Florence Nightingale: Founder of Modern Nursing and Hospital Epidemiology : Epidemiology

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Florence Nightingale

Founder of Modern Nursing and Hospital Epidemiology

Winkelstein, Warren Jr

Epidemiology 20(2):p 311, March 2009. | DOI: 10.1097/EDE.0b013e3181935ad6
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Florence Nightingale is revered as the founder of modern nursing. Her substantial contributions to health statistics are less well known. She first gained fame by leading a team of 38 nurses to staff an overseas hospital of the British army during the Crimean War.1 Newspaper reports of unsanitary conditions at the military hospital had aroused the public, and the Secretary of War responded by appointing a team of nurses to address the situation. The Secretary was a friend of Nightingale's and knew her leadership skills. Nightingale and her team arrived in Turkey in November 1854. They found hospital conditions were far worse than reported. The wards were vastly overcrowded, patients were covered with rags soiled with dried blood and excrement, the water supply was contaminated, and the food inedible. Sewage discharged onto floors of wards and dead animals rotted in the courtyards. According to Nightingale, the hospital case-fatality rate during the first months after her arrival was 32%.2

Although Nightingale did not accept the concept of bacterial infection, she deplored crowding and unsanitary conditions. She put her nurses to work sanitizing the wards and bathing and clothing patients. Nightingale addressed the more basic problems of providing decent food and water, ventilating the wards, and curbing rampant corruption that was decimating medical supplies. She had to overcome an inept and hostile military bureaucracy, which she did in part by paying for remediation from private sources, including her own funds. She also kept careful statistics. Within 6 months, the hospital case fatality had dropped to 2%.

When Nightingale returned to London 3 years later, she was a national hero. However, within a few more years she had become an invalid herself (suffering at age 40 from what may have been chronic fatigue syndrome). Although she lived as a recluse for the next 50 years, she continued to exert substantial influence on nursing and public health through letters, books, conference presentations, and personal persuasion.3

She was skilled in mathematics and far ahead of her time in understanding the importance of health data. She argued (unsuccessfully) that Parliament should extend the 1860 census to collect data on sickness and disability, and she advocated for the creation of a Chair in Applied Statistics at Oxford University. The Royal Statistical Society acknowledged her contributions to health data by electing Florence Nightingale to membership—the first woman to be so honored—and the American Statistical Association made her an Honorary Member.

Florence Nightingale


1. Cook E. The Life of Florence Nightingale. New York: The Macmillan Company; 1942.
2. Vandenbroucke JP, Vandenbroucke-Grauls CM. A note on the history of the calculation of hospital statistics. Am J Epidemiol. 1988;127:699–702.
3. Nightingale F. Notes on Hospitals: Being Two Papers Read Before the National Association for the Promotion of Social Science at Liverpool, in October1858: With Evidence Given to the Royal Commissioners on the State of the Army in 1857. London: John W Parker and Son, West Strand; 1859.
© 2009 Lippincott Williams & Wilkins, Inc.