Before the war: Nightingale was a proponent of woman taking on a career in nursing, and imposed strict discipline as a leader. Founded the Nightingale Fund to help train nurses, Sent to Scutari as head of nurses (?) during the Crimean war. During the war at Scutari: believed that soldiers were dying fast because of (1) the poor state they were in when they were sent to her hospital, and (2) mismanagement of supplies on the frontline. Worked with McNeill and Tulloch to draft a report to the government about such mismanagement. In fact improvements were made due to a hygiene commission lead by Sutherland in the second year of the war. Immediately after the war: McNeill’s report was discredited, pushback from both government and army, which did not was to take responsibility for the lost army. Conversion: learned from Dr. Farr about using statistics to study causes of death. Lead to believe that hygiene, not supplies, was the main cause of high mortality in her hospital. Made a confidential report but was suppressed. Activism: worked with Chadwick to promote hygiene measures as part of public health projects in the government. Main rival was John Simon, who controlled the public health branch at the time and believed that disease control was only possible through scientific understanding of them. 1871 electorate reform brought in a liberal government and allowed Nightingale to push through the 1872 Public Health Act via the cabinet minister Stansfeld. It overthrew the centralized control of Simon and lead to admin reforms; another 1875 Act forced landlords to upgrade hygiene infrastructure in their houses and allowed for Slum clearings. Death rate dropped from 22 to 18 per 1000 people (1860s to 1890s), and life expectancy increased from 40 years (till 1870s) to 50+ (1910) ### William Farr Hygiene specialist and statistician, promoted use of medical stats to improve public health Aimed to prove the importance of hygiene as the main factor of hospital mortality (rather than medical treatment or lack of supplies), and believed a hygiene could hinder the transmission of diseases (similar to the later germ theory) Convinced Nightingale that the Scutari hospital’s high mortality was caused by bad hygiene, and was alleviated by Sutherland’s Sanitary Commission