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Thursday, May 28, 2020

Explaind: Why Florence Nightingale matters today, how Covid-19 outbreak threatens her legacy

From her stress on handwashing to the use of data to assess healthcare outcomes, the battle against the pandemic is a constant reminder of her work. Yet the same pandemic threatens to shut down a museum dedicated to her.

Written by Kabir Firaque | New Delhi | Updated: May 12, 2020 1:38:52 pm
Explained: Why Florence Nightingale matters today, how her legacy is under cloud Florence Nightingale (1820-1910).

The 200th birth anniversary of Florence Nightingale, founder of modern nursing, falls on Tuesday, May 12. Her relevance today cannot be understated, given the Covid-19 pandemic. And yet the events leading up to the anniversary can only be called ironic.

Nightingale (1820-1910), who had considerable mathematical skills, is credited with being the first healthcare professional to use data to show that infection control improves health outcomes. Through her career she stressed a practice that is relevant as ever today — handwashing. The irony is that the pandemic has not only ruined her anniversary but is also threatening part of her legacy. The Florence Nightingale Museum in London, which no longer gets the visits that sustain it, has announced it is facing a battle for survival and launched fundraising schemes to save itself.

Nurse and mathematician

In 1840, Nightingale begged her parents to let her study mathematics instead of “worsted work and practising quadrilles”, but her mother did not approve of this idea (Archive of Mathematical History, University of St Andrews). Eventually, they did grant her permission to be tutored in the subject. Then in 1851, she resisted her parents and studied nursing, which was not considered a respectable profession in those days.

Her signature effort came during the Crimean War (1854-56), when she answered a government call for nurses and took a posting as ‘Superintendent of the Female Nursing Establishment of the English General Hospitals in Turkey’. This is where she earned the name ‘Lady with the Lamp’, for walking around patients’ beds at night, holding a lamp. This also where she did her pioneering work with statistics.

Florence Nightingale’s polar area diagram on deaths in hospitals during Crimean war compared areas to show that deaths due to disease exceeded those due to wounds.

When she arrived, diseases such as cholera and typhus were rife in the hospitals. Nightingale collected data, calculated the mortality rate, and showed that an improvement of sanitary methods would reduce the number of deaths. The mortality rate dropped from 60% to 42.7% by February 1855, and to 2.2% by the spring, according to the St Andrews archive.

She used her data to create graphics, the most famous of which is a polar area diagram (pictured) that used areas to represent variations in death rate. The blue wedges, representing death by sickness, are far bigger than those representing wounds.

In an email to The Indian Express, Hugh Small, author of Florence Nightingale: Avenging Angel, described two steps in her statistical analysis. First, it proved that there were large differences in outcomes (death rates) between hospitals, so that deaths must have been caused by local factors in the hospital. Second, it showed that the improvement in death rate over time in one hospital following hygiene improvements showed that the local factor was hospital hygiene.

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“In the context of Covid-19 the first step is important. There has been a large difference in death rates between countries, and statistical analysis will show which country did best and what mistakes the other countries made,” Small said.

Covid-19, the spoiler

The Florence Nightingale Museum, located at St Thomas’s Hospital, is designed around three pavilions that tell the story of Nightingale’s life. It had been planning to celebrate big in 2020, designated the International Year of the Nurse and Midwife (May 12 is International Nurses Day every year). The 2020 bookings diary was full with exhibitions and events, Director David Green said in a statement emailed by the museum. It closed on March 17.

“Prolonged closure and decimated tourist markets for the foreseeable future now threaten the future of the museum as we rely heavily on admissions and retail income to support our small charity, which receives no core funding from government or elsewhere,” Green said. On its website, the Museum has put up an appeal for donations.

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“If the museum at St Thomas’s Hospital closes, I hope she will find a place in other museums,” Small said, in reply to a question. “Perhaps these will cover more of her non-nursing work, like her statistics and her drafting of the revolutionary 1875 Public Health Act that saved so many lives.”

Small has written about Nightingale’s influence on the drafting of the Act, which introduced provisions covering sanitation in British slums. She built her case with her polar area diagram to show how sanitation had reduced deaths in the army.

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