Nightingale’s passionate commitment to statistics was based on her faith in a god of order, who created a world that ran by law. God’s laws could be known through research, as a result of which suitable interventions to better the world could be applied. Statistics were a vital component in her holistic approach to health care as a system. They served both to indicate serious problems and to assist in policy making, and then again to monitor the effects of the new policies. She pioneered the use of evaluative statistics and saw reforms achieved as a result of her advocacy. This article explores three key aspects selected from Nightingale’s more than 40 years of applied statistical work: her adaptation of
Quetelet’s methodological foundations, the use of statistics in monitoring public health care systems, and her pioneering study of maternal mortality in childbirth.
Keywords: statistics; health care; public health
Nightingale’s passionate commitment to statistics was intimately related to her spirituality. God was a god of order, who created the world and let it run by law. We should not pray to be delivered from plague, pestilence, and famine, but to learn how to intervene in nature to prevent such disasters. Nightingale complained at length about how impractical the medieval mystics were. Spiritual retreats should equip one for practical action in the world, into which one returned refreshed and strengthened. Statistics helped one by indicating precisely what to do to second God’s creative work, to be a fellow worker with God.
Statistics were a vital component of Nightingale’s systemic approach to health care. She advocated health promotion and disease prevention as a better use of resources than treatment of the ill on a case-bycase basis after they succumbed. Her mentor on all things statistical was the Belgian statistician
L. A. J. Quetelet (an astronomer, head of Belgium’s central statistical agency, and a widely respected expert on the collection of official statistics and probability theory).1 From Quetelet she learned that
“Administration saves more hospital patients than the best medical science,”2 that is, of course, administration that was based on the best possible knowledge, namely, good statistical data. Sloppy administration
was a worse sin than sexual immorality because its consequences harmed so many more people.
Nightingale’s holistic approach to health care may indeed be said to be based on statistics, for it was statistical analysis that taught her the importance of the environment, social, and biophysical, both in regard to susceptibility to disease and treatment outcomes.
Nightingale was a passionate statistician (the expression comes from a chapter title in E. T. Cook’s
Life of Florence Nightingale), not least of all because she could see the individuals in quantitative data
(Cook, 1913). In a letter to Sir John McNeill, a close collaborator from Crimea on, she described unnecessarily high mortality rates in the army (17 to 20 per
1,000 compared with 2 in civilian life) as being criminal, comparable to taking 1,100 men out on Salisbury
Plain and shooting them (Kopf, 1916-1917). Similarly, in arguing for a new hospital to be built at Winchester, she compared the death toll from erysipelas (8 out of 24 affected, in a hospital of 100 to 120 beds) as akin to the hospital massacre that occurred for a short period at Scutari, “so that Winchester aspires to rival the most colossal calamity of history in its
Author’s Note: Please address correspondence to Lynn
McDonald, Department of Sociology & Anthropology, University of Guelph, Guelph, Ontario N1G 2W1, Canada; e-mail: lynnmcd
@uoguelph.ca.
Downloaded from jhn.sagepub.com at UNIV OF CO HEALTH SCIENCE CTR on March 20, 2015
