page_title: Florence Nightingale
section_title: Statistics and sanitary reform
hierarchical_section_title: Florence Nightingale / Contributions / Statistics and sanitary reform
caption_attribution_description: Example of polar area diagram by w:Florence Nightingale (1820–1910). This "Diagram of the causes of mortality in the army in the East" was published in Notes on Matters Affecting the Health, Efficiency, and Hospital Administration of the British Army and sent to Queen Victoria in 1858. This graphic indicates the number of deaths that occured from preventable diseases (in blue), those that were the results of wounds (in red), and those due to other causes (in black). The legend reads: The Areas of the blue, red, &amp; black wedges are each measured from the centre as the common vertex. The blue wedges measured from the centre of the circle represent area for area the deaths from Preventable or Mitigable Zymotic diseases, the red wedges measured from the centre the deaths from wounds, &amp; the black wedges measured from the centre the deaths from all other causes. The black line across the red triangle in Nov. 1854 marks the boundary of the deaths from all other causes during the month. In October 1854, &amp; April 1855, the black area coincides with the red, in January &amp; February 1856, the blue coincides with the black. The entire areas may be compared by following the blue, the red, &amp; the black lines enclosing them.
context_page_description: Florence Nightingale, OM, RRC, DStJ was an English social reformer, statistician and the founder of modern nursing. Nightingale came to prominence while serving as a manager and trainer of nurses during the Crimean War, in which she organised care for wounded soldiers. She gave nursing a favourable reputation and became an icon of Victorian culture, especially in the persona of "The Lady with the Lamp" making rounds of wounded soldiers at night.
  Recent commentators have asserted Nightingale's Crimean War achievements were exaggerated by media at the time, but critics agree on the importance of her later work in professionalising nursing roles for women. In 1860, she laid the foundation of professional nursing with the establishment of her nursing school at St Thomas' Hospital in London. It was the first secular nursing school in the world, and is now part of King's College London. In recognition of her pioneering work in nursing, the Nightingale Pledge taken by new nurses, and the Florence Nightingale Medal, the highest international distinction a nurse can achieve, were named in her honour, and the annual International Nurses Day is celebrated on her birthday.
context_section_description: Florence Nightingale exhibited a gift for mathematics from an early age and excelled in the subject under the tutelage of her father. Later, Nightingale became a pioneer in the visual presentation of information and statistical graphics. She used methods such as the pie chart, which had first been developed by William Playfair in 1801. While taken for granted now, it was at the time a relatively novel method of presenting data.
  Indeed, Nightingale is described as "a true pioneer in the graphical representation of statistics", and is credited with developing a form of the pie chart now known as the polar area diagram, or occasionally the Nightingale rose diagram, equivalent to a modern circular histogram, to illustrate seasonal sources of patient mortality in the military field hospital she managed. Nightingale called a compilation of such diagrams a "coxcomb", but later that term would frequently be used for the individual diagrams. She made extensive use of coxcombs to present reports on the nature and magnitude of the conditions of medical care in the Crimean War to Members of Parliament and civil servants who would have been unlikely to read or understand traditional statistical reports. In 1859, Nightingale was elected the first female member of the Royal Statistical Society. In 1874 she became an honorary member of the American Statistical Association.
  Her attention turned to the health of the British Army in India and she demonstrated that bad drainage, contaminated water, overcrowding and poor ventilation were causing the high death rate. Following the report The Royal Commission on India (1858–1863), which included drawings done by her cousin, artist Hilary Bonham Carter, with whom Nightingale had lived, Nightingale concluded that the health of the army and the people of India had to go hand in hand and so campaigned to improve the sanitary conditions of the country as a whole.
  Nightingale made a comprehensive statistical study of sanitation in Indian rural life and was the leading figure in the introduction of improved medical care and public health service in India. In 1858 and 1859, she successfully lobbied for the establishment of a Royal Commission into the Indian situation. Two years later, she provided a report to the commission, which completed its own study in 1863. "After 10 years of sanitary reform, in 1873, Nightingale reported that mortality among the soldiers in India had declined from 69 to 18 per 1,000".
  The Royal Sanitary Commission of 1868–1869 presented Nightingale with an opportunity to press for compulsory sanitation in private houses. She lobbied the minister responsible, James Stansfeld, to strengthen the proposed Public Health Bill to require owners of existing properties to pay for connection to mains drainage. The strengthened legislation was enacted in the Public Health Acts of 1874 and 1875. At the same time she combined with the retired sanitary reformer Edwin Chadwick to persuade Stansfeld to devolve powers to enforce the law to Local Authorities, eliminating central control by medical technocrats. Her Crimean War statistics had convinced her that non-medical approaches were more effective given the state of knowledge at the time. Historians now believe that both drainage and devolved enforcement played a crucial role in increasing average national life expectancy by 20 years between 1871 and the mid-1930s during which time medical science made no impact on the most fatal epidemic diseases.
caption: "Diagram of the causes of mortality in the army in the East" by Florence Nightingale.
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