CHAPTER II

THE PASSIONATE STATISTICIAN

(1859-1861)

Full and minute statistical details are to the lawgiver, as the chart, the compass, and the lead to the navigator.--LORD BROUGHAM.

I remember hearing the first Lord Goschen make a speech in Whitechapel many years ago, in which he avowed that for his part he was "a passionate statistician." "Go with me," he said, "into the study of statistics, and I will make you all enthusiasts in statistics." Mr. _Punch_ parodied Marlowe thereupon, and invited his readers to "all the pleasures prove That facts and figures can supply Unto the Statist's ravished eye." I do not know whether any large response to the invitation was forthcoming from Lord Goschen's hearers or Mr. _Punch's_ readers; though, since the day when Lord Goschen spoke, social reformers have more and more guided their schemes by the chart and compass of statistics. If Miss Nightingale saw the speech, it fell upon eyes long ago opened. A fondness for statistical method, a belief in its almost illimitable efficacy, was one of her marked characteristics.

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Few books made a greater impression on Miss Nightingale than those of Adolphe Quetelet, the Belgian astronomer, meteorologist, and statistician; and she had few friends whom she valued more highly than Dr. William Farr, the leading statistician of her day in this country. From his meteorological studies, Quetelet deduced a law of the flowering of plants. One of his cases was the lilac. The common lilac flowers, according to Quetelet's law, when the sum of the squares of the mean daily temperatures, counted from the end of the frosts, equals 4264° _centigrade_. Miss Nightingale was greatly interested in such calculations, and the lilac had a special place in her year. Lady Verney's birthday was April 19, and a branch of flowering lilac was Florence's regular birthday present to her sister. Miss Nightingale used to talk of Quetelet's law with great delight, and commended it to gardening friends for verification in their Naturalist's Diaries. But this is a lighter example of Quetelet's researches. What fascinated Miss Nightingale most was his _Essai de physique sociale_ (first published in 1835), in which he showed the possibility of applying the statistical method to social dynamics, and deduced from such method various conclusions with regard to the physical and intellectual qualities of man. In regard to sanitation, we have heard already of the reforms which Miss Nightingale was instrumental in carrying out in Army Medical Statistics. She turned next to the question of Hospital Statistics, where improvement seemed desirable both for the surer advance of medical knowledge and in the interests of good administration.

Miss Nightingale had been painfully impressed during the Crimean War with the statistical carelessness which prevailed in the military hospitals. Even the number of deaths was not accurately recorded. "At Scutari," she said, "three separate registers were kept. First, the Adjutant's daily Head-roll of soldiers' burials, on which it may be presumed no one was entered who was not buried, although it is possible that some may have been buried who were not entered. Second, the Medical Officers' Return, in regard to which it is quite certain that hundreds of men were buried who never appeared upon it. Third, the return made in the Orderly Room, which is only remarkable as giving a totally different account of the deaths from either of the others."[312] When Miss Nightingale came home, and began examining Hospital Statistics in London, she found, not indeed such glaring carelessness as this, but a complete lack of scientific co-ordination. The statistics of hospitals were kept on no uniform plan. Each hospital followed its own nomenclature and classification of diseases. There had been no reduction on any uniform model of the vast amount of observations which had been made. "So far as relates," she said, "either to medical or to sanitary science, these observations in their present state bear exactly the same relation as an indefinite number of astronomical observations made without concert, and reduced to no common standard, would bear to the progress of astronomy."[313]

[312] _A Contribution_, p. 3 (Bibliography A, No. 14).

[313] _Hospital Statistics_ (Bibliography A, No. 28).

