弗洛伦丝·南丁格尔Florence Nightingale

弗洛伦丝·南丁格尔最为人所铭记的是她在克里米亚战争期间作为护士的工作，以及她对改革战地医院卫生条件的贡献。然而，关于这位了不起的女性，鲜为人知的是她对数学，尤其是统计学的热爱，以及这种热爱如何在她毕生的事业中发挥了重要作用。

南丁格尔以她出生的城市命名，于1820年5月12日出生在意大利南丁格尔的哥伦比亚别墅。她的父母威廉Edward Nightingale和他的妻子弗朗西斯·史密斯在结婚的头两年在欧洲旅行。南丁格尔的姐姐前一年出生在那不勒斯。南丁格尔夫妇给他们的第一个孩子取了该城市的希腊名字，即Parthenope。

南丁格尔出生时姓肖尔，但在从一位富有的亲戚、德比郡马特洛克附近利府的Peter Nightingale那里继承遗产后，他改姓为南丁格尔。两个女孩在乡间长大，大部分时间都在德比郡的利赫斯特度过。当南丁格尔大约五岁时，她的父亲在汉普郡罗姆西附近买了一栋名为恩布利的房子。这意味着这家人现在在德比郡度过夏季的几个月，而一年中的其余时间则在恩布利度过。在这些搬迁之间，还有去伦敦、怀特岛以及探亲的旅行。

Parthenope和南丁格尔的早期教育由女家庭教师负责，后来她们在剑桥受过教育的父亲亲自接管了这项责任。南丁格尔热爱她的课程，并且具有学习的天然能力。在父亲的影响下，南丁格尔熟悉了古典著作、欧几里得、亚里士多德、圣经以及政治事务。

1840年，南丁格尔恳求父母让她学习数学，而不是：-

……精纺毛线活和练习卡德里尔舞，

但她的母亲不赞成这个想法。尽管William Nightingale热爱数学并将这种热爱传给了女儿，他还是敦促她学习更适合女性的科目。经过多次漫长的情感斗争，南丁格尔的父母最终同意了，并允许她接受数学辅导。她的导师包括詹姆斯·约瑟夫·西尔维斯特，后者与阿瑟·凯莱共同发展了不变量理论。据说南丁格尔是詹姆斯·约瑟夫·西尔维斯特最杰出的学生。课程包括学习算术、几何和代数，在南丁格尔进入护理工作之前，她曾花时间辅导孩子们学习这些科目。

南丁格尔对数学的兴趣超出了学科本身。也影响了南丁格尔的人之一是比利时科学家阿道夫·凯特勒。他曾将统计方法应用于多个领域的数据，包括道德统计或社会科学。

宗教在南丁格尔的生活中扮演了重要角色。她对宗教的不偏不倚的看法，在当时很不寻常，这归功于南丁格尔在家中感受到的自由主义观点。尽管她的父母出身于一位论派背景，Frances Nightingale却觉得一个更传统的教派更可取，于是女孩们作为英格兰教会的成员被抚养长大。1837年2月7日，南丁格尔相信她在恩布利的花园中散步时听到了上帝的召唤，尽管此时她还不知道这召唤是什么。

南丁格尔对当时的社会问题产生了兴趣，但在1845年，她的家人坚决反对南丁格尔获得任何医院经验的建议。在此之前，她所做的唯一护理工作是照顾生病的亲友。在十九世纪中叶，护理不被认为是一份适合受过良好教育的女性的职业。当时的护士缺乏训练，而且还有粗俗、无知、放荡和酗酒的名声。

南丁格尔从1849年开始与家族朋友查尔斯和塞琳娜·布雷斯布里奇一起游历欧洲和埃及，她有机会研究不同的医院体系。1850年初，南丁格尔在埃及亚历山大的圣文森特·德·保罗学院开始接受护士培训，这是一所由罗马天主教会运营的医院。南丁格尔于1850年7月参观了位于杜塞尔多夫附近凯撒斯韦特的西奥多·弗利德纳牧师医院。南丁格尔于1851年回到凯撒斯韦特，在新教女执事学院接受3个月的护理培训，之后她从德国搬到巴黎附近圣索菲·热尔曼的一所由仁慈修女会运营的医院。1853年回到伦敦后，南丁格尔接受了位于哈雷街1号的Establishment for Gentlewomen during Illness的无薪主管职位。

1854年3月，克里米亚战争爆发，英国、法国和土耳其对俄国宣战。尽管俄军在1854年9月20日的阿尔马河战役中战败，The Times报纸仍批评了英国的医疗设施。为此，她的朋友、英国陆军大臣西德尼·赫伯特在信中请南丁格尔担任护理行政主管，负责监督护士进入军队医院的工作。她的正式头衔是Superintendent of the Female Nursing Establishment of the English General Hospitals in Turkey。1854年11月4日，南丁格尔与38名护士抵达斯库塔里，那是君士坦丁堡（今伊斯坦布尔）的亚洲郊区 [2]：-

