F lorence Nightingale, or “The Lady with the Lamp”, as she came to be known, was the founder of modern nursing so it’s fitting to take a look back at her life as the NHS turns 70.
A dedicated reformer and nurse, she came to prominence while training other nurses during the Crimean War. Notes on Matters Affecting the Health, Efficiency, and Hospital Administration of the British Army (Lot 314 in the English Literature sale) is undoubtedly her most important work.
“REGARDED AS A WHOLE, I THINK IT CONTAINS A BODY OF INFORMATION AND INSTRUCTION, SUCH AS NO ONE ELSE SO FAR AS I KNOW HAS EVER BROUGHT TO BEAR UPON ANY SIMILAR SUBJECT. I REGARD IT AS A GIFT TO THE ARMY AND TO THE COUNTRY ALTOGETHER PRICELESS.”
Notes is remarkable for its early use of infographics. A dedicated statistician, Nightingale was trained in mathematics by her father. Her most famous graph, found in this volume, ‘Diagram of the Causes of Mortality’ shows the amount soldiers dying of preventable diseases. She called this form of a diagram a ‘coxcomb’. A variation on the pie chart, the coxcomb is used best to demonstrate patterns. In this first instance, it was used to demonstrate that more soldiers were dying from infections rather than wounds.
Data visualisation and infographics can be traced to over 70 years earlier when William Playfair, the Scottish engineer, introduced bar charts and line graphs into his writings of the economic state of 18th century England. However, Nightingale was the first to use these visual graphs as a way to persuade the public and plead for practical change. With this single infographic Nightingale had proven just how powerful visual representation of data could be.
Nightingale’s coxcomb was followed by Charles Joseph Minard’s 1869 infographic depicting Napoleon’s march on Moscow in 1812. The same year Dmitri Mendeleev produced his Periodic Table of Elements. In 1860 the U.S. Coast Survey drafted an infographic map that illustrated the distribution of slavers and influenced the course of the civil war. In 1931 Harry Beck gave us the tube map. In 1946 Fortune published its “Red Star Rising” infographic which fostered a climate of fear between the United States and the Soviet Union.
Now, it’s hard to imagine a world where statistics and information is not made visual: The pictorial ascent of man from apes to upright homo-sapiens; the representation of women amongst Fortune 500 CEOs; the pyramid of food groups. Data has been made digestible. What all of these infographics have in common is what Nightingale captured in her first coxcomb. They are statistics made accessible and convincing.
In 1858, a year after Notes was written, Nightingale was elected as the first female member of the Royal Statistical Society. Her report was so convincing that the practical reforms advocated by Nightingale were carried out by the Royal Commission immediately and the drop in mortality rates was instantaneous. Stephen Paget, in the Dictionary of National Biography, claimed that Nightingale reduced the death rate from 42% to 2%.
Notes on Matters Affecting the Health, Efficiency, and Hospital Administration of the British Armywas not commercially published. It was considered unsuitable for the report to be available before the official ‘Royal Commission on the Sanitary State of the Army’ report (a commission which Nightingale convinced Lord Panmure, the Secretary of State, to instigate in October 1856). Nightingale’s report was never presented to the public but rather only privately printed for circulation amongst friends and influential peers. The present copy comes directly from the shelves of West Horsley Place and a few leaves even remain uncut.
Henry M. Hurd, M.D., of Johns Hopkins, has said in retrospect: “This work constitutes in my opinion one of the most valuable contributions ever made to hospital organisation and administration in time of war. Had the conclusions which she reached been heeded in the Civil War in America, or in the Boer War in South Africa, or in the Spanish-American War, hundreds of thousands of lives might have been saved.”
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