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\noindent{\bf Florence NIGHTINGALE}\\
b. 12 May 1820 - d. 13 August 1910
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\noindent
{\bf Summary.} Nightingale - a "Passionate Statistician" rather than "Lady
with the Lamp" - was driven by the scandalous legacy of the Crimean War to
use statistical weapons in her fight for hospital reform.
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To most of her contemporaries, as to later generations, Florence
Nightingale (FN for short) was the ``Lady with the Lamp''. However, it
was not her lamp but her pen, combined with administrative skill and
political influence, that FN wielded so effectively -- both in the
Crimean War and in her later battles with officialdom, in the cause of
army hospital reform and other sanitary concerns. In this work, she
wholeheartedly embraced, as a weapon, the new tool of statistics that
became available in the nineteenth century -- and with such conviction
as to be labelled the ``Passionate Statistician''.

In her 'teens, FN had demanded tuition in mathematics, which she
followed with much self-education. Her interest in statistics stemmed
from an intense concern with public health and hospitals, manifested
well before her first appointment.

Her work in the Crimea does not need retelling. Back in England in
1856, she rejected the role of heroine for that of a practical-minded
empiricist, determined to exploit facts and figures in her various
campaigns. In this, FN relied heavily on the advice of leading
statisticians, especially the registrar-general's officer William
Farr.

Her goal was always the winning of the argument -- her method was that
of overwhelmingly effective communication. In her collaboration with
Farr over two decades, her singular contribution was a flair for
publicising their statistical findings through the use of diagrams --
``to affect thro' the Eyes what we may fail to convey to the brains of
the public through their word-proof ears''. 

In the controversy that followed a Royal Commission on the sanitary
scandals of the Crimean War, she invented what are now widely referred
to as FN's ``coxcombs''. The one here reproduced is from her 1858
{\em Notes on Matters affecting the Health, Efficiency and Hospital
Administration of the British Army}.

\begin{figure}[ht]
\begin{center}
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%\epsfig{file=graph.ps,width=\textwidth}
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\caption{Diagram of the Causes of Mortality in the Army in the East --
April 1855 to March 1856}
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It shows the progression of the death rates from wounds (red),
``preventible disease'' (blue) and other causes (black). The legend is
careful to explain that ``the Areas of the blue, red $\&amp;$ black wedges
are each measured from the centre as the common vertex''. Correcting
an earlier misleading graphical representation, FN has here made a
square-root transformation -- by requiring the areas, not the lengths,
of the sectors to be proportional to the death rates. In a lecture for
the Florence Nightingale Museum, Hugh Small has observed that, in her
use of the term ``coxcomb'', FN was not referring to such diagrams
but, with greater thoughtfulness, to the whole document of which they
might form part, such as the colourful attention-getting annex she had
earlier attached to the Report of the Royal Commission. If we are to
respect FN's subtlety in this matter, perhaps we should adopt David
Spiegelhalter's description of the diagrams as ``polar area charts''. 

At times, FN's concern with the effectiveness of presentation
disturbed Farr, who expressed the fear that, in her search for an
audience, his colleague sometimes went beyond good statistical
method. He even wrote to tell that

\begin{quote}
We do not want impressions. We want facts $\ldots$ Again I
must repeat my objections to intermingling Causation with Statistics
$\ldots$ The statisticians has nothing to do with causation; he is
almost certain in the present state of knowledge to err $\ldots$ You
complain that your report would be dry. The dryer the
better. Statistics should be the driest of all reading; what I
complain of is that on reading your report I am conscious of receiving
a wrong impression, because your details are not sufficiently dry and
sufficiently extensive.
\end{quote}

FN cannot have been moved much by this appeal.  Interest in causes and their 
uncovering lay at the heart of her activities.  
Hugh Small's book is almost a statistical whodunnit, as it documents the story 
that comes from FN's revolutionary statistical demonstration, after six months 
of careful investigation, that the principal cause of the frightful mortality 
of the Crimean soldiers in her charge was not their poor, half-starved 
condition on admission, but the filthy state of the hospital itself--a state 
of affairs hitherto regarded as inevitable in hospitals!  Small makes the case 
that it was FN's overwhelming sense of statistical guilt--when, alas too late, 
she uncovered the truth with William Farr's help--that triggered the physical 
collapse that has puzzled her biographers.  
Fortunately, her interest in the dispassionate analysis of causes revived.  
Her 1860 International Statistical Congress scheme for uniform hospital 
statistics was driven by an interest in causes of sickness
and mortality. In her 1863 {\em Notes on Hospitals}, she wrote that
the current method of estimating mortality (without reference to age,
sex, type of operation or post-operative complications)
\begin{quote}
``can at best lead to very loose approximations. It can convey
but a very imperfect idea of the real state of the case. And one thing
is quite certain, that it can lead to no practical result whatever,
either as regards the true causes of the mortality, or how these might
be mitigated.''
\end{quote}

