months in Crimea happened because people ignored these laws.
‘Nature is the same everywhere, and never permits her laws to be
disregarded with impunity.’ She was also adamant about what had
caused the problems. ‘The three things which all but destroyed the
army in Crimea were ignorance, incapacity, and useless rules.’[35]
Nightingale’s advocacy sometimes made Farr nervous. He warned
her against focusing too heavily on messages rather than data. ‘We
do not want impressions,’ he said. ‘We want facts.’[36] Whereas
Nightingale wanted to suggest explanations for the cause of the
deaths, Farr believed the job of a statistician was simply to report
what had happened, rather than speculating about why. ‘You
complain that your report would be dry,’ he once told her. ‘The drier
the better. Statistics should be the driest of all reading.’
Nightingale used her writing to campaign for change, but she’d
never wanted to be just a writer. When she first decided to train as a
nurse in the 1840s, it came as a surprise to her wealthy, well-
connected family, who’d expected her to pursue the more traditional
role of wife and mother. A friend suggested that she could still pursue
a literary career alongside this role. Nightingale was not interested.
‘You ask me why I do not write something,’ she replied. ‘I think one’s
feelings waste themselves in words; they ought all to be distilled into
actions and into actions which bring results.’[37]
When it comes to improving health, actions need to be grounded in
good evidence. Today, we routinely use data analysis to show how
much health varies, why that might be, and what needs to be done
about it. Much of this evidence-based approach can be traced to
statisticians like Farr and Nightingale. As she saw it, people generally
had little grasp of what controlled infections and what didn’t. In some
cases, hospitals may well have increased people’s risk of disease.
‘These institutions, created for the relief of human distress, positively
do not know whether they relieve it or not,’ as she put it.[38]
Nightingale’s research was highly respected by her scientific
contemporaries, including statistician Karl Pearson. In the public
mind, she was the ‘lady with the lamp’, a nurse who cared for soldiers
and in turn made people sympathetic to her cause. But Pearson
argued that mere sympathy doesn’t lead to change; it requires