Florence Nightingale's Statistical Diagrams.

September 15, 2011 9:46 PM

Florence Nightingale's Statistical Diagrams. Famous as the mother of modern nursing, she was also an immensely talented applied statistician and visual information artist. These skills were instrumental in persuading 19th century British health authorities to improve hospital hygiene. She originated a graph type now known as “Nightingale's Coxcomb” and used it to dramatic effect. Examples of these graphs were presented in her monograph, “Notes on matters affecting the health, efficiency and hospital administration of the British army” published in 1858. That same year she became the first female fellow of the Statistical Society of London (now Royal Statistical Society). An animation of the coxcombs here. The Nightingale Crimean War coxcombs are considered by some to be one of the three best graphics in history.

Backgrounder: Florence Nightingale and the Crimean War.

posted by storybored (30 comments total)

Very, very cool. Thanks for this. As a child I went through a Florence Nightingale/Clara Barton period. Fourth grade was all about biographies and geography. But none of them mentioned any of this. Also, her sister's name was "Parthenope"? Wow.
posted by emhutchinson at 9:57 PM on September 15, 2011 [1 favorite]

Parthenope, whose father in Greek mythology was a river god named "Meander." Nothing to do with her sister Florence and her coxcombs, but interesting to me. Sorry if this qualifies as a derail, but a garden of forking paths of information anyway.
posted by emhutchinson at 10:02 PM on September 15, 2011 [2 favorites]

Unbelievable, and awesome. It's one thing to see "improving sanitary conditions would help reduce secondary mortality by blah blah blah" and another thing to see those graphs. Thanks.
posted by KathrynT at 10:04 PM on September 15, 2011 [1 favorite]

It must be really late because I read this whole post and all the comments before realizing it wasn't about Florence Henderson.
posted by hermitosis at 11:43 PM on September 15, 2011

Thanks storybored, what an (unexpectedly) interesting post.
posted by peacay at 12:04 AM on September 16, 2011

Andy Zaltzman, is that you ?
posted by Pendragon at 12:12 AM on September 16, 2011 [3 favorites]

Good post.
posted by CCBC at 1:53 AM on September 16, 2011

The first link states that "Edward Tufte does not mention Nightingale in his book on the history of graphics". True, but on his website he comments:

The diagrams improve on pie charts in exchange for a greater difficulty of reading. As is the case for pie charts, the inherent problem is the difficulty of making good comparisons across the wedges, as Sally Bigwood points out. In general, for such small data sets, tables (or for maps, numbers distributed on the surface perhaps sized as names of cities are sometimes sized in proportion to their population) will outperform graphics.

I agree.
posted by James Scott-Brown at 2:11 AM on September 16, 2011

The BBC covered this in their "The Beauty of Diagrams" series. The episdoe on Nightengale is on YouTube: Part 1, Part 2.

The same YouTube user has uploaded all the other episodes too if you have a few hours to kill:

1. Vitruvian Man: Part 1, Part 2.
2. Copernicus: Part 1, Part 2.
3. Newton's Prism: Part 1, Part 2.
4. Florence Nightingale (see above)
5. DNA: Part 1, Part 2.
6. Pioneer Plaque: Part 1, Part 2.
posted by The Ultimate Olympian at 4:08 AM on September 16, 2011 [8 favorites]

Wow, that economist link killed my browser completely and instantly, twice.
posted by DU at 4:21 AM on September 16, 2011

The diagrams look good, but I agree with James Scott-Brown and Tufte: the data sets are so small that tables would be more effective for conveying data.
posted by sonic meat machine at 4:29 AM on September 16, 2011

I had no idea. That's cool!
posted by OmieWise at 4:33 AM on September 16, 2011

Posts like this introduce me to brand new topics I never imagined on my own. It is thrilling to experience the effect. This is why I have MetaFilter as my homepage. Thank you.
posted by Sparkticus at 4:36 AM on September 16, 2011 [3 favorites]

Related: Dutch anarchist punk band The Ex, with cellist Tom Cora, doing "Lamp Lady," which pushes aside the "lady with the lamp" image in favor of another one:

The image: a woman, helpful, attending, and handling with care.
Imagine: a battlefield with sparse light at lives lost, a red cross to bear.
The lady with the lamp is what they called her;
Country needed heroes, papers had to sell
The medicines, the lady, the cupboard, the lamp
The lock not the key, a light in the hand.
Prescriptions, the wounded, the look through the glass.
Demand not supply, a pain in the ass.
Soldiers, sickbay, cupboard, medicines.
Smashed front window, demand for supply.
Stories, hearsay, covers, magazines
Wounded, they knew the papers lied.
The lady without glamour is the lady with the hammer is what she was.

