Let there be light: Florence Nightingale

This year, 2020, the word Nightingale has acquired new connotations. It is no longer just a word to refer to a passerine bird with beautiful and powerful birdsong, it is the name that NHS England has given to the temporary hospitals set up for the COVID-19 pandemic. In normal circumstances it is indeed a very good name to use for a hospital, but given the circumstances, it becomes more poignant. It is even more so considering the fact that this year, 2020, is the bicentenary go Florence Nightingale’s birth.

Florence Nightingale was born on 12th May, 1820 in Florence, Italy (hence the name!) and became a social reformer, statistician, and the founder of modern nursing. She became the first woman to be elected to be a Fellow of the Royal Society in 1874.

With the power of data, Nightingale was able to save lives and change policy. Her analysis of data from the Crimean War was compelling and persuasive in its simplicity. It allowed her and her team to pay attention to time – tracking admissions to hospital and crucially deaths – on a month by month basis. We must remember that the power of statistical tests as we know today were not established tools and the work horse of statistics, regression, was decades in the future. The data analysis presented in columns and rows as supported by powerful graphics that many of us admire today.

In 2014 had an opportunity to admire her Nightingale Roses, or to use its formal name polar area charts, in the exhibition Science is Beautiful at the British Library.

Florence Nightingale’s “rose diagram”, showing the Causes of Mortality in the Army in the East, 1858. Photograph: /British Library

These and other charts were used in the report that she later published in 1858 under the title “Notes in Matters Affecting the Health, Efficiency, and Hospital Administration of the British Army”. The report included charts of deaths by barometric pressure and temperature, showing that deaths were higher in hotter months compared to cooler ones. In polar charts shown above Nightingale presents the decrease in death rates that have been achieved. Let’s read it from her own hand; here is the note the accompanying the chart above:

The areas of the blue, red & black wedges are each measured from the centre as the common vortex.

The blue wedges measured from the centre of the circle represent area for area the deaths from Preventible or Mitigable Zymotic diseases, the red wedged measured from the centre the deaths from wounds, & the black wedged measured from the centre the deaths from all other causes.

The black line across the read triangle in Nov. 1854 marks the boundary of the deaths from all other caused during the month.

In October 1854, & April 1855, the black area coincides with the red, in January & February 1855, the blue area coincides with the black.

The entire areas may be compared bu following the blue, the read & the black lines enclosing them.

Nightingale recognised that soldiers were dying from other causes: malnutrition, poor sanitation, and lack of activity. Her aim was to improve the conditions of wounded soldiers and improve their chances of survival. This was evidence that later helped put focus on the importance of patient welfare.

Once the war was over, Florence Nightingale returned home but her quest did not finish there. She continued her work to improve conditions in hospitals. She became a star in her own time and with time the legend of “The Lady with Lamp” solidified in the national and international consciousness. You may have heard of there in the 1857 poem by Henry Wadsworth Longfellow called “Santa Filomena”:

Lo! in that house of misery
A lady with a lamp I see
Pass through the glimmering gloom,
And flit from room to room

Today, Nightigale’s lamp continues bringing hope to her patients. Not just for those working and being treated in the NHS Nightingale hospitals, but also to to all of us through the metaphorical light of rational optimism. Let there be light.

Now Reading: Hearing

Now reading: Hearing, an introduction & practical guide. Edited by JR Tysome and RG Kanegaonkar

Hearing Hearing is essential for normal communication. We are able to localise sound with surprising accuracy and can detect time differences as small as the time it takes for sound to pass from the mouth of one person to the ear of another. However, hearing loss is underdiagnosed, poorly understood and a common cause of social isolation. Hearing: An Introduction and Practical Guide provides a basic understanding of the science of hearing, the causes of hearing loss and how hearing loss can be clinically assessed and effectively treated.

The book is divided into three sections, beginning with a review of the basic anatomy, physiology and principles of hearing. The second section addresses clinical and audiological assessment of hearing as well as imaging of the ear. The third section features an extensive series of chapters on focused topics covering the range of causes of hearing loss, their management and options for hearing rehabilitation.

Clear, concise and comprehensive, Hearing: An Introduction and Practical Guide is an excellent source of information for ENT surgeons, general practitioners and trainees. It presents a quick reference and practical guide for assessing and managing patients with hearing loss.