21
RITATIVE REPORTS ON ITS USE AND VALUI
GOUT
RHEUMATISM
ARTHRITIS
SPRAIN
SCIATICA
ECZEMA
Etc., Etc.
-pinion the aiuable of ail methods of
} the use of bat perheated
PROF. JAMES STEWART on Rhc
Meeting, British Medical A- i, see
i 30, 1897.
a
BAlLLiERE TINDVLL &, COX
BICHARD KIMPTOHt,
BOOKSELLER, .
US, "WABDOpB,STBJOHfc
OXFORD STREET, W.
THE TALLERMAN TREATMENT.
THE TALLEEMAN TREATMENT
IRbeumatism, (Bout, iRbeumatic Brtbritis, Stiff ant
painful joints, Sprains, Sciatica, ant>
otber Bffcctions.
CASE NOTES AND MEDICAL REPORTS, WITH
NUMEROUS ILLUSTRATIONS.
EDITED BY
ARTHUR SHADWELL, M.A., M.B. OXON., M.E.C.P.
LONDON :
BAILLIERE, TINDALL AND COX,
KING WILLIAM STREET, STRAND.
1898.
[All rights reserved.]
PREFACE.
THE object of this book is to present in a convenient
form full and authoritative information respecting the
Tallerrnan treatment, which has been in use now for some
four or five years in various countries, but is still very
imperfectly known. When requested to supervise the pre-
paration of the volume, I readily consented, for three
reasons. In the first place, experience has convinced me of
the value of the treatment ; in the second, I think it ought
to be very much better known than it is ; and in the third,
I have no personal interest in it whatever. I originally
approached Mr. Tallerman's invention with the scepticism
which becomes second nature to medical men, but having
tested it on my own corpus vile, I found that it did what it
pretended to do ; and then I saw a boy with a knee-joint
full of fluid and wincing at every movement gradually
charmed off within half an hour into a smiling and pain-
less indifference, which permitted the free handling and
flexion of the limb without a murmur. Since then I have
repeatedly seen results produced in old and hopeless
cases of rheumatic arthritis which I could not have
believed on any lesser evidence than my own eyesight.
The facts related in this volume amply corroborate my
experience, and make it unnecessary for me to say any-
thing more on that head. Attested as they are by many
independent observers of high standing in the profession,
they form a body of evidence which no one can affect to
ignore or despise. They do not come from one or from a
few cliniqites, but from a large number of first-rate
1C9C850
fi Preface.
hospitals, not only in this country, but in Paris, the
United States, and in Canada. It is impossible to deny
the weight of so large a mass of concurrent testimony.
In particular I may refer to the conclusions recently
formulated by Professor James Stewart, of Montreal,
Dr. Dejerine, of the Salpetriere, and Professor Landouzy,
of the Laennec Hospital, on the marked superiority of
this treatment over any other hitherto used in various
intractable forms of rheumatism.
The value of the invention, however, appears to be still
very inadequately recognised. In some quarters it has
met with liberal appreciation from the profession, as the
medical reports here collected abundantly prove, but in
others it has encountered indifference and opposition.
Indifference is due to a general distrust of specious
novelties, which is healthy enough when not carried too
far. But opposition implies prejudice, and that is another
matter. It seems to be due to the fact that the appliance
is patented by a layman, and is therefore a commercial
article. I fail to see what this has to do with the matter.
Every appliance and every drug is a commercial article,
and at least half of those in daily use are patented by
laymen. What of antiseptics and thermometers and
stethoscopes? The sole question is whether a thing is
useful, not whether somebody or other has a pecuniary
interest in it. Somebody has a pecuniary interest in
everything used, if it is only a bandage or a bottle. And
in justice to the inventor in this case, it ought to be
known that he has brought forward his apparatus in the
most legitimate manner, and at very great cost to himself.
He has placed it in the hands of the medical profession,
and worked entirely with them from first to last, refraining
from all popular advertisement. With the most scrupulous
good faith, he has repeatedly refused lucrative and in-
fluential clients, who wished to be treated, but declined
to see a doctor. Anything further removed from quackery
could not be imagined. He has not always received equally
honourable treatment in return.
Preface. vii
It is hoped that this explanation, together with the proofs
of the real value of Mr. Tallerman's invention, will lead to
its extended use. Putting aside other instances of its
successful application of which full particulars will be
found in this book it has been proved beyond all question
capable of affording marked relief in those saddest of all
cases in which every other known remedy has failed. To
permit these unfortunates on account of a baseless pre-
judice to go their painful way to a hopeless end, when a
fair chance of materially ameliorating their condition still
remains, would be so opposed to all the best traditions of
the medical profession, that I cannot conceive its happen-
ing when once the facts are known.
I should add that I am merely responsible for the
arrangement of the medical sections of the book, a great
part of which has already appeared in various professional
journals.
A. SHADWELL.
CONTENTS.
PAGE
PREPACK -------- v-vii
CHAPTER I.
INTRODUCTORY.
The local application of heat Failure of previous attempts to
obtain high temperatures Description of the Tallennan
apparatus Mode of use Physiological and therapeutic effects
Diseases and conditions treated Safety of treatment in cases
of weak heart Conditions of successful use A new departure
in therapeutics - - - - 1
CHAPTER II.
RHEUMATIC ARTHRITIS.
Mr. Jonathan Hute-hinson's opinion A common and intractable
disease Remarkable success of the Tallerman treatment
Notes of twenty-seven cases from various hospitals and private
practice - - 14
CHAPTER III.
RHEUMATISM, ACUTE AND CHRONIC.
Value of the superheated dry-air method in old-standing cases,
with involvement of the joints Notes of thirty-four cases - 48
CHAPTER IV.
GONORRHOZAL RHEUMATISM.
Rapid recovery reported by Dr. Dejerine, Professor Landouzy
and Mr. Alfred Willett, F.R.C.S. Notes of eight cases - 71
x Contents.
CHAPTER V.
PAGE
STIFF, PAINFUL AND ANCHYLOSED JOINTS TUBKECULOUS AND
TRAUMATIC INFLAMMATION SYNOVITIS WITH EFFUSION STIFF-
NESS AFTER FRACTURES AND OTHER INJURIES PERIOSTITIS,
Notes of twenty cases - 76
CHAPTER VI.
GOUT.
In acute attacks pain and inflammation rapidly reduced In
chronic conditions morbid products eliminated by increased
excretion through the kidneys Observations by Dr. Chretien
and others Notes of eighteen cases - - 88
CHAPTER VII.
SCIATICA LUMBAGO LOCAL PARALYSIS WASTING WRITER'S
CRAMP CHOREA.
Notes of fourteen cases - - 104
CHAPTER VIII.
SPRAINS AND OTHER INJURIES.
Frequency of sprains among manual workers and from bicycle
accidents Their troublesome character Rapid cure Notes of
fourteen cases - - - . 116
CHAPTER IX.
CHRONIC ULCERS.
Encouraging results Notes of three cases - 121
CHAPTER X.
FLAT-FOOT.
Paper by Mr. W. J. Walsham, F.R.C.S. - . 123
CHAPTER XI.
REPORT OF THE TALLERMAN FREE INSTITUTE, OPENED FOR
THE TREATMENT OF THK NECESSITOUS POOR.
Particulars of seventeen cases - - - 129
Contents. xi
CHAPTER XII.
MEDICAL REPORTS.
PAGE
Clinical Lecture at St. Bartholomew's by Mr. Alfred Willett,
F.E.C.S. Paper by Professor James Stewart, of Montreal
The British Medical Association Report by Professor Landouzy
Report by Dr. Dejerine Paper by Dr. Edouard Chretien
Report from the North- West London Hospital Cases shown
at the Harveian Society Philadelphia Medical Society Paper
by Dr. Knowsley Sibley Report from Liverpool Workhouse
Infirmary Report from the Livingstone Cottage Hospital
Letter to the Lancet from F. Fitzherbert Jay, M.D. - - 135
APPENDIX.
NOTE BY THE INVENTOR ------ 171
THE TALLERMAN TREATMENT,
CHAPTER I.
INTRODUCTORY.
THE; Tallerman treatment is a new method of applying
heat locally to the cure of disease and the relief of pain.
The most important feature of the invention is the use
of perfectly dry air, which enables a much higher tem-
perature to be applied to the part affected than has
hitherto been possible, with correspondingly powerful
results. Heat has always been recognised as one of the
most valuable therapeutic agents which Nature has placed
at our disposal, and various means have been devised for
employing it both locally and generally in the service of
medicine and surgery. The bath, the fomentation, the hot
bottle, and the poultice, are instances familiar to every-
body ; but, indispensable as these things are, their efficacy
is necessarily limited by the comparatively low tempera-
ture which is all that can be borne when applied by
ordinary means. Hot water becomes painful at about 115
Fahrenheit, and vapour or steam cannot well be borne above
120; whereas it has been ascertained by experiment that hot
air, when dry, can be tolerated up to 300, and even higher.
Attempts have accordingly been made to utilize this fact
by so-called hot-air baths of different kinds, of which the
best known is the hot chamber (calidarium) of the Turkish
or Roman bath. In this, of course, the hot air is breathed,
but portable baths have been tried in the form of a box,
1
2 The Tallerman Treatment.
with an aperture for the head, while the air inside is
heated by a lamp, thus avoiding the disadvantage of making
the patient inhale the superheated atmosphere to which it
is desired to subject his body. Similar appliances on a
smaller scale have also been used for single limbs. But
they have all turned out practical failures. The difficulty
has always been to make the high temperature a reality.
Either the construction of the apparatus will not permit a
high temperature to be obtained at all, or the air is not
really dry, and therefore a high temperature cannot be
borne when obtained. The air may be dry at first, but as
soon as the skin begins to perspire it becomes more or less
charged with moisture until the perspiration, which is ex-
cessive in the hot-air bath, can no longer evaporate freely,
with the result that discomfort at once ensues and the
proceeding has to be abandoned. Thus it happens that the
hot chamber of the Turkish bath is practically limited to a
temperature of about 170. Even a single limb cannot be
exposed to a really high temperature in an ordinary closed
chamber for more than a few minutes, for the simple reason
that the perspiration resting on the skin has a scalding
effect when 200 or less is reached.
DESCRIPTION OF THE APPARATUS.
These difficulties are completely overcome by the
Tallerman apparatus, in which a temperature of from 250 C
to 300 or more can be borne for an indefinite time, not
only without discomfort, but with a sensation of pleasure.
The secret lies in an ingenious arrangement for keeping
the air really dry. The apparatus consists of a copper
chamber, varying in size and shape according to the part
which it is desired to treat, but generally taking the
form of a cylinder. The hand, the forearm, or the whole
arm, including the shoulder, may be placed in it; and
similarly with the lower extremity the foot, the knee, and
the hip may be treated. The treatment may also be applied
to the abdomen and other parts of the trunk. The limb
to be treated is passed into the open end of the cylinder
Introductory, 3
through an airtight curtain, which is afterwards secured in
such a way as to close the chamber completely. The
distal end of the cylinder is furnished with an opening,
so contrived as to permit the escape of the evaporated
moisture at intervals. In this way the air is kept dry and
scalding prevented.
The heat is supplied externally by gas-jets. Oil could
be used where gas is not laid on, but the latter is more
convenient. The stand on which the cylinder rests is sup-
plied with rows of gas-burners, which can be connected with
any ordinary gas supply by a piece of rubber-tubing, and
turned up or down according to the degree of heat required.
The apparatus can therefore be used in any private house,
under the care of the patient's own medical attendant.
The temperature is indicated by a thermometer, the bulb
of which is inside the cylinder, at the level of the limb to
be treated, while the scale passes outside, and can be read
off at any moment by a glance. The cylinder is also
furnished with stopcocks, which may be used with or
without an air-pump either for drawing off heated vapour
or admitting medicated vapour.
METHOD OF USING THE APPARATUS.
The limb to be treated rests at the bottom of the
cylinder on a metal cradle protected by asbestos, which
prevents all danger of scorching the skin by contact with
the heated metal. The patient may lie in bed or be seated
in an armchair during treatment, whichever is considered
most comfortable or suitable to the case. The most con-
venient way of administering the treatment is to heat the
cylinder up to 150 Fahrenheit before inserting the limb
and then gradually raise the temperature, the process of
drying the air being frequently repeated, which enables the
patient to bear exposure to 250, 300, and even higher,
without the least discomfort. This striking result is clearly
due to the system of ventilation employed, because each
time it is brought into play a considerably higher tempera-
ture can be borne without incommoding the patient, until the
12
4 The Tallerman Treatment.
air again becomes charged with moisture evaporated from
the skin. The plan for keeping the air dry is the most
distinctive and valuable feature of the Tallerman bath,
although in other respects it is a much more complete,
reliable, and convenient apparatus than anything else of
the kind yet brought forward.*
The temperature found most suitable for treating the
majority of cases ranges from 240 to 280 ; and the
duration of an ordinary sitting is from thirty minutes to
one hour, but it may be prolonged to two hours or more
without discomfort or ill-effect.
EFFECTS : PHYSIOLOGICAL AND THERAPEUTIC.
In general terms, the effects are those of heat, affecting first
the part treated, and then, to some extent, the whole body.
They are thus described by Dr. Knowsley Sibley, senior
assistant-physician to the North-West London Hospital,
who has given great attention to the investigation of the
subject : ' Locally (1) The heat produces dilatation of all
the cutaneous vessels and free circulation through the
parts it is impossible to say how deeply into the tissues
this extends, but from the results it may be judged to be
some distance and at the same time there is a marked
stimulation of the nutrition of the cutaneous nerves ;
(2) there is free perspiration of an acid sweat ; and (3) relief
from pain, however produced, is almost at once apparent.
Generally (1) There is profuse perspiration and dilatation
of vessels ; (2) increase of the rate of the pulse and force of
the heart's action ; (3) increase (slight) of the respiratory
movements ; and (4) an increase in the body temperature,
* The late Dr. Bell Hunter, the eminent authority on hydro -
therapeutics and medical superintendent of Smedley's hydropathic
establishment, Matlock, writing under date March 18, 1894, observed :
'We have our hot-air baths, and with arrangements for local applica-
tion of the heated air. Your apparatus is a great advance on these
in precision of working and extent of range of temperature, however,
and I am not unwilling to give it the welcome I can see it deserves.'
Mr. Oscar Jennings, writing to the Lancet, November 3, 1896, says :
* With ordinary apparatus a local hot-air bath is nothing more than a
vapour bath, and all those who are practically acquainted with the
question will recognise the value of the Tallerman invention, if it really
provides us with a means of keeping the hot air dry and reaching a
temperature of 300.
