MEI Conference 2015
Florence Nightingale
Stella Dudzic
Stella.dudzic@mei.org.uk
26/05/2015
Florence
Nightingale
Statue to "The Lady of the Lamp", and famous nurse,
beside the allegorical Crimean War Memorial in Waterloo Place.
© Copyright Colin Smith and licensed for reuse under
this Creative Commons Licence
About MEI
Early years
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mathematics education
• Independent UK curriculum development body
• We offer continuing professional development
courses, provide specialist tuition for students
and work with industry to enhance mathematical
skills in the workplace
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teaching and learning resources
• Born in Florence, 1820.
• Family connections to parliament; grandfather
MP for Norwich for 50 years.
• Educated at home by her father.
• At the age of 20, she wanted to learn more
mathematics and had tutors to enable her to do
so.
• She visited hospitals and compiled statistics and
was allowed to train to be a nurse at the age of
30.
Florence Nightingale taught some mathematics
Early nursing career
“How far is the topmost point of Europe from the
Equator? How far do you come to school? Two
miles now, if you were to walk two geographical
miles a day, how long should you be walking to the
equator?”
From one of Florence Nightingale’s lesson plans
• Studied at the Institute of Saint Vincent de Paul
in Alexandria, Egypt, and at the Institute for
Protestant Deaconesses at Kaiserwerth,
Germany.
• After graduation, became unpaid superintendent
of the “Hospital for Invalid Gentlewomen in
Distressed Circumstances” in London.
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26/05/2015
Crimean War 1854-1856
Times Oct 13 1854
The worn-out pensioners who were brought out as an
ambulance corps are totally useless, and not only are
surgeons not to be had, but there are no dressers or
nurses to carry out the surgeon’s directions and to attend
on the sick during intervals between his visits. Here the
French are greatly our superiors. Their medical
arrangements are extremely good, their surgeons more
numerous, and they have also the help of the Sisters of
Charity, who have accompanied the expedition in incredible
numbers. These devoted women are excellent nurses.
Nurse Elizabeth Davis
“The first that I touched was a case of frost bite.
The toes of both the man's feet fell off with the
bandages. The hand of another fell off at the wrist.
It was a fortnight, or from that to six weeks, since
the wounds of many of those men had been
looked at and dressed.... One soldier had been
wounded at Alma.... His wound had not been
dressed for five weeks, and I took at least a quart
of maggots from it. From many of the other
patients I removed them in handfuls.”
War reporting thanks to new technology
...it is with feelings of surprise and anger that the public will
learn that no sufficient medical preparations have been
made for the proper care of the wounded. Not only are
there not sufficient surgeons--that, it might be urged, was
unavoidable--not only are there no dressers and nurses-that might be a defect of system for which no one is to
blame--but what will be said when it is known that there is
not even linen to make bandages for the wounded? The
greatest commiseration prevails for the suffering of the
unhappy inmates of Scutari, and every family is giving
sheets and old garments to supply their want. But, why
could not this clearly foreseen event have been supplied?...
Times Oct 12 1854
Florence Nightingale in the Crimea
• October 1854, Florence Nightingale leads 38 nurses to
Scutari hospital in the Crimea, sent by the Secretary for
War.
• The idea of germs causing illness was still a theory at
this time.
• Florence Nightingale organised the cleaning of the
hospital and an improvement in sanitary conditions.
• How do you think the authorities at Scutari reacted to
this?
• Death rate drops from 43% of patients to 2% in 14
months.
Comparison of British and French Army
death rates by winter †
no. of dead total troops
1st winter
French
British
2nd winter
French
British
%
deaths/troops
10,934
10,989
89,885
47,749
11%
23%
21,191
606
106,634
27,384
20%
2.5%
† Source: Chenu (1870)
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26/05/2015
Crimean War death rates by type of hospital
and sanitary condition
Deaths/
Type of
Sanitary Condition
Admissions
Hospital
Koulali
25.9%
general
worst, very serious defects
Camp
18.8%
general
half-buried, defective huts
Varna
13.1%
general
cholera conditions
Scutari
11.9%
mainly large
2nd and 3rd worst hospitals
Abydos
10.1%
small, civil
N.A.
