The LANCET, June 13, 1914 – A Danish Physician Continues Rasmus Malling-Hansen’s Medical Research

Research, transcription and comments by Jørgen Malling Christensen.

Niels Julius Strandgaard, 1867-1953, was a Danish physician with a strong involvement in research into tuberculosis and the treatment of this disease. He studied in Denmark, Germany, Schwitzerland, France and Sweden. Strandgaard was a member of the International Society for the Prevention of Tuberculosis (founded in Denmark in 1901), becoming an honorary member in 1922; he was president of the Association of Head Doctors of Danish Sanatoriums 1914-21, ‘membre titulaire de l’Union internationale contra la tuberculose’ from 1922 and was involved in many international and local causes and tasks of that nature. On April 1, 1914 he published an article in the Danish medical periodical “Hospitalstidende”, and an English summary appeared in the LANCET, issue of June 13, 1914, pages 1698-1699. The following is a transcription in extenso of the article in the LANCET.

SEASONAL CHANGES IN THE HEALTH OF THE CONSUMPTIVE[1].

The popular belief that the summer months are the most favourable for the consumptive is, no doubt, largely founded on the observation that coughs and colds are much more frequent in the winter than in the summer.  But even when the non-tuberculous conditions are excluded it would seem that the prevailing belief in the salubrity of the summer months is founded on fact as far as consumption is concerned.  This view has lately been confirmed and amplified by Dr. N.J. Strandgaard, whose investigations, communicated at a meeting at the Medical Society of Copenhagen[2], have been published in Hospitalstidende[3] of April 1st. It is the practice for patients in the Danish sanatoriums to be weighed every Saturday morning, and the average gain of weight is between 200 and 300 grammes.  To be exact, the average is 270 grammes, which is the figure given for eight sanatoriums with an average total of 800 patients during a period of 10 years.  The average gain of weight varies much with the season of the year.  From December to May it is fairly uniform but low, being 225 to 250 grammes. It rises rapidly and steadily from May to September, during which month it reaches the maximum of 380 grammes. It falls from October to December, which is the month showing the smallest gain of weight.  The average gain of weight in September is almost double that in December, and there can be little doubt that gain in weight is, as a rule, accompanied with improvement in the patient’s health.  Thus at Boserup[4], one of the Danish sanatoriums, it was noted during an observation period of 10 years, that the proportion of febrile patients confined to bed was about twice as great in the winter as in the summer months.  The proportion of patients without expectoration and bacilli was greatest in August and September, least in the months January to April.  Among the factors responsible for the seasonal changes in the patient’s weight are the atmospheric conditions.  In one week in the summer of 1908 the average for five sanatoriums actually showed a loss of weight, whereas there had been a substantial gain of weight during the preceding and following weeks.  During these weeks the humidity of the air had been high; during the middle week it had been low.  This relationship is further illustrated by the uniformity with which the average gain of weight curve follows that of the relative humidity of the atmosphere. The warmth of the air also seems to affect the patient’s weight, for the atmospheric temperature was 2˚ C. higher during “heavy” than it was during “light” weeks.  Dr Strandgaard suggests that these observations point to sunlight, warmth and moisture being fattening, while darkness, cold and dryness would appear to be relatively emaciating.  His observations on the relation of the consumptive’s weight to the seasons of the year show a striking similarity to the results obtained by Bondeson and Jörgenson in connexion  with soldiers,  by Adsersen[5] and Milo in connexion with the new born, and by Malling-Hansen in connection with older children.  Finsen’s investigations into the amount of hæmoglobin in the blood during the seasons of the year also tally with Dr. Strandgaard’s conclusions.  These are instructive, but it should be borne in mind that they are based on statistics, and are not applicable to the individual. Probably in no disease so much as in consumption in the familiar adage true – “One man’s meat, another man’s poison”.

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JMC: What is important here is to take note that in the generation after RMH’s death, some of the famous and influential Danish medical doctors and scientists were, in a sense, continuing RMH’s research along his lines of focus on seasonal variations, and that he was seen as a medical authority – Rasmus Malling-Hansen’s Law! – Our continued research into the medical literature of the era will possibly confirm this and show that other medical scientists of the first decades of the 20th century were influenced and inspired by Malling-Hansen.