U.S. National Library of Medicine

Introduction to Health Services Research : A Self-Study Course

Module 2: Brief History of Health Services Research (Page 7 of 40)

Efficacy of Medical Services

William Petty Examines Medical Services

Early studies of the efficacy of medical services can be traced to William Petty in seventeenth century England. A physician and economist, Petty was remarkable for his attempt to apply quantitative reasoning to assess the benefits of physician practice and hospital care. Among his published works were Observations upon the Dublin-Bills of Mortality(1683) and Further Observation upon the Dublin-Bills of Mortality(1686).

William Farr and Statistics

In the nineteenth century another Englishman, William Farr, 1807-1883, turned his attention to collecting statistical data on mortality, morbidity and disability, and challenged his medical colleagues to evaluate "the medical contributions of the country on a liberal scientific basis."

In 1837 he wrote a chapter called "Vital Statistics" for a book published in that year by John MacCulloch titled, Statistical Account of the British Empire.

Florence Nightingale's Work Influences Health Care

A bit later, Florence Nightingale, a trained nurse who had worked in the Crimea during the Crimean war (1853), proposed to work with Farr on a uniform reporting system for London hospitals so that their relative "life-risks" could be rigorously determined.

Her influence on health care cannot be underestimated.

Nightingale was one of the first to use graphics designed to show how improvements in building hygiene could save many lives. Her graphics were used to persuade people of the need for change.

Florence Nightingale was one of the first to use graphics designed to show how improvements in building hygiene could save many lives.

In 1858 she privately published Mortality of the British Army. In the same year she also published Notes on Matters Affecting the Health of the British Army, both of which included interesting graphics.

View Key Projects and Milestones in Health Services Research.

Discussion Questions

1. What importance is Petty's work using quantitative reasoning to assess the benefits of physician practice and hospital care?
2. What is the equivalent in the US of the "uniform reporting system for London hospitals" developed by Nightingale and Farr?
3. How important was Nightingale's work to statistics and health services research?