Lynn McDonald is a professor emerita at the University of Guelph. McDonald’s career has focused on enduring contributions as a scholar and social activist. She also served as a member of Parliament when her Non-Smokers’ Health Act of 1988 led the world in enacting legislation to establish smoke-free work and public spaces. In addition, in a labor of love, she published the definitive collection of Florence Nightingale’s writings, bringing renewed attention to this important female icon for a new generation.
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Rosemary Pennington: This year marks the 200th anniversary of Florence Nightingale’s birth. Widely regarded as one of the progenitors of modern nursing, Nightingale was also influential in the field of statistics. In 1858 she was the first woman elected to the Royal Statistical Society and was made an honorary member of the American Statistical Association in 1874. As with many historical figures, both story of the lady with the lamp who nursed injured soldiers has, at times, served to almost mythologize Nightingale’s contributions to the fields of public health and statistics. The fact and fiction of Florence Nightingale’s statistical legacy is the focus of this episode of Stats and Stories, where we explore the statistics behind the stories and the stories behind the statistics. I’m Rosemary Pennington. Stats and Stories is a production of Miami University’s Departments of Statistics and Media, Journalism and Film, as well as the American Statistical Association. Joining me is regular panelist John Bailer, Chair of Miami’s Statistics Department. Richard Campbell is away. Our guest today is Lynn McDonald, Professor Emerita at- oh, Lynn I should ask you, how do you pronounce the University’s name? Guelph? Okay, I’m going to start from that spot again Charles. In three, two… Our guest today is Lynn McDonald, Professor Emerita at the University of Guelph and a former member of the Canadian Parliament. McDonald is also an expert on Florence Nightingale, serving as the Director of the Sixteen Volume, the Collected Works of Florence Nightingale. McDonald also recently wrote an article for Significance Magazine examining Nightingale’s contribution to the fields of statistics. Lynn thank you so much for being here today.
Lynn McDonald: Thank you
Pennington: How did you first become interested in Nightingale’s work?
McDonald: Well I’m a social scientist; I am not a nurse or a doctor, and I got on to her because when I started to work on sociological theory, I discovered guess what? There were only men, the women didn’t count. And I suspected that just as women, you know, composers, women artists had been neglected but they had been there, that there must be women. And Nightingale was one of the ones I found. So, she’s in my early origins in social sciences. Only gets a small part; there are still more men. And then I did two other books on women social theorists, Nightingale is there especially because of her research methodology. I like to keep research methods and theory together, and she got bigger and bigger sections, and I had to eventually take over the nursing aspects and many many other aspects of her work because she ranged so very far.
John Bailer: So, could you talk a little bit about how she went from kind of her first roots to becoming this person that we’ve known and celebrated for her many contributions?
McDonald: Well she came from a very upper-class English family, so when she experienced what she understood to be a call from God to nurse, to save lives, to serve- she wanted to follow it, but it was unseemly for a woman of her status to be a nurse. It was like being a kitchen maid and in fact, they were quite disreputable, nurses in England at that time. She was allowed to travel, and she’d learn and visit hospitals. Women couldn’t go to university then, so her education was very casual, but she read widely, she was very critical, very smart, she worked very hard, she read government reports on statistics, she analyzed census data, she wanted to understand, you know, what’s in the population, which is all very good background for when she actually had to face the Crimean War and the high death rates there and analyze them after the war.
Bailer: So, you talked about in your article in Significance about the kind of things that she did and things that she didn’t do, and sort of that distinction. What are some of the things that we think she did that she really didn’t? And what are some of the things that she did that people don’t really appreciate?
McDonald: Well she is often credited with actually collecting statistics during the Crimean War. Even out in the battlefield collecting statistics. Well, the Crimean War took place in the Crimea and her big hospital, the Scatera Berwick Hospital, was in Turkey 300 miles away across the Black Sea. And she didn’t get there until November and the deaths started in April, and the Army Medical Department certainly counted death data, actually not terrifically well; they got better at it later. But she did not do any data collection. Where she made a great contribution was after the war in analyzing it and learning the lessons from that war. She was terrific at she asked the right questions. The Army Medical Department thought that climate had a lot to do with the high death rates. Nightingale didn’t think that, and of course, climate is a wonderful excuse. If it’s climate you can’t do anything about it, but if it is fecal material in the drinking water, dead horses in the water supply, overcrowding, lack of ventilation, poor nutrition, all of those things can be dealt with. You need better organization, that’s what.
Pennington: Why is it- why do you think it is that you know again, people imagine that she went to the Crimea, how do these myths around her kind of erupt? And how do you think it is that the truth of her contributions has been overlooked or obscured?