……她的热忱、她的奉献和她的毅力，不会因任何挫折和任何困难而屈服。她以判断力、自我牺牲精神、勇气、温柔的同情心，以及一种安静而不张扬的风度，坚定而不倦地从事她的工作，赢得了所有未被官方偏见所阻碍、能够欣赏她工作和品格之高尚的人的心。

尽管身为女性意味着南丁格尔在每一步都必须与军事当局抗争，她仍着手改革医院制度。当时的条件导致士兵躺在光秃秃的地板上，周围满是害虫，手术也不卫生，因此当南丁格尔初到斯库塔里时，医院里霍乱和斑疹伤寒等疾病肆虐也就不足为奇了。这意味着受伤士兵在医院死于疾病的概率是在战场上的7倍。在土耳其期间，南丁格尔收集数据并建立了一套记录保存系统，这些信息随后被用作改善城市和军队医院的工具。南丁格尔的数学知识在她利用收集的数据计算医院死亡率时变得显而易见。这些计算表明，改进所采用的卫生方法将导致死亡人数减少。到1855年2月，死亡率已从60%降至42.7%。通过建立淡水供应以及用自己的资金购买水果、蔬菜和标准医院设备，春季的死亡率进一步降至2.2%。
插图：piechart.jpeg ↗
南丁格尔利用这些统计数据制作了她的极区图，她称之为“coxcombs”。这些图用于以图形方式表示克里米亚战争（1854—56）期间的死亡数字。

每个彩色楔形的面积，以中心为共同点测量，与其所代表的统计数字成比例。蓝色外楔形表示死于以下原因的人数：-

……可预防或可减轻的发酵性疾病

换言之，即霍乱和斑疹伤寒等传染病。中央红色楔形显示死于创伤的人数。中间的黑色楔形代表死于所有其他原因的人数。英国野战医院的死亡人数在1855年1月达到顶峰，当时有2,761名士兵死于传染病，83人死于创伤，324人死于其他原因，总计3,168人。该月军队的平均兵力为32,393人。利用这些信息，南丁格尔计算出死亡率为每10,000人1,174人，其中每10,000人1,023人死于发酵性疾病。如果这一比率持续下去，且部队没有频繁补充，那么仅疾病就会消灭克里米亚的整个英国军队。

然而，这些不卫生的条件并不仅限于野战军队医院。1856年8月，即签署和平条约四个月后，南丁格尔返回伦敦时发现，和平时期20至35岁士兵的死亡率是平民的两倍。她利用自己的统计数据，说明所有军队医院都需要进行卫生改革。在力陈自己的主张时，南丁格尔引起了维多利亚女王和亚伯拉罕·阿德里安·艾伯特亲王以及首相帕默斯顿勋爵的注意。她要求进行正式调查的愿望于1857年5月得到批准，并促成了皇家军队健康委员会的成立。南丁格尔避开公众关注，开始关心驻扎在印度的军队。1858年，由于她对军队和医院统计的贡献，南丁格尔成为第一位当选为皇家统计学会会士的女性。

1860年，位于伦敦圣托马斯医院的南丁格尔护士培训学校和之家开学，有10名学生。它由南丁格尔基金资助，该基金是南丁格尔在克里米亚期间设立的公共捐款基金，共筹集了50,000英镑。它基于两项原则。首先，护士应在专门为此目的组织的医院接受实践培训。另一项是护士应住在一个适合形成道德生活和纪律的家中。由于这所学校的建立，南丁格尔实现了护理从过去声名狼藉的状况转变为女性负责任且受人尊敬的职业。南丁格尔回应了英国陆军部关于加拿大军队医疗护理建议的请求，并在美国内战期间担任美国政府军队健康的顾问。

在她余生的大部分时间里，南丁格尔因在克里米亚染上的疾病而卧床不起，这使她无法继续自己的护士工作。然而，这种疾病并没有阻止她致力于改善健康标准；她出版了200本书、报告和小册子。其中一份出版物是一本名为Notes on Nursing（1860年）的书。这是第一本专门用于护士教学的教科书，并被翻译成多种语言。南丁格尔的其他出版作品包括Notes on Hospitals（1859年）和Notes on Nursing for the Labouring Classes（1861年）。南丁格尔深信她的工作是上帝的召唤。1874年，她成为美国统计协会的荣誉成员，1883年维多利亚女王授予南丁格尔皇家红十字勋章以表彰她的工作。1907年，她还成为第一位从爱德华七世那里获得功绩勋章的女性。

南丁格尔于1910年8月13日去世，享年90岁。她葬于恩布尔公园附近的东韦洛的圣玛格丽特教堂。南丁格尔从未结婚，尽管这并非缺乏机会。然而，她相信上帝已决定她是被他：-

... 明确指定 ... 成为单身女性。

克里米亚纪念碑于1915年在伦敦滑铁卢广场竖立，是为了纪念南丁格尔对这场战争和军队健康所做的贡献。

Florence Nightingale is best remembered for her work as a nurse during the Crimean War and her contribution towards the reform of the sanitary conditions in military field hospitals. However, what is less well known about this amazing woman is her love of mathematics, especially statistics, and how this love played an important part in her life's work.