The same command of the statistical highground is evidenced in her
1871 {\em Introductory Notes on Lying-In Institution} -- a publication
that led to the saving of many mothers' lives at childbirth. In 1872,
FN sent a copy of this book to the Belgian statistician Quetelet, whom
she had met at the 1860 International Statistical Congress. She
received in return the two volumes of Quetelet's 1969 {\em Physique
Sociale\/} and the companion work {\em L'Anthropometrie}. Of {\em
Physique Sociale}, she told Farr that she was

\begin{quote}
astounded at the force of genius and accurate observation
which has produced such a work.
\end{quote}

This is borne out by many notes that FN made in the margins of {\em
Physique Sociale}, and that are now reproduced in Diamond $\&amp;$ Stone
(1981). In Quetelet's work she found expression of the ``laws of moral
statistics'', which for her became the ``very highest kind of
religion''. She saw Quetelet as \\
{\small the founder of the most important science in the whole world:
for upon it depends the practical application of $\ldots$ every other
Art: the one Science essential to all Political $\&amp;$ Social
Administration, all Education $\&amp;$ Organisation based on
experience. For it only gives exact results of our experience.}

Her enthusiasm for Quetelet was possible only because Quetelet made
his excursions into pure theory a very small part of his writings. Her
distaste for theoretical ``research'' surfaced when she withdrew her
offer of $\pounds 2000$ to the research-minded Francis Galton for the
endowment of a chair of Applied Statistics at Oxford. There is little
to indicate that she understood the statistical theory available to
her, or that she cared in the least about it. Her interests, even when
overlaid with a mystical concern with God's laws, were not academic
(in the worst sense) but practical, and it is as an advocate of the
practical application of statistics that she deserves to be noticed by
statisticians today.

However, it is a moot question whether any statistician today,
especially one working for some organisation with little or even
negative social concern, can take much heart or instruction from FN's
example -- even though there are many ethical statistical battles to
be fought both within and outside such organisations. FN was helped in
her statistical work by a ``starting capital'' that made her unique --
family connections, financial independence, and, dwarfing all else, the
prodigious public support she acquired during the Crimean
War. Nonetheless, FN's involvement with statistics was marked by
qualities that were not bought with her starting capital, and that
will always repay emulation -- qualities of persistence, intellectual
passion, and ({\em pace\/} the critic F.~B.~Smith) a manifest inner
integrity. She was one who found statistics ``more enlivening than a
novel'' and loved to ``bite on a hard fact''. When Farr told her he
had a New Year's gift for her ``in the shape of Tables'', she replied
that she was ``exceedingly anxious to see your charming Gift,
especially those returns showing the Deaths, Admissions, Diseases''.
An eye-witness claimed that, however exhausted Florence might be, the
sight of long columns of figures was ``perfectly reviving'' to her.\\
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\noindent{\bf Further Reading}

\noindent Diamond, M.~ $\&amp;$ Stone, M.~(1981). Nightingale on
Quetelet. {\em Journal of the Royal Statistical Society, Series A}, {\bf 144}, 66-79,
176-213, 332-351.

\noindent Kopf, E.~W.~(1916). Florence Nightingale as statistician.
{\em Journal of the American Statistical Association}, {\bf 15}, 338-404.

\noindent Small, Hugh (1998). {\em Florence Nightingale: Avenging
Angel}. Constable, London.

\noindent Smith, F.~B.~(1982). {\em Florence Nightingale: Reputation and
Power}. Croon Helm, London $\&amp;$ Canberra.

\noindent Stone, Sir Richard (1998). {\em Some British Empiricists in the
Social Sciences 1650-1900}. Cambridge University Press.

\noindent Spiegelhalter, D.~J.~(1999). Surgical audit: statistical
lessons from Nightingale and Codman. {\em
Journal of the Royal Statistical Society, Series A}, {\bf 162}, 45-58.
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\hfill{M. Stone}


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