Nightingale, Florence (1820–1910)

In the 19th century, Florence Nightingale played a key role in the areas of public health policy, medical statistics, hospital design, and patient care. Stepping over gender stereotypes, she reached beyond the typical role of a nurse by studying statistics, hospital management, philosophy, and sanitation. She was a fan of Edwin Chadwick, a sanitary reformer who was influential in passing England's Public Health Act of 1848. Chadwick's premise was that filth, poor ventilation, and unclean water were the causes of disease development. Each of these factors was present in Scutari (the Greek name for Istanbul, Turkey) during the Crimean War. Nightingale's statistical abilities were apparent in her work there; according to historical documents, approximately a year after her arrival at Scutari in 1854, survival rates improved significantly.

Nightingale was never mentioned in a voluminous post–Crimean War report written by the surgeons who served in the war. Historians attribute their refusal to grant her credit for her accomplishments to their resentment of her obtained power. They argued that her statement that providing hygiene, clean air, and nourishment had beneficial effects on mortality rates was inaccurate; instead, they claimed decreased mortality rates were a consequence of lower nursepatient ratio after she arrived with more nurses. In spite of her critics, her successes were acknowledged by the creation of the Nightingale Fund as a ‘thank you’ offering from the people of England. The first nonsectarian nursing school was established as a result of the fund. Furthermore, Nightingale is credited for using statistical graphs effectively to make changes in hospitals. She became a Fellow of the Royal Statistical Society in 1858 and an honorary member of the American Statistical Association in 1874. Nightingale's contributions to health statistics and epidemiology are clearly outlined in Table 1.

Nightingale's words reflect the challenge for health care researchers worldwide:

• You can see the power of careful, accurate, statistical information from the way that I used them in my pleas to Government to improve the conditions of ordinary soldiers and of ordinary people. I collected my figures with a purpose in mind, with the idea that they could be used to argue for change. Of what use are statistics if we do not know what to make of them? What we wanted at that time was not so much an accumulation of facts, as to teach the men who are to govern the country the use of statistical facts. (Maindonald & Richardson, 2004, unpaginated)

Table 1 Modern Hospital Epidemiology Versus 19th Century Hospital Epidemiology