Go back to article: A statistical campaign: Florence Nightingale and Harriet Martineau’s England and her Soldiers

Towards reform

By the time war ended in 1856, British losses totalled 21,097, of which 16,323 were deaths by disease (Lambert, 2011 [1990], p 15). Returning to England, Nightingale was determined to see that permanent reforms were made. To this end, she set about producing a persuasive set of statistics from the data she had gathered in the Crimea. This approach was not without precedent; indeed, by the time of the Crimean War, statistics were a popular means of instigating social change.

Figure 4

Black and white lithograph of a scene depicting Florence Nightingale on horseback looking over a graveyard

Florence Nightingale and Mr Bracebridge at Cathcart's Hill burial ground. Tinted lithograph after William Simpson. Published P. & D. Colnaghi & Co., London, and printed by Day & Son, lithographers to the Queen. No date supplied.

The science of statistics was enthusiastically developed throughout the nineteenth century, especially in Britain. The Royal Statistical Society (of which Nightingale later became the first female fellow) was founded in 1833 and was primarily concerned with the statistical study of social conditions (Smith, 1970, p 1). Figures such as William Farr and Edwin Chadwick carried out studies which led to the passing of the Public Health Acts, aimed at improving the living conditions of the poor. Reports on social conditions were produced in great quantity, with notable texts including Factory Inspector’s Report (1839), Chadwick’s Report on the Sanitary Conditions of the Labouring Population (1842), the Royal Commission on the Health of Towns (1844) and the Draining and Sewerage of Towns Report (1852) (Smith, 1970, p 28).

Nightingale’s own methodology for gathering data has been described by scholar Lynn McDonald as follows:

…read the best information available in print, especially government reports and statistics; interview experts; if the available information is inadequate send out your own questionnaire; test it first at one institution; consult practitioners who use the material; send out draft reports to experts for vetting for publication (McDonald, 2006).

In the case of the Crimea, ‘the best information available’ was almost certainly inadequate. Upon her arrival, Nightingale was dismayed not only by the environmental conditions, but by the haphazard record keeping in the hospitals:

…there was a complete lack of co-ordination among hospitals and no standardised or consistent reporting. Each hospital had its own nomenclature…and classification of diseases, which were then tabulated on different forms, making comparisons impossible. Even the number of deaths was not accurate; hundreds of men had been buried, but their deaths were not recorded (Magnello, 2010, p 23).

To further confuse matters, data for the hospitals at Scutari and Koulali was combined for some time, making it difficult to identify trends in individual hospital environments (McDonald, 2010, p 33).

Subsequently, Nightingale spent a great deal of time interrogating the dataset, attempting to aggregate as accurate a set of numbers as possible. She dedicated seven months to this task, consulting experts for advice on methods and supplementary data. Perhaps most significantly, she sought the help of William Farr, who provided comparable datasets on mortality amongst civilians, and advised Nightingale on the development of the ‘Rose Diagram’ (Magnello, 2010, p 23).[2]

Once she had a suitable dataset, Nightingale used it to lobby the government for reform, initially through official channels and later more subversively. Her first port of call was the Royal Commission, appointed after the war ‘to inquire into the regulations affecting the sanitary condition of the army, the organisation of military hospitals, and the treatment of the sick and wounded’ (Royal Commissioners, 1858). Nightingale’s testimony and statistical analyses were published with the Commissions’ findings in 1858. Her contribution included a graphic which appears to be the precursor of the ‘Rose Diagram’; this compares the rate of mortality in the army with that of Manchester, then the city with the highest mortality rate in the country (Royal Commissioners, 1858).

The publication of the Royal Commission in February 1858 caused a stir amongst the public, with The Times noting:

…the chief cause of the evil is the deficient accommodation and the consequent overcrowding in barracks…the closeness, the dirt, the indecency spoken of remind one of a slave ship more than of a place for English soldiers to inhabit (Bostridge, 2008, p 333).

Nightingale had hoped that Lord Panmure, head of the Royal Commission, would instigate reforms in tandem with publication; however, Panmure’s influence came to an abrupt end with the unexpected resignation of Viscount Palmerston as prime minister and the subsequent change of administration. Eager to avoid further delay, Nightingale began to take matters into her own hands (Bostridge, 2008, pp 333–334).

Component DOI: http://dx.doi.org/10.15180/160504/003