Introductory. > 5
often of two or three degrees Fahrenheit. The treatment
appears to lower the blood-pressure of the body, and in
some way to increase the alkalinity of the blood, which
enables it to dissolve the uric acid from the tissues and
joints, and get rid of this substance through the various
excretory organs. This is evidenced by the relief from
local pain, and the removal of the frequent uric acid nerve-
depression. Hence the treatment is of a tonic nature, and
bestows an increased general vitality upon the patient.'*
Dr. Edouard Chretien, commenting on the cases treated
at the Laennec and Salpetriere hospitals in Paris, states
the effects observed in the following terms, which are
virtually identical with Dr. Sibley's account :
(1) More or less profuse perspiration, not only of the
part treated, but over the whole surface of the body.
(2) Marked reddening of the skin on the part treated,
indicating an intense dilatation of the bloodvessels.
(3) Diminution and rapid disappearance, sometimes
almost immediate, of pain.
(4) Restoration of movement, where the functional
impotence was due only to pain.
(5) More or less marked acceleration of the pulse, caused
evidently by the peripheral dilatation of the bloodvessels,
which facilitates the action of the heart, and makes it
contract more vigorously.
(6) Temporary elevation of the body temperature.^
The increased local circulation, relaxation of the tissues,
and free perspiration, are the ordinary effects of the
application of heat, and call for no special explanation.
But it is to be observed that, owing to the very high
temperature to which the part is continuously subjected
for a considerable period of time, they are all produced in a
much higher degree than by any other existing method.
That is, indeed, the distinctive peculiarity of the treatment
as a local application, and to it much of the therapeutic
effect must be ascribed. The elimination of morbid products
is more complete, the improvement of nutrition more rapid,
* The Lancet, August 29, 1896.
f La, Presse Medicale, December 26, 1896.
6
The Tallerman Treatment.
and the reaction more powerful, in proportion to the tem-
perature employed and the length of time it is maintained.
But that is by no means all : the local effects are accom-
panied by general ones, which are less easy to understand ;
the whole circulation is quickened and the body tem-
perature raised, with all the results involved in those
changes. These phenomena have been repeatedly attested
by various observers, and particulars will be found in the
case notes ; but the point is so interesting that we append
here a series of detailed observations made by Dr. Sibley :
TABLE GIVING PARTICULARS OF CASES.
2
o _
so
2 -a >
2fl
o
s
Date.
o
|,a
o o o*.a
T _.
0^
1|!|
ill
Part Treated.
^d
|!-s fe
2
||
|"8
,
Nov. 11, 1895
72
98-0
88
99-4
240
Right hand
Nov. 14, 1895
76
98-4
90
99-6
240
Nov. 16, 1895
76
98-2
92
99-8
248
i
May 23, 1896
80
98-0
92
99-6
240
R ght leg
*'
May 26, 1896
88
98-6
92
99-8
240
j?
May 28, 1896
80
98-4
92
100-0
260
June 1, 1896
80
982
96
99-8
250
5
'
June 4, 1896
76
98-2
88
99-0
250
1
i
April 22, 1896
96
99-0
100
99-6
238
Right hand
j
April 24, 1896
88
99-2
96
100-0
240
,
April 25, 1896
92
99-0
116
100-0
250
.
April 27, 1896
92
99-0
100
100-0
250
,
April 28, 1896
96
99-4
104
100-0
240
,
April 30, 1896
88
99-0
96
100-0
250
,
May 1, 1896
92
98-6
100
99-6
250
,
May 5, 1896
84
98-2
92
99-4
250
,
May 6, 1896
84
98-4
96
99-2
240
,
May 8, 1896
92
98-4
104
99-2
270
,
May 11, 1896
92
99-0
104
100-0
260
,
tt
Mav 13, 1896
92
99-0
108
100-4
260
,
May 15, 1896
96
98-6
108
99-6
260
,
May 18, 1896
92
98-6
100
99-8
270
,
May 20, 1896
92
99-0
108
100-0
260
,
May 22, 1896
92
99-0
104
100-0
260
,
May 26, 1896
80
99-0
92
100-0
260
,
May 28, 1896
92
99-0
104
100-0
260
,
June 1, 1896
88
99-0
100
100-0
260
,
June 3, 1896
88
99-0
100
100-2
230
Left leg
June 5, 1896
88
99-0
96
100-2
240
51 i
June 8, 1896
92
99-0
104
100-2
240
n i
June 16, 1896
99
98-4
104
99-4
250
Right arm
\
June 22, 1896
92
99-0
108
100-0
240
Left arm
Introductory.
-
g
35 S
<y
2.g g
2s
*
Date.
Is
* ci *^
o o o
H
jfrf
ifi
Part Treated.
.
3*
--
ga
Hi'Sii
=.4| g^2
;
S
s'S.s
H' ""'
^
s'
June 19, 1896
78
98-4
92
100-0
220
Right arm
June 22, 1896
78
98-4
92
100-0
200
Left leg
June 23, 1896
84
98-2
90
100-0
220
t
June 25, 1896
84
99-0
100
101-0
230
JJ >
3.
June 26, 1896
88
98-0
92
100-8 ;
230
J> 5
June 29, 1896
96
99-6
104
101-0
230
j )
June 30, 1896
92
99-2
100
100-6 '
240
July 1, 1896
88
98-0
96
101-0
240
} }
July 3, 1896
92
99-4
100
101-0
240
1
V
July 10, 1896
84
98-6
102
99-4
220
(
July 20, 1896
70
98-0
88
99-2
230
Left leg
4
July 24, 1896
76
98-4
84
99-0
220
j
July 27, 1896
72
98-0
88
99-2
230
I
July 29, 1896
76
98-6
88
99-4
200
,
July 22, 1896
88
98-2
92
99-2
240
Right arm
Julv 24, 1896
92
98-6
100
99-6
240
Left arm
5. ]
Julv 27, 1896
88
98-0
100
99-6
260
M
July 28, 1896
88
98-6
96
99-6
230
,, ,,
1
July 29, 1896
80
97-6
92
99-2
230
i, ..
1
July 21, 1896
88
97-2
100
100-0
240
Left arm
M
July 22, 1896
72
98-0
88
99-2
240
(
July 24, 1896
72
98"2
84
99-0
250
it
7-!
July 20, 1896
72
98-4
100
99-2
235
Right leg
1 1
July 21, 1896
80
99-0
96
100-0
230
>i
1
July 16, 1896
76
97-4
240
Right arm
8.
July 20, 1896
80
98-4
100
99-2
230
>
1
July 22, 1896
80
98-0
96
99-0
260
,,
July 16, 1896
76
98-4
88
99-4
230
Right leg
9.
July 17, 1896
72
98-2
92
99-0
230
Hip
^ July 20, 1896
68
98-0
84
99-2
240
10
' July 28, 1896
100
99-0
112
100-0
220
Left arm
I July 29, 1896
92
98-6
100
99-4
230
u >
r July 28, 1896
80
98-0
92
99-2
250
Hips.
'
July 29, 1896
74
98-2
80
99-2
240
ii
July 31, 1896
72
98-4
84
99-2
210
"
Note. In Cases 4, 5, 10, and 11, and corroborated by isolated
observations in several other cases, it was found that the pulse about
an hour after treatment was usually slower than before the bath.
Occasionally it was of the same rate, but in no instance was it found
to be more rapid.*
* The Lancet, August 29, 1896.
8 The Tallerman Treatment.
The quickened circulation may be due in some measure
to excitement and, as Dr. Chre'tien suggests, to peripheral
dilatation of the bloodvessels ; but the raised temperature is
more remarkable. It will be seen that every operation was
invariably accompanied by a heightened temperature in the
case of each patient, but that some were more susceptible
than others. Speaking generally, the rise is from one to
three degrees Fahrenheit. The Hospital (August 1, 1896),
discussing the point, suggests the following explanation :
* The rise in temperature is an interesting phenomenon,
and at first appears in contradiction to physiological
teaching. Although not explained by any of the observers
who have used this method, it is probably due to im-
perfectly co-ordinated diaphoresis in parts of the body
other than that exposed to the direct heat of the bath
that is to say, the blood as it flows through the heated area
is not completely cooled down before it passes on to other
areas, where the conditions are different, and where reflex,
superficial, vascular dilatation, and consequent diaphoresis,
are not correspondingly established.'
However this may be, there can be no doubt that the
therapeutic effects are largely due to the increased circula-
tion throughout the body, which produces constitutional
changes affecting parts other than those treated, and im-
proving the general health. Numerous instances will be
found among the case notes in which the treatment of one
limb has effectually relieved others at the same time ; and
with regard to the general health, the experience of Mrs.
L. B. Walford, the eminent novelist, who was treated for
pain and failure of strength in the right arm, is worth
quoting : ' The treatment for my " poor arm " has operated
favourably upon my whole system. I was slightly rheu-
matic all over. Since undergoing the hot-air cure, I have
not felt a twinge of rheumatism. I feel better in every
way, refreshed, strengthened ' (see p. 114).
This undoubtedly points to constitutional changes, which
are probably due in a great measure to the elimination of
morbid products both by the skin and the kidneys. With
Introductory. 9
regard to the latter point, some interesting observations
were made in the Paris hospitals and recorded by Dr.
Chretien. In a case of long-standing gout the daily
elimination of uric acid by the kidneys was found to rise
from 57 centigrammes after the fourth bath to 89 centi-
grammes after the ninth (see pp. 89, 151). Dr. Sibley is
inclined to ascribe the relief of pain in a large measure to
the same action.
The relief of pain is the most immediate and striking
therapeutic effect of the treatment. In some instances it
is so remarkable that it must be seen to be believed.
Patients racked with pain, which no remedy has been able
to remove, are relieved as though by a charm, and the
relief is often permanent. At the same time sleep and free
movement, which had been banished by suffering, are both
restored. In short, the treatment is an extremely powerful
anodyne, affecting not only the part treated, but the whole
of the body.
Further therapeutic effects are the rapid reduction of
inflammation in acute and subacute cases, and the restora-
tion of mobility to stiff joints of old standing where no
bony adhesions have formed.
They will be found fully illustrated in the case notes.
DISEASES AND AFFECTIONS TREATED.
The full uses of the superheated dry-air treatment have
not yet been thoroughly explored experience is constantly
bringing new ones to light ; but the affections in which its
efficacy has been proved are the following :
(1) The arthritic diseases namely, rheumatism, gout,
rheumatic arthritis, gonorrhceal rheumatism, tuberculous
inflammation of the joints.
(2) Other affections of the joints sprains, synovitis, and
inflammation due to injury, with their after-effects in the
shape of pain, stiffness, and adhesions.
(3) Affections of the nerves sciatica, tic-douloureux,
and other neuralgias, to which may be added peripheral
10 The Tallerman Treatment.
neuritis, and cases of mal-nutrition from injury to nerves
and bloodvessels.
(4) Chronic ulcers.
(5) Flat-foot.
(6) Certain diseases of the skin.
There is reason to believe that in time this list will be
considerably extended. For instance, encouraging results
have already been obtained in some forms of heart disease,
in chorea, and anaemia, and cases of bronchitis and Bright's
disease have incidentally been markedly benefited. Various
other disorders have been suggested as suitable for treat-
ment, and no doubt many will occur to the medical reader
when he grasps the mode of action and learns what has
already been achieved. But it is not desired to claim
here more than can be vouched for on unimpeachable
authority.
ILL EFFECTS.
No serious ill effects have been observed, and very few
cases have occurred in which the patients have found the
treatment at all trying. Those are probably explained by a
careless use of too high a temperature at first, owing to
inexperience on the part of the attendant or to the
patient's want of intelligence. Of course patients vary in
susceptibility, but the temperature is so easily regulated at
will that it can be adjusted to suit the most susceptible
constitution. So far from complaining of the treatment
or being weakened by it, the vast majority of patients find
it one of ' luxurious ease,' and are frequently inclined to fall
asleep during the operation.
Considering the number of rheumatic patients treated,
and the marked effect upon the heart, the important
question arises whether there is any danger of untoward
results in cases of valvular disease. Happily, all the
evidence is the other way. The effect on the heart appears
to be distinctly beneficial. In fact, cases of cardiac disease
are at the present time being treated at some of the
London hospitals ; and it is hoped that results will be
published before long. Meanwhile, reference may be made
Introductory. 11
to a suggestive and promising trial carried out at St.
Bartholomew's.
It had been repeatedly found in treating patients for
rheumatism, gout and other affections, that the heart's
action and the general circulation were so much improved
by the hot-air bath as to encourage its use even when
valvular disease was present ; and the fact was communi-
cated to Dr. Lauder-Brunton, who had shown in a paper
upon the Nauheim treatment, previously published in the
Lancet, that massage relieved the blood pressure by pro-
moting a flow of blood through the muscles. The same
result, it was suggested, could be better and more quickly
obtained by the Tallerman treatment, and it was decided
to test the method as soon as a suitable case was found.
A case was found early in January in the person of a book-
seller then lying in the ' Rahere ' ward of the St. Bartholo-
mew's Hospital; it was one of aortic regurgitation and
obstruction and mitral regurgitation and obstruction, and
was described as utterly hopeless, and that the man must
die very shortly. Under the circumstances it was con-
sidered proper to afford the patient an opportunity of trying
whether he could derive any benefit from this new treat-
ment, and on January 14, 1896, the apparatus, which had
been in use at the hospital for between three and four years,
was taken into the ward, and the patient was treated with
Mr. Tallerman's assistance, in the presence of Dr. Lauder-
Brunton.
At the commencement the temperature was 97*1 and
pulse 94.
After thirty-five minutes the temperature was raised to
97'7 C , and the pulse was considerably firmer. The patient
had been comfortable throughout. The treatment was
continued for a fortnight, during which so great was the
improvement that hopes were entertained that some
permanent benefit might be derived ; at the expiration
of that time, however, the patient relapsed into the old
condition.
This temporary improvement in a case in which the heart
12 The Tallerman Treatment.
might be said to have practically reached the last stage of
organic disease can only be regarded as most satisfactory,
and as indicating that more permanent benefit may be
expected from this treatment in cases if taken at a less
advanced stage. It also demonstrates the safety with
which the Tallerman treatment may be administered in
gout, rheumatism, and other cases in which cardiac weak-
ness or valvular disease is present.
FAILURES.
Like every other method of treatment in existence, this
has had its failures. Here and there cases, apparently
suitable, turn out refractory and derive no benefit. That
must always be so. But it is to be observed that some
apparent cases of failure are due either to their being quite
unsuitable or to an improper use of the apparatus. It
requires some intelligence, and considerable care for its
effective application, and in certain instances it also
requires a fair amount of patience. Persons applying it
carelessly and indifferently to the first chance patient they
come across are not likely to get a good result. It is
necessary to say this because certain institutions, after a
perfunctory trial, or none at all, have flippantly thrown
the thing aside. A good instance is St. Thomas's
Hospital, which returned the apparatus with a curt
intimation that they ' had no use for it.' From that very
hospital a patient was discharged as ' incurable.' She was
suffering from rheumatic arthritis. Nearly every joint in
her body was affected, she could not kneel, walk, or raise
her arm higher than her chin. She had nothing but
a life of hopeless misery and suffering before her, until
she sank into the grave worn out by pain or starvation.