Miss Nightingale set herself to remedy this defect. With assistance from friendly doctors on the medical side, and of Dr. Farr, of the Registrar-General's Office, on the statistical, she prepared (1) a standard list, under various Classes and Orders, of diseases, and (2) model Hospital Statistical Forms. The general adoption of her Forms would, as she wrote, "enable us to ascertain the relative mortality in different hospitals, as well as of different diseases and injuries at the same and at different ages, the relative frequency of different diseases and injuries among the classes which enter hospitals in different countries, and in different districts of the same countries." Then, again, the relation of the duration of cases to the general utility of a hospital had never been shown. Miss Nightingale's proposed forms "would enable the mortality in hospitals, and also the mortality from particular diseases, injuries, and operations, to be ascertained with accuracy; and these facts, together with the duration of cases, would enable the value of particular methods of treatment and of special operations to be brought to statistical proof. The sanitary state of the hospital itself could likewise be ascertained."[314] Having formed her plan, Miss Nightingale proceeded with her usual resourcefulness to action. She had her Model Forms printed (1859), and she persuaded some of the London hospitals to adopt them experimentally. Sir James Paget at St. Bartholomew's was particularly helpful; St. Mary's, St. Thomas's, and University College also agreed to use the Forms. She and Dr. Farr studied the results, which were sufficient to show how large a field for statistical analysis and inquiry would be opened by the general adoption of her Forms.

[314] _Hospital Statistics_. Of course the statistics would have to be interpreted.

The case was now ready for a further move. Dr. Farr was one of the General Secretaries of the International Statistical Congress which was to meet in London in the summer of 1860. He and Miss Nightingale drew up the programme for the Second Section of the Congress (Sanitary Statistics), and her scheme for Uniform Hospital Statistics was the principal subject of discussion. Her Model Forms were printed, with an explanatory memorandum; the Section discussed and approved them, and a resolution was passed that her proposals should be communicated to all the Governments represented at the Congress. She took a keen interest in all the proceedings, and gave a series of breakfast-parties, presided over by her cousin Hilary, to the delegates, some of whom were afterwards admitted to the presence of their hostess upstairs. The foreign delegates much appreciated this courtesy, as their spokesman said at the closing meeting of the Congress; "all the world knows the name of Miss Nightingale," and it was an honour to be received by "the illustrious invalid, the Providence of the English Army." The written instructions sent by "the Providence" to her cousin for the entertainment of the guests show her care for little things and her knowledge of the weaknesses of great men: "Take care that the cream for breakfast is not turned." "Put back Dr. X.'s big book where he can see it when drinking his tea." Miss Nightingale also induced her friend Mrs. Herbert to invite the statisticians to an evening party. The feast of statistics acted upon her as a tonic. "She has been more than usually ill for the last four or five weeks," wrote her cousin Hilary (July 12); "now I cannot help thinking that her strength is rallying a little; she is much interested in the Statistical Congress." Congresses, like wars, are sometimes "muddled through" by our country, and Miss Nightingale was able here and there to smooth ruffled plumes. A distinguished friend of hers, though his name had been printed as one of the secretaries of a Section, had not received so much as an intimation of the place of meeting; he was disgusted at so unbusiness-like an omission, and was half inclined to sulk in his tents. Miss Nightingale's letter on the subject is characteristic:--

(_Miss Nightingale to Dr. T. Graham Balfour._) 30 OLD BURLINGTON ST., _July_ 12 [1860]. You are quite right in what you say. We are all of us in the same boat. And, if it were not that England _would not be_ the mercantile nation she _is_, if she had not business habits somewhere, I should wonder from my experience where they are. Certain of us, who were asked to do business for the Statistical Congress, had it all ready since December last--and were not able to get it out of the Registrar-General's Office till this week. Certain of us were asked to do business this morning, and to have it ready by to-night, which, if _not_ done, would arrest the proceedings of the Congress, and, _if_ done, must be the fruit of only five hours' consideration, when five months might just as well have been granted for it. I don't say that this is so bad as the treatment of you who are Secretary. But still it is provoking to see a great International business worked in this way.