Apparently, she was as known for breaking into supply areas to get medicine for the wounded as she was for walking around with a lamp.
posted by mediareport at 6:19 AM on September 16, 2011 [1 favorite]

Also, her sister's name was "Parthenope"?

The two girls were named after the cities in which they were born. Parthenope was always called Parthe, which is quite pretty and which I much prefer to Florence. Poor Parthe got the short end of the stick in almost every other way, though. She was highly intelligent and talented in her own right, but her younger sister was meteorically brilliant and gifted in so many directions (she spoke multiple languages, could sing opera at a professional level, was a talented artist, and learned every subject like a house afire), and was very healthy and beautiful while Parthe was frail and plain. Their parents were aware that they needed to separate the girls, but Parthe’s poor health made it impossible for her to attend boarding school and no school was willing to undertake the education of Florence — any school they tried shipped Florence back home within two weeks.

Parthe was tormented by her inferiority in her youth. By her teenaged years she had developed a neurotic and parasitical attachment to Florence. Parthe tried to live through Florence and demanded that Florence live the conventionally successful life expected of an upper-class Victorian girl rather than reform the medical system (to be fair, Mr. and Mrs. Nightingale were of the same opinion as to what Florence should do with her life). It wasn’t until mid-life, when Parthe got married and wrote a number of books, that Parthe finally started to settle into her own sphere and be contented with it. But even then, Parthe’s husband was a man who had wanted Florence and married Parthe so that he could have a place in Florence’s life. Ouch.
posted by orange swan at 6:20 AM on September 16, 2011 [10 favorites]

Florence Nightingale's coxcomb graphs are impressive, but she's not the only female social reformer who did some kick-ass visual display of information. Jane Addams at Hull House did some excellent multicolored maps of ethnicity and weekly wages in her work as a sociologist and social worker in Chicago. In fact, women were so closely associated with these statistical diagrams in the mid-to-late 19th century that the predominantly male Chicago school of sociology viewed "collecting quantitative data as women's work."
posted by jonp72 at 6:44 AM on September 16, 2011 [6 favorites]

orange swan, that's fascinating! Where did you get all that info? I would love to read whatever you were reading.
posted by ThatCanadianGirl at 7:18 AM on September 16, 2011

But none of them mentioned any of this.

I need to read the Economist more closely.

Thank you for bringing this information to light of day.
posted by infini at 7:22 AM on September 16, 2011

ThatCanadianGirl, I read this information about Florence and Parthe in Nightingales: The Extraordinary Upbringing and Curious Life of Miss Florence Nightingale, by Gillian Gill. Really good read on the whole and I recommend it.

Gill does make one really silly error in reasoning that I always think of when I remember that book, though. There is some speculation among historians that Florence was possibly a lesbian. Gill declares that there is no evidence that Florence was anything other than entirely celibate all her life, and since being a lesbian means being a woman who is sexually involved with women, therefore Florence was not a lesbian. Uh, no. A lesbian is a woman who is sexually attracted to other women, regardless of whether she acts on that attraction or remains celibate. By Gill's argument Florence wasn't heterosexual either, since she never slept with men. Whoever edited that book shouldn't have let that stand.
posted by orange swan at 8:02 AM on September 16, 2011 [4 favorites]

I must be a complete dolt, because my belief regarding charts is that if I cannot look at them and immediately understand the point without reading extensive explanatory text, then the chart is a failure. Looking at Nightingale's 'chart', I can't for the life of me figure out what the hell it is trying to say without painstakingly reading her text. On the contrary, Playfair's chart so ridiculously obvious that it passes my test with flying colors.

So, what the hell is Nightingale's chart trying to say?
posted by spicynuts at 8:13 AM on September 16, 2011 [1 favorite]

So, what the hell is Nightingale's chart trying to say?

Short version: wash your damn hands!
posted by The Ultimate Olympian at 8:18 AM on September 16, 2011 [1 favorite]

Wow. I did not know that.
Thanks Storybored.
posted by SLC Mom at 8:29 AM on September 16, 2011

Stellar post, best of mefi. Thanks, storybored.
posted by madamjujujive at 8:48 AM on September 16, 2011

I'm with spicynuts. I've loved the Minard chart from the moment I saw it at a Tufte presentation in Boston many years ago.
The Nightingale one is impressive but I don't get the shape at all and find it getting in the way of my comprehension--luckily the colors help. A simple bar chart would have done the trick for me.