McDonald: She was sent to lead the first team of women nurses to nurse in the war for the British Army and that was a result of press coverage of the war and the bad conditions, and far more men died of disease than died of wounds, and they died from the unsanitary conditions. Okay, the French army had nuns, Sisters of Charity, and that got good press in the UK. And so the war department decided that they should send some women. As it happens the Junior War Minister, Sydney Herbert, knew Nightingale and his wife Elizabeth Herbert was on the board of the small hospital in London that Nightingale was running, a very small hospital. Although she was- although she didn’t have a lot of experience, she was probably the best-experienced person to go because nursing, of course, was still a very lowly thing to do, and the kinds of people who did nursing could never lead a team and what so much of what she did was not even just the nursing. She did nurse and that’s part of it, but it was getting supplies in. Beds, bedding, better food, clothes. The men would come in and they had scurvy, their feet were blackened from frostbite, they had verminous clothes they hadn’t washed in a long time. The army didn’t send soap until the second year of the war.
Pennington and Bailer: Wow.
McDonald: And so, Nightingale had to do all those things and she did them with funds raised by the Times newspaper in England. So, when the Army Medical Department fell down on the job, Nightingale was buying supplies in Constantinople, now Istanbul, and getting them into the hospitals. So, she improved the conditions. Now, that war also is considered in some respects the first modern war because there were war correspondents and they could get their stories back. Now it wasn’t instant, but it only took ten days.
Pennington: Right right.
McDonald: And so, the stories got back, and the stories were also about what Nightingale did. And people saw her, and soldiers saw her, and their conditions were improved. And then one of the things she did, and this is where the lamp comes from, and usually it was carried by a recovered soldier, well he was just a boy when he enlisted, and he would hold the lamp for Nightingale and she would go and go by the soldiers and in the case of some who were clearly dying she would take down the last letter and send it to his family. Now, can you imagine a family getting a letter sympathetic from Florence Nightingale? These are wonderful letters and we know this because some people sent the letter to the local newspaper and they published it, you see? And so, this reputation grew that she was a kind, decent person, as well as the person who got things done, who got the food into the kitchen and the beds into the wards.
Pennington: You’ve raised the press a couple of times and the Victorian-Crimean War is sort of seen as a sort of one of the first modern wars, and you know Nightingale’s work in the hospital in Turkey is seen as this sort of moment of really important moment for modern public health, but also for journalists, and again I’m a journalism professor. William Howard Russell, who covered the Crimea for British outlets was an Irish individual covering this conflict, is seen as one of the first modern war correspondents. But he got a lot of flack because the British authorities did not like the stories that seemed to be critical of what the British were doing, and in particular the conditions that soldiers were living in, and I wonder if there’s any evidence that there was some discomfort or push back from British authorities of the publication of Florence Nightingale’s work, right? I would assume it’s making the British government look bad because the conditions- their soldiers are being- are living in these horrid conditions, and again, so much of the death is about the sanitation of the conditions. Was there any sort of push back from British authorities on Nightingale’s work either in the field or when she came back and was crunching the numbers later?
McDonald: There is a very good explanation for all of this. It was the Aberdeen government that sent the British army to the Crimean War in the first place and declared war in March of 1854. And the war actually started in September and the death started, and the horrible hospitals got revealed in the Fall. High death rates over the winter then in January 1855 a British MP Arthur Roebuck moved a motion on the mismanagement of the war by the government and it passed, and after it passed the government resigned and it was replaced by a new government led by Lord Palmerston, a liberal, who happened to be a next-door neighbor of the Nightingales. And better still, Lord Palmerston was a sanitarian. The word simply means somebody who believes in sanitary science, which is basically what we would call public health, cause, and effect. And Lord Chancery who was a conservative MP was also a sanitarian, and so the government was pressed to do something and Lord Palmerston wrote this wonderful, vicious letter to Lord Raglan, the commander in chief and sent it with Dr. Sutherland who became Nightingale’s lifelong ally on public health, he was a public health officer of health, medical officer of health in Liverpool an experienced person, and he and a civil engineer who was a water expert went with one other person and some practical workmen, and they also had to hire some, and they’re the ones who cleaned up the hospitals. They had to be literally renovated the sewers- the toilets didn’t work. There were- I could ruin your day… the feces on the floor spread and Nightingale didn’t go in the men’s bathrooms, and so to depict this apart from the smell, which went very far and wide, she quoted a report by an MP who happened to be there and described how awful the men’s toilets were because they were plugged and they didn’t work, and so the Sanitary Commission cleaned these things up. And this is another thing that has to be understood, that I think it’s the Sanitary Commission that did the most to bring down the death rates. Bedside nursing, however nice it is, doesn’t help if the water is polluted. If the men have to trample through feces to get anywhere near a hole in the ground if the air is polluted and there’s no ventilation you need to have renovations done, and that was done by the Sanitary Commission. And Nightingale’s work after the war [inaudible] so when you see the report you see the wedges get larger and larger as the death rates increase, and then they start to decline and Nightingale actually puts in a little line saying arrival of the Sanitary Commission.
