematician Charles Babbage (Magnello, 2010, p 18).
An enthusiastic mathematician from an early age, Nightingale began taking private lessons with a Cambridge-trained mathematician at the age of twenty. Statistics became her primary mathematical interest; indeed, she would later call it ‘the most important science in the world’ (Magnello, 2010, p 19). Yet mathematics was not Nightingale’s only passion: she believed that nursing, the vocation for which she is now best known, was her calling from God. For Nightingale, mathematics and nursing were not mutually exclusive. Rather, the two complemented each other; even as a student she undertook private statistical studies of public health, amassing a personal dossier of data (Magnello, 2010, p 20).
Nightingale was working as Superintendent of the Hospital for Invalid Gentlewomen in Harley Street when the war began. She had plans to leave the hospital and establish a school for nurses, but all such ambitions were delayed when she was called upon to offer her services in the Crimea (Goldie, 1997, p 1). Nightingale was closely acquainted with numerous politicians, including Sidney Herbert, the Secretary of War at the outbreak of the Crimean conflict (Magnello, 2010, pp 18, 22). Keenly aware of deficiencies in the army’s medical care, Herbert asked Nightingale to be ‘Superintendent of the female nursing establishment in the English General Military Hospitals in Turkey’ (Matthew, 2009 [2004]). Nightingale agreed and was sent to the Crimea with 38 female nurses in October 1854 (Magnello, 2010, pp 18, 20).
Conditions in the Crimea were dire. Infectious disease was rife: soldiers were dying in their thousands of illnesses including typhus, typhoid, cholera and dysentery (Lambert, 2011 [1990], p 143). Shortly after her arrival, Nightingale wrote to her friend Dr William Bowman, describing the horrors she was facing:
But oh! you gentlemen of England, who sit at home in all the well-earned satisfaction of your successful cases, can have little idea from reading the newspapers, of the horror & misery (in a military Hospl.) of operating upon these dying and exhausted men […] I have no doubt that Providence is quite right and that the Kingdom of Hell is the best beginning for the Kingdom of Heaven, but that this is the Kingdom of Hell no one can doubt (Nightingale, 1997 [14 November 1854], p 36).
Nightingale endeavoured to reduce infection and improve efficiency, but her resources were severely limited (Magnello, 2010, p 23). In letters to Herbert, she bemoans the inexperience of her staff and calls for greater resources, requesting the most basic of supplies: plates and dishes, knives and forks, socks, matting, disinfectant, mops, towels, and scissors (Nightingale, 1997 [21 December 1854], p 52; Nightingale, 1997 [25 December 1854], p 59). Openly critical, Nightingale chastises Herbert for sending her so ill-equipped: ‘You have sacrificed the cause, so near my heart. You have sacrificed me, a matter of small importance now’ (Nightingale, 1997 [15 December 1854], p 51).
Criticism of the government’s management of the conflict grew and, in January 1855, the House of Commons passed a motion for a committee of inquiry into the state of the army (Matthew, 2009 [2004]). In February 1855, a Sanitary Commission was appointed to investigate and correct conditions in the Crimea. Led by Dr John Sutherland and Robert Rawlinson, the Commission radically improved sanitation in the hospitals (McDonald, 2010, pp 5, 24). The subsequent dip in instances of infectious disease is largely attributed to these improvements. It was this – the prevention and limitation of infectious disease – which became the focus of Nightingale’s campaigns after the war.
Towards reform
By the time war ended in 1856, British losses totalled 21,097, of which 16,323 were deaths by disease (Lambert, 2011 [1990], p 15). Returning to England, Nightingale was determined to see that permanent reforms were made. To this end, she set about producing a persuasive set of statistics from the data she had gathered in the Crimea. This approach was not without precedent; indeed, by the time of the Crimean War, statistics were a popular means of instigating social change.
The science of statistics was enthusiastically developed throughout the nineteenth century, especially in Britain. The Royal Statistical Society (of which Nightingale later became the first female fellow) was founded in 1833 and was primarily concerned with the statistical study of social conditions (Smith, 1970, p 1). Figures such as William Farr and Edwin Chadwick carried out studies which led to the passing of the Public Health Acts, aimed at improving the living conditions of the poor. Reports on social conditions were produced in great quantity, with notable texts including Factory Inspector’s Report (1839), Chadwick’s Report on the Sanitary Conditions of the Labouring Population (1842), the Royal Commission on the Health of Towns (1844) and the Draining and Sewerage of Towns Report (1852) (Smith, 1970, p 28).
Nightingale’s own methodology for gathering data has been described by scholar Lynn McDonald as follows:
…read the best information available in print, especially government reports and statistics; interview experts; if the available information is inadequate send out your own questionnaire; test it first at one institution; consult practitioners who use the material; send out draft reports to experts for vetting for publication (McDonald, 2006).