Smyrna
8.2%
convalescent
serious defects
Balaclava
7.7%
general
excellent, stone, on heights
Hospitals in operation only after sanitary reforms
Renkioi
3.8%
hut
excellent, new prefab
Castle
3.8%
hut
excellent, on heights
Monastery
3.1%
convalescent
excellent, on heights
Inquiries
• July 1856 Florence Nightingale returns to
England.
• Royal Commission into causes of high death
rate at Scutari.
• Florence Nightingale submits 800 pages of data.
• Data suppressed.
• Florence Nightingale leaks the data to influential
people.
Notes on Matters Affecting the Health, Efficiency,
and Hospital Administration of the British
Army sent to Queen Victoria in 1858.
The key text:
The blue, red and black wedges are each
measured from the centre as the common vertex.
•Blue: preventable disease
•Red: death from wounds
•Black: all other causes
November 1854: black line shows where deaths
from other causes is.
October 1854 & April 1855: black and red
coincide
Understanding the diagrams
The area of each wedge represents the number
of soldiers who died from the 3 causes.
Wedges are overlaid, with blue on the bottom,
then black and then red on top. This means
that some wedges cannot be seen at all. It also
means that it is not possible to see the entire
blue wedge at any time.
Do you think this might mislead people?
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26/05/2015
War hospital death rates
and London peacetime
hospital death rates-centre circle
X start
here
Oct 1854
Y
Y sanitary improvements
begin, March 18, 1855
Mortality rates in army barracks in England
Army in East v general English population
From notes on nursing
“The very first requirement in a hospital is that it
should do the sick no harm.”
― Florence Nightingale, Notes on Nursing: What It Is,
and What It Is Not (published 1859)
For a long time an announcement something like
the following has been going the round of the
papers:—"More than 25,000 children die every
year in London under 10 years of age; therefore
we want a Children's Hospital."
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26/05/2015
continued
From Notes on Hospitals
The causes of the enormous child mortality are
perfectly well known; they are chiefly want of
cleanliness, want of ventilation, want of
whitewashing; in one word,
defective household hygiene. The remedies are
just as well known; and among them is certainly
not the establishment of a Child's Hospital.
continued
If the function of a hospital were to kill the sick,
statistical comparisons of this nature would be
admissible. As, however, its proper function is to
restore the sick to health as speedily as possible,
the elements which really give information as to
whether this is done or not, are those which show
the proportion of sick restored to health, and the
average time which has been required for this
object ...
1857 Indian Mutiny
• Florence Nightingale became interested in conditions in
India.
• 1859-1863 works for the Royal Commission on the
Sanitary State of the Army in India, gathering evidence
and preparing the report.
• Average death rate of troops serving in India 69 per
1000 per year.
• Wrote “How people may live and not die in India”.
• By the end of the nineteenth century, the mortality of the
British armies in India had dropped to 5 per 1000 per
year.
continued
... Accurate hospital statistics are much more rare than is
generally imagined, and at the best they only give the
mortality which has taken place in the hospitals, and take
no cognizance of those cases which are discharged in a
hopeless condition, to die immediately afterwards, a
practice which is followed to a much greater extent by
some hospitals than others. We have known incurable
cases discharged from one hospital, to which the deaths
ought to have been accounted and received into another
hospital, to die there in a day or two after admission,
thereby lowering the mortality rate of the first at the
expense of the second
“How people may live and not die in India”.
The statement that the average death-rate of troops,
serving in India, was no less than 69 per 1,000 per annum,
took the country by surprise. The accuracy of the average
could not be denied…….. But it was endeavoured to
explain away the obvious result of the figures, by showing
that the average was not constant — that, in certain years
and groups of years, the death-rate was much greater
than in others ; that the mortality in the years of excess was
due to wars or other causes ; that peace, and not sanitary
measures, was therefore the remedy. And, in short, that the
statement of a death-rate averaging 69 per 1,000 per
annum, was not a fair representation of the case.
