On her death in 1910, Florence Nightingale left a vast collection of reports, letters, notes and other written material. There are numerous publications that make use of this material, often highlighting Florence’s attitude to a particular issue. In this paper we gather a set of quotations and construct a dialogue with Florence Nightingale on the subject of statistics. Our dialogue draws attention to strong points of connection between Florence Nightingale’s use of statistics and modern evidence-based approaches to medicine and public health. We offer our dialogue as a memorable way to draw the attention of students to the key role of data-based evidence in medicine and in the conduct of public affairs. 1. Introduction
1.1 Who Was Florence Nightingale?
Florence Nightingale (1820 - 1910), hereafter referred to as FN, made remarkable use of her ninety years of life. She was the second of two daughters, born in England to wealthy and well-connected parents. There were varied religious influences. Her parents both came from a Unitarian religious tradition that emphasized “deeds, not creeds”. The family associated with the Church of England (Baly 1997b) when property that FN's father had inherited brought with it parochial duties. A further religious influence was her friendship with the Irish Sister Mary Clare Moore, the founding superior of the Roman Catholic Sisters of Mercy in Bermondsey, London. Her father supervised and took the major responsibility for his daughters’ education, which included classical and modern languages, history, and philosophy. When she was 20 he arranged, at FN’s insistence, tutoring in mathematics. These and other influences inculcated a strong sense of public duty, independence of mind, a fierce intellectual honesty, a radical and unconventional religious mysticism from which she found succour in her varied endeavours, and an unforgiving attitude both toward her own faults and toward those of others.
At the age of 32, frustrated by her life as a gentlewoman, she found herself a position as Superintendent of a hospital for sick governesses. Additionally she cooperated with Sidney Herbert, a family friend who was by now a Cabinet minister, in several surveys of hospitals, examining defects in the working conditions of nurses. On the basis of this and related experience she was chosen, in 1854, to head up a party of nurses who would work in the hospital in Scutari, nursing wounded soldiers from the newly declared Crimean war. Her energy and enthusiasm for her task, the publicity which the Times gave to her work, the high regard in which she was held by the soldiers, and a national appeal for a Nightingale fund that would be used to help establish training for nurses, all contributed to make FN a heroine. There was a huge drop in mortality, from 43% of the patients three months after she arrived in Scutari to 2% fourteen months later, that biographers have often attributed to her work.
Upon her return to England at the end of July 1856 FN become involved in a series of investigations that sought to establish the reason for the huge death rate during the first winter of the war in the Crimea. Theories on the immediate cause abounded; was it inadequate food, overwork, lack of shelter, or bad hygiene? In preparation for a promised Royal Commission, she worked over the relevant data with Dr William Farr, who had the title “Superintendent of the Statistical Department in the Registrar-General’s Office”. Farr’s analysis persuaded her that the worst affects had been in Scutari, where overcrowding had added to the effect of poor sanitation. Sewers had been blocked, and the camp around had been fouled with corpses and excrement, matters that were fixed before the following winter. The major problem had been specific to Scutari. FN did not have this information while she was in the Crimea. The data do however seem to have been readily available; they were included in a report prepared by...