In the case of the Crimea, ‘the best information available’ was almost certainly inadequate. Upon her arrival, Nightingale was dismayed not only by the environmental conditions, but by the haphazard record keeping in the hospitals:
…there was a complete lack of co-ordination among hospitals and no standardised or consistent reporting. Each hospital had its own nomenclature…and classification of diseases, which were then tabulated on different forms, making comparisons impossible. Even the number of deaths was not accurate; hundreds of men had been buried, but their deaths were not recorded (Magnello, 2010, p 23).
To further confuse matters, data for the hospitals at Scutari and Koulali was combined for some time, making it difficult to identify trends in individual hospital environments (McDonald, 2010, p 33).
Subsequently, Nightingale spent a great deal of time interrogating the dataset, attempting to aggregate as accurate a set of numbers as possible. She dedicated seven months to this task, consulting experts for advice on methods and supplementary data. Perhaps most significantly, she sought the help of William Farr, who provided comparable datasets on mortality amongst civilians, and advised Nightingale on the development of the ‘Rose Diagram’ (Magnello, 2010, p 23).[2]
Once she had a suitable dataset, Nightingale used it to lobby the government for reform, initially through official channels and later more subversively. Her first port of call was the Royal Commission, appointed after the war ‘to inquire into the regulations affecting the sanitary condition of the army, the organisation of military hospitals, and the treatment of the sick and wounded’ (Royal Commissioners, 1858). Nightingale’s testimony and statistical analyses were published with the Commissions’ findings in 1858. Her contribution included a graphic which appears to be the precursor of the ‘Rose Diagram’; this compares the rate of mortality in the army with that of Manchester, then the city with the highest mortality rate in the country (Royal Commissioners, 1858).
The publication of the Royal Commission in February 1858 caused a stir amongst the public, with The Times noting:
…the chief cause of the evil is the deficient accommodation and the consequent overcrowding in barracks…the closeness, the dirt, the indecency spoken of remind one of a slave ship more than of a place for English soldiers to inhabit (Bostridge, 2008, p 333).
Nightingale had hoped that Lord Panmure, head of the Royal Commission, would instigate reforms in tandem with publication; however, Panmure’s influence came to an abrupt end with the unexpected resignation of Viscount Palmerston as prime minister and the subsequent change of administration. Eager to avoid further delay, Nightingale began to take matters into her own hands (Bostridge, 2008, pp 333–334).
Component DOI: http://dx.doi.org/10.15180/160504/003
Collaborating with Martineau
In addition to the Commission’s publicly distributed report, Nightingale had completed a ‘confidential report’ for the government, known as Notes on Matters Affecting the Health of the British Army. Never officially published, Notes featured the first appearance of the ‘Rose Diagram’.
It had not been well-received: numerous pamphlets and an anonymous paper (attributed to senior medical officials) were published refuting its contents (Small, 2010, p 2). Nightingale began to leak Notes, sending it to influential figures including the novelist Elizabeth Gaskell, statistician Edwin Chadwick and, of course, Harriet Martineau.
On 30 November 1858, Nightingale wrote to Martineau, hoping to appeal to the latter’s interest in the military:
I know that you have been interested about our army matters and therefore, although an old story now, I venture to send you a copy of a ‘confidential’ report of mine to the War Office. It is really ‘confidential’ and no copy has been (or is to be) presented to the House of Commons. Therefore it is only for your own private reading that I send it, if you have still time, strength or inclination for this subject (Nightingale, 2010 [30 November 1858], p 993).
Nightingale’s report impressed Martineau, who called it ‘one of the most remarkable political or social productions ever seen’ (Bostridge, 2008, p 342). Thus began a fruitful collaboration and friendship.
The two women had much in common. Born in 1807, Martineau had, like Nightingale, been intellectually curious from an early age and was mostly educated at home. Her studies included classics, ancient and modern languages, literature, philosophy and history. With an industrialist father, she was raised in relative comfort until the 1820s, when the family’s economic situation was severely reduced. Subsequently, Martineau was obliged to support herself financially; she quickly established herself as an author working in a diverse range of formats, including reviews, novels, biographies, how-to manuals, newspaper columns, essays and articles (Hoecker-Drysdale, 2001, p 76). Economic necessity aside, Martineau was passionate about writing; like Nightingale, she had a keen sense of vocation, writing in her autobiography:
Authorship has never been for me a matter of choice. I have not done it for amusement, or for money, or for fame, or for any reason but because I could not help it. Things were pressing to be said; and there was more or less evidence that I was the person to say them (Martineau, 2010 [1877], p 188; Hoecker-Drysdale, 2001, p 77).
A leader-writer of the left-wing newspaper Daily News, Martineau published extensively on social issues including women’s rights, the poor laws, and the abolition of slavery. She frequently chose to convey her ideas through fiction, weaving political arguments into a series of popular tales. Well-connected, she was closely acquainted with a number of political figures, including William Gladstone (Woodham-Smith, 1950, p 315 ).