As it happened, she came under treatment. She has now
regained the use of her limbs, she can kneel, walk up and
down stairs, and raise her arm above her head ; all active
mischief hi the joints has ceased, pain has disappeared,
and her general health has greatly improved. Particulars
will be found on page 22. How many like cases are there
Introductory. 13
at the gates of St. Thomas's Hospital ? And what is the
notion of their responsibility to the public entertained by
the gentlemen who could find no use for the appliance
which has restored their ' incurable ' patient to health and
activity ?
In conclusion, it is submitted, on the evidence which
follows in the succeeding chapters, that the Tallerman
treatment is virtually a new departure in therapeutics and
a valuable addition to the existing means of dealing with
a class of cases in which medicine has often to confess itself
peculiarly powerless. In particular, it offers a rapid and
effective method of treating those intractable arthritic
affections which are too often abandoned as beyond the
reach of aid, after every known remedy has been tried and
failed. Such cases, if they possess means, are usually sent
about to this and that expensive watering-place at home
or abroad, at great cost of time and money, in the forlorn
hope that they may perhaps derive a little benefit ; if they
are poor, they pass from one hospital to another, to find
their last refuge in the workhouse infirmary. In either
case their lot is pitiable in the extreme. The advantages of
an expeditious remedy, which can be applied at home with
the certainty of relieving their suffering and a good pros-
pect of restoring their activity, need no emphasizing.
CHAPTER II.
RHEUMATIC ARTHRITIS.
FULL details are here given of twenty-seven cases of this
disease, which is also called ' rheumatoid arthritis ' and
' arthritis deformans,' treated at the following hospitals :
North- West London; St. Bartholomew's; Laennec Hospital,
Paris; Royal Portsmouth; Union Hospital, Cork; Royal
Victoria Hospital, Montreal; St. Mary's; Livingstone
Cottage Hospital, Dartford; Children's Hospital, Bristol;
at the Institution at 50, Welbeck Street, and by private
practitioners.
It is a common disease in this country. As Mr. Jonathan
Hutchinson has said : ' England is the home of rheumatic
gout ; no place beats it excepting Ireland.' It is also a
very painful disease, and the results of ordinary treatment
are at least as unsatisfactory as the disease is common and
painful. ' In a severe case,' to quote Mr. Hutchinson
again, ' it must be admitted that the prognosis, under the
ordinary conditions of life in England, is a gloomy one.'
In point of fact, the prospect is all but hopeless. The
malady is of a progressive character, and as one joint is
involved after another the patient becomes a hopeless
cripple, to die eventually a lingering and painful death,
worn out by constant suffering.
In dealing with this intractable disorder, the Tallerman
treatment has met with the most brilliant and unequivocal
success. Case after case will be found of the severest kind,
which had resisted every other remedy and been pro-
nounced incurable, but which has yielded to superheated
Rheumatic Arthritis. 15
dry-air treatment. Not only has all pain been removed and
the progress of the disease arrested, but a large degree of
mobility has been restored even in the most desperate
cases, and experience goes to show that the amelioration is
of a permanent character. In the Lancet of August 29,
1896, Dr. Sibley writes as follows :
'It must be admitted by those who have had much
practical experience of severe cases of arthritis deformans
such as cases No. 1, 2, and 3, how very hopeless these
have generally been considered, and what little chance of
permanent good medical treatment offers, that this treat-
ment by hot air at a very high temperature meets a
general want. I must add I have never seen results so
immediate and satisfactory produced by any other treat-
ment. It is now two years since treatment by the local
hot-air bath was commenced in the first case, and yet the
patient continues comparatively free from the complaint,
and even the deformity of the fingers has greatly dis-
appeared.'
The reader can judge from the case notes which follow
how fully this experience of the treatment is borne out by
the observation of others.
CASE 1.
Treated at the North- West London Hospital. Under the
care of Dr. Knowsley Sibley.
Arthritis deformans ; duration four and a half years.
In January, 1894, a single woman, aged 64 years, came
under treatment. The patient's father died at the age of
66 years, from bronchitis ; a sister, since dead, suffered
from rheumatism. The patient had suffered from bronchitis
for twenty years. About four years ago she had a good
deal of trouble and then influenza, and ever since this time
she had suffered from rheumatism, which came first in the
ankles, then in the knees, and finally in the hands. This
had gradually become worse. There was no cardiac
murmur, but there was a good deal of general bronchitic
rhonchi. She had been under private treatment, and had
been attending University College Hospital for four months,
and then came to the North- West London Hospital, at
16 The Tallei v man Treatment.
which place she attended regularly from January till
August, when the baths were first tried. During this time
the following drugs were prescribed in the order given:
colchicum, salicylates, iodide of potassium, guaiacum,
gentian and rhubarb, salines, strychnia and iron, salicin,
antipyrin, exalgin, and lithia, together with various lini-
ments, etc., but nothing seemed to give the patient any
relief from the constant pain, or produced any amelioration
of the gradually progressing disease ; in fact, she was daily
becoming worse and more crippled. On August 4, 1894.
the following note was made : ' All the finger-joints of
both hands are now greatly enlarged, very painful and
tender ; there is hardly any movement of the fingers, and
the patient is quite crippled and unable to use the hands
at all, it being impossible to close or separate the fingers.
The movement of the wrists is also very limited, and any
attempt at flexion causes great pain. The right elbow is
fixed at a right angle. Both the knees and shoulders are
enlarged and painful, with very distinct grating and con-
siderable disorganization of the joints. The patient is very
anaemic, and looks ill and worn out with constant pain.
She cannot dress or even feed herself, being unable to get
her hands to her mouth.' On August 10, the medicines
were stopped and the hot-air treatment commenced. After
the first bath the patient said she had less pain than she
had had for months ; the joints showed some improvement,
the fixity not being quite so complete. After the fourth
operation the patient, who for a year and a half had not
been able to do any work, was again able to use her needle
a little. After the fifth bath the right arm could be fully
extended without pain, and with a little assistance all the
fingers could be flexed on the palms. The left hand,
although it had not yet been placed in the cylinder, also
showed considerable improvement. On August 24, after
the ninth bath the patient reported that she had resumed
her former occupation as a dressmaker, and was able to
walk up and down stairs with comparative ease and with-
out pain. On September 9, the patient had had twenty
baths and considered herself practically cured, but as the
apparatus was still at the hospital, she had an occasional
bath up to the end of October, 1894. From this time to
November, 1895, she continued at her work, and although
she had some other ailments (uterine), she suffered no
inconvenience from the joint affections. At this time she
again complained of some stiffness and pain in the right
CASE 1. Arthritis deformans, taken in June, 1896 (twenty months
after treatment) ; showing the patient permanently restored to her
business of dressmaking.
To face p. 161.
CASE 1. Arthritis deformans, taken in June, 1896 (twenty months
after treatment) ; showing free movement of all extremities and
permanency of benefit obtained in 1894.
To face p. 1011.
CASE 1. Arthritis deformans, taken in June, 1896 (twenty months
after treatment) ; showing free movement of all extremities and per-
manency of benefit obtained in 1894.
To face p. 16 III.
Rheumatic Arthritis. 17
hand, so three more baths were prescribed, and she again
rapidly recovered and continued well for some months.
Condition on July 2, 1896 .- She has had an occasional
bath recently and is practically well. All the movements
of the fingers are quite free, and the joints, which were
formerly considerably enlarged, are now but very slightly
swollen. On July 20, the patient was suffering from head-
aches, but otherwise she continued to be quite free from
pain. She stated that her bronchitis was better than it
had been for many years, and the patient had continued
uninterruptedly at her work since August, 1894.
CASE 2.
Treated at the North-west London Hospital. Under the
care of DR. KXOVVSLEY SIBLEY.
Arthritis deformans ; duration eight years. The patient
was a married woman aged 69 years, and she came under
observation on April 22, 1896. Her father suffered from
rheumatism and died at the age of 97 years ; her mother
died, aged 51 years, from hernia; she also suffered from
rheumatism. Four brothers and three sisters had died
from old age ; of these, one brother and one sister were
rheumatic subjects. The patient was the youngest of her
family ; she had had one daughter, who died in an asylum
at the age of 39 years. The patient had suffered from
rheumatism and bronchitis on and off for the last eight
years, but was especially worse in the winter. There was
no cardiac murmur. The hands were especially affected
and greatly deformed. All the fingers were enlarged and
very painful ; for eight months she had been unable to use
them for anything, although she had been all this time
under medical treatment. The knees and ankles were also
stiff and swollen, and she had great difficulty in getting
about. On the 22nd the right hand was treated with the
hot-air bath, and she was photographed before and after
the bath to show the improvement. By May 21 the
patient had had fifteen baths and had very considerably
improved ; she was then able to flex her fingers, and had
free movement of the arms and shoulders. The knees and
ankles were both much less swollen and painful. Her
cough and general nervous condition had much improved.
By the 26th she had had seventeen baths, was able to
touch the tips of all the fingers with the thumb, and had
done some needlework. By July 1 the patient had had
18 The Tallemian Treatment.
twenty-four baths. The hands were quite free and comfort-
able, and she could do anything with them. There was still
a good deal of pain in the left foot and ankle ; the varicose
veins of this leg were rather prominent ; there was also a
small and very painful ulcer over the back of the lower
part of this leg, which was redematous. As she was unable
to lie up at home, she was taken into the hospital, and
remained till the ulcer had healed on July 22. She was
then quite free from pain except in the left leg, which still
kept swollen, notwithstanding her three weeks' rest. She
complained of general weakness from lying in bed, and
some strychnia and iron were prescribed, and she left the
hospital. On August 6 she had much improved in general
strength, and had had no more pain in the hands, the
movements of which were quite free and comfortable. She
still had pain in the left leg from the varicose veins, which
prevented her from getting about.*
CASE 3.
Treated at the North-west London Hospital. Under the
care of DR. KNOWSLEY SIBLEY.
Arthritis deformans ; duration thirty years. On June
2, 1896, a woman aged 51 years came under treatment.
Her mother died aged 82 years, after being for six years
confined to bed with rheumatism. The patient had never
been seriously ill, but she had had a mild attack of
rheumatic fever when she was 20 years of age, lasting
about a fortnight, and she had suffered from rheumatism
on and off ever since. The pain had been especially in the
knees and hands. Two years ago she had an injury to the
left knee from a fall Since January of this year the pains
had become much worse, and had prevented her following
her occupation. She had been under the care of several
medical men, and, getting no better, she was recommended
by her medical attendant to come to the hospital. The
hands, shoulders, and knees were especially affected, being
much swollen and very painful ; the patient suffered a
great deal of pain, and was unable to do any work. She
could only get about with the greatest difficulty on account
of the pain and swelling in the knees. There was no
cardiac murmur, but the sounds were rather feeble. She
was given salicylate of soda and digitalis for the pain.
* Dr. Sibley, Lancet, August 29, 1896.
CASE 2. Arthritis deformans, taken April 22, 1896, before treatment, fingers
fixed in above position.
To face p. 18 I-
CASE 2. Taken April 24, 1896, after second operation, showing some
separation of fingers.
CASE 2. Taken August 7, 1896, showing result of treatment.
To face p. IS II.
Rheumatic Arthritis. 19
Until the 17th the patient had been gradually getting
worse, and was then unable to raise the right arm or to
close her hands, and could only walk, or rather drag herself
about, with the greatest difficulty. On the 19th the first
bath was given, the right arm being placed in the cylinder.
She was photographed before and after the operation. By
the 23rd the patient had had three baths, and there was
considerable general improvement, the pain and stiffness
having quite left the hands and arms. On July 2 there
was no pain in the hands or arms, but the legs, especially
the left knee, continued weak and painful, keeping her
awake at night. She was put on guaiacum and an opium
pill at night. On the 10th she had her tenth bath, and
with the exception of the knees was comfortable. The
fact that the patient lived on the top of the house and had
several flights of stairs to mount was very detrimental to
the progress of her case, so she was admitted into the
hospital on July 23. She felt much better, and only had
very occasional pain in the hands. On August 4 the
knees had become better, but great difficulty in standing
still continued ; there was slight pain in the hands first
thing in the morning, otherwise these were quite comfort-
able. The temperature was usually between 99 and 100
F. Strychnia and iron were administered, and the knees
were strapped with Scott's dressing.*
CASE 4.
Treated at St. Bartholomew's Hospital. Under the care of
MR. ALFRED WILLETT, F.R.C.S.
Alice C., 25 years of age, was admitted into President
Ward on September 29. Her history was one of gradual
onset of pains seven years previously, a dull aching by
day and night. Six years ago, or one year after the onset
of these pains, she had rheumatic fever. She was under
treatment at Reading, and subsequently at Bath. On
admission, her condition was that of an anaemic girl, with
very pained expression ; heart's sounds natural. She was
almost helpless and bedridden from crippled joints. The
affected joints were the right ankle, knee and hip, the left
hip and both elbow and wrist joints ; all these were stiff
and painful. The right hip and knee were flexed at angles
respectively of 165 and 90 ; both elbows were flexed to
* Dr. Sibley, Lancet, August 29, 1896.
22
20 The Tallerman Treatment.
about 120, with about 35 angle of movement. The wrists
were completely anchylosed. The changes chiefly affected
the fibrous structures of the joints, but about the elbows,
especially the left, were bony and cartilaginous defects,
with creaking and grating on movement in both. The
electrical reactions were normal.
On January 17 the right hip, knee, ankle and right
-elbow and wrist joints, were all forcibly broken down and
moved under an anaesthetic. The right hip and knee
were brought straight and fixed upon a Thomas's hip-joint
splint. On the 25th, under passive movement there was
some improvement. Nitrous oxide gas was again ad-
ministered for wrenching the right wrist and elbow. At
this time the left elbow was the worse, but I thought it
better to confine myself to the joints on the right side of
the patient's body. She was still being treated by passive
movement and given cod-liver oil. On February 20,
Tallerman's hot-air bath was used at a temperature of 260
for fifty minutes. There was much less pain afterwards ;
the range of motion was not increased ; the movements,
however, were more free through the given range. But on
any stretching of the joints, with the view to obtaining
increased range of movement, the old pain was felt. The
baths were continued from February 20 to March 21. Up
to this time there was no very definite improvement beyond
the above changes. On April 9 gas was administered, and
the left elbow extended and flexed, all the adhesions in it
being broken down, and afterwards placed in the bath. On
the 19th it was noticed there was general improvement in
all her joints. The left elbow, which was the worse, was
much less painful and more mobile.
