Florence Nightingale, medical statistician

She is a ‘ministering angel’ without any exaggeration in these hospitals, and as her slender form glides quietly along each corridor, every poor fellow’s face softens with gratitude at the sight of her. When all the medical officers have retired for the night and silence and darkness have settled down upon those miles of prostrate sick, she may be observed alone, with a little lamp in her hand, making her solitary rounds

– the Times newspaper, 8 February 1855

It’s Ada Lovelace Day, and time to write about your favorite woman in science.

Florence Nightingale is best known for founding the profession of modern nursing. Today nursing is a skilled degree-earning profession, requiring extensive training, with professional rights and responsibilities. That was not the case less than 120 years ago, when normally only  the military and religious orders offered semi-skilled assistance to physicians.  Nightingale changed all that, and revolutionizing the way medicine is practiced. Historically known as the “Lady with the Lamp”, the angel of soldiers in the Crimean War, she ministered to  the wounded not only with care and compassion, but with a newly-applied professionalism. This professional approach included keeping medical records and using them to improve health care.

Nightingale is less known for her managerial and statistical acumen, and her pivotal role in medical statistics. Nightingale kept meticulous notes of mortality rates at the Scutari hospital in Istanbul which declined dramatically during her administration. Upon her return to London, she compiled the records into a new polar diagram, known as Nightingale Rose Chart. The data is plotted by month in 30-degree wedges. Red represents deaths by injury, blue – death by disease, and black – death by other causes.

Note that this is not a pie-chart. The wedges are all in 30-degrees (so 12 wedges/months fill a circle) and the contribution of each cause of death is proportional to each wedge’s radius. Nightingale’s  visualization of the role preventable diseases play in battlefield deaths made a very strong case to military authorities, Parliament and Queen Victoria to carry out her proposed hospital reforms. Specifically for adopting hospital sanitation practices and dramatically reducing death from preventable infectious diseases.

Here is an interesting critique of the Nightingale Rose Charts which is presented at Dynamic Diagrams.  It appears that by placing the preventable diseases wedge-section in the outer section of the wedge, the blue  received a proportionally larger area, an artifact of this radial plot. This does not detract at all from her achievements, and, as shown in the corrected charts, not even from her case for improving hospital sanitation to reduce preventable diseases as the leading cause of death, regardless of presentation format. (Pie charts are usually problematic).

You can read more about the Mathematical affiliation of  Nightingale in this excerpt form the Newsletter of the Association for Women in Mathematics. One interesting factoid: she was the first woman to be nominated a fellow of the Royal Statistical Society.

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One Response to “Florence Nightingale, medical statistician”

  1. Maria says:

    I was lucky enough to see the original of that chart at the British Library. A little group of us from web publishing at Nature were invited behind the scenes and we saw a collection of her beautiful charts. We also saw correspondence between Wallace and Darwin about some experiments in the garden crossing peas…