Prior to her collaboration with Nightingale, Martineau had been acquainted with the Nightingale family, though not Florence herself. Like many others, she had read of Nightingale’s endeavours in the Crimea in the press. She shared Nightingale’s commitment to empirical methods of observation – a cause she had championed in her 1838 methodology, How to Observe Morals and Manners – and had even written an article supporting a fund for Nightingale and her nurses in the Crimea (McDonald, 1994, pp 51–52).
Given these circumstances, it is perhaps unsurprising that Martineau responded so positively to Nightingale and her cause. Their subsequent letters – which date as late as the 1870s – reveal a strong professional and personal relationship. Though the pair never met, their correspondence is warm and affectionate, with salutations moving quickly from ‘Dear Madam’ to ‘Dear Friend’, and closings from ‘yours faithfully’ to ‘yours truly and gratefully’ (McDonald, 1994, pp 206–207).
Martineau soon began to publicise Nightingale’s findings, carefully excluding confidential data, first in a series of articles in the Daily News, and ultimately in England and her Soldiers (Bostridge, 2008, p 342). She shared Nightingale’s outrage, writing in the Daily News on 11 February 1859:
There is no excuse for the loss of an hour when the lives of our soldiers and the military strength of the nation are in question… [N]ow that we have learned that military Hygiene is something different from the art of amputating limbs and treating dysentery or sunstroke, we shall be guilty of murder on a wholesale scale if we do not apply our new knowledge (Logan, 2010, p 248).
The book was very much a collaborative effort, as Martineau explained in a letter to Henry Reeve:
The book is to be mine, as to form, style, responsibility in every literary sense […] but F. N. is (at my request) to see the whole, in order to preclude mistakes of fact & to keep me informed of the latest movements (Bostridge, 2008, p 342).
Combining statistics with literature was not without precedent. Indeed, other authors had seized upon the new wealth of statistical data, both as a means of lending credibility to their stories, and to make political statements. This included Charles Kingsley, who used the 1843 ‘Report on the Employment of Women and Children in Agriculture’ in his novel, Yeast: A Problem (1848), and Disraeli, whose novel Sybil, or The Two Nations (1845) drew on reports including the ‘Reports of the Children’s Employment Commission’, the ‘Report from the Select Committee on Payment of Wages’ (1842) and the ‘Report on the Commission to Inquire into the Plight of the Handloom Weavers’ (1841) (Smith, 1970).
Like Disraeli and Kingsley, Martineau and Nightingale grasped that the lay reader was more receptive to statistical information in a literary format than in the government issued reports known as ‘Blue Books’ (Magnello, 2010, p 21). Indeed, Martineau notes in the preface to England and her Soldiers that ‘few persons read Blue Books; and very few have time to go through the mass of evidence collected by the various authorities who have reported on the state of the army’ (Martineau, 1859, p vi). Accordingly, the book was carefully pitched to appeal to a wide audience, particularly soldiers. It was also deftly presented so as to avoid censure. Nightingale outlined this strategy in a letter to Martineau:
I feel for two reasons that it is desirable to work up the instructional matter into a narrative by introducing the battles […] My two reasons are (1) that it will be impossible for me to gain admission into the regimental libraries for this book unless the instructional matter is disguised in narrative (no chaplain or inspector would sanction it); (2) that no careless person (and soldiers too are careless) would ever read it without the battles (Nightingale, 2010 [ 21 March 1859], p 1004).
This is not to say that Martineau and Nightingale’s message is hidden away or only hinted at, quite the opposite. The message – that infectious disease was deadly, preventable and all too rife in the army – is explicitly laid out. For instance, in this passage, Martineau plainly argues her point, with the assistance of Nightingale’s data:
Take any set of Englishmen of the same age, – say between 15 and 45, – and you will find the annual mortality 1 in 100 from epidemic and constitutional disease, from local disease, and from violent death collectively; whereas the deaths from those causes were, in our army in the East, nearly 23 per cent., – only 3 percent being from wounds in hospital, while more than 18 were from epidemic disease. The object of introducing this last illustration is to show how little the wounds received in action have to do with the soldier’s peril. The deduction of the 3 per cent. for shot, sword, bayonet, and accidents, leaves a mortality of nearly 20 per cent (Martineau, 1859, p 41).
Strikingly, the text of England and her Soldiers also goes some way to puncturing the popular myth of Nightingale as the untouchable heroine of the Crimean War (Small, 2010, p 150). This is not to say that Nightingale appears in a negative light. Indeed, she is described as a welcome and benevolent presence: ‘What a change it was when Miss Nightingale and the nurses appeared, with hands full of good things at the right time!’ (Martineau, 1859, p 214). Yet conditions at the Scutari hospitals where Nightingale was based are reported damningly, as they had not been in Nightingale’s public reports (Small, 2010, p 150):
…the ground within the Barrack Hospital square was wet, from being insufficiently drained; six dead dogs lay just under one ward window, and a dead horse 'for some weeks in the aqueduct!' […] the filth, vermin, and rats, alive and dead, under the wooden divans on which the men lay, were in themselves a sufficient poison (Martineau, 1859, p 191).
