Celebrating Florence by 'working that data'

1 May 2010

The centenary of Florence Nightingale’s death is marked by ANDREW JULL paying tribute to Florence the epidemiologist and WILLEM FOURIE introducing a new Kiwi website showcasing the profession she founded

International Nurses’ Day this year marks 190 years since Florence Nightingale’s birth on May 12th 1820, and 100 years since her death in 1910. Although she is best remembered as a founder of modern nursing, and as something of an organisational genius, Florence Nightingale was also an early and leading proponent of epidemiology. An avid reader of Blue Books – the government reports on social problems in the 1830s – she noted the complete absence of statistics within them. It was not an example she was to follow.

Florence Nightingale was an adept mathematician from an early age – her first table of data was in a letter written aged nine – and she became the first woman elected to the London Statistical Society, precursor to the Royal Statistical Society. This recognition was for her innovative presentation of statistics in reports on mortality in the British Army during the Crimean War. For these reports she developed the polar area diagram for depicting the total mortality attributable to deaths from disease, compared with war injuries, for each month over the years of her involvement. It is this diagram that best exemplifies Nightingale’s ability to persuasively use data to challenge practice and create change.

However, her work in the Crimea was not Nightingale’s only effort in epidemiology. An advocate for the measurement of social phenomena, she led developments in standardising data collection in hospitals, improved statistics in surgery, investigations of mortality during birthing, and worked with the Raj in India to document and improve sanitation in rural India. As a consequence she was also honoured by the American Statistical Association in 1874.

Sir George Grey, an early Governor of New Zealand, had strong connections with Florence Nightingale – Nightingale’s first cousin, Frederick Smith, died of starvation on Grey’s disastrous expedition to Western Australia in 1839. This death did not influence her cordial relations with Grey and there are five letters from Nightingale to Sir George in the Special Collections Room at Auckland City Library. In one letter Nightingale implored of Grey to “pray, think of your statistics” before noting “that people often despise statistics as not leading to an immediate good”. Not Nightingale – she believed statistics to be the most important of subjects, as every other science depended upon its application. It was with this belief that she exhorted a graduating class of nurses “to the sacred duty of applying statistics to reforming the world”. These sentiments have led Iain Sharp to suggest Florence Nightingale should be described not as the ‘Lady with the Lamp’, but as the ‘Lady with the Statistics’.

If Florence Nightingale was with us now, what would she be analysing? I have no doubt she would be collecting and collating data on smoking, on ethnic disparities, on nosocomial infections and the like (and revelling in statistical applications like SPSS, SAS and Stata, as well as the capacities of Excel). Using this information Nightingale would be leading the charge for improvements.

So on this day, her day and our day, let us remember her example and ‘work that data’.

Dr Andrew Jull, associate professor at The University of Auckland school of nursing and quality nursing advisor for the Auckland District Health Board.