Florence Nightingale campaigned to improve the quality of life of those who were powerless to improve their own lot. This programme illustrates how she helped to change society for the better through her innovative and systematic collection and analysis of health data, and through the presentation of her conclusions visually using existing methods such as line diagrams and pie charts, as well as her own ‘coxcomb’ diagrams.
When Florence Nightingale arrived at a British hospital in Turkey during the Crimean War, she found a nightmare of misery and chaos. Men lay crowded next to each other in endless corridors. The air reeked from the cesspool that lay just beneath the hospital floor. There was little food and fewer basic supplies.
By the time Nightingale left Turkey after the war ended in July 1856, the hospitals were well-run and efficient, with mortality rates no greater than civilian hospitals in England, and Nightingale had earned a reputation as an icon of Victorian women. Her later and less well-known work, however, saved far more lives. She brought about fundamental change in the British military medical system, preventing any such future calamities. To do it, she pioneered a brand-new method for bringing about social change: applied statistics.
When Nightingale returned from the war, she was obsessed with a sense of failure, even though the public adored her. Despite her efforts, thousands of men had died needlessly during the war from illnesses they acquired in the hospital. “Oh, my poor men who endured so patiently,” she wrote to a friend, “I feel I have been such a bad mother to you, to come home and leave you lying in your Crimean graves, 73 percent in eight regiments during six months from disease alone.” Without widespread changes in Army procedures, the same disaster could occur again, she worried.
So she began a campaign for reform. She persuaded Queen Victoria to appoint a Royal Commission on the Army medical department, and she herself wrote an 830-page report. Her stories, she decided, weren’t enough. She turned to William Farr, who had recently invented the field of medical statistics, to help her identify the reasons for the calamity and the necessary policy changes. He advised her, “We do not want impressions, we want facts.”
Under Farr’s tutelage, Nightingale compiled vast tables of statistics about how many people had died, where and why. Many of her findings shocked her. For example, she discovered that in peacetime, soldiers in England died at twice the rate of civilians — even though they were young men in their primes. The problem with the military health service, she realized, extended far beyond a few terrible hospitals during a war.
Furthermore, the statistics changed Nightingale’s understanding of the problems in Turkey. Lack of sanitation, she realized, had been the principal reason for most of the deaths, not inadequate food and supplies as she had previously thought. Deaths from disease began to fall only in March 1855, after a Sanitary Commission arrived in Turkey. They did what she could not do alone: They flushed the sewers, removed putrid animal carcasses that were blocking the water supply, replaced rotten floors and improved ventilation. Almost immediately, the mortality rate dropped from 52 percent to 20 percent.