Pennington: You’re listening to Stats and Stories and today we’re talking about Florence Nightingale with Nightingale scholar, Lynn McDonald.
Bailer: I’m curious when you were talking about her funding of some of the work that she did in purchasing supplies for the troops, that some of this was from the press and, you know, stories about this. Did she have any connection to particular reporters? Did she correspond with reporters related to this and enlist them to tell the story?
McDonald: No, I don’t think so. They found out what she was doing. Russel certainly did and reported on her work, but I think she was perhaps being a loyal civil servant, she wasn’t going to squeal on the authorities, and after all the British Press is pretty robust and they can get their stories and the stories were very hard-hitting. So, Nightingale was very clean that way, she didn’t tell stories. She was probably very confident that they’d get out anyways.
Bailer: I really liked your, you know, when I was reading your Significance piece, you know just the idea of- you know that she was an expert at asking the right questions and analyzing data and writing it up persuasively. I mean, that combination of good data intuition, good analytic skills, but then the connection to this persuasive writing, I wonder where did she learn that? Do you have any intuition or any sense about how that might have emerged?
McDonald: I don’t know how she learned to write. She certainly read good literature, but she was an excellent writer and I think she got better over a lifetime. You can see some of the things she wrote quite late in life and they’re very very good, I think her writing style even improved, but she had a message to deliver, she kept it simple, she asked the right questions, and her data analysis is simple. It’s columns and rows, numbers and percentages, and very simple charts, very very simple. And you want to get them out to a scholarly audience, you want people to look at them who are themselves, experts and medical doctors, you also want the general public too. So, she always wanted journalists to see the materials, she wanted the stories to go into magazines, not just academic journals.
Pennington: It seems like- you mention this idea that Nightingale was a loyal civil servant who was doing this public health work and had connections with people in power in the British government to help make change and it feels like a lot of the conversations around public health, you know in the last several decades there’s a lot more tension around that. It doesn’t seem like they’re- at least what we see publicly feels tense. Do you think there are things that we can learn, either living during the time of COVID or other things, that we can take examples or lessons we can take from Nightingale’s work with authorities as far as it comes to the approach to public health and dealing with public health issues?
McDonald: I think Nightingale is a very good example and her modus operandi should be followed in the COVID-19 crisis that we have right now because Nightingale was very good at learning what went wrong. And the British army brought their death rates down, while the French army’s death rates went up in the second year of the war, even though there was no fighting in the war. But the British had sent the Sanitary Commission. They had made physical changes in the living conditions in the hospitals, also in the camps, and so as a result death rates went down and you can- well we can make those comparisons, the British didn’t actually have the hard French data at that time, but they did know that the rates were going down. And the point I would make for comparison nowadays is different countries and different states are using different methods to combat COVID-19. Some have more thorough lockdowns, some are more casual, some started early, some started late, some do a lot of testing, some only test serious cases, there’s quite a bit of variation. Well, who has the lowest death rates? Those are the kinds of questions we should be asking. There could well be another wave or more than one wave of COVID-19 and so it would be very useful to know what gets the best results, and Nightingale was very good at finding out what gets the best results.
Bailer: Can you talk a little bit about what some of her contributions beyond the sanitary conditions in the hospitals during the war? What are some of the other areas that you would mention in terms of the impact of Florence Nightingale?
