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2 posts from August 2016

12 August 2016

“Like light shining in a dark place”: Florence Nightingale and William Farr

On the anniversary of Florence Nightingale’s death, Katie Howe explores her scientific legacy.

Perhaps best known as ‘the lady with the lamp’ Florence Nightingale was also an accomplished scientist and social reformer.

In 1854, with Britain in the midst of the Crimean conflict, Nightingale was appointed to lead a party of nurses to a military hospital in Scutari (in modern day Istanbul). When she arrived she discovered a lack of coordination between hospitals and no standardised or consistent reporting of mortality rates and causes of death. Nightingale set to work gathering extensive information on all aspects of hospital care.

After returning from the Crimea, Nightingale used her new found celebrity status and personal connections to enlist the help of the eminent Victorian epidemiologist and statistician William Farr in analysing the vast quantities of data she had collected.

Their correspondence, which is held at the British Library, reveals a respectful professional relationship, with Farr often signing off,

“I have the honour to be your very faithful servant.”

In May 1857, when Nightingale sent Farr the death rates calculated from her Crimean war data, he replied,

“Dear Miss Nightingale. I have read with much profit your admirable observations. It is like light shining in a dark place. You must when you have completed your task - give some preliminary explanation - for the sake of the ignorant reader.” (Add MS 43398 f.10)

Add MS 43398 f.10
Add MS 43398 f.10


So Florence Nightingale was not only the literal ‘lady with the lamp’, but her statistical work also illuminated worrying trends in army mortality rates.

After receiving further data from Nightingale in November the same year, Farr wrote:

“This speech is the best that was ever written on diagrams or on the Army.”  (Add MS 43398 f.37)

 

Add MS 43398 f.37
Add MS 43398 f.37


As a result of this productive collaboration with Farr, Nightingale learned that the majority of deaths in the Crimean War were not due to battle wounds but to preventable diseases like typhus and cholera.

To get this important message across to high-ranking government officials who had no statistical training, Nightingale knew she needed a powerful visual message. She represented the cause of death in a revolutionary new way. Rather than using a table or list as was common at the time she created this striking rose diagram. 

Each of the 12 wedges represents a month of the year and changes in the wedges’ colour reveal changes over time. At a glance it was easy to see the deaths from epidemic diseases (blue) far outweighed deaths from battlefield wounds (red) and deaths from other causes such as accidents or frostbite (black).  After sanitary reforms such as the introduction of basic sanitation, hand washing and ventilation, deaths dropped dramatically. Compare the right rose (April 1854-March 1855) with left rose (April 1855-March 1856).

Rose diagram
Florence Nightingale’s Rose diagram “Notes on matters, affecting the health, efficiency and hospital administration of the British Army. London, 1858”. C.194.b.297

 

Her rose diagram was so easy to understand it was widely republished. Ultimately this striking visualisation and the accompanying report convinced the government that deaths were preventable if sanitation reforms were implemented in military hospitals. Nightingale’s work provided a catalyst for change, driving better and cleaner hospitals and the establishment of a new army statistics department to improve healthcare.

08 August 2016

Local heroes: “Without the least sense of pain or the movement of a muscle”

As part of a new series exploring local heroes in the Knowledge Quarter area, Philip Eagle reveals the curious history of anesthesia. 

Francis_Boott
Francis Boott. Image: Public domain

A short bus ride away from the British Library, at 52 Gower Street, a blue plaque records the site of the first operation under general anaesthesia in the UK. On 19th December 1846, the dentist James Robinson performed a tooth extraction on a Miss Lonsdale. At the time, 52 Gower Street was the home of Dr. Francis Boott, an American expatriate physician who had heard from friends of the development of diethyl ether as an anaesthetic by William Morton in Boston.

Robinson lived further down the street towards the West End, at 14 Gower Street, where he has his own blue plaque. As well as his work on anaesthetics, he was the author of The Surgical and Mechanical Treatment of the Teeth, claimed to be the first British dental textbook of real scientific quality. He would later become dentist to Prince Albert, and be significantly involved in the creation of the College of Dentistry and the National Dental Hospital.

In a letter to the Lancet, Boott described the operation with the following words:

“I beg to add, that on Saturday, the 19th, a firmly fixed molar tooth was extracted in my study from Miss Lonsdale, by Mr. Robinson, in the presence of my wife, two of my daughters, and myself, without the least sense of pain, or the movement of a muscle”

In a book published later in the year, Robinson himself stated that the patient was only thirteen years old, and reported that:

“She had not felt the slightest pain, but had been dreaming of the country”.

Anaesthesia blue plaques
Blue plaque images by Spudgun67 CC BY-SA 4.0

Subsequently in the nineteenth century, diethyl ether was largely replaced as a general anaesthetic in the UK by chloroform, which was less irritating to the throat and lungs and less likely to have the initially stimulant effect that ether had on some patients. Since the mid twentieth century, the most important inhaled anaesthetics have been the fluorinated alkane halothane and fluorinated ethers such as sevoflurane and desflurane, which are pharmacologically safer and more effective, and also physically safer due to their lower flammability.

Philip Eagle, STM Content Expert

Sources and further reading:

  • Anesthesiology, Science, Technology & Business (P) GY 30-E(4), since 2012 available electronically through Ovid in the Reading Rooms
  • Boott, F. Surgical operations performed during insensibility produced by the inhalation of sulphuric ether*, Lancet, 1847, 49 (1218): 5-8. General Reference Collection P.P.2787. Also available electronically through Science Direct in the Reading Rooms. * Note for chemists: “sulphuric ether” was a common name at the time for diethyl ether, due to its preparation by reacting ethanol with sulphuric acid. The chemical itself did not contain any sulphur.
  • British Journal of Anaesthesia, Science, Technology & Business (P) GY 30-E(2), since 2014 available electronically through OUP in the Reading Rooms
  • Ellis, R H. James Robinson: England’s true pioneer of anaesthesia. In The History of Anesthesia, Third International Symposium, Proceedings, 1992: 153-164. Document Supply 4317.854000. Available online.
  • Johnson, K B. Clinical pharmacology for anesthesiology. London: McGraw-Hill Education, 2015. Science, Technology & Business (B) 615.781
  • Pain, Document Supply 6333.795000, also available electronically through Ovid in the Reading Rooms
  • Robinson, J. Treatise on the inhalation of the vapour of ether for the prevention of pain in surgical operations, etc. London: Webster & Co. 1847. General Reference Collection 7481.cc.6
  • Robinson, J. The surgical and mechanical treatment of the teeth: including dental mechanics. London, 1846. General Reference Collection 1186.c.46 and RB.23.a.27503.
  • Shafer, S L and others. Stoelting’s pharmacology and physiology in anesthetic practice. Philadelphia: Lippincott Williams & Wilkins, 2015. Science, Technology & Business (B) 615.781.
  • Snow, S J. Blessed days of anaesthesia. New York: Oxford University Press. 2008. General Reference Collection YC.2009.a.15022