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26/05/2015
continued
Influence on statistics education
To this there is the simple reply that, during this present
century, there has been an average loss, from death alone,
of 69 men out of every 1,000 per annum — it matters not
how the mortality has been distributed — that there is every
reason to believe that, if things go on as they have done in
this present century, we shall go on losing our troops at the
rate of 30, 50, 70, 90, 100, and upwards per 1,000. And all
the arithmetic in the world cannot conceal the fact that
the law, by which men perish in India under existing
sanitary negligence, is 69 per 1,000 per annum; this deathrate is, in fact understated, for it says nothing of the invalids
sent home from India who die at sea, or within a short time
of their arrival at home
• Florence believed politicians should be trained in
statistics so that they could understand the data
they had access to and make appropriate
decisions.
• She wanted to establish a course of statistics at
Oxford, since that is where many politicians
were educated.
• 1911 Department of Statistics set up at UCL.
The first in the world.
Florence Nightingale David
• Florence Nightingale was friends with the David
family.
• They had a daughter in 1909 and named her
Florence Nightingale David.
• Florence Nightingale David graduated with a
degree in mathematics.
• She was unable to get a job as an actuary due
to being a woman and went to work at UCL.
• F N David became professor of statistics in
1962.
6
NIGHTINGALE'S REPUTATION
Joint letter to Baron Patten of Barnes, Chair of the BBC Trust
My colleagues and I were greatly pleased with your comments on becoming chair of the BBC Trustees. Your commitment to the
editorial freedom of the BBC is much valued by those of us who listen and watch the BBC here (and in Canada). Your commitment
to maintaining and, where possible, improving the quality of the material broadcast is likewise most welcome. You have
acknowledged the uniquely influential position of the BBC as an opinion former. It is with this in mind that we bring the matter of
the BBC’s persistent, hostile and greatly erroneous treatment of Florence Nightingale to your attention, and ask for any advice you
can give on its being adequately and creatively addressed. We hope also a mutual connection with Balliol College will give you
sympathy to our cause.
Roger Bannister tells a neurology colleague at Oxford that Florence Nightingale failed to keep her wards clean. A taxi driver tells
the director of the Collected Works of Florence Nightingale that Florence Nightingale was not all she was cracked up to be. A more
sympathetic lady expressed sympathy for Nightingale, how badly she must have felt when she discovered that she had caused so
many deaths. None of these people has a shred of hard evidence for these points (none exists to the best of our knowledge) and
none ever read even any of the hostile books on the subject; all picked up this misinformation from the BBC.
Two hour­long “documentaries” attack and belittle Nightingale, BBC2's 2001 “Florence Nightingale: Iron Maiden,” and BBC1's 2008
“Florence Nightingale.”
Men of course are also maliciously treated by the BBC, notably in the Reputations series, but is there anyone attacked in two full­
scale “documentaries,” plus one partial one, at the level of Joseph Lister increasing death rates with his use of disinfectants in
surgery? or accusations that he stole the idea from someone else? Has the BBC ever broadcast a film, “The Real Pioneer of
Antiseptic Surgery?”
The demeaning treatment of Nightingale includes routine reference to her by her first name, while you don’t call Darwin “Charles” or
“Charlie,” The BBC should make a commitment to the routine use of adult names and honorifics for adult women, on the same
basis as for men. (This was done in Canada decades ago.)
There is no complaints procedure for misleading coverage of this scope. In the case of the 2001 film, the intention was malicious,
and done after a warning that the major hostile source, was not reliable. (Lynn McDonald, director of the Collected Works of
Florence Nightingale informed the producer/director and researcher, when being interviewed, and screened out, that her exposé of
Smith’s errors was about to be published in the Times Literary Supplement—it appeared Dec. 6 2000:14­15—whereupon F.B.