I now show you the patient, who, as I mentioned, was
admitted practically bedridden and helpless just at the end
of last year. She left the hospital walking on crutches.
Any movement was attended with great pain when she
came here ; on leaving, the joint movements were much
freer, almost painless, and the patient was able to do
almost everything for herself. These noticeable changes,
relief from pain and freer movement, were mainly attri-
butable, I think, to the influence of the hot-air baths. She
was under the bath treatment for about eight weeks. On
asking her to strike at my hand, we find that the right
upper extremity is the stronger, but with both she can hit
my hand a fairly vigorous blow; on admission it would
have been absolutely impossible for her to have attempted
CASE 3. Arthritis deformans, taken June 19, 1896, before treatment:
showing (i.) highest point hand and arm could be raised ; (ii.) inability to flex
the fingers ; (iii.) expression of pain.
To face >). 201.
CASE 3. Arthritis deformans, taken June 19, 1896, after the first treatment,
showing full extension of arm and forearm, flexion of hand, absence of pain.
To face p. 2011.
Rheumatic Arthritis. 21
anything of the kind. I mentioned the great creaking
which occurred in the joints ; now within the range of
movement the joint has become quite natural. The range
of movement in her left elbow-joint is better than it is in
the right ; the flexion is a little greater, the extension
perhaps not quite so good, but here again the movement,
although not absolutely smooth, or so smooth as in the
right, is accompanied by less marked creaking than when
admitted. The wrist-joints were absolutely fixed. She
has a moderate amount of pronation and supination ; still,
if I put any strain upon the joints, it is obvious that it
pains her. Her right wrist remains very stiff.
CASE 5.
Treated at the Laennec Hospital, Paris. Under the care
of M. OULMONT.
Chronic Deformatory Rheumatism of long standing.
Jean P. ; 49 years old. Illness began in 1885. Fingers
and toes deformed ; anchylosis, with an abnormal position
of the large joints; slight movements are extremely
painful ; the arms hang close to the body, and the knees
are bent. For two years P. has been confined to bed, and
has been absolutely helpless.
The patient was treated fifteen times by superheated
dry air. At the beginning of the treatment the pain almost
entirely disappeared, We could see little by little the return
of the limited movements of elevation and abduction of
the arms, and the flexion and extension of the knees. The
fingers also partially recovered the powers of flexion, exten-
sion, and resistance. The patient could lift his hands to
the back of his head ; he could use his hands to cut his
bread and meat, to eat and drink, all of which acts had
been impossible for him for two years. As for the legs, we
cannot say that such results were obtained, but we must
attribute that to the existence of several fibrous adhesions ;
the patient could, however, lift his legs a little from the
bed, and his pain had entirely disappeared.
CASE 6.
Treated at the Laennec Hospital, Paris. Under the care
of M. OULMONT.
Chronic Deformatory Rheumatism of long standing.
Alfred G. ; 43 years old. Illness began in 1888. Con-
22 The Tallerman Treatment.
siderable deformity of the feet and hands ; fibrous anchylosis
of the large and small joints, with abnormal positions;
excessive pain, which caused the patient to cry out when
he tried to move. Eight baths.
Pain disappeared. The patient became able to touch
his forehead with his left hand, and to place his right hand
behind his head ; the hands, which had been closed, were
opened, but incompletely. The patient fed himself, which
he had been unable to do for a long time. Medium results
obtained in the legs.
CASE 7.
Treated at the Laennec Hospital, Paris. Under the care
of DR. OULMONT.
Deformatory Rheumatism of the Hands : rapid in
development. Louise B. ; 32 years old. The illness began
in the middle of the year 1894, in an attack of general
rheumatic fever, which attacked more particularly the
small joints of the hands and feet. It is impossible to say
that it might not be gonorrhceal rheumatism. After the
first attack the joints of the hands remained swollen and
slightly painful ; there was a continual suffering from slight
subacute pains, and the hands became gradually deformed.
It was during one of the severe attacks that the patient
underwent the treatment. She took seven baths. The
pains disappeared almost immediately, so much so that the
patient was able to knit. The swelling diminished. The
treatment was interrupted by the departure of the patient.
CASE 8.
Treated at 50, Welbeck Street. Under the care of
DR. KNOWSLEY SIBLEY.
Alice Williams ; aged 10 years. The patient had
rheumatic fever about fourteen months ago, and was treated
in bed for several weeks. She had a serious relapse a few
weeks after this, lasting some days. Rheumatoid arthritis
then developed itself, attacking in rapid succession all the
large joints. The patient was treated by a private prac-
titioner for some time, and then became an in-patient
of one of the large general Metropolitan hospitals, where
a diagnosis of rheumatoid arthritis was made, and from
which, after seven weeks, she was discharged as incurable.
CASE 6. Before treatment : showing position of hands fixed against chest.
CASK 6. After treatment.
To face />. 22,
Rheumatic Arthritis. 23
She came under observation on April 10, 1896, and on
examination the following condition was observed :
Hip joints stiff and painful, only allowing very limited
movement ; there was marked lardosis, with an upward
tilting of the pelvis, causing an apparent shortening of the
right leg.
Knees. Considerable thickening round both knees, with
slight effusion into the joint. Possible movement is very
slight, flexion only being able to be effected to the extent
of a few degrees, and at the expense of much pain. The
left knee is slightly less affected than the right.
Feet. Both ankles are much swollen and painful.
The legs are abducted to such an extent that the knees
cannot be separated. The patient cannot kneel or walk
upstairs.
Wrists are enlarged, stiff, and painful.
Finger joints are characteristically spindle - shaped.
The hands cannot be closed.
Shoulders. The patient cannot raise either hand higher
than the chin, and cannot touch the ears.
Neck. This is very stiff", and interferes with free move-
ment of the head.
The patient can only walk a few steps with evident pain.
She is neurotic, restless at night, and occasionally faints.
Treatment was commenced at the Tallerman Institute,
in Welbeck Street, on April 7, 1896, and was continued
until June 10, 1896, the patient having been treated
thirty-four times in all.
After the first operation (on the right arm only) the
patient could partially flex the fingers of both hands and
raise her arms above her head. After the last bath it was
found that the patient was very much improved, being able
to stand with the legs extended normally, to kneel, and
to cross the legs, and walk up and down stairs, could
partially flex the fingers on the palm, and could raise the
arms above the head. All inflammatory mischief in the
joints appeared to be arrested, as they were now quite
painless on forcible movements. The patient had also
much improved in her general health.
Condition, July 28, 1897. Patient has grown and looks
very well in herself in fact, she has nothing to complain
of, and is about on her feet all day.
Patient has had no treatment since the baths were dis-
continued last October (1896), but has continued to improve
in every joint. At the present time there appears to be no
24 The Tallerman Treatment.
ordinary movement she cannot execute as well as any child
of her age ; she can button her boots, pick up pins from
the carpet, kneel on the floor, quite dress and undress her-
self, does needlework very well, and, when standing on the
floor, can raise her feet on to an ordinary chair.
Patient has been living at home under hygienic con-
ditions not advantageous to her recovery.
CASE 9.
Treated at the Royal Victoria Hospital, Montreal. Under
the care of PROFESSOR JAMES STEWART.
SUBACUTE RHEUMATISM OF FOUR MONTHS' DURATION MULTIPLE
ARTHRITIS, INVOLVING CHIEFLY THE SHOULDER, KNEE AND VER-
TEBRAL JOINTS RECEIVED THIRTEEN HIP BATHS LEFT THE
HOSPITAL GREATLY RELIEVED THE GENERAL NUTRITION MUCH
IMPROVED.
A. T. L., aged 42, was admitted to hospital on December
30, 1896, complaining of rheumatism, he giving his history
as follows : About the middle of September, 1896, he
suffered from headache and feverishness. Towards October 1
pain and swelling set in in the left ankle, and still later in
the right ankle and in both knees, giving a clinical picture
of acute rheumatism. For about a month he suffered
acutely, then the pain disappeared to some extent, but the
patient was unable to walk, while with the disappearance
of the pain in the joints above mentioned he complained of
pain in the spine, and pain and stiffness in the shoulder-
joints, so that motion was almost impossible.
Of his personal history, it may be said that he has had
repeated attacks of acute rheumatism, and, in addition, has
had much mental worry, consequent on business difficulties.
On examination after admission, the patient was seen to
be a rather emaciated, poorly-nourished man, with some
anaemia, unable to remain in any position for any length
of time, and suffering great pain on movement. He was
unable to walk without crutches, and then only with great
difficulty. The right shoulder joint was very painful on
manipulation, and movement in all directions much limited,
the same, but to a lesser extent, being the condition of the
left shoulder joint. Motion of the vertebrae caused severe
pain, chiefly in the lumbar regions. The knees were semi-
flexed, and could be with great difficulty extended, but
could be fully flexed. There was nothing abnormal about
the ankle-joints. In addition to the above, there was a
ASE 8. Before treatment : showing swollen and crippled joints and
general emaciation.
To face p. 241.
CASE 8. Skiagraph of right knee before treatment.
To face p. 24 II.
CASE 8. Skiagraph of right knee before treatment.
To face p. 24 III.
CASE 8. Skiagraph of right hand before treatment.
To fuce p. 21 IV.
CASK 8. Skiagraph of left hand before treatment.
To face p. 24 V.
CASE 8. After treatment : showing free movement without pain, reduction of
swelling, and great improvement in general health.
To face p. 24 VI.
CASK 8. After treatment : showing free movement, etc.
To face p. 24 VII.
CASE 8. After treatment : showing free movement, etc.
To face />. 24 VJII.
CASE 8. After treatment : showing easy and natural movement.
To I'acen. 24- -IX.
CASE 8. Skiagraph of right knee after treatment.
To face i>. '24-
Rheumatic Arthritis. 25
faint systolic murmur at the apex, and the pulmonary
second sound was accentuated. The other viscera were
normal.
The patient was treated by the Tallerman hot - air
apparatus, and had in all thirteen baths, with the result
that, at the time of discharge, the pain and stiffness had
been entirely removed from the knees, and the patient
could walk without aid; but he still had slight pain in
the back, and the right shoulder was a little stiff, but not
painful ; the left was free from both pain and stiffness.
The appetite and general health were much improved,
notwithstanding that the patient had a severe attack of
tonsilitis while in hospital.
CASE 10.
Treated at the Royal Victoria Hospital, Montreal. Under
the care of PKOFESSOR JAMES STEWART.
REPEATED ATTACKS OF SUBACUTE RHEUMATISM ANEMIA EMACIATION
ARTHRITIS OF THE RIGHT KNEE AND SHOULDER MARKED LIMITA-
TION OF MOVEMENT IN SEVERAL JOINTS AIR TREATMENT QUICKLY
FOLLOWED BY RELIEF TO PAIN MARKED IMPROVEMENT IN GENERAL
NUTRITION.
J. H., aged 26, was admitted to the hospital November 3,
1896, complaining of pain in the back and joints, and
difficulty in walking.
The outset of the illness is stated to have been six years
previously, at which time he suffered severe pain in the
right hip-joint on movement or pressure. Two months
later he had acute inflammation in the right knee, and
subsequently the ankles and shoulders became involved
successively.
After being in bed for nearly a year, the patient began
to move about on crutches, and still later was able to get
about when using a cane, but not otherwise. The condition
remained stationary, apparently, for the next four years,
then he began to suffer from pain in the back, with pro-
gressive weakness and loss of flesh. In December, 1895,
he had acute inflammation in the right knee, and this has
persisted to some extent up to the present time.
Save that he had a great deal of domestic worry, his
personal history was negative.
On examination he was found to be emaciated and
anaemic. There was enlargement of the right knee-joint,
due to fluid, and the joint was hot and painful, and, in
26 The Tallerman Treatment.
addition, there was some enlargement of the right shoulder-
joint. There was limitation of movement in the left hip,
and in the left knee and right hip pseudo-crepitus was
easily demonstrated. The patient could not walk without
a cane, and when walking there was limitation of move-
ment about the pelvis, the trunk much bent forward, the
feet widely apart, and he could not stoop to pick an object
off the floor.
The examination of the viscera revealed nothing abnormal.
This patient is still under treatment, but after the first
application an improvement was noticed. He can now
walk about without a cane, has become much more erect,
and can pick an object off the floor readily. The effusion
into the joints has disappeared, and there is practically no
pain either in the joints of the extremities or in the back.
His general health has much improved, there being a much
better appetite and a rapid gain in weight.
On February 20 the patient left the hospital practically
well
CASE 11.
Treated at the North-west London Hospital. Under the
care of MR. MAYO COLLIER, F.R.C.S.
A. C. ; aged 64. Dressmaker. Chronic rheumatoid
arthritis of four years' standing ; both knees, shoulders,
and wrists and all finger-joints affected. Patient had been
under hospital treatment for four years without improve-
ment four months at University College Hospital, and two
years at the North-west London Hospital. On examination
all the finger-joints were found to be enlarged and painful,
and there was great limitation of movement, patient not
being able to flex the fingers on the palm. The movement
of both wrists was limited and painful ; the right elbow was
fixed at a right angle, and any attempt at movement caused
great pain. Both knees and shoulders were enlarged and
painful, and distinct grating could be heard on movement.
This patient was first treated in the hot-air cylinder on
August 10. After the first operation it was noticed that
the pain -was considerably less, and the joints showed
marked improvement.
After the fourth operation the patient, who had been
unable to work at her business for eighteen months, was
again able to use her needle.
After the fifth operation the right arm could be fully
extended without pain, and with a little pressure the
Rheumatic Arthritis. 27
fingers could be flexed on the palm. The left hand and
arm also showed marked improvement, although they had
not been treated in the cylinder.
After the eighth operation, with the exception of the
forefinger, in which a little stiffness still remained, all the
fingers closed readily.
On August 24, after the ninth operation, the patient
reported having resumed her former occupation of dress-
maker, and her ability to walk up and down stairs without
pain.
The average length of each operation was forty minutes.
Note. This case of chronic rheumatoid arthritis had
been under continual medical supervision from its outset,
and the usual remedies were applied. Its history shows
that so far from yielding to treatment, the disease made
rapid strides, so much so that, whereas eighteen months
ago the patient was able with some effort to follow her
occupation of dressmaker, twelve months later she was
incapacitated from even feeding or dressing herself.
The improvement wrought by the local and hot dry-air
cylinder was as immediate as it was remarkable. The
progress of the disease was arrested, and a curative process
was set up at the first operation, which became more
manifest with every succeeding one, proving beyond doubt
the value of the treatment in cases of this nature.