Nightingale thus appears, not as the ministering angel (Bostridge, 2008, p 342) valiantly healing all, but as a well-intended professional rendered helpless by government inefficiencies.
Component DOI: http://dx.doi.org/10.15180/160504/004
Publication and legacy
When England and her Soldiers was published, Nightingale applied to her friend Colonel Lefroy (the inspector general of army schools) for permission to send a copy to each regiment, but was refused. Though Lefroy admired the book, the request was vetoed by Sidney Herbert, by then Chair of the Royal Commission (Matthew, 2009 [2004]), as he feared it would make the men ‘discontented’ (Nightingale, 2010 [21 August 1859], p 1008).
It is difficult to quantify the success or otherwise of England and her Soldiers. Gradual, but significant, changes were made to the governance of army healthcare in the years that followed its publication, including the creation of a permanent Army Sanitary Committee (Bostridge, 2008, pp 343–344). Outside of Britain, the book became popular amongst American medical professionals. In 1861, Martineau wrote to Nightingale:
Our book, England and her Soldiers, is at present quoted largely and incessantly in American medical journals, as a guide in the newness of military management in the Northern states […] the medical journals are learning from us; and I am sure you will be glad to hear it (Martineau, 2009 [20 September 1861], p 148).
England and her Soldiers was one part of a broader campaign, by Nightingale, Martineau and others. Many of the subsequent legislative changes are likely to have been kick-started by Nightingale’s earlier work on the Royal Commission; as such, it is impossible to say whether England and her Soldiers directly influenced the reforms that followed it. Nonetheless, it remains a fascinating example of the way Nightingale and Martineau were attempting to communicate statistical data and hard facts to a general audience, and demonstrates their remarkable commitment to their cause.
Acknowledgements
With thanks to the Florence Nightingale Museum and in particular to Head Curator Natasha McEnroe for her advice on including the book in the Mathematics Gallery. I am grateful also for guidance and support from Kate Steiner, Richard Nicholls, and my colleagues on the mathematics gallery project, David Rooney (Lead Curator), Claire Kennard (Assistant Curator), and Jessica Bradford (Interpretation Manager). Finally, my thanks to the peer reviewer for their useful suggestions.
FYI Col Carl Whicker PFC Richard Hughes SSG Chad HenningSP5 Jeannie CarleSPC Chris Bayner-Cwik TSgt David L.PO1 Robert George SPC Nancy GreeneSSG Franklin Briant1stsgt Glenn Brackin Sgt Kelli Mays1SG Walter Craig PO2 (Join to see)Lt Col Charlie Brown Lt Col John (Jack) Christensen PO3 Bob McCordSP5 Jesse EngelSSG Robert "Rob" WentworthCapt Rich Buckley
https://www.youtube.com/watch?v=ax3B4gRQNU4
Images:
1. Florence Nightingale’s ‘Rose Diagram’ a statistical graphic illustrating the causes of mortality in the army.
2. Title page from Notes on Nursing, the first book by Florence Nightingale
3. Florence Nightingale and Mr Bracebridge at Cathcart's Hill burial ground. Tinted lithograph after William Simpson. Published P. & D. Colnaghi & Co., London
4. Florence Nightingale's horse drawn hearse carrying her remains to be buried
5. Florence Nightingale's family tomb
Background from {[http://journal.sciencemuseum.ac.uk/browse/issue-05/a-statistical-campaign/]}
A statistical campaign: Florence Nightingale and Harriet Martineau’s England and her Soldiers
This article was written by Iris Veysey
03-15-2016 Cite as 10.15180; 160504
Abstract
This essay is an account of the making of England and her Soldiers (1859) by Harriet Martineau and Florence Nightingale. The book is a literary account of the Crimean War, written by Martineau and based on Nightingale’s statistical studies of mortality during the conflict. Nightingale was passionate about statistics and healthcare. Whilst working as a nurse in the Crimea, she witnessed thousands of soldiers die of infectious diseases that might have been prevented with proper sanitation. After the war, she launched a campaign to convince the British government to make permanent reforms to military healthcare, compiling a dataset on mortality in the Crimea. She worked with the government’s Royal Commission investigating healthcare during the war, but also worked privately with Martineau to publicise her findings. Martineau and Nightingale grasped that the lay reader was more receptive to statistical information in a literary format than in dense statistical reports. As such, Nightingale’s data was interwoven with Martineau’s text. The pair illustrated their book with Nightingale’s ‘Rose Diagram’, a statistical graphic which simply illustrated the rate of mortality.
Introduction
‘This book is not a work of invention. It is no fancy-piece...’