Named after the city of her birth, Nightingale was born at the Villa Colombia in Florence, Italy, on 12 May 1820. Her parents, William Edward Nightingale and his wife Frances Smith, were touring Europe for the first two years of their marriage. Nightingale's elder sister had been born in Naples the year before. The Nightingales gave their first born the Greek name for the city, which was Parthenope.

William Nightingale had been born with the surname Shore but he had changed it to Nightingale after inheriting from a rich relative, Peter Nightingale of Lea, near Matlock, Derbyshire. The girls grew up in the country spending much of their time at Lea Hurst in Derbyshire. When Nightingale was about five years old her father bought a house called Embley near Romsey in Hampshire. This now meant that the family spent the summer months in Derbyshire, while the rest of the year was spent at Embley. Between these moves there were trips to London, the Isle of Wight, and to relatives.

The early education of Parthenope and Florence was placed in the hands of governesses, later their Cambridge educated father took over the responsibility himself. Nightingale loved her lessons and had a natural ability for studying. Under her father's influence Nightingale became acquainted with the classics, Euclid, Aristotle, the Bible, and political matters.

In 1840, Nightingale begged her parents to let her study mathematics instead of:-

... worsted work and practising quadrilles,

but her mother did not approve of this idea. Although William Nightingale loved mathematics and had bequeathed this love to his daughter, he urged her to study subjects more appropriate for a woman. After many long emotional battles, Nightingale's parents finally gave their permission and allowed her to be tutored in mathematics. Her tutors included Sylvester, who developed the theory of invariants with Cayley. Nightingale was said to be Sylvester's most distinguished pupil. Lessons included learning arithmetic, geometry and algebra and prior to Nightingale entered nursing, she spent time tutoring children in these subjects.

Nightingale's interest in mathematics extended beyond the subject matter. One of the people who also influenced Nightingale was the Belgian scientist Quetelet. He had applied statistical methods to data from several fields, including moral statistics or social sciences.

Religion played an important part in Nightingale's life. Her unbiased view on religion, unusual at the time, was owed to the liberal outlook Nightingale found in her home. Although her parents were from a Unitarian background, Frances Nightingale found a more conventional denomination preferable and the girls were brought up as members of the Church of England. On 7 February 1837 Nightingale believed she heard her calling from God, whilst walking in the garden at Embley, although at this time though she did not know what this calling was.

Nightingale developed an interest in the social issues of the time, but in 1845 her family was firmly against the suggestion of Nightingale gaining any hospital experience. Until then the only nursing that she had done was looking after sick friends and relatives. During the mid-nineteenth century nursing was not considered a suitable profession for a well-educated woman. Nurses of the time were lacking in training and they also had the reputation of being coarse, ignorant women, given to promiscuity and drunkenness.

While Nightingale was on a tour of Europe and Egypt starting in 1849, with family friends Charles and Selina Bracebridge, she had the chance to study the different hospital systems. In early 1850 Nightingale began her training as a nurse at the Institute of St Vincent de Paul in Alexandria, Egypt, which was a hospital run by the Roman Catholic Church. Nightingale visited Pastor Theodor Fliedner's hospital at Kaiserswerth, near Düsseldorf, in July 1850. Nightingale returned to Kaiserswerth, in 1851, to undertake 3 months of nursing training at the Institute for Protestant Deaconesses and from Germany she moved to a hospital in St Germain, near Paris, run by the Sisters of Mercy. On returning to London in 1853 Nightingale took up the unpaid position as the Superintendent at the Establishment for Gentlewomen during Illness at No 1 Harley Street.

March of 1854 brought the start of the Crimean War, with Britain, France and Turkey declaring war on Russia. Although the Russians were defeated at the battle of the Alma River, on 20 September 1854, The Times newspaper criticised the British medical facilities. In response to this Nightingale was asked in a letter from her friend Sidney Herbert, the British Secretary for War, to become a nursing administrator to oversee the introduction of nurses to military hospitals. Her official title was Superintendent of the Female Nursing Establishment of the English General Hospitals in Turkey. Nightingale arrived in Scutari, an Asian suburb of Constantinople, (now Istanbul), with 38 nurses on 4 November 1854 [2]:-

... her zeal, her devotion, and her perseverance would yield to no rebuff and to no difficulty. She went steadily and unwearyingly about her work with a judgement, a self-sacrifice, a courage, a tender sympathy, and withal a quiet and unostentatious demeanour that won the hearts of all who were not prevented by official prejudices from appreciating the nobility of her work and character.