Smith was invited and flown in from Australia to repeat and augment his attack in the film.)
The short documentary on Nightingale’s statistics broadcast on BBC4 in 2010, “The Beauty of Diagrams,” differs from the other 3
films in being highly positive in its coverage; it uses her surname (LM gave the director, or someone, a blast about his use of her
first name) and its errors are harmless. It does not, however, undo the damage of the 3 films still being shown.
Of course scholars may differ in interpretation, but still the BBC’s record is appalling. Not one of the academics used to attack
Nightingale ever published his/her accusations in a peer­reviewed book or journal. The writer of this complaint is the editor of the
Collected Works, every volume of which must survive peer review.
A detailed list of factual errors and fictionalized sections on all 3 films is available. Two brief comments are provided here to give
you the flavour.
On the BBC2 film: Richard Brooks, “Nightingale’s nursing ‘helped kill soldiers,’” The Sunday Times (8 July 2001:14) describes FN
as “in fact a manipulative, neurotic and sexually repressed woman. Under her nursing supervision during the Crimean war, hundreds
of wounded soldiers died unnecessarily...10 times more men perished at her Scutari hospital near Sebastopol from illness than
from wounds.” Nightingale, a lifelong Liberal, is also likened to Margaret Thatcher. She, FN, is said further to have “had an
unsatisfactory love life,” spurned as a youngish woman by a social climber and “had just one passionate romance in the Crimea with
a soldier.” Hugh Small is quoted that “Nightingale was not really a nurse.”
On the BBC1 film: Stuart Wavell, “The Liability with a Lamp,” The Sunday Times (June 1, 2008) “Errors by Florence Nightingale
killed thousands of troops in the Crimea, says a new BBC drama.” “We still think of Florence Nightingale as the saintly nurse of the
Crimean war, eulogised by Longfellow as the ‘lady with a lamp,’ whose flitting image was kissed by dying soldiers as she passed
through the wards. But this stereotype has more shadow than substance, for in reality she was the kiss of death to thousands of
men in her care. Thanks to her mistakes, the death rates in her hospital near Sebastopol were double those of smaller regimental
hospitals in the winter of 1854­5. Ten times more soldiers perished from illness than from their wounds. They would have been
better off staying at the front that with Nightingale.” Hugh Small has sued the BBC for plagiarizing his book, Florence Nightingale:
Avenging Angel on this point. (The cynic would advise the BBC to plagiarize a more accurate source.)
We ask the BBC to (preferably) withdraw the two hostile films, at the very least to identify them as including unsubstantiated and
fictional portrayals of Nightingale.
Two possible means of redress are obvious:
1. that the BBC produce commission a new film that would meet a high standard of historical accuracy. We contend that the
“real story” of Nightingale’s accomplishment in public health, nursing, statistics, etc., would be of great interest.
2. That the BBC produce a documentary of how the hostile portrayal came to be so widely accepted (by academics as well as
in the BBC films). The BBC did not invent the false portrayal, but drew enthusiastically and uncritically from poor sources—
the historiography is fascinating. The director of the Collected Works of Florence Nightingale is willing to debate any and all
the producers/directors/researchers/sources of the BBC on any of this.
We would appreciate any advice you can give on how to proceed and would be glad to provide further information to your office.
Yours sincerely
Lynn McDonald, PhD, LLD, professor, director, Collected Works of Florence Nightingale
Tom Keighley (the Rev), FRCN
Alison Macfarlane, City University London
Eileen Magnello, PhD, University College
Susan McGann, PhD, archivist, Royal College of Nursing
Copyright © 2007­2013 The Collected Works of Florence Nightingale
Polar Area Diagrams
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From http://understandinguncertainty.org/node/214
zymotic disease
An old name for a contagious disease, which was formerly thought to develop within the
body following infection in a process similar to the fermentation and growth of yeast.