J. F. SARGEANT, M.R.C.S, M.R.C.P.
CASE 12.
Treated at the North-west London Hospital. Under the
care of MR. MAYO COLLIER, F.R.C.S.
G. S. ; aged 71. Carpenter. Chronic rheumatoid
arthritis of twelve months' standing. Both elbows and all
the joints of the fingers were stiff and painful, so much so
that it was with the greatest difficulty that he continued
his work as carpenter. After five operations the improve-
ment in this case, both as to pain and stiffness, was so
marked that he was enabled to go to his work without
inconvenience.
Note. The result of the treatment in this case was quite
as satisfactory as in the preceding one.
J. F. SARGEANT, M.R.C.S., M.R.C.P
28 The Tallerman Treatment.
CASE 13.
Treated at St. Peter's Home, Kilburn.
Miss H. ; aged 45. For seven years suffering from
chronic rheumatic arthritis, which had made her incapable
of almost any movement in the hands and arms. After a
course of the baths she can now feed herself, and is
certainly wonderfully better.
W. D. WATERHOUSE, B.A., LL.D., L.R.C.P.I., etc.
CASE 14.
Treated at the Royal Portsmouth Hospital. Under the care
of MR. D. WARD COUSINS, F.R.C.S., President of the
Council of the British Medical Association.
Miss M. suffered from rheumatoid arthritis for some
years, being a complete cripple. Knees and elbows stiff',
and considerable deformity of the hands, especially the
left, which is distorted and useless, the fingers being all
flexed and stiff, and any attempt at movement causing
severe pain. Unfortunately the patient was unable to
undergo full course of treatment ; but the results of treat-
ment after two applications of the cylinder were most
encouraging. The fingers became more movable and less
painful. The little and ring fingers, which had been abso-
lutely stiff' and rigid before the treatment, became pliant,
and could with perseverance be almost straightened.
T. H. BISHOP, M.B., C.M., House-Surgeon,
H. W. MORLEY, M.R.C,S., L.R.C.P.
CASE 15.
Mrs. E. N. G.; aged 31.
History. Synovitis right knee at 14, left knee at 18,
and right wrist at 21, after fall while skating.
Patient's joints, which had been gradually stiffening with
much pain during pregnancy, became much worse after her
confinement, and left patient entirely crippled and confined
to her couch.
Patient states that notwithstanding she availed herself
of the advice of several eminent physicians, the disease
made rapid strides, and last February found her with both
elbows rigidly fixed at an angle of 45, unable to raise her
hand to her face. Jaw very stiff, hardly able to chew;
both hip-joints rigid, knees also, with inversion and rotation
of the left leg. The thumbs were rigid, and there was no
movement at the wrists, and the phalanges bent, so that
Rheumatic Arthritis. 29
the hand looked like a bird's claw through the rigidity of
the fingers. She was absolutely helpless, and reduced to a
skeleton through pain and want of sleep. Most violent
palpitation of the heart, with frequent diarrhoaa.
The patient, who is evidently of a highly neurotic
temperament, then adopted the Salisbury treatment, and at
the end of nine months exhibited marked improvement in
her joints and condition, the patient digesting well and
thriving.
The case was then considered to be one of those which
might be treated with advantage by the superheated dry-
air cylinder, and a course of twenty baths was prescribed.
After which, on examination, it was found patient's knees
had extended, and were no longer rigid in one position.
The hips are quite flexible, the patient being able to sit on
her bed and swing her feet backwards and forwards. She
can grasp the head of her bed over her head, do her own
hair, hold and raise a cup to her lips. She is bright and
cheery, and looks forward with hope to having the power
to walk restored to some extent.
The local hot-air baths have quickened her movements
and markedly relieved general pain ; they have improved
her sleep and digestion, and rendered possible the move-
ment of joints which appeared absolutely rigid.
Temperature in this case varied during the application
of the bath from 99'8, after fifteen minutes, to 100'4,
temperature at commencement being normal.
Since returning to the country the patient reports her-
self as much better, and that her muscles are steadily
increasing in power and freedom of action. She is able
to sit up for meals, which she has not done for three
years.
ARCHIBALD KEIGHTLEY, MJX, L.KC.P.
CASE 16.
Miss N. M. ; aged 2-i.
History. Always weak health ; never as strong as the
other members of her family, who enjoyed good health.
Father not alive died of consumption.
No trouble with joints till aged 17, except slight stiff-
ness during school life. Nothing noticed until after a
dance, when there was great muscular stiffness and some
swelling of the joints. Power of movement gradually
diminished. Last winter caught cold, which developed
30 The Tallerman Treatment.
weakness in lungs ; this was associated with some degree
of anaemia. Went to Kiviera, where the joints became
decidedly worse, and there was no special improvement in
the lungs.
Condition in May, 1894. Lungs, considerable cough (no
bacilli), no cavity ; some dulness over middle sub-clavicular
region on left side. Right ankle stiff', swollen, and painful.
Right knee almost rigid, swollen and painful, especially at
night. Patella apparently fixed by fibrous anchylosis. This
knee was the size of a small cocoanut. Hip is free. Left
knee could not be fully extended. The tendons at the
inside are rigid and painful, and patella moved very stiffly,
with pain on attempting to move it. The swelling was
slight, though on each side of the patella there was a
' doughy ' feeling on pressure. Left hip free. Shoulders
are both free. Both elbows stiff' and rigid, very slight
swelling. Wrists are enlarged and stiff. Thumbs are stiff'
and painful. All phalangeal joints are slightly enlarged
and flexed. Strictly dieted on meat, very little bread and
a little fruit. Oil and a little cinchona.
October 3, 1894. General health greatly improved.
Less pain, better digestion and sleep. Right knee less
swollen and painful ; rather more pain in left knee ; the
wrists also were reduced, but the power of supination and
pronation had much diminished.
Patient was then advised to take the Tallerman treatment,
and a course of twenty baths was taken.
Though of a very neurotic temperament, the patient has
received much benefit. Almost all the power of pronation
and supination has been restored to the right arm. The
right elbow is much less stiff', and moves with fair freedom
throughout. The left elbow is less stiff, but pronation and
supination only slightly improved. The phaJangeal joints
are free, though still slightly swollen. The ankles are free.
The right knee, though stiff', can be flexed and extended, and
the patella is freely movable. The removal of swelling is
especially marked in the case of the right knee. The left
knee is much more free, very much less painful, and the
swelling has almost disappeared. The knees are most
markedly improved the moment they are subjected to the
hot air. If they are flexed and pain is found on extending,
ten minutes' treatment enables them to be almost entirely
extended without pain.
Rheumatic Arthritis. 31
Great difficulty was experienced with this patient because
the action of the skin on both legs was almost entirely
absent. Since this action has been restored, the beneficial
effect of the treatment has been much more marked on the
knees. There was no difficulty in this respect as regards
the body and arms, the joints of which received marked
benefit from the first.
The patient, who for three months had been unable to
even stand, is now able to walk several times across the
room with very little support.
The baths have also had considerable effect in improving
the condition of the left lung.
Temperature, always normal at first, varies from 99'4 at
commencement to 100*2.
ARCHIBALD KEIGHTLEY, M.D., L.R.C.P.
CASE 17.
Miss C. C. ; aged 54. Suffering from chronic rheumatoid
arthritis. All joints affected except the temporo-maxillary,
and all those affected rigidly fixed except the left elbow,
which is freely movable, and the right elbow, which admits
only of limited extension and flexion.
This condition is the outcome of twenty years' suffering,
the first onset being an attack of acute rheumatism, from
which only a partial recovery was made, succeeded at a
short interval by a second attack, from which time more or
less pain has always been present with a subacute exacer-
bation from time to time, and the loss of function of one
or more joints till now. The above condition of utter help-
lessness has been reached attended always by a constant
gnawing pain, increased to acute agony when any move-
ment- whatever is attempted.
A trial was made on November 19 of the Tallerman local
and superheated dry-air treatment, the right arm being in-
serted, whilst the rest of the body was wrapped in blankets.
The operation occupied one hour, during which the pain
almost entirely disappeared. There was a general profuse
perspiration, having a pungent characteristic odour. The
temperature of the body as taken in the mouth gradually
rose from 98'2 to 100 C . Pulse rose from 96 to 116.
On the arm being drawn from the bath there was some
passive movement in many of the smaller joints of both
hands and more freedom of movement in both elbows, the
right now admitting of some degree of pronation and
supination, whilst that of flexion and extension was in-
creased.
32 The Tallerman Treatment.
A good night was passed, and next day the patient said
that she was ' much lithesomer,' and was able to stand
without support, whilst her attendant said that she was
lighter to lift and very much easier to nurse.
Some improvement accrued after each bath, which was
most noticeable in the feet and legs, the latter, before
operations were begun, being rigid and firmly approxi-
mated to each other, whilst after the fourth bath they
could be separated at the ankles to the extent of ten
inches.
The temperature was carefully taken in the mouth every
fifteen minutes during the bath, and found to rise uniformly,
one degree in the hour, and to fall to normal after the
operation had been completed ten minutes.
Unfortunately, it was only possible to treat this patient
four times, as Mr. Tallerman, who was good enough to
superintend the operations, was prevented by his engage-
ments from prolonging his stay at Southport.
J. G. G. CORKHILL, M.B., L.RC.R, etc.
CASE 18.
Miss E. R. ; aged 21 years. No family history of rheu-
matism or allied diseases.
1890. In 1890 first contracted disease in Germany.
Returned to England and underwent a course of treatment
at Buxton. Got much worse, and was unable to walk.
Wintered in Manchester. Adhesions in right elbow and
one finger-joint broken ; no passive movement was per-
formed after operation.
1891. Went to Aix-les-Bains ; took waters and baths;
slight temporary improvement.
Spent summer in Liverpool ; treated by splints ; got
worse ; mamy joints fixed.
Spent the autumn at Grange-on-Sands ; got rapidly
worse.
In December went to Egypt ; slept in damp bed on
board ship ; arrived in Alexandria in agony with sciatica
and pain in various joints.
1892. Stayed in Alexandria two to three months.
In April went to the sulphur baths of Helouan, near
Cairo, for one month ; slight improvement. Returned to
Cairo ; stayed two months ; got worse again, and was
unable to move or to sleep except in one position in a
chair.
Rheumatic Arthritis. 33
In August returned to Europe ; took another course at
Aix-les- Bains ; stayed till end of September ; got weaker,
however, and was crippled in almost every joint.
In October returned to England. Dr. G. saw her at
Charing Cross Hotel, and pronounced her case perfectly
hopeless.
1893. Underwent a course of special diet.
1894. In January I first saw Miss E. R. at Brighton,
and heard that her bodily condition had greatly improved
under the special diet, that she had gained flesh, and was
comparatively free from pain.
On examination found the following joints affected :
Right knee still enlarged, and leg flexed on thigh at an
angle of about 130. Left ankle firmly fixed ; also right
hip, the thigh being rotated inwards and adducted so that
the left knee rested on right thigh. The fingers of both
hands all more or less fixed and deformed. Left wrist
quite stiff'; right wrist partially so. Right elbow quite
fixed at an angle of 90 ; left elbow allowed slight move-
ment. There was decided tilting of the pelvis, the right
brim being nearly four inches below the left, and there
was double curvature of the spine.
In February, under an anaesthetic, broke down adhesions
in left hip.
This was followed by intense pain, resembling sciatica,
for a fortnight. Passive movement was commenced on
second day, but accompanied by great pain.
Movements by no means free, and I broke down more
adhesions under gas. This caused a renewal of the pain
for a few days, but the result was fairly satisfactory, as the
legs could now be separated ; there was considerable power
of flexion and extension, the tilting of the pelvis was much
lessened, and the curvature of the spine almost dis-
appeared.
Miss E. R. returned to Brighton, and remained there
until October, during which time she greatly improved.
In November, patient commenced the first course of
treatment under the Tallerman localized and superheated
dry-air treatment. After two preliminary baths to the left
arm, I operated on November 26 on the elbow and other
joints, and loosened as far as possible the adhesions, paying
most attention to those about the elbow-joint.
As soon as the patient recovered consciousness she com-
plained of great pain, but this was quickly relieved when
the arm was placed in an apparatus ; and after forty
3
34 The Tallerman Treatment.
minutes' treatment, the arm was taken out and passive
movement permitted.
The treatment was continued every day for ten days at
temperatures first of 230 F., afterwards 240 and 250, and
finally at 260.
At no period did the patient experience any pain or un-
comfortable sensation from the high temperature.
As the hip-joint had again become rigid although in a
better position than formerly I prescribed an interval of
rest, to ascertain the permanency of the benefit derived
before subjecting the patient to further treatment.
1895. After five months and a half, I found that the
condition of the elbow was extremely satisfactory, the
patient being able to move her arm freely and without
pain, and could lift a weight of 35 Ib. I therefore deter-
mined to try the effect of the treatment on the hip.
On May 16 and 18 patient had two preliminary baths
before operating on the hip, which was now almost rigid
again and strongly adducted, and the left pelvic brim was
about 2 inches higher than the right.
On May 20, assisted by Drs. Hewitt and Bolus, I broke
down (with considerable difficulty) the adhesions until per-
fectly free movement was capable of being made in every
direction.
On recovering from the anaesthetic the patient was
placed in the pelvic apparatus, the temperature being
gradually raised from 170 to 235.
The patient complained of very little pain only of
aching and after treatment in the apparatus for fifty
minutes I was able to perform all the movements I had
previously done under an anaesthetic.
During the night the patient had very little pain, and on
May 21 had another bath, after which passive move-
ments more rapid than on the previous day were per-
formed.
The patient had a restless night, but this was most
probably due to the catamenia, which appeared on the
morning of May 22. The patient could not therefore have
a bath, but she was able to move her limb in every direc-
tion without pain.
The case is still under treatment.
F. A. BARTON, M.RC.S.
Rheumatic Arthritis. 35
CASE 19.
Mr. P. R. Composer and pianist.
October 9, 1893. First consulted by patient, and found
him suffering from rheumatoid arthritis.
History. In 1891, the disease attacked the shoulders,
elbows and hands ; two years later the knees and ankles
became involved, the knees being extremely painful at all
times aud prevented patient sleeping at night.
Prescribed iodide of potassiun and usual drugs, and on
October 12 consulted Dr. Gower, who approved of the
treatment. Continued same until October 25, with little
benefit, when, on the advice of Dr. Gower and myself, patient
went to Bath for about one month. He derived practically
no benefit, and then proceeded to Aix. After undergoing a
course of treatment at Aix he returned no better, being
unable to walk without extreme fatigue, the walk itself
being really a limp attended with considerable pain. On
March 20, 1896, the disease having made great progress, the
case was considered one in which the Tallerman treatment
should be tried.
