Florence Nightingale was born 200 years ago this month. Warped by Victorian romanticism and our antiquated view of women, she has been taught for generations as “the lady with the lamp” who during the Crimean war in 1854 heeded God’s call to travel to Scutari, part of today’s Istanbul. With her small troupe of dedicated nurses, she scrubbed hospital floors, swept away rats, and saw to it that soldiers’ wounds were tended to properly.
Yet, she did much more than this. She transformed society for generations through her social activism and intellect. Were she alive today, Nightingale would not be walking, torch in hand, among the patients of the Covid-19 hospitals named after her. She would instead be gazing intently at her laptop, her smartphone holding thousands of texts with the most influential people of the day, from the Queen and the prime minister to mathematicians and epidemiologists. Her computer would be filled with data-laden spreadsheets and she would be having a lively Twitter debate about the reliability of death figures.
Of course, the question of what Nightingale would be doing requires a degree of poetic licence. But there are clues within her enormous archive of letters, books and reports that allow the exercise to rise above a flight of fancy.
For example, in an 1864 letter to Charles Hathaway, a special sanitary commissioner for Calcutta, she decries the absurdity of politicised health data. “I could not help laughing at your critics who ‘exclude’ specific diseases such as ‘cholera’, accidents ‘proving fatal’ etc. It is very convenient indeed to leave out all deaths that ought not to have happened, as not having happened. And it is certainly a new way of preventing preventable mortality to omit it altogether from any statement of mortality, then they would ‘exclude deaths above 60.’ Their principle, if logically carried out, is simply to throw out all ages and all diseases and then there would be no mortality whatever.”
Nightingale would be furious about Donald Trump’s fake data. But she would also fume at Boris Johnson’s early indecision and the UK’s shortages of medical equipment.
“The three things which all but destroyed the army in Crimea were ignorance, incapacity, and useless rules; and the same thing will happen again, unless future regulations are framed more intelligently, and administered by better informed and more capable officers,” she wrote, exasperated by inept civil servants and politicians.
Nightingale came back from Scutari a celebrity. Today, she would have millions of Twitter followers and use her popularity to press and cajole the government to make informed decisions about when to come out of lockdown and how to decrease the enormous death toll in care homes. And also to fundraise for supplies, as she did in her day.
Nightingale was born on 12 May, 1820 to a wealthy family. This gave her access to a first-class home education and an erudite network of influential acquaintances ranging from the mathematician Charles Babbage to Sidney Herbert, the secretary of state for war. She had a strong sense of justice and was an immensely studious child who excelled at every subject. But her greatest love was mathematics, particularly statistics. The statistician Karl Pearson wrote that for Nightingale, the study of statistics was a religious duty. “To understand God’s thoughts, she held we must study statistics, for these are the measure of His purpose.”
She made her biggest impact by unleashing her quantitative skills on the data she had collected about Scutari. She used her findings and her dogged determination to drive the restructuring of the army medical services and sanitation in the UK, later taking her expertise abroad to as far afield as India and North America. The same data-led approach led her to develop modern nursing – she founded her nursing school at St Thomas’, the same London hospital Johnson was rushed to last month with the coronavirus. She also developed palliative care and midwifery, and to rethink the design of hospital buildings and the civilian health system.
Mathematicians and data scientists revere Nightingale as one of history’s most important statisticians. She used data comparisons to find the causes of problems and to make forecasts.
But Nightingale knew that data was only as persuasive as the graphs that illustrated them, so she became a pioneer in data visualisation. She made famous the polar area graph, which showed that soldiers in Scutari died of preventable diseases rather than their battle wounds, and that their mortality rate plummeted when a sanitation commission cleaned up the hospital’s infected water supply. She would use the information to save countless more civilians and soldiers from dying because of poor living standards and sanitation at home. In 1858, the woman who was not allowed to attend university because of her gender was elected the first female member of the Royal Statistical Society.
Lynn McDonald, the author of numerous books based on Nightingale’s writing, believes Nightingale’s statistically driven ideas of social reform created the early bedrock on which the NHS was founded after the second world war.
Were Nightingale alive today, I could imagine her as prime minister, guiding the UK through a pandemic experience closer to that of New Zealand and Germany. But now I am taking a lot of poetic licence.
At the very least, she would not be known as the lady with the lamp. Instead, generations would know her as “the social reformer with the spreadsheet”.