What I want now is to put a good face upon it before the foreigners. Let _them_ not see our short-comings and disunions. Many countries, far behind us in political business, are far before us in organization-power. If any one has ever been behind the scenes, living in the interior, of the Maison Mère of the "Sisters of Charity" at Paris, as I have--and seen their Counting House and Office, all worked by women,--an Office which has twelve thousand Officials (all women) scattered all over the known world--an office to compare with which, in business habits, I have never seen any, either Government or private, in England--they will think, like me, that it is this mere business-power which keeps these enormous religious "orders" going.

I hope that you will try to impress these foreign Delegates, then, with a sense of _our_ "enormous business-power" (in which I don't believe one bit), and to keep the Congress going. Many thanks for all your papers. I trust you will settle some sectional business with the Delegates here to-morrow morning. And I trust I shall be able to see you, if not to-morrow morning, soon.

Mind, I don't mean anything against _your_ Office by this tirade. On the contrary, I believe it is one of the few efficient ones now in existence.

Having received the _imprimatur_ of an International Congress, Miss Nightingale circulated her paper on Hospital Statistics widely among medical men and hospital officials. Thereby she produced immediate effect. She printed large quantities of her Model Forms, and supplied them, on request, to hospitals in various parts of the country. Through the good offices of M. Mohl, she also worked upon public opinion in France. "Some months ago," she wrote to Dr. Farr (Oct. 20, 1860), "I got inserted into the leading medical journals of Paris an article on the proposed Hospital Registers; and you see they are at work." The London Hospitals took the matter up. Guy's printed a statistical analysis of its cases from 1854 to 1861; St. Thomas's, of its from 1857 to 1860; St. Bartholomew's, a table of its cases for 1860. With regard to the future, a meeting was held at Guy's Hospital on June 21, 1861, and it was unanimously agreed--by delegates from Guy's, St. Bartholomew's, St. Thomas's, the London, St. George's, King's College, the Middlesex, and St. Mary's--that the Metropolitan Hospitals should adopt one uniform system of Registration of Patients; that each hospital should publish its Statistics annually, and that Miss Nightingale's Model Forms should as far as possible be adopted. She called further attention to her scheme in a paper sent to the Social Science Congress at Dublin in August 1861,[315] and incorporated it in a later edition of her _Notes on Hospitals_. The statistics of the various hospitals which had accepted her Forms were published in the _Journal of the Statistical Society_ for September 1862, but I do not find that the experiment has been continued. So far from there being any uniform hospital statistics, of the kind contemplated by Miss Nightingale, even in London some of the hospitals do not keep, or at any rate do not publish, any at all. The laboriousness, and therefore the costliness, of the work of compilation, the difficulty of securing actual, as well as apparent, uniformity, and a consequent doubt as to the value of conclusions deduced from the figures are presumably among the causes which have defeated Miss Nightingale's scheme. Some limited portion of her object is perhaps attained by the statistical data which the administration of King's Hospital Fund demands, but even here there are possibilities of misleading comparison. There is probably no department of human inquiry in which the art of cooking statistics is unknown, and there are sceptics who have substituted "statistics" for "expert witnesses" in the well-known saying about classes of false statements. Miss Nightingale's scheme for Uniform Hospital Statistics seems to require for its realization a more diffused passion for statistics and a greater delicacy of statistical conscience than a voluntary and competitive system of hospitals is likely to create.

[315] See Bibliography A, No. 28.