On Examination, it was found that the left knee was
very stiff, greatly enlarged, and painful on any movement ;
both ankles, shoulders and elbows were slightly swollen
and painful ; left elbow slightly contracted, left wrist stiff',
and painful when flexed.
Right hand. The fingers were abducted, typical of the
disease ; and although they could be flexed, the span was
limited, owing to contraction of the palm and effusion over
the back of the hand.
Left hand. Fingers were contracted at middle joints,
some effusion over third joints. The power in both hands
was very limited. Patient had been for some time quite
unable to follow his profession of pianist.
After the first operation it was found that the knee
was reduced three quarters of an inch in circumference,
also that it was less hard, and patient reported that
he experienced less pain on movement, especially when
walking.
After the second operation patient was able to walk a
short distance without any pain, and when 'that distance
was exceeded the pain was less severe. Patient also stated
that he felt he had derived more benefit than from the
lengthened and varied treatments he had previously under-
gone.
After the fourth operation patient reported that he
3-2
36 The Tallerman Treatment.
had walked a quarter of a mile without pain. The hands
were considerably improved, there being less contraction,
less pain, and greater strength.
After the eighth operation the knee exhibited consider-
able improvement as to shape, and there was a further
reduction in size in both knee and ankle. As is usual
under this method of treatment, the other joints, although
they had not been operated upon, had participated in the
benefit : they were smaller and almost free from pain.
Patient again expressed his satisfaction with the Tallerman
treatment. The hands were now almost normal in shape,
with increased strength; the other joints continued to
improve.
On May 8 the treatment ceased. Patient walked
without pain, his general health had been much benefited,
and he was again able to follow his profession of pianist,
which he had been unable to do for some time.
Patient was treated twenty times between March 20 and
May 8, 1896, at an average temperature of 260 F., reaching
on some occasions 300 F.
An active condition of the skin was induced and
maintained, which materially aided in the recovery.
The average clinical temperature taken in the mouth
(before treatment commenced) was 98 to 98*2, and it was
usually raised during treatment to 100'2. Pulse beat
before treatment commenced about 92 to 96 ; in about
fifteen to twenty minutes it would be found fuller, firmer,
and somewhat accelerated, generally to about 112 to 116.
June 18, 1896. Patient called and reported that the
improvement had not stopped with the cessation of treat-
ment, but had continued, and that there undoubtedly was
an increasing improvement since May 8, when he had
discontinued it. He walked more firmly and without pain,
slept well, and had gained in weight ; he stated also that
his general health had been much improved by the treat-
ment. Patient, who before treatment had been unable to
accept professional engagements, and was looked upon as
hopelessly incurable, expressed his great desire that the
success of the Tallerman treatment in his case might be
made known.
(Signed) L. CROSS, M.D.
Rheumatic Arthritis. 37
CASE 20.
Rheumatoid Arthritis, with Chronic Albuminuria ; tivo
years. Mr. A., aged 54, confectioner.
History. In 1894 patient's kidneys were severely
affected, and he was confined to bed until the summer
(1895), when he improved, and was able to get about until
the return of the cold weather. Rheumatoid arthritis
developed during this illness, involving several joints,
especially the right knee. The progress of the disease was
so marked, and the influence of drugs so unavailing, that
the case was considered to be one in which the treatment
by the Tallerman Localized Hot-Air Bath might well be
tried.
February 5, 1896. On examination it was noted that
the right knee was very much swollen (particularly on
the inner side), slightly contracted, and extremely painful ;
patient walked with great difficulty ; has at times con-
siderable effusion over the ankles and feet. The right hand
was almost powerless, some of the joints were enlarged, and
he was not able to flex the fingers to the palm, nor raise a
cup to his lips ; left hand not so powerless, and could close
it; right elbow contracted with 'cracks' on movement.
There was chronic albuminuria.
After the first operation the right knee was ex-
tremely painful when moved before it was placed in the
cylinder, but afterwards I was able to move it freely
without causing any pain up to a certain point, and when
moved beyond that the pain was only slight. I thought
the improvement in the joint was most marked.
After the second operation joint much improved.
Patient reported that he could move limb better in bed,
and slept better.
After the fourth operation it was noted that the knee
was more flexible, and had a wider range of movement ;
the right hand was much steadier, and patient was able to
lift a glass to his lips easily.
After the fifth operation there was some amount of
improvement in the condition of the kidneys.
Patient has had an attack of gout over top of right foot,
the pain of which was greatly relieved by the bath. This
acute attack appeared to have been caused by the elimina-
tion of morbid products from the knee ; these products,
when dissolved out by the hot-air bath, would be eliminated
through the skin and the kidneys, and if these organs
88 The Tallerman Treatment.
cannot act freely and rapidly, the uric acid must settle
elsewhere.
The general improvement in the affected joints con-
tinued ; and after the tenth operation it was noted that the
right knee had decreased in size one and three-quarter
inches ; there was great mobility and wider range of move-
ment, with considerably less pain. The hands were more
flexible and stronger, and patient's general health was greatly
improved ; but he was still unable to walk by himself.
Skin acted well throughout, and there was copious per-
spiration.
The patient was treated ten times, the last occasion on
March 20, each operation averaging forty-five minutes.
Average temperature attained 240 F. It will be noted
the body temperature was raised on each occasion, and the
pulse beat was accelerated.
BODY TEMPERATURE. PULSE BEAT.
^-
Before
Treatment.
99-0 F.
98-0
98-2
99-0
100-0
99-0
98-2
98-2
98-0
98-4
Remarks.
The most notable circumstance in connection with
Mr. A.'s case has been the marked and rapid diminution
of size of the affected joint under the hot-air treatment.
The improvement in the general health has been notice-
able also, but the subsidence of the disease implicating the
kidneys has not continued. There is still albumin in the
urine, but it is not so much as before treatment.
After the tenth bath Mr. A. was put on an alkaline
alterative mixture, containing potassium iodide and potas-
sium bicarbonate. This seemed to clear out of the system
the morbid products which had been thrown out of the
knee by the influence of the hot-air cylinder.
Mr. A. was treated by the Tallerman Hot-Air Bath for
the tenth and last occasion on March 20. The improve
After
Treatment.
Before
Treatment.
After
Treatment.
99-8 F.
100
108
99-2
84
92
99-6
88
100
100-2
96
100
100-6
80
100
100-0
100
108
99-6
100
108
99-4
88
96
99-0
100
106
99-2
88
92
Rheumatic Arthritis. 31>
ment had not alone been maintained, but had steadily
increased, and he now, and for weeks past, has been able
to walk up and down stairs, to dress himself, and to see
after his business affairs, things which he had not been
able to do for many months.
H. V. KNAGGS, M.D.
CASE 21.
K. B. ; 43. Unmarried.
I have attended this lady for occasional attacks of
bronchitis during the last two years. At my first visit I
was much shocked at her miserable condition ; her head
was fixed almost to the left side of the chest quite fixed,
so that she could neither move it nor bear it to be raised at
all ; her elbows were fixed firmly at right angles ; her
hands, resting on her abdomen, were painful, joints en-
larged ; fingers were of various abnormal shapes, some of
the joints dislocated, the ring-finger bent backwards from
the first metacarpal joint ; the knees were swollen, and
very painful on the slightest movement the poor creature
was, in short, rolled up almost like a ball. She was a very
intelligent person, and conversed with me quite cheerfully.
The rheumatism attacked her more than twenty years
ago, but more severely in Jubilee year (1887). With the
exception of a slight amelioration in 1890, she has got
steadily worse. She has -not been able to bear her feet on
the floor since 1890. This was a case where medicines of
all kinds had been tried, change to various places Buxton,
etc. without benefit; an incurable person, generally
suffering pain.
On November 16 last I managed with much difficulty to
place one of the legs in the hot-air bath. She could not
bear more than 220. Next day she told me that she had
been more free from pain, and decidedly easier than she
had been for a long time. I gave her a bath daily till the
21st. After the fourth bath she raised her left hand to her
head ; she could raise her head and look up to the ceiling.
This she had not been able to do for years. Three years
ago her father carried her into the garden to look at a
beautiful star, but it was quite impossible for her to see it.
After fifteen baths the highest temperature that could be
borne was 240 she could raise both hands above her
head, reach things she wanted from the table, and open
the hands, which previously had been so contracted that it
was scarcely possible to see the palms. Also she could
40 Tfie Tallerman Treatment.
now lie nearly at full length on the sofa, and with the help
of two persons she could walk across the room, and she
could stand with one person supporting her on one side ;
she can turn herself in bed as she wishes ; for years past
she had to awake her sister several times every night to
move her.
All rheumatic pains quite disappeared after the first few
baths ; and when I saw her on the 26th inst. there had
been no return, and she told me she was daily improving
in her physical powers.
(Signed) W. J. HODGSON.
CASE 22.
Treated at the Union Hospital, Cork. Under the care of
DR. W. ASHLEY CUMMINS.
K. M. ; aged 19. Nurse.
Chronic rheumatoid arthritis ten months. Admitted to
Union Hospital October 28, 1895, and having been pre-
viously under treatment at the South Infirmary, when she
took her discharge, her case being considered incurable.
Both elbows, wrists, and most of the joints of the fingers
were affected, as also the left knee and both ankles.
Patient has been under hospital treatment for six months.
On examination the affected finger-joints were found
to be enlarged and painful, and the movement was greatly
limited, so that the patient could not flex the fingers on the
palm. Left knee was found enlarged and painful, and the
movement of flexion limited. Right knee the patient
describes as having been enlarged and painful about five
months ago, but the swelling has completely subsided
under hospital treatment, she is now free from pain, and
can freely flex and extend the joint. Both ankles are
swollen, and the patient cannot stand without aid.
This patient was first treated in the Tallerman super-
heated dry-air apparatus on December 3, her right fore-
arm being placed in the hot-air cylinder for forty minutes ;
during that time her temperature rose half a degree, and
she perspired freely ; when the forearm was taken out it
was covered with perspiration, and the skin presented a
mottled bright-red appearance.
The average temperature of the hot-air bath during the
operation was 260.
Result. After the first sitting, it was noted that the
Rheumatic Arthritis. 41
pain was very much less, and that the affected joints
showed signs of marked improvement, the various move-
ments being considerably freer.
After the second operation duration seventy minutes
when the left forearm was submitted to treatment in the
hot-air cylinder, I was able, with a little force and without
causing much pain, to completely extend the forearm,
which before had been fixed at an angle of 130. She can
now move the affected joints much more freely.
The patient was comfortable throughout both operations ;
the second was carried on over one hour, when the patient,
hearing that it was to be the last, owing to Mr. Tallerman's
departure, expressed the desire that it might be continued.
It was noted that the joints other than the one sub-
mitted to treatment showed the same general signs of im-
provement. After the second bath I found the patient
could stand without aid.
(Signed) T. J. MURPHY, M.B.
CASE 23.
Treated at the Livingstone Cottage Hospital, Dartford.
Under the care of T. F. CLARKE, M.D.
E. W. ; aged 58. The disease commenced eighteen years
ago, the left hip being first affected ; pains in most of the
other joints quickly followed, and were gradually accom-
panied by swelling and stiffness. The joints became
enlarged in the following order : Wrists and hands, twelve
years ago ; left kuee and both ankles, ten years ago ; right
knee, six years ago ; both elbows, three to four years ago ;
and both hips, two years ago.
On examination patient unable to stand, there being no
power in either thigh ; both knees enlarged, especially the
right; both legs slightly flexed, inability to straighten
them or to flex them beyond a few degrees ; ankle-joints
enlarged and give pain on movement; hip-joints slightly
swollen and very painful on movement ; wrists and meta-
carpo-phalangeal joints much swollen and very stiff;
fingers slightly flexed and very stiff'; elbows slightly
swollen, but movement free both here and at the shoulders ;
movement of lower jaw now and then causes crackling.
This examination was made on March 18, 1896, and the
patient's right leg was then placed in the hot-air cylinder,
that leg being the most painful and stiff.
42 The Taller man Treatment.
Temperature of bath at commencement ... 150
Patient's temperature ... ... ... 97
pulse 96
After fifteen minutes.
Temperature of bath ... 180
Patient's temperature 98'6
,, pulse ... ... ... ... 105
At the end of thirty minutes.
Temperature of bath ... ... ... 200
Patient's temperature ... ... ... 98'8
,, pulse 112
At the end of forty -Jive minutes.
Temperature of bath ... 210
Patient's temperature ... ... ... 100
,, pulse ... ... ... ... 116
The patient's leg was taken out at the expiration of
forty-five minutes. During the latter part of the time she
perspired fairly well, but not profusely ; the pulse, though
quickened, was quite regular, and was fuller and firmer than
at first.
On again examining the patient the right leg could now
be all but straightened without pain, there was much freer
flexion of the knee-joint, and the hip-joint could also be
moved to a greater extent and with but little pain. The
ankle-joint now caused no pain on movement. The left leg
was also much improved in all its movements, and a similar
improvement was noticeable at the wrists and finger-
joints.
The patient could also with a little assistance bear more
weight on her feet.
Further applications of the bath were made on March 20,
23, 26, and April 5, 9 and 13. It was noticed that with
each application it was necessary to lower the temperature
of the bath ; the average duration of each bath was about
forty minutes. The limb inserted never perspired freely.
Since this treatment with the hot-air bath was adopted
the patient has been able to move all her joints much more
freely, and the swelling of the knees, wrists and hands has
subsided to a marked extent. She is also able to stand,
though not to walk without assistance.
I would observe that this has been a very extreme case
Rheumatic Arthritis. 43
with which to test the value of this form of treatment, but
so far the results have been most promising ; and although
a cure could scarcely be expected, one might reasonably
rely on still greater improvement following further applica-
tions of the bath.
September 5, 1896. Since the baths were discontinued
the patient has undergone a course of massage. This has
not effected any marked improvement, but at all events has
prevented her going back in any way.
I am firmly of opinion, and this is backed up by the
patient's own feelings, that further applications of the bath
would have brought about considerable improvement in all
the symptoms.
CASE 24.
Treated at the Children's Hospital, St. Michael's Hill,
Bristol, at a Demonstration.
M. A. S. ; 64. Well-marked polyarticular rheumatoid
arthritis of twenty-five years' standing. Movement limited in
all the joints of left arm and hands. Can just raise hand up
to head. Right arm, cannot move elbow-joint, cannot close
hand. Has great pain in the joints, especially at night, and
cannot sleep in one position for any length of time.
First bath, May 12: temperature, 220; duration, forty
minutes.
Patient's temperature : before bath, 98 ; after, 100.
Patient's pulse : before bath, 80 ; after, 120.
