Volume I Part 36 (1/2)
[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 istrar-General's Office, on the statistical, she prepared (1) a standard list, under various Classes and Orders, of diseases, and (2) eneral 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 saes, the relative frequency of different diseases and injuries a the classes which enter hospitals in different countries, and in different districts of the saain, 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 ht to statistical proof The sanitary state of the hospital itself could likewise be ascertained”[314] Having forale proceeded with her usual resourcefulness to action She had her Model Forms printed (1859), and she persuaded some of the London hospitals to adopt theet at St Bartholomeas particularly helpful; St Mary's, St Thoreed to use the Forms She and Dr Farr studied the results, which were sufficient to sho 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 ale drew up the prograress (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 coress 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 ere afterwards adn delegates much appreciated this courtesy, as their spokesress; ”all the world knows the naale,” 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 entertains and her knowledge of the weaknesses of great men: ”Take care that the crea 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 resses, like wars, are soale was able here and there to sh his name had been printed as one of the secretaries of a Section, had not received so usted at so unbusiness-like an ohtingale'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 saland _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, ere asked to do business for the Statistical Congress, had it all ready since Deceistrar-General's Office till this week Certain of us were asked to do business this ht, 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 ranted for it I don't say that this is so bad as the treat 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 _thes 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 Mere 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 knoorld--an office to compare hich, in business habits, I have never seen any, either Governland--they will think, like me, that it is this ious ”orders” going
I hope that you will try to iates, 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 soates here to- And I trust I shall be able to see you, if not to-ainst _your_ Office by this tirade
On the contrary, I believe it is one of the few efficient ones now in existence
Having received the _iale circulated her paper on Hospital Statistics widely a medical men and hospital officials Thereby she produced ie 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 ”Soot 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
Bartholoard to the future, awas held at Guy's Hospital on June 21, 1861, and it was unaniates from Guy's, St Bartholo's College, the Middlesex, and St Mary's--that the Metropolitan Hospitals should adopt one uniforistration 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 scheress 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 experi any uniforhtingale, 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 co actual, as well as apparent, uniformity, and a consequent doubt as to the value of conclusions deduced fro the causes which have defeated Miss Nightingale's scheme Some limited portion of her object is perhaps attained by the statistical data which the ad's Hospital Fund de comparison There is probably no depart statistics is unknown, and there are sceptics who have substituted ”statistics” for ”expert witnesses” in the well-known saying about classes of false stateale's scheme for Uniform Hospital Statistics seems to require for its realization a reater delicacy of statistical conscience than a voluntary and competitive systeraphy A, No 28
At the ti obtained a start with medical statistics, she next pursued the subject in relation to surgical operations Sir Jaet 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 htingale (May 1, 1861) congratulated hi 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 unifor all the elee, sex, accident, habit of body, nature of operation, after-accidents, etc, etc Could you co your list of the causes of death after operations? It would be invaluable, co a Foreons, civil and military, and wrote a paper, with Model Forress 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 Coale's Forress 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 i e aave various instances in which useful lessons ht 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, reht to take care to make itself acquainted with, and proood e every improvement With our habits and institutions, there is but one instruy and power sufficient to secure this salutary influence--that instruale statistics were a passion and not enial to the nature of her mind Her correspondence with Dr Balfour and Dr Farr sho 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 aly anxious,” she replied, ”as youGift, 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 preventablethe 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 ansas 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 h Mr Lowe (Vice-President of the Council), subreed 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 lie 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 indeterard to an enuht 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 avohich he also made in the House of Commons The cleverest of e Lewis, added to his subsequent conduct of the War Office, earned for hiale's familiar correspondence, the sobriquet of ”Thethe result of her first atte 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 saan 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_, ton does not choose to take the trouble” It is a letter such as I have scores of in lan, from Sir John Hall (the doctor) and from Andrew Smith It is a true ”Horse Guards”
letter
They are the very saainst 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 everyto 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 knohat 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-acco her the printed notice of his athened 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 knohether she gave permission; the debate is reported very briefly in Hansard But in any case Mr Caird's aatived
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 h, who, so far fro 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 hi people so ale was in advance of the tienerations Recent Censuses have included h 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
Deprived by the recalcitrance of the Home Secretary and Parliaale 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 h she was already (1860-1) engaged in these inquiries, they belong in the main to a later period; and we ale's work for the improvement of the National Health