McDonald: Well, certainly hospital design and that’s something that she took up with a vengeance afterward, especially you start a nursing school; a nursing school has got to be attached to a hospital. Why would you want women to go to a nursing school when hospitals have such high death rates? And it’s not just military hospitals, army hospitals, you know far from home, the regular hospitals, the London hospitals- this is the best teaching hospitals in London had death rates of 10% of admissions. It’s hard to imagine, so Nightingale was very concerned about changing hospital design. You build a hospital and it’s going to be around easily for 100 years or more, and so if you build it badly so that cross-infection is fostered, you want to build hospitals to minimize cross-infection, which the pavilion model did and so Nightingale became a very strong advocate of that. And that was- I don’t know if it was something she learned from the Crimean War, she picked it up very quickly after the war. And then, of course, the profession of nursing when Nightingale started there weren’t trained nurses, her school was the first in the world, and British so-called nurses, I mean, there’s no copyright on the name and they were called nurses, but they weren’t trained, and in the case of the UK they were quite disreputable; they were known for boozing on the job and taking opiates, but the worst thing they did according to Nightingale was to demand bribes for services. Now nuns on the continent, Sisters of Charity and so forth, they were respectful women, they did not demand bribes for services, although Nightingale noted that their servants did, they weren’t trained. So however decent they were and however well-meaning they were, they weren’t doing the kind of job Nightingale wanted. Nightingale wanted a secular profession. She had a faith; she was called by God, and she was working for God as far as she was concerned, but the nursing profession had to be open up to people of any faith or none at all. And people should be paid for their work, and well paid. Nuns do it because of their beliefs, and then, of course, these disreputable women were paid but paid very badly. And so Nightingale’s vision of a nursing profession was very very different. And you see, at that time, and here’s another parallel with Covid-19, at that time the great diseases, the infectious diseases the fevers and the bowel diseases, their sources were not known. The bacilli that cause it was not known. Covid-19 at least it’s known what it is, but there was no effective treatment and no vaccine, so there’s a parallel there. So what the nurse did is she helped the patient get through the crisis and if they did they would survive, and that’s what happens, although people are on respirators now in worst situations, but there isn’t a cure, there isn’t a vaccine, and so skilled medical and nursing staff have to get the patient through. And Nightingale was very good at that.
Bailer: You talked a lot about her work on teams, that that was a big part of her success and her connection and the impact of her work, could you talk a little bit about some of the teams that she worked on and particularly could you talk a little bit about the connection to the stat community of that day?
McDonald: Yes the statistics community was quite small then, but she did connect right after the Crimean war with Dr. William Farr, a medical doctor who was considered the best medical statistician, and adored Nightingale, and he did a lot of work, we don’t know how much, especially of the charts, we don’t know how much was Farr’s work and how much was Nightingale’s. He had done charts before and he had a staff at the General Register office to work, we don’t know what Nightingale did and what he did, but we do know that the result of their collaboration was better than anything he had ever done before. So that’s a medical statistician, and the absolute top one. She had civil engineer Robert Rawlinson, who was a water expert, and he continued to be a loyal supporter and did all kinds of things for her for many years afterward. Douglas Galton was a Royal Engineer and actually a hospital designer in effect, and Nightingale would send plans of hospitals that she was asked to criticize, she would send them to Dr. Sutherland, her medical officer of health who had been chair of the Sanitary Commission, he was a close connection. So she had top top top close connections and she sent them stuff and asked them to look at it, so that when she gave a reply she knew that she was getting it right, it wasn’t just her idea, that other very good people had gone over it for her. And they liked that. they were glad to work for her in that sense. They had expertise she couldn’t have, she didn’t go to university, she didn’t take engineering, you know, she wasn’t an architect, but she asked the right questions and she could understand, she was demanding and respectful of them and encouraging of them.
Pennington: You mentioned that you first wrote about Nightingale in relation to sort of the origins of social science or the early days of social science, what do you think- I mean, I think you’ve talked a little bit about this, but what do you think people who want to train to be social scientists or train to work in public health – what can they take from Florence Nightingale’s work? What should they take from – what should they think about in relation to her work, as they sort of- you know whether their students just starting out or maybe people who are in the field now, what can they learn what can we learn? I consider myself a social scientist, what can we learn from her?
McDonald: I think in the social sciences, especially in classical social theory, people want to deal with someone more elegant than Florence Nightingale; they want some high-flying theorist. And Nightingale, I call her a mainstream social theorist. What works? Now Marks will tell you why capitalism doesn’t work and why it will break down. Nightingale didn’t take that view; she’d try to make it work. She tried to get and eventually the UK did get a national health service, a really good public health care and treatment, and these are system changes, but not at the level of Marks have. So, she just – well she’s too applied and that’s not practical, well actually it saves lives, but that’s not as exciting as taking you know- Max Beber wrote about very global issues, you know changes in from one type of society to another type of society, and Nightingale said, well let’s get death rates down and let’s get education improved and let’s get people to be healthy. And these, of course, they are very important issues, but they don’t quite have the glamor that the big-name theorists went for.
Pennington: Well, Lynn that’s all the time we have for this episode of Stats and Stories, thank you so much for being here.
McDonald: Very pleased to be with you.
Bailer: Thanks, Lynn.
Pennington: Stats and Stories is a partnership between Miami university’s Departments of Statistics and Media, Journalism and Film, and the American Statistical Association. You can follow us on Twitter or Apple podcasts or other places you can find podcasts. If you’d like to share your thoughts on the program send your email to statsandstories@miamioh.edu or check us out on statsandstories.net, and be sure to listen for future editions of Stats and Stories, where we discuss the statistics behind the stories and the stories behind the statistics.