May 13. Said she had had a better night than for many
years. The bath had completely relieved her pain ; she
could move her hands better, and her feet were also easier.
Second bath : temperature, 250; duration, thirty minutes.
Patient's temperature : before bath, 98 ; after 100.
Patient's pulse : before bath, 70 ; after, 82.
After the operation she could close her hand much
better, and it was perfectly easy to apply passive movement
without giving pain.
E. C. WILLIAMS, M.B. Cantab.
CASE 25.
Treated at the same Hospital as the Preceding.
S. S. ; 47. Well-marked rheumatoid arthritis of both
hands, elbows and shoulders. Could not extend her
elbows. Had a good deal of pain.
44 The Tallerman Treatment.
One bath : temperature, 240 ; duration, thirty - five
minutes.
Patient's temperature : before, 99'6 ; after, 100'4.
Patient's pulse : before, 102 ; after, 128.
She said next day the pains were quite abolished by the
bath ; she was able to sleep, and could move her fingers
better. In both the above cases the patients were most
emphatic in their statements as to the abolition of pain after
the bath. They also said that the other joints were
rendered more supple.
E. C. WILLIAMS, M.B. Cantab.
CASE 26.
Treated at St. Mary's Hospital, London, W. Under the
care of MR. HERBERT W. PAGE, F.R.C.S.
W. H. ; employ^ G.W.R. The patient was a man who
had rheumatism of many joints after exposure to cold ;
one knee was left swollen, painful, and crippled, and the
patient was confined to his bed.
On November 14, 1894, the patient was first treated in
the hot-air bath for forty-five minutes at 220 F.
On the 17th he stated that he was 'decidedly better,'
and he was discharged after further treatment on several
occasions ; he expressed himself as having been distinctly
benefited by the treatment.
CASE 27.
Treated at the Hospital for the Ruptured and Crippled,
New York. Under the care of V. P. GIBNEY, M.D.
Chronic Rheumatoid Arthritis, already improving under
Massage and Traction. A lady, 45 years of age, came under
my care May 18, 1896. It was in 1890 that her disease
began, and the knees were stiff and painful almost from the
beginning. She had patronized several of the baths in the
United States, with a slight amount of relief, during the
earlier years of her disease. It is only fair to state that
from July 1 to November 27, 1896, a vast deal had been
accomplished in the way of correcting her deformity at the
knees, and in getting some use of her right elbow and of
both hands. In addition to massage and traction she had
taken large doses of potassium iodide. From July 29 to
October 28 she was in solid plaster of Paris bandages, with
Rheumatic Arthritis. 45
knees extended to about 155. When we began treating
her in the Tallerman apparatus her range of motion was
from 130 in flexion to 170 in extension. She had been
able for one or two months to use her hands in feeding
herself, after a fashion, and even in adjusting her hair ; but
the thumbs and fingers were so distorted that she was
unable to use the third, fourth and fifth fingers at all, but
with the index-finger and the thumb she managed to grasp
objects. Heretofore, whenever any attempt had been
made to move the hands or fingers, rather violent reaction
had set in, and it had been necessary to discontinue. She
was subjected to this treatment on May 27. Her tempera-
ture was raised 0'2, her pulse only 5 beats. After this
bath she had gained very little, if any, in motion. At
present writing she has had four baths, of a temperature
ranging from 240 to 260 F. The bodily temperature has
been raised less than a degree. She has expressed herself
as being very comfortable. Profuse diaphoresis occurs,
and for the last two mornings I have employed passive
motion of the thumb and fingers without producing any
reaction and very little pain. She winces when I break up
little adhesions, but tells me that the pain soon passes oft',
and not only her knees are becoming more flexible, but her
hands as well. There has been very little, if any, gain in
the extensibility of the legs. She will probably need
breaking up of adhesions under an anaesthetic.
CHAPTER III.
RHEUMATISM.
IN this chapter thirty-four cases of acute, subacute and
chronic rheumatism are given from various sources. Most
of them are of the chronic type, with involvement of the
joints. These have naturally come under treatment more
frequently than the acute forms, because they are regarded
as test cases, in which the ordinary remedies have been tried
and failed. On that account they particularly illustrate the
value of the superheated dry-air method, which has been
resorted to as a last resource, and has succeeded where
everything else had failed. But there is good reason to
believe that if it were tried more often in the earlier and
in acuter stages, patients might be saved from the chronic
condition altogether. A good many of the cases are quite
indistinguishable from rheumatic arthritis, and might have
been included under that head ; but it has been thought
better to classify them according to the nomenclature
adopted by the medical gentlemen who have treated them,
and are responsible for the case-notes.
CASES 1-7.
Treated at the North-West London Hospital, and at the
Tallerman Treatment Institute, 50, Welbeck Street.
Under the care of DR. KNOWSLEY SIBLEY.
CASE 1.
The patient was a girl, aged 26, single. Her mother
suffered for fifteen years from rheumatism, and her father
died, aged 56, from kidney and heart troubles; her maternal
great-grandfather also suffered from rheumatism.
Rheumatism. 47
History. Always well until about four years ago. She
suffered from amemia as a girl. The rheumatic affection
commenced gradually in the right little finger, then left big
toe, right knee, then the other fingers, and then hands and
elbows in succession.
In August, 1894, she went to Bath, and took the baths at
the Mineral Water Hospital, and was there seven months ;
she had baths and salicylate treatment. She became worse,
the right knee became contracted and fixed, so the baths
were stopped ; she had a series of colds, and the rheumatism
was worse. She returned to her home in Wales in April,
1895, then in many respects better; but shortly afterwards
she again relapsed.
By November, 1895, she had become much worse, and
was unable to open her mouth on account of rheumatism in
the jaw.
In January, 1896, she went to Brecon ; while there was
given colchicurn, salicylates, iodide of potassium, and tonics.
In September. 1896, she was sent to London for treat-
ment.
State on admission, September 30, 1896 : Patient had
used crutches for two years ; she was unable to walk up or
down stairs, to wash her neck, to put her jacket on or off,
or to do her hair ; she fed herself with a large spoon with
difficulty, as she could not get her hands to her mouth ;
she could only see the back of her hands, and was quite
unable to rotate the elbows. Pulse 72, regular ; no cardiac
bruit.
Hands. The middle phalangeal joints of both were con-
siderably thickened, the right little finger was deformed at
the terminal phalanx, wrists were thickened, and the hands
deflected outwards.
Elbows. Both were almost fixed at right angles, and
completely pronated ; there was little or no movement of
either flexion, extension or rotation.
Shoulders. Considerable grating in both ; movements
fairly free.
Right Knee. Anchylosed nearly at a right angle ; abso-
lutely no movement ; muscles of this leg and also of the
thigh much wasted ; the tip of the toes could just be placed
on the ground ; the limb was powerless patient could not
even raise it off the bed without assistance and there was
considerable thickening around the knee-joint ; but there
was little or no effusion. The tendons at the back of knee
were very rigid, tense and fixed. Patient was unable to
48 The Tallerman Treatment.
place this foot on the ground without the gutta-percha splint
round the knee-joint, and even then was unable to bear
any weight on this limb. The knee was very painful.
Left Foot. (Edema on dorsum. Pain on movement.
The first hot-air bath was given on October 1, the right
arm being placed in the cylinder.
On October 3, after the second bath, it was possible to
rotate the left elbow, so as to supinate the palm of the hand.
After the third bath the patient was able to see the palm of
her hand, which she had not been able to do for two years,
and also to touch her forehead with it.
On October 7, after the sixth operation, patient was
able to do her front hair, and there was now some more
movement of flexion and extension in the elbows.
On October 12, after the tenth bath, the patient was able
to walk a few steps without her crutches ; there was dis-
tinctly some movement in the right knee-joint, and she was
able to take a few steps upstairs.
On October 13, the right leg was placed in the cylinder,
and after treatment there was increased movement in the
knee-joint.
On October 14, the patient walked out of doors for an
hour, and on returning, walked upstairs with the aid of one
crutch.
By October 21 patient had had sixteen operations,
extending over twenty-one days. The movements of the
elbows and wrists were now sufficient to permit her washing
and dressing herself, including doing her hair ; she was also
able to feed herself with ease. All through the treatment
she had been practically free from pain, even in the knee-
joint, after one had forcibly broken down some adhesions.
These active movements had not been accompanied by any
effusion into the joint. Her general health had also greatly
improved. She has been taking a teaspoonful of the syrup
of iodide of iron three times a day, and some natural saline
water as a mild aperient when necessary.
On October 22 she had the eighteenth operation, and
was shown before the North- West London Clinical Society.
She could then put the right foot more firmly on the
ground.
By November 4 patient could walk round the room
without her crutches, with the help of a stick.
On November 6, after the thirtieth bath, she was shown
before the Harveian Society of London, and the movement
which was then to be seen in the knee-joint was demon-
strated (Lancet, November 21, 1896).
CASE 1. Before treatment : showing fixed position of elbows and inability to
flex same.
To face p. 48 I.
CASE 1. Before treatment : showing nearest approach of hands to mouth
when feeding herself.
To fact p. 4S IB
CASE 1. Before treatment : showing fixed position of leg.
To face p. 48 III.
CASE 1. After treatment.
To face p. 48 IV.
CASE 1. After treatment.
). 48 V.
Rheumatism. 49
On November 10, it being thought desirable to hasten the
increase of movement in the right elbow, patient was given
a little gas and oxygen, and the elbow forcibly flexed and
extended, and the same, to a less extent, was done to the
right knee. As soon as she came round the right arm was
put into the apparatus. She had little or no pain after-
wards, and passed a very good night. The next day there
was no effusion into either of the joints which had been
moved, and no pain about them. The increased movement
was with difficulty maintained on account of the wasting of
the muscles, especially of the biceps, through disuse.
On November 20 patient's condition had steadily im-
proved. There had been no rise of temperature or effusion
into the joints since the movement under the anaesthetic.
She left the home for a fortnight's change, and returned on
December 14, when she was able to walk up and down
stairs without her crutches or stick.
On January 4, 1897, after the fifty-fourth operation, she
walked out without her crutches, only using a stick.
On January 15 patient left for a convalescent home in
the Isle of Wight, where she continued to make steady,
uninterrupted progress. She remained till the middle of
April, by which time she could walk about without a stick
for four or five hours a day, and she had had no return of
rheumatism in any form.
The patient was also able to dress, undress, and, in fact,
do everything for herself, and no longer considered herself
a cripple or invalid.*
CASE 2.
Subacute Articular Rheumatism; Aortic Regurgitation ;
Psoriasis. On September 10, 1894, there was seen a married
woman, aged 19 years, with two children. The patient's father
was living, but suffered from chronic rheumatism and bron-
chitis. No other family history of importance was elicited.
She had had psoriasis on the knees and elbows since 7 years
of age, but had never been treated for it. She had rheum-
atic fever at 15 years of age, and again at 18 J years, compli-
cated with heart disease. She now had a subacute attack
of rheumatism, with much pain, especially in the right
shoulder and the left knee and leg. She looked ill, and
had an aortic diastolic murmur ; the heart was not much
enlarged. Salicylate of soda was prescribed and continued
to October 4. Not making much progress, and the patient
Medical Times and Gazette, May 22, 1897.
4
50 The Tallerman Treatment.
still suffering much pain and inconvenience, the hot-air
treatment was tried, the salicylates being omitted. On
October 4, the right shoulder was placed in the cylinder,
and the next time the left leg. On October 16, the pain
had nearly all gone, and she was able to run to catch the
tram, a thing she had been unable to attempt for weeks.
On the 22nd all pain had gone ; the psoriasis appeared to
be slightly more extensive. On the 25th she had had six
baths at a temperature of about 220 F., the duration of
each being forty minutes. The heat brought out an
irritable eruption, which, however, soon subsided. On
November 11, she had been quite free from rheumatism
since the previous date. After this she was for a time
under the care of an obstetric physician for some uterine
displacement. On November 7, 1895, there had been no
more rheumatism. The patient was rather anaemic ; the
condition of the heart and the psoriasis were much the
same. The pulse was 90. Strychnia and iron were pre-
scribed. On July 23, 1896, the patient said she had her
third child in May ; she was very ill during the greater part
of the pregnancy. She was now very pale and worried, the
infant being ill. The psoriasis was possibly not quite so
extensive as it was formerly. The pulse was 88. The
condition of the heart and the aortic murmur had not
changed. She had much dyspnoea on quick movement.
No more rheumatism had occurred. She was given
strychnia and iron.
CASE 3.
Chronic Rheumatism; duration eight years. The patient,
an unmarried woman, aged 61 years, came under notice on
October 29, 1894. She had had two attacks of rheumatic
fever some years previously. For the last eight years the
fingers, especially of the right hand, had gradually become
stiff. She continued at her work till a recent date, when
the pain and stiffness appeared in the right shoulder, and
she was unable to raise her arm, and so was discharged.
The right shoulder was very painful and more or less fixed ;
the right leg was also swollen and painful. There were
considerable deformity of the hands and enlargement of
the middle phalangeal joints and bones. She was given an
alkaline gentian mixture. On the 30th the right hand was
placed in the hot-air apparatus. On November 11 the
patient had had two baths, the right shoulder was much
freer, and there was less pain. She did not come to the
Rheumatism. 51
hospital again, and I have been unable to find out what
became of her.
CASE 4.
Chronic Rheumatism; duration ten years. The patient,
who came under treatment on June 6, 1896, was an
unmarried woman, aged 59 years. Her grandfather on her
mother's side died aged 82 years ; her father died aged 40
years, from a chill; her mother died aged 76 years, and
suffered slightly from rheumatism ; two sisters and two
brothers died from phthisis at the ages of 9, 15, 17, and
24 years respectively, and another sister died from cancer
of the breast aged 36 years. The patient had congestion
of the lungs when 20 years of age, and had suffered slightly
from bronchitis ever since. She had a mild attack of
rheumatic fever when aged 38 years, which was followed by
some left hemiplegia, from which she soon recovered. She
had rheumatic fever again when 50 years of age, and
another severe attack when aged 52 years. At that time
she was in bed for five months, and the heart was said to
have become affected. She had been a constant victim to
rheumatism ever since that time, the pains being especially
severe in the legs and feet. The patient had been obliged
to walk with a stick for many years. There was no cardiac
murmur, but the first sound of the heart was not clear. An
alkaline mixture was prescribed. On July 20, not getting any
better, she was ordered a superheated dry-air bath. After
the first bath all the pain had gone ; she was rather tired
the following day. On the 23rd she was much stronger,
the movements were freer, and she slept better. On the
24th there was a slight return of the pain in the left knee
and toes, and a second bath was administered. On the
27th she had had some pain all over her, but this became
better. After the third bath she could walk much better,
and could put her foot fiat on the ground, which she had
been unable to do for many years on account of the con-
traction of the toes. On the 29th there was some return
of the pain, which was relieved by another bath. On the
30th the patient reported herself well.
