A Nightingale sang…

A decade before Charles Joseph Minard famous chart that portrays the losses suffered by Napoleon’s army in the Russian campaign of 1812, which Edward Tufte claims was “probably the best statistical graphic ever drawn”, English nurse Florence Nightingale created a “rose diagram.”

In 1858 she published Notes on Matters Affecting the Health, Efficiency, and Hospital Administration of the British Army. Founded Chiefly on the Experience of the Late War. Presented by Request to the Secretary of State for War. This work contained a color statistical graph. Her “Diagram of the Causes of Mortality in the Army of the East” showed that epidemic disease, which was responsible for more British deaths in the course of the Crimean War than battlefield wounds, could be controlled by a variety of factors including nutrition, ventilation, and shelter. This was, believe it or not, denied by the medical establishment of the time.

Rose chart showing the causes of mortality in the Crimean War

Nightingale went on to develop other statistical graphics in her reports to Parliament, realizing this was the most effective way of bringing data to life.

Statistician Hugh Small explains how the ‘rose chart’ works:

The circle on the right has 12 sectors going clockwise representing the first 12 months of the war. The circle on the left is the second 12 months. The superimposed dark shapes show the monthly death rates. The diagram illustrates how the Sanitary Commission, sent out in the middle of the war, dramatically reduced the death rate. The length of the radial line in each month is proportional to the death rate, but both the text and the appearance imply that it is the shaded area that is proportional to the death rate, rather than the length of the radial lines. Florence recognized this error and inserted an erratum slip, but then replaced this diagram in later documents.

Indeed, the 19th Century was a time of great progress in data collection.  In 1837 the General Registry Office at Somerset House, led by William Farr who later helped Nightingale with her Crimean statistics, began to systematically record births, deaths, and marriages in the UK.  While census data had been collected every ten years since 1801, the 1841 census was the first to list the names of every individual. This gave researchers the opportunity to examine new cause and effect relationships using registration statistics.

Here’s another chart created by Nightingale:

Hugh Small comments on the ways in which this chart is designed for maximum emotional impact:

The title ‘Lines’ (in ornate script in the original) makes it sound like a poem, as in  Lines on the Death of Bismarck.  There are four pairs of bars, when actually the message is clear from one pair alone.  There seems to be a kind of repetition, as in a chorus.  This effect is increased by the words, repeated at the end of each line, English Men, English Soldiers … It sounds like a funeral march.  Second, the red bar for the soldiers would certainly make some people think of the  ‘Thin Red Line’ which had become famous in the Crimean War when a two-deep row of red-jacketed British infantrymen stopped a Russian heavy cavalry charge, something that was thought to be impossible.  The thin red lines on Nightingale’s chart represented these same heroic soldiers who were now dying unnecessarily because of bad hygiene in their barracks.

The variation of death rates due to differences in hygiene was very important to reformers like Nightingale because it showed that even the civilian death rate could probably also be improved by better hygiene. 

Her goal with these charts was not just to inform, but to change hearts and minds.

In our time

In recent weeks, a number of temporary field hospitals have sprung up across Britain for the treatment of COVID-19 patients. Named “Nightingale Hospitals,” they pay homage to the famous “lady of the lamp.” Florence Nightingale’s pioneering approach to sanitation changed the understanding of public health in Victorian Britain and laid the foundations for the profession of nursing as we know it.

In our time of “mask deniers” and people who doubt the safety of vaccinations, or even that the pandemic is “real” and not a “Plandemic“, we need the persuasive power of modern-day Nightingales more than ever.

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