For the record, I have similar problems with some of Nate Silver's charts--I don't know if they're just overloaded with info or there's something wrong with how I digest the presentations but I do know I can't look at them and immediately have an ah-ha! moment, the way that some people do.
posted by etaoin at 8:58 AM on September 16, 2011

But as usual, what a great post and discussion. Thanks to all who contributed. I'm home sick today but I know what I'll be reading...
posted by etaoin at 8:59 AM on September 16, 2011

I'm really failing to understand what the coxcomb chart relates that a simple stacked-column chart would not. In fact, it implies a cyclical nature to the yearly mortality rates, which (in times of war, and possibly at other times) is probably not true.

In short, why did she reinvent the wheelstraight line as a dodecagon?

(To be fair, I only glanced over the links; maybe the advantage is explained somewhere therein. Feel free to educate impatient me.)
posted by IAmBroom at 9:13 AM on September 16, 2011

I’m an RN and in graduate school in the field of nursing. My program has a hard emphasis on research, and so discussions that cite Nightingale happen with not a little frequency. Her statistical modeling, in particular, continues to be useful to public health research in a way that continues to make nurse scientists among the most important researchers that keep all of us safe.

Interesting to me, especially, is that her contribution to healthcare is often perceived primarily as one of hygiene (so-called “modern nursing” or “modern medicine” has a mythological fixation on hygiene practices). However, her real contribution, speaking as someone in the applied and scholarly field of nursing, is the communication of practices well-known to globally benefit patients in such a way that rapidly encouraged change.

This requires me to discuss healthcare models, scope of practice, and professional fields, generally, to explain my dedication to Nightingale. Nursing, often thought as a “professional support” field (support, that is, to the physician) or, more broadly, as a field primarily concerned, motivated, and built on value principles of service, is actually a separate model of healthcare. In other words, we tend to define nursing by its scope of practice as it compares to medicine, rather than understanding that nursing has adapted its own scope of practice in order to practice an entirely different model of healthcare.

The nursing model and its theories focus on patient response. Intervention is applied multi-valiantly after assessment of first, physiological homeostatis as well as the patient’s own report of his or her response to abnormal findings. Then, the intervention itself is assessed from the perspective of the patient’s response. Many, if not the majority, of healthcare delivery innovations have been developed by nurses because nursing is uniquely suited, by their own model, to see trends of patient response to various interventions and respond, then to the population—as if the population itself is a patient. Statistics is vital to nursing science.

So, by the time Nightingale was practicing, her and her colleagues knew very well that certain hygiene practices predicted better patient response to interventions (like field amputation), but this anecdotal knowledge was useful only to small, localized pockets of care, not to the field as a profession. Her statistical modeling dramatically and rapidly communicated healthcare delivery innovations to several professions at once, including those in power due to the sexist constraints of the time (like medicine and pharmacology). Using population to describe efficacy of intervention, then, created nursing and other fields of healthcare as true professions with scopes and standards of practice.

It’s so easy to take for granted how statistical and population research is the bread and butter of healthcare change and evolution that actually saves lives—especially in a world where a single trial with no meta-analysis makes huge media news because the anecdotal patient response was so dramatic. To know one patient, we truly do have to know the population, and this was Nightingale’s critical, life-saving contribution and why all of us, not just the practitioners who don’t kill patients in their own hospital, wash our hands.

Wonderful post.
posted by rumposinc at 9:42 AM on September 16, 2011 [6 favorites]

Interesting Clara Barton fact: she was the great-niece of midwife Martha Ballard, who some of you may know from Laurel Thatcher Ulrich's fantastic book. Whenever I read about women who worked in the medical field during this time period, I am just AMAZED at everything they accomplished in the face of so many logistical challenges, let alone everything else.

(By the way, if you think Parthenope is bad, you should hear some of the other names in the Ballard diary...)
posted by bitter-girl.com at 10:22 AM on September 16, 2011

Wonderful post.
posted by infini at 10:23 AM on September 16, 2011 [1 favorite]

I know where to buy the Tufte chart, but does anybody know where to get poster versions of the other two charts mentioned in the Economist article?
posted by nushustu at 1:38 PM on September 16, 2011