Harriet Martineau, England and her Soldiers, 1859
In 1859, the writer Harriet Martineau and the statistician Florence Nightingale published a little-known book called England and her Soldiers. A literary account of the Crimean War which marries Martineau’s text with Nightingale’s statistical studies, the book was intended to inform the public of gross failings in military health care provision during the conflict. Perhaps most significantly, the pair illustrated their argument with Nightingale’s ‘Rose Diagram’, a statistical graphic which demonstrates that the primary cause of death amongst soldiers was infectious disease, not injury incurred in battle. As Martineau firmly asserts in the preface, England and her Soldiers is no ‘work of invention’ (Martineau, 1859, p 5); rather, it is a serious endeavour to campaign for better military health care.
Nightingale believed diagrams to be a vital means of communicating statistics to non-specialist audiences, writing, ‘diagrams are of great utility for illustrating certain questions of vital statistics by conveying ideas on the subject through the eye, which cannot be so readily grasped when contained in figures’ (Nightingale, 1858). In the ‘Rose Diagram’ – also known as the ‘Coxcomb’ or ‘Wedges’ (Small, 2010, p 1) – twelve wedges, one for each month of the year, are arranged around a point. The area of each wedge, measured from the central point, corresponds to the number of mortalities that month, with a larger wedge indicating a higher rate of mortality. Each wedge is further divided into blocks of colour, which represent the causes of mortality. Blue indicates death from contagious disease, red indicates death from wounds, and black represents any other cause of death. The diagram on the right shows that in the year 1854–1855, when sanitation was poor, disease was the most common cause of death. The diagram on the left shows that in the year 1855–1856, after sanitation was improved, death by disease was drastically reduced.
Nightingale’s ‘Rose Diagram’, and its deployment in England and her Soldiers, remains a prime example of the way complex statistics can be communicated simply in visual formats. Indeed, a copy of England and her Soldiers (generously lent by the Florence Nightingale Museum) will be displayed in the Science Museum’s new Mathematics Gallery, which opens later this year.[1] This essay explores the making of Martineau and Nightingale’s book, from its basis in Nightingale’s experience during the Crimean War, to its publication and distribution. Beginning with an account of Nightingale’s early life and career, it continues to her time in the Crimea, describing the events which led her to produce England and her Soldiers. The women’s collaboration, and their methodological approach to communicating the facts of the war to the general public, are then explored in the latter half of the essay.
Florence Nightingale and the Crimean War
By the time war broke out in 1853, Nightingale was an accomplished statistician and experienced nursing administrator. Born into an upper-middle class family with liberal-humanitarian views, Nightingale was raised in privilege. She and her sister, Parthenope, were educated to university level at home by their father, who taught them mathematics, Latin and Greek. Outside of their studies, the sisters were introduced to a wide range of intellectuals by their parents, including the mathematician Charles Babbage (Magnello, 2010, p 18).
An enthusiastic mathematician from an early age, Nightingale began taking private lessons with a Cambridge-trained mathematician at the age of twenty. Statistics became her primary mathematical interest; indeed, she would later call it ‘the most important science in the world’ (Magnello, 2010, p 19). Yet mathematics was not Nightingale’s only passion: she believed that nursing, the vocation for which she is now best known, was her calling from God. For Nightingale, mathematics and nursing were not mutually exclusive. Rather, the two complemented each other; even as a student she undertook private statistical studies of public health, amassing a personal dossier of data (Magnello, 2010, p 20).
Nightingale was working as Superintendent of the Hospital for Invalid Gentlewomen in Harley Street when the war began. She had plans to leave the hospital and establish a school for nurses, but all such ambitions were delayed when she was called upon to offer her services in the Crimea (Goldie, 1997, p 1). Nightingale was closely acquainted with numerous politicians, including Sidney Herbert, the Secretary of War at the outbreak of the Crimean conflict (Magnello, 2010, pp 18, 22). Keenly aware of deficiencies in the army’s medical care, Herbert asked Nightingale to be ‘Superintendent of the female nursing establishment in the English General Military Hospitals in Turkey’ (Matthew, 2009 [2004]). Nightingale agreed and was sent to the Crimea with 38 female nurses in October 1854 (Magnello, 2010, pp 18, 20).
Conditions in the Crimea were dire. Infectious disease was rife: soldiers were dying in their thousands of illnesses including typhus, typhoid, cholera and dysentery (Lambert, 2011 [1990], p 143). Shortly after her arrival, Nightingale wrote to her friend Dr William Bowman, describing the horrors she was facing:
But oh! you gentlemen of England, who sit at home in all the well-earned satisfaction of your successful cases, can have little idea from reading the newspapers, of the horror & misery (in a military Hospl.) of operating upon these dying and exhausted men […] I have no doubt that Providence is quite right and that the Kingdom of Hell is the best beginning for the Kingdom of Heaven, but that this is the Kingdom of Hell no one can doubt (Nightingale, 1997 [14 November 1854], p 36).
