Tuesday, May 12, 2015

Florence Nightingale; Nursing, Statistics and Data Visualization Pioneer

Florence Nightingale portrait
Florence Nightingale, 2nd edition linocut on kozo, Ele Willoughby, 2014

I confess that Florence Nightingale (12 May 1820 – 13 August 1910) wasn't on my shortlist of women in science I wished to portray. I felt a little like she was an old-fashioned heroine, from a time where if a woman wasn't going to be defined strictly as a person who served and cared for her family, it was okay if (and only if) she cared for other people. This bias was somewhat reinforced by my own family history: my mother is a nurse, her mother was a nurse, whereas I am a physicist. I know my grandmother wanted to be a pharmacist, and my mother felt her career options were school teacher or nurse. Plus, I take after my father's side of the family and have been known to have a vasovagal response to the mere description of medical procedures; I have a high pain threshold, but am squeemish, and faint like the rest of them. All of which means I partially define myself by not being a nurse. However, I was (luckily) commissioned to make a portrait of Florence Nightingale. The more I read, the more interesting she became to me.

Nightingale earned the nickname "The Lady with the Lamp" during the Crimean War, from a phrase used by The Times, describing her as a “ministering angel” making her solitary rounds of the hospital at night with “a little lamp in her hand”. The image was immortalized by Henry Wadsworth Longfellow's 1857 poem Santa Filomena in the stanza:

Lo! in that house of misery
A lady with a lamp I see
Pass through the glimmering gloom,
And flit from room to room.

So, I’ve shown Nightingale with her little lamp, based on contemporary photos and illustrations. But inventing modern nursing wasn't her only accomplishment. Taking up a profession, travelling to a war zone, nursing the wounded, taking on hospital administration and the training of a professional class of nurses weren't the only things she did which were so unusual for a woman of her time to do. It turns out that her father fostered her gift for mathematics, and she made significant contributions to statistics and data visualization too.

Behind Nightingale is her own ‘Diagram of Causes of Mortality in the Army in the East’ plotted as a polar area diagram – her own statistical and data visualization innovation, sometimes called a Nightingale Rose Diagram. It illustrates the causes of death in the military hospital she managed during the Crimean War. April 1855 to March 1856 is shown on the left and April 1854 to March 1855 to the right. When she researched the causes of mortality, looking back at the data, she saw clearly that the lack of hygiene was a far greater risk to soldiers’ lives than being wounded. The sections represent one month of data {J,F,M,A,M, J,J,A,S,O,N,D} for each month of the year. The green “wedges measured from the centre of the circle represent area for area the deaths from Preventible or Mitigable Zymotic diseases, the [yellow] wedges measured from the centre the deaths from wounds, & the [orange] wedges measured from the centre the deaths from all other causes. The […] line across the [yellow] triangle in Nov. 1854 marks the boundary of the deaths from all other causes during the month. In October 1854, & April 1855, the [orange] area coincides with the [yellow], in January & February 1856, the [green] coincides with the [orange]. The entire areas may be compared by following the [green], the [yellow], & the […] lines enclosing them.” 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 experience influenced her later career and she campaigned for sanitary living conditions, knowing how dangerous unsanitary conditions can be to survival. She also made extensive use of similar polar area diagrams on the nature and magnitude of the conditions of medical care in the Crimean War, or sanitation conditions of the British army in rural India, to make such statistics transparent to Members of Parliament and civil servants who would have been unlikely to read or understand traditional statistical reports. This is an excellent example of how careful selection of how data is presented can influence whether the information is successfully communicated and how important that can be - occassionally even influencing people's survival!

In 1859, Nightingale was elected the first female member of the Royal Statistical Society. She later became an honorary member of the American Statistical Association.

Though her own opinion  of other women was often harsh, she has been credited with contributing to feminist literature with a book she wrote while sorting out her thoughts on her role in the world, including the essay Cassandra, which protested the over-feminisation of women into near helplessness. She helped abolish laws regulating prostitution that were overly harsh to women. She also clearly expanded the acceptable forms of female participation in the workforce.

This, and in particularly, the way she insisted on making decisions based on scientific evidence, and using data to save lives, makes her an apt addition to the women in science portrait series.

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