At the time she was full of hope, and, having obtained a start with medical statistics, she next pursued the subject in relation to surgical operations. Sir James Paget had been in communication with her on this point. "We want," he had written (Feb. 18, 1861), "a much more exact account and a more particular record of each case. Thus in some returns we have about 40 per cent of the deaths ascribed to 'exhaustion,' in others, referring to the same [kind of] operations, about 3 per cent or less; the truth being that in nearly all cases of 'exhaustion' there was some cause of death which more accurate inquiry would have ascertained." Miss Nightingale (May 1, 1861) congratulated him on "St. Bartholomew's having the credit of the first Statistical Report worth having," but the table of operations was still, she thought, most unsatisfactory. "It would be most desirable that an uniform Table should be adopted in all Hospitals, including all the elements of age, sex, accident, habit of body, nature of operation, after-accidents, etc., etc. Could you come in to-morrow between 2 and 4, and bring your list of the causes of death after operations? It would be invaluable, coming from such an authority, for constructing a Form." She consulted other surgeons, civil and military, and wrote a paper, with Model Forms, for the International Statistical Congress held at Berlin in September 1863. These also were included in a revised edition of _Notes on Hospitals_. The Royal College of Surgeons referred the subject to a Committee, which, however, reported adversely upon Miss Nightingale's Forms.

II

Before the International Congress at London in 1860 separated, Miss Nightingale addressed a letter to Lord Shaftesbury (President of the Second Section), which was read to the whole Congress, and adopted by it as a resolution. The point of it was to impress upon Governments the importance of publishing more numerous abstracts of the large amount of statistical information in their possession. She gave various instances in which useful lessons might thus be enforced upon the public mind, and cited Guizot's words: "Valuable reports, replete with facts and suggestions drawn up by committees, inspectors, directors, and prefects, remain unknown to the public. Government ought to take care to make itself acquainted with, and promote the diffusion of all good methods, to watch all endeavours, to encourage every improvement. With our habits and institutions, there is but one instrument endowed with energy and power sufficient to secure this salutary influence--that instrument is the press." With Miss Nightingale statistics were a passion and not merely a hobby. They did, indeed, please her, as congenial to the nature of her mind. Her correspondence with Dr. Balfour and Dr. Farr shows how she revelled in them. "I have a New Year's Gift for you," wrote Dr. Farr (Jan. 1860); "it is in the shape of Tables, as you will conjecture." "I am exceedingly anxious," she replied, "as you may suppose, to see your charming Gift, especially those Returns showing the deaths, admissions, diseases," etc., etc. But she loved statistics, not for their own sake, but for their practical uses. It was by the statistical method that she had driven home the lessons of the Crimean hospitals. It was the study of statistics that had opened her eyes to the preventable mortality among the Army at home, and that had thus enabled her to work for the health of the British soldier. She was already engaged on similar studies in relation to India. She was in very serious, and even in bitter, earnest a "passionate statistician." And the passion, as will appear in a later chapter,[316] was even a religious passion.

[316] See below, p. 480.

Miss Nightingale made a valiant attempt to extend the scope of the Census of 1861 in the interest of collecting statistical data for sanitary improvements. There were two directions in which she desired to extend the questions. One was to enumerate the numbers of sick and infirm on the Census day. For sanitary purposes it would be extremely useful to determine the proportion of sick in the different parts of the country. To those who said that it could not be done, because the people would not give the information, the answer was that it had been done in Ireland. The other point was to obtain full information about house accommodation; facts which, as would now be considered obvious, have a vital bearing on the sanitary and social conditions of the people. This point also had been covered in the Irish Census. Dr. Farr entirely agreed with Miss Nightingale, but he could not persuade Sir George Lewis, the Home Secretary, to include these provisions in the Census Bill (1860). Miss Nightingale thereupon drew up a memorandum on the subject, and, through Mr. Lowe (Vice-President of the Council), submitted it to the Home Secretary. Mr. Lowe may have agreed with her, but he failed to persuade his colleague. "Whenever I have power," wrote Mr. Lowe (May 9), "you can always command me, but official omnipotence is circumscribed in the narrow limits of its own department." Sir George Lewis replied that "both of Miss Nightingale's points had been duly considered before the Census Bill was introduced. It was thought that the question of health or sickness was too indeterminate." "With regard to an enumeration of houses, it was thought that this is not a proper subject to be included in a Census of population." A very official answer! But Sir George added that he did not see how the result of such enumeration could be "peculiarly instructive"--an avowal which he also made in the House of Commons. The cleverest of men are sometimes dense; and this remark of Sir George Lewis, added to his subsequent conduct of the War Office, earned for him, in Miss Nightingale's familiar correspondence, the sobriquet of "The Muff." In communicating the result of her first attempt to Dr. Farr, she said, "If you think that anything more can be done, pray say so. I'm your man." But she had not waited to be spurred on. She had already bethought herself of a second string in the House of Lords. Lord Shaftesbury, to whom she had appealed, promised to do all he could. Lord Grey did the same, and asked her to send Dr. Farr to coach him. She began to "thank God we have a House of Lords":--