Nightingale endeavoured to reduce infection and improve efficiency, but her resources were severely limited (Magnello, 2010, p 23). In letters to Herbert, she bemoans the inexperience of her staff and calls for greater resources, requesting the most basic of supplies: plates and dishes, knives and forks, socks, matting, disinfectant, mops, towels, and scissors (Nightingale, 1997 [21 December 1854], p 52; Nightingale, 1997 [25 December 1854], p 59). Openly critical, Nightingale chastises Herbert for sending her so ill-equipped: ‘You have sacrificed the cause, so near my heart. You have sacrificed me, a matter of small importance now’ (Nightingale, 1997 [15 December 1854], p 51).
Criticism of the government’s management of the conflict grew and, in January 1855, the House of Commons passed a motion for a committee of inquiry into the state of the army (Matthew, 2009 [2004]). In February 1855, a Sanitary Commission was appointed to investigate and correct conditions in the Crimea. Led by Dr John Sutherland and Robert Rawlinson, the Commission radically improved sanitation in the hospitals (McDonald, 2010, pp 5, 24). The subsequent dip in instances of infectious disease is largely attributed to these improvements. It was this – the prevention and limitation of infectious disease – which became the focus of Nightingale’s campaigns after the war.
Towards reform
By the time war ended in 1856, British losses totalled 21,097, of which 16,323 were deaths by disease (Lambert, 2011 [1990], p 15). Returning to England, Nightingale was determined to see that permanent reforms were made. To this end, she set about producing a persuasive set of statistics from the data she had gathered in the Crimea. This approach was not without precedent; indeed, by the time of the Crimean War, statistics were a popular means of instigating social change.
The science of statistics was enthusiastically developed throughout the nineteenth century, especially in Britain. The Royal Statistical Society (of which Nightingale later became the first female fellow) was founded in 1833 and was primarily concerned with the statistical study of social conditions (Smith, 1970, p 1). Figures such as William Farr and Edwin Chadwick carried out studies which led to the passing of the Public Health Acts, aimed at improving the living conditions of the poor. Reports on social conditions were produced in great quantity, with notable texts including Factory Inspector’s Report (1839), Chadwick’s Report on the Sanitary Conditions of the Labouring Population (1842), the Royal Commission on the Health of Towns (1844) and the Draining and Sewerage of Towns Report (1852) (Smith, 1970, p 28).
Nightingale’s own methodology for gathering data has been described by scholar Lynn McDonald as follows:
…read the best information available in print, especially government reports and statistics; interview experts; if the available information is inadequate send out your own questionnaire; test it first at one institution; consult practitioners who use the material; send out draft reports to experts for vetting for publication (McDonald, 2006).
In the case of the Crimea, ‘the best information available’ was almost certainly inadequate. Upon her arrival, Nightingale was dismayed not only by the environmental conditions, but by the haphazard record keeping in the hospitals:
…there was a complete lack of co-ordination among hospitals and no standardised or consistent reporting. Each hospital had its own nomenclature…and classification of diseases, which were then tabulated on different forms, making comparisons impossible. Even the number of deaths was not accurate; hundreds of men had been buried, but their deaths were not recorded (Magnello, 2010, p 23).
To further confuse matters, data for the hospitals at Scutari and Koulali was combined for some time, making it difficult to identify trends in individual hospital environments (McDonald, 2010, p 33).
Subsequently, Nightingale spent a great deal of time interrogating the dataset, attempting to aggregate as accurate a set of numbers as possible. She dedicated seven months to this task, consulting experts for advice on methods and supplementary data. Perhaps most significantly, she sought the help of William Farr, who provided comparable datasets on mortality amongst civilians, and advised Nightingale on the development of the ‘Rose Diagram’ (Magnello, 2010, p 23).[2]
Once she had a suitable dataset, Nightingale used it to lobby the government for reform, initially through official channels and later more subversively. Her first port of call was the Royal Commission, appointed after the war ‘to inquire into the regulations affecting the sanitary condition of the army, the organisation of military hospitals, and the treatment of the sick and wounded’ (Royal Commissioners, 1858). Nightingale’s testimony and statistical analyses were published with the Commissions’ findings in 1858. Her contribution included a graphic which appears to be the precursor of the ‘Rose Diagram’; this compares the rate of mortality in the army with that of Manchester, then the city with the highest mortality rate in the country (Royal Commissioners, 1858).
The publication of the Royal Commission in February 1858 caused a stir amongst the public, with The Times noting:
…the chief cause of the evil is the deficient accommodation and the consequent overcrowding in barracks…the closeness, the dirt, the indecency spoken of remind one of a slave ship more than of a place for English soldiers to inhabit (Bostridge, 2008, p 333).
Nightingale had hoped that Lord Panmure, head of the Royal Commission, would instigate reforms in tandem with publication; however, Panmure’s influence came to an abrupt end with the unexpected resignation of Viscount Palmerston as prime minister and the subsequent change of administration. Eager to avoid further delay, Nightingale began to take matters into her own hands (Bostridge, 2008, pp 333–334).