Although being female meant Nightingale had to fight against the military authorities at every step, she went about reforming the hospital system. With conditions which resulted in soldiers lying on bare floors surrounded by vermin and unhygienic operations taking place it is not surprising that, when Nightingale first arrived in Scutari, diseases such as cholera and typhus were rife in the hospitals. This meant that injured soldiers were 7 times more likely to die from disease in hospital, than on the battlefield. Whilst in Turkey, Nightingale collected data and organised a record keeping system, this information was then used as a tool to improve city and military hospitals. Nightingale's knowledge of mathematics became evident when she used her collected data to calculate the mortality rate in the hospital. These calculations showed that an improvement of the sanitary methods employed would result in a decrease in the number of deaths. By February 1855 the mortality rate had dropped from 60% to 42.7%. Through the establishment of a fresh water supply as well as using her own funds to buy fruit, vegetables and standard hospital equipment, the mortality rate in the spring had dropped further to 2.2%.
插图：piechart.jpeg ↗
Nightingale used this statistical data to create her Polar Area Diagram, or "coxcombs" as she called them. These were used to give a graphical representation of the mortality figures during the Crimean War (1854 - 56).

The area of each coloured wedge, measured from the centre as a common point, is in proportion to the statistic it represents. The blue outer wedges represent the deaths from:-

... preventable or mitigable zymotic diseases

or in other words contagious diseases such as cholera and typhus. The central red wedges show the deaths from wounds. The black wedges in between represent deaths from all other causes. Deaths in the British field hospitals reached a peak during January 1855, when 2,761 soldiers died of contagious diseases, 83 from wounds and 324 from other causes making a total of 3,168. The army's average manpower for that month was 32,393. Using this information, Nightingale computed a mortality rate of 1,174 per 10,000 with 1,023 per 10,000 being from zymotic diseases. If this rate had continued, and troops had not been replaced frequently, then disease alone would have killed the entire British army in the Crimea.

These unsanitary conditions, however, were not only limited to military hospitals in the field. On her return to London in August 1856, four months after the signing of the peace treaty, Nightingale discovered that soldiers during peacetime, aged between 20 and 35 had twice the mortality rate of civilians. Using her statistics, she illustrated the need for sanitary reform in all military hospitals. While pressing her case, Nightingale gained the attention of Queen Victoria and Prince Albert as well as that of the Prime Minister, Lord Palmerston. Her wishes for a formal investigation were granted in May 1857 and led to the establishment of the Royal Commission on the Health of the Army. Nightingale hid herself from public attention, and became concerned for the army stationed in India. In 1858, for her contributions to army and hospital statistics Nightingale became the first woman to be elected to be a Fellow of the Royal Statistical Society.

In 1860, the Nightingale Training School and Home for Nurses based at St Thomas's Hospital in London, opened with 10 students. It was financed by the Nightingale Fund, a fund of public contributions set up during Nightingale's time in the Crimea and had raised a total of £50,000. It was based around two principles. Firstly that the nurses should have practical training in hospitals specially organised for that purpose. The other was that the nurses should live in a home fit to form a moral life and discipline. Due to the foundation of this school Nightingale had achieved the transformation of nursing from its disreputable past into a responsible and respectable career for women. Nightingale responded to the British war office's request for advice on army medical care in Canada and was also a consultant to the United States government on army health during the American Civil War.

For most of the remainder of her life Nightingale was bedridden due to an illness contracted in the Crimea, which prevented her from continuing her own work as a nurse. This illness did not stop her, however, campaigning to improve health standards; she published 200 books, reports and pamphlets. One of these publications was a book entitled Notes on Nursing (1860). This was the first textbook specifically for use in the teaching of nurses and was translated into many languages. Nightingale's other published works included Notes on Hospitals (1859) and Notes on Nursing for the Labouring Classes (1861). Florence Nightingale deeply believed that her work had been her calling from God. In 1874 she became an honorary member of the American Statistical Association and in 1883 Queen Victoria awarded Nightingale the Royal Red Cross for her work. She also became the first woman to receive the Order of Merit from Edward VII in 1907.

Nightingale died on 13 August 1910 aged 90. She is buried at St Margaret's Church, East Wellow, near Embley Park. Nightingale never married, although this was not from lack of opportunity. She believed, however, that God had decided she was one whom he:-

... had clearly marked out ... to be a single woman.

The Crimean Monument, erected in 1915 in Waterloo Place, London, was done so in honour of the contribution Florence Nightingale had made to this war and the health of the army.