(_Miss Nightingale to Robert Lowe._) OLD BURLINGTON ST., _May_ 10 [1860]. I cannot forbear thanking you for your letter and for your exertions in our favour. Sir George Lewis's letter, _being interpreted_, means: "Mr. Waddington does not choose to take the trouble." It is a letter such as I have scores of in my possession, from Airey, Filder, and alas! from Lord Raglan, from Sir John Hall (the doctor) and from Andrew Smith. It is a true "Horse Guards" letter.

They are the very same arguments that Lord John used against the feasibility of registering the "cause of death" in '37--which has now been the law of the land for 23 years. He was beaten in the Lords. And we are now going to fight Sir George Lewis in the Lords. And we hope to beat him too. It is mere child's play to tell us that what every man of the millions who belong to Friendly Societies does every day of his life, as to registering himself sick or well, cannot be done in the Census. It is mere childishness to tell us that it is not important to know what houses the people live in. The French Census does it. The Irish Census tells us of the great diminution of mud cabins between '41 and '51. The connection between the _health_ and the _dwellings_ of the population is one of the most important that exists. The "diseases" can be obtained approximately also. In all the more important--such as smallpox, fevers, measles, heart-disease, etc.--all those which affect the _national_ health, there will be very little error. (About ladies' nervous diseases there will be a great deal.) Where there is error in these things, the error is uniform, as is proved by the Friendly Societies; and corrects itself....

The passionate statisticians were, however, hopelessly out-voted in the House of Commons. Mr. Caird moved in her sense on the subject of fuller detail about house-accommodation, and in sending her the printed notice of his amendment, said that "his position would be greatly strengthened with the House if he could obtain Miss Nightingale's permission to quote her name in favour of the usefulness of such an inquiry." I do not know whether she gave permission; the debate is reported very briefly in Hansard. But in any case Mr. Caird's amendment was promptly negatived. As for the House of Lords, Miss Nightingale's reliance upon a better love of statistics in that assembly was cruelly falsified. The Census Bill came up late in the session, and I do not find that either Lord Grey or Lord Shaftesbury said a word upon the subject. The only critical contribution made to the debate proceeded from Lord Ellenborough, who, so far from wanting the Census Bill to include provision for more statistical data, proposed to exclude most of those that were already in. He could not for the life of him see what was the use of asking people so many questions.[317] Here, then, Miss Nightingale was in advance of the time; in one case, by a generation, in the other, by two generations. Recent Censuses have included more particulars of the housing of the people, though still not so many as she wanted. Official statistics of the local distribution of sickness will presently be obtained, I suppose, in a different way, through the machinery of the National Health Insurance Act.

[317] Lords' debate, July 24; principal Commons' debate, July 12, 1860.

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Deprived by the recalcitrance of the Home Secretary and Parliament of a fuller feast of statistics at home, Miss Nightingale turned to the Colonies and Dependencies. The Secretary for the Colonies gave her facilities for collecting much curious and instructive information; and the Secretary for India accepted her aid in collecting and tabulating facts and figures which were the foundation of some of the most notable and beneficent of her labours. But, though she was already (1860-1) engaged in these inquiries, they belong in the main to a later period; and we must now turn to another side of Miss Nightingale's work for the improvement of the National Health.