Component DOI: http://dx.doi.org/10.15180/160504/003
Collaborating with Martineau
In addition to the Commission’s publicly distributed report, Nightingale had completed a ‘confidential report’ for the government, known as Notes on Matters Affecting the Health of the British Army. Never officially published, Notes featured the first appearance of the ‘Rose Diagram’.
It had not been well-received: numerous pamphlets and an anonymous paper (attributed to senior medical officials) were published refuting its contents (Small, 2010, p 2). Nightingale began to leak Notes, sending it to influential figures including the novelist Elizabeth Gaskell, statistician Edwin Chadwick and, of course, Harriet Martineau.
On 30 November 1858, Nightingale wrote to Martineau, hoping to appeal to the latter’s interest in the military:
I know that you have been interested about our army matters and therefore, although an old story now, I venture to send you a copy of a ‘confidential’ report of mine to the War Office. It is really ‘confidential’ and no copy has been (or is to be) presented to the House of Commons. Therefore it is only for your own private reading that I send it, if you have still time, strength or inclination for this subject (Nightingale, 2010 [30 November 1858], p 993).
Nightingale’s report impressed Martineau, who called it ‘one of the most remarkable political or social productions ever seen’ (Bostridge, 2008, p 342). Thus began a fruitful collaboration and friendship.
The two women had much in common. Born in 1807, Martineau had, like Nightingale, been intellectually curious from an early age and was mostly educated at home. Her studies included classics, ancient and modern languages, literature, philosophy and history. With an industrialist father, she was raised in relative comfort until the 1820s, when the family’s economic situation was severely reduced. Subsequently, Martineau was obliged to support herself financially; she quickly established herself as an author working in a diverse range of formats, including reviews, novels, biographies, how-to manuals, newspaper columns, essays and articles (Hoecker-Drysdale, 2001, p 76). Economic necessity aside, Martineau was passionate about writing; like Nightingale, she had a keen sense of vocation, writing in her autobiography:
Authorship has never been for me a matter of choice. I have not done it for amusement, or for money, or for fame, or for any reason but because I could not help it. Things were pressing to be said; and there was more or less evidence that I was the person to say them (Martineau, 2010 [1877], p 188; Hoecker-Drysdale, 2001, p 77).
A leader-writer of the left-wing newspaper Daily News, Martineau published extensively on social issues including women’s rights, the poor laws, and the abolition of slavery. She frequently chose to convey her ideas through fiction, weaving political arguments into a series of popular tales. Well-connected, she was closely acquainted with a number of political figures, including William Gladstone (Woodham-Smith, 1950, p 315 ).
Prior to her collaboration with Nightingale, Martineau had been acquainted with the Nightingale family, though not Florence herself. Like many others, she had read of Nightingale’s endeavours in the Crimea in the press. She shared Nightingale’s commitment to empirical methods of observation – a cause she had championed in her 1838 methodology, How to Observe Morals and Manners – and had even written an article supporting a fund for Nightingale and her nurses in the Crimea (McDonald, 1994, pp 51–52).
Given these circumstances, it is perhaps unsurprising that Martineau responded so positively to Nightingale and her cause. Their subsequent letters – which date as late as the 1870s – reveal a strong professional and personal relationship. Though the pair never met, their correspondence is warm and affectionate, with salutations moving quickly from ‘Dear Madam’ to ‘Dear Friend’, and closings from ‘yours faithfully’ to ‘yours truly and gratefully’ (McDonald, 1994, pp 206–207).
Martineau soon began to publicise Nightingale’s findings, carefully excluding confidential data, first in a series of articles in the Daily News, and ultimately in England and her Soldiers (Bostridge, 2008, p 342). She shared Nightingale’s outrage, writing in the Daily News on 11 February 1859:
There is no excuse for the loss of an hour when the lives of our soldiers and the military strength of the nation are in question… [N]ow that we have learned that military Hygiene is something different from the art of amputating limbs and treating dysentery or sunstroke, we shall be guilty of murder on a wholesale scale if we do not apply our new knowledge (Logan, 2010, p 248).
The book was very much a collaborative effort, as Martineau explained in a letter to Henry Reeve:
The book is to be mine, as to form, style, responsibility in every literary sense […] but F. N. is (at my request) to see the whole, in order to preclude mistakes of fact & to keep me informed of the latest movements (Bostridge, 2008, p 342).
Combining statistics with literature was not without precedent. Indeed, other authors had seized upon the new wealth of statistical data, both as a means of lending credibility to their stories, and to make political statements. This included Charles Kingsley, who used the 1843 ‘Report on the Employment of Women and Children in Agriculture’ in his novel, Yeast: A Problem (1848), and Disraeli, whose novel Sybil, or The Two Nations (1845) drew on reports including the ‘Reports of the Children’s Employment Commission’, the ‘Report from the Select Committee on Payment of Wages’ (1842) and the ‘Report on the Commission to Inquire into the Plight of the Handloom Weavers’ (1841) (Smith, 1970).
Like Disraeli and Kingsley, Martineau and Nightingale grasped that the lay reader was more receptive to statistical information in a literary format than in the government issued reports known as ‘Blue Books’ (Magnello, 2010, p 21). Indeed, Martineau notes in the preface to England and her Soldiers that ‘few persons read Blue Books; and very few have time to go through the mass of evidence collected by the various authorities who have reported on the state of the army’ (Martineau, 1859, p vi). Accordingly, the book was carefully pitched to appeal to a wide audience, particularly soldiers. It was also deftly presented so as to avoid censure. Nightingale outlined this strategy in a letter to Martineau:
I feel for two reasons that it is desirable to work up the instructional matter into a narrative by introducing the battles […] My two reasons are (1) that it will be impossible for me to gain admission into the regimental libraries for this book unless the instructional matter is disguised in narrative (no chaplain or inspector would sanction it); (2) that no careless person (and soldiers too are careless) would ever read it without the battles (Nightingale, 2010 [ 21 March 1859], p 1004).
This is not to say that Martineau and Nightingale’s message is hidden away or only hinted at, quite the opposite. The message – that infectious disease was deadly, preventable and all too rife in the army – is explicitly laid out. For instance, in this passage, Martineau plainly argues her point, with the assistance of Nightingale’s data:
Take any set of Englishmen of the same age, – say between 15 and 45, – and you will find the annual mortality 1 in 100 from epidemic and constitutional disease, from local disease, and from violent death collectively; whereas the deaths from those causes were, in our army in the East, nearly 23 per cent., – only 3 percent being from wounds in hospital, while more than 18 were from epidemic disease. The object of introducing this last illustration is to show how little the wounds received in action have to do with the soldier’s peril. The deduction of the 3 per cent. for shot, sword, bayonet, and accidents, leaves a mortality of nearly 20 per cent (Martineau, 1859, p 41).
Strikingly, the text of England and her Soldiers also goes some way to puncturing the popular myth of Nightingale as the untouchable heroine of the Crimean War (Small, 2010, p 150). This is not to say that Nightingale appears in a negative light. Indeed, she is described as a welcome and benevolent presence: ‘What a change it was when Miss Nightingale and the nurses appeared, with hands full of good things at the right time!’ (Martineau, 1859, p 214). Yet conditions at the Scutari hospitals where Nightingale was based are reported damningly, as they had not been in Nightingale’s public reports (Small, 2010, p 150):
…the ground within the Barrack Hospital square was wet, from being insufficiently drained; six dead dogs lay just under one ward window, and a dead horse 'for some weeks in the aqueduct!' […] the filth, vermin, and rats, alive and dead, under the wooden divans on which the men lay, were in themselves a sufficient poison (Martineau, 1859, p 191).
Nightingale thus appears, not as the ministering angel (Bostridge, 2008, p 342) valiantly healing all, but as a well-intended professional rendered helpless by government inefficiencies.
Component DOI: http://dx.doi.org/10.15180/160504/004
Publication and legacy
When England and her Soldiers was published, Nightingale applied to her friend Colonel Lefroy (the inspector general of army schools) for permission to send a copy to each regiment, but was refused. Though Lefroy admired the book, the request was vetoed by Sidney Herbert, by then Chair of the Royal Commission (Matthew, 2009 [2004]), as he feared it would make the men ‘discontented’ (Nightingale, 2010 [21 August 1859], p 1008).
It is difficult to quantify the success or otherwise of England and her Soldiers. Gradual, but significant, changes were made to the governance of army healthcare in the years that followed its publication, including the creation of a permanent Army Sanitary Committee (Bostridge, 2008, pp 343–344). Outside of Britain, the book became popular amongst American medical professionals. In 1861, Martineau wrote to Nightingale:
Our book, England and her Soldiers, is at present quoted largely and incessantly in American medical journals, as a guide in the newness of military management in the Northern states […] the medical journals are learning from us; and I am sure you will be glad to hear it (Martineau, 2009 [20 September 1861], p 148).
England and her Soldiers was one part of a broader campaign, by Nightingale, Martineau and others. Many of the subsequent legislative changes are likely to have been kick-started by Nightingale’s earlier work on the Royal Commission; as such, it is impossible to say whether England and her Soldiers directly influenced the reforms that followed it. Nonetheless, it remains a fascinating example of the way Nightingale and Martineau were attempting to communicate statistical data and hard facts to a general audience, and demonstrates their remarkable commitment to their cause.
Acknowledgements
With thanks to the Florence Nightingale Museum and in particular to Head Curator Natasha McEnroe for her advice on including the book in the Mathematics Gallery. I am grateful also for guidance and support from Kate Steiner, Richard Nicholls, and my colleagues on the mathematics gallery project, David Rooney (Lead Curator), Claire Kennard (Assistant Curator), and Jessica Bradford (Interpretation Manager). Finally, my thanks to the peer reviewer for their useful suggestions.
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