CASE 5.
Subacute Rheumatism ; Mitral Reyurgitation. On
July 9, 1896, a married woman, aged 32 years, was seen.
The patient's father suffered from rheumatism for many
years. She was the youngest of six, and the only one who
4-2
52 The Tallerman Treatment.
was rheumatic. She had rheumatic fever when 16 years
old, and was then in St. Bartholomew's Hospital for about
sixteen weeks. After this she was free from rheumatism
till two years ago, when she had two attacks of inflamma-
tion of the lungs, followed by a mild attack of rheumatic
fever, with which she was laid up for three weeks. After
this she went to Buxton. She felt better on her return, and
kept well till July 6 of this year, when she woke up in the
morning with pain in the feet and legs, and then it
extended to the arms and shoulders, and she became quite
crippled. The patient was anaemic, the pulse was 120, and
there was a faint systolic apex murmur. Salicylate of soda
and digitalis were prescribed. She continued under treat-
ment, but was not much better on July 20 ; there was still
a good deal of pain. The salicylates were stopped and
strychnia and iron prescribed. On July 21 the first bath
was given. She could not raise the left arm or close the
hands, she had had but little sleep at night for more than
a week, and she was very depressed in herself. After the
first bath the arm could be fully extended over the head
and the hands clenched, and all pain and feeling of
depression were gone. On the 23rd she was able to walk
home after the first bath, a thing she had not been able to
do since the commencement of the attack. She had now
had two baths, was quite free from pain, and also felt much
better in herself. On the 24th there was some return of
pain in the left shoulder ; she attributed it to having slept
in a draught and having eaten meat the previous day for
the first time. After another bath the pain again was all
gone. On the 27th she had a return of pain generally.
Salicylates were again prescribed. On the 30th the pain
had all gone except a little in the left shoulder. Strychnia
and iron were given, and salicylate of soda at night. On
August 6 she felt much better, the pulse was 80, she slept
well, but still had slight pain in the shoulder.
CASE 6.
Chronic Rheumatism. On June 15, 1896, a married
woman aged 61 years came under observation. Her
father's mother suffered from rheumatism. Her father
died at the age of 49 years from asthma. She had three
brothers and three sistevs living and well, and had lost
three brothers and two sisters, probably some of them from
phthisis. The patient had had six children, and her eldest
daughter suffered from rheumatism. The patient had
CASE 5. Subacute rheumatism, taken July 21, 1896, before treatment :
showing highest point arm and forearm could be raised, with pain.
To face p. 521
CASE 5. Subacute rheumatism, taken June 21, 1896. before treatment
showing inability to flex fingers on palm.
To face j,. 5211.
CASE 5. Subacute rheumatism taken June 21, 1896, after first bath : showing
full extension of arms and forearms and flexion of fingers without pain.
To face p. 52111.
Rheumatism. 53
never been confined to bed, but about a year and a half
ago she suffered from rheumatism in the knees and other
joints, and this had continued ever since. For the last six
months it had been getting worse. She had now to be up
some hours in the morning before she was able to use her
hands even to dress herself. There was no cardiac
murmur, but the pulse was rather small. All the fingers
and hands were swollen and painful ; there was marked
wasting of the muscles on the back of the hand. She was
given mistura guaiaci. On July 6 the patient was
becoming worse ; she was unable to raise the left arm and
the metacarpo-phalangeal articulations of both hands were
more swollen and tender. On the 21st the first bath was
given. The left shoulder was very stiff and the arm could
only be raised a very little, and she was unable to close the
hand. The pulse was very small and feeble. The right
arm and hand were placed in the cylinder, and after a
short time the pulse much improved in character, and in
fifty minutes the left arm could be fully extended, and the
hand closed without much difficulty. On the 24th there
was still some pain in the left shoulder, but otherwise she
was very much better. On the 27th she had had four
baths and was able to do a little work. On the 30th she
had had six baths. All the pain had gone from the hands
and the right shoulder, but she had occasional pain in the
left shoulder when in bed and the first thing in the
morning. Strychnia and iron were prescribed. On
August 6 all the movements of the fingers, hands, and
arms were quite free ; there was still some pain, or rather
what she described as ' numbness in the muscle ' of the left
arm ; she slept well.
CASE 7.
Chronic Rheumatism; duration six months. A man 59
years of age was seen on July 16, 1896. For six months he
had suffered from persistent pain in the right shoulder,
which prevented him following his occupation, as he was
unable to raise this arm above the horizontal. The pain
was worse at night and kept him awake. On April 15 he
went into the Greenwich Infirmary, where he remained till
June 2. When he came out he was very little better.
On July 16 he appeared to be in pain and unable to raise
his right arm above the horizontal. A hot-air bath was
given. On the 22nd he had had three baths. He reported
54 The Tallerman Treatment.
that he had had much less pain and had been able to do
some work. He had slept much better.*
CASE 8.
Treated in the Laennec Hospital, Paris. Under the care
of PROFESSOR LANDOUZY.
Subacute Rheumatic Fever ; Mitral Affection. B. T.,
23 years old. First (?) attack of rheumatic fever. Mitral
obstruction at first unnoticed. Pains generally subacute,
causing a relative powerlessness ; increased by pressure
and by the passive movements. After being treated three
times by the superheated dry- air method, the pains were
so much lessened that the patient asked to be allowed to
leave the hospital.
CASES 9-13.
Treated in the Philadelphia Hospital.
CASE 9.
Thomas Miles ; aged 50 ; birthplace, England ; residence,
city ; occupation, plasterer ; attending physician, F. A.
Packard ; resident physician, Raymond Spear.
Father died of dropsy. Mother died at age of 63 ; cause of
death unknown. Has seventeen brothers and two sisters, all
living. No history of rheumatism in family. Has had scarlet
fever and measles. Has had two attacks of jaundice. Had
great paroxysms of pain at those times. Has used alcohol
to excess. Had gonorrhoea twenty years ago. No specific
history. Has had frequent attacks of pain in his back.
The pain was sharp and shooting in character, very short
in duration. These attacks occurred about twice a week.
The pain did not shoot down into his groins or testicles or
penis. About four years ago was suddenly seized with a
sharp pain in his right hip. This pain lasted a month.
He kept on working, however. The pain gradually dis-
appeared. He was compelled to stop work for three weeks.
He then started to work again. He has been compelled to
stop work frequently. The pain was then felt in the
anterior portion of his right thigh, also in his back and
right knee. The pains were shooting in character and of
short duration. Has had frequent attacks in past four years.
Last autumn, 1895, was suddenly seized with a sharp pain
in his right hip and anterior portion of thigh. Pain short ;
* Cases 2-7 published in Lancet, August 29, 1896.
Rheumatism. 55
followed the course of the obturator and anterior crural
nerves. The man walks with a cane and has a decided
limp. Legs were swollen on admission, and he passed only
a small amount of urine at that time.
On November 19, 1896, was treated by the Tallerman
Localized Superheated Dry- Air Process for forty minutes.
The temperature was raised to 280. After the bath the
man discarded his cane and walked unaided. He said the
pain was all gone except a little in the outer side of his
right knee.
On November 20 the improvement in the case continued.
The only complaint was a slight uneasiness in the outer
side of his right knee.
The apparatus was removed from the hospital, and he
could not be given any further treatment.
CASE 10.
Timothy Bow ; coloured ; aged 48 ; barber by occupa-
tion ; born in North Carolina ; a resident of Philadelphia ;
father died of cause unknown ; mother died of apoplexy ;
had ordinary diseases of childhood ; had pneumonia ; had
rheumatism nine years ago ; had one attack of gonorrho3a ;
had malaria about five weeks ago. About October 1, 1896,
caught cold and had severe pain in back, also his right
hip. On admission to the Philadelphia Hospital the pain
in his back was intense. He could scarcely walk, and could
not even raise himself up in bed the day after admission
in fact, he presented all the symptoms of a violent attack of
lumbago. Was admitted on November 3. His condition
did not improve. On November 11 he was taken to the
College of Physicians and Surgeons, and treated before it by
the Tallerman superheated dry-air method, at a meeting
of the County Medical Society. The man when lifted upon
the bed groaned out with pain. At the conclusion of the
bath, which lasted forty minutes, the man got up from the
bed unassisted and dressed himself. He said the pain had
almost disappeared. He had been carried to the room
on a stretcher. He walked down to the ambulance un-
assisted and into the Philadelphia Hospital, and went to bed
unaided. On November 17 the man was discharged cured.
He had no return of pain after the hot-air bath. The only
complaint he made was that he felt a little weak, which was
probably due to his previous confinement in bed and his
loss of sleep before the treatment.
RAYMOND SPEAR.
56 The Tallerman Treatment.
CASE 11.
John Hogan ; colour, white ; aged 48 ; birthplace,
America ; residence, Philadelphia ; occupation, driver ;
attending physician, F. A. Packard ; resident physician,
Raymond Spear.
Father was killed ; mother died of old age ; had pneu-
monia on left side twice ; had malaria in 1863 ; had
typhoid in 1867 ; has used alcohol to excess ; had a
venereal sore in 1866 ; it was followed by no secondary
symptoms ; had an attack of rheumatism, involving right
shoulder and arm, in 1894 ; was exposed to weather on
September 22, 1896, and caught cold. Immediately
following exposure was taken with an acute attack of
rheumatism, involving left shoulder. The joint swelled,
became red, and was very tender and painful. At that
time he could not raise his right arm without great pain.
His condition improved up to a certain extent under anti-
rheumatic treatment ; then became stationary. The motion
in the joint was limited, and the joint was the seat of
constant pain. The pain was worse in damp weather. On
November 19 was subjected to the Tallerman treatment.
After the operation he could raise his arm above his head
and the pain had almost disappeared. A second bath was
given on November 18, lasting fifty minutes. Temperature
was raised to 310 F. The motion in the joint is perfect,
and he now has only a slight pain under his left scapula.
CASE 12.
Thos. Birmingham ; father died of typhoid fever ; mother
alive ; one brother and one sister living and healthy ; no
history of rheumatism or phthisis ; had malaria ten years
ago ; had scarlet fever and measles and typhoid ; had
gonorrhoea eight years ago ; two years ago had two venereal
sores, followed by no secondary symptoms, except a few
sores (?) in his mouth. He was told he had syphilis, and
took medicine for three weeks. Has had no secondary
symptoms since.
In February, 1896, his left knee swelled up and became
very painful. His left hip then became involved, then his
right elbow. The swelling and pain disappeared from all
his joints, except his left knee. This remained somewhat
swollen and painful ever since. He could bend his knee
only with great pain. The joints felt weak and the motion
Rheumatism. 57
was limited. On November 17 he was placed under the
Tallerman treatment for forty minutes ; temperature, 240
to 280 F. After half an hour the pain had greatly
lessened and the joint was more movable.
On November 18 was given a second bath, lasting fifty
minutes; temperature, 240 to 315 F. The pain almost
left the joint, and there was still more motion. On
November 19 was given a third bath ; temperature, 240
to 280, with the result that the motion in the joint is
almost perfect, and the pain has almost disappeared. On
November 20 the improvement was maintained.
CA.SE 13.
Andrew Cathcart ; native ; aged 46 ; single ; teamster.
Family History. Negative as far as present disease is
concerned.
Present History. Disease of childhood ; gonorrhoea at
20 ; used alcohol and tobacco to excess ; toes of both
feet frosted ten years ago, necessitating amputation of two
toes ; right ankle deformed from accident, in which a
carriage wheel twisted it.
In April, 1893, first noticed that he had pains in the
joints of the leg in motion. These began to swell. Then
later the tissues became involved ; the neck became stiff.
This pain persisted, and the fingers became clumsy. The
swelling in the joints continued to increase, and infiltration
of the tissues about the joint took place, which was greater
in the right knee. The joint presented a hard, indurated
feeling, rather sensitive to touch, and as the disease pro-
gressed there was a progressive loss of motion, due to a
fixation of both legs in a semiflexed position. These could
not be straightened out, and finally the patient was unable
to walk, or even to stand on his feet for more than a minute
and a half at a time. There seemed to be a feeling of weak-
ness and ' lack of confidence ' in both knees. The right
wrist was practically motionless, and the left wrist was nearly
so. Both these joints were thickened, infiltrated, and tender
to the touch, as were the knees. No cardiac involvement ; no
pulmonary or hepatic trouble. Persistent partial insomnia,
sleeping but one to two hours per night. After Tallerman
treatment, two applications of forty minutes each to left
leg (November 19 to 20, 1896), patient stated the following
morning that he slept well all night, as he has every night
since, and that his entire body feels easier, and with a
marked diminution of that ' malaise ' and feeling of tension
58 The Tallerman Treatment.
which formerly troubled him. The right wrist was slightly
reduced in size, but now there was no pain or tenderness.
There was an arc of motion of 1 J inches at finger-tips ; no
lateral motion. The same was true of left wrist, except that
the previous range of motion was increased, and now without
any pain.
The Knee. Left Knee: The relief here was marked. The
joint decreased from | inch to 1 inch in all its measurements.
The joint was softer. The tissue infiltration was diminished
in consistency, and there was lack of tenderness and pain
in motion. The leg, which before was fixed at an angle of
about 145, could now, with little effort, be stretched out
straight (80). The patella seemed to be more freely movable.
The knee seemed to feel stronger to the patient himself.
Right Knee. The improvement in this knee was not so
marked as the left knee, yet decided and considerable.
While the knee could not be straightened out, there was a
gain of 15 to 20 of motion. There was here, as in the
other knee, a softening of skin and tissues, with a diminution
of the consistency and lack of pain and tenderness. There
was, however, still a feeling of weakness left in this joint. For
the last three days the patient has been able to walk the
length of the hospital ward (thirty yards) with the aid of a
cane. Previous to this he had to be assisted from his bed
to the wheeling- chair by assistants. The improvement in
a case of such formidable appearance, and in which we were
able to do nothing to check the onward progress of its
course, is remarkable.
A. J. MCCARTHY, Resident Physician,
Philadelphia Hospital.
CASE 14.
Treated in South Charitable Infirmary, Cork. Under the
care of N. H. HOBART, M.B.
J. K. Had rheumatic fever, September, 1895 ; laid up
for seven weeks. Treated April, 1896. Pain in left ankle
and elbow and right heel. Had ten baths. After the
tenth he was perfectly well, free from all pain and stiffness,
both in foot and elbow, although his elbow had never been
inserted in the apparatus.
Rheumatism. 59
CASES 15-24.
Treated in the Liverpool Infirmary. Under the care of
DR. ALEXANDER.
CASE 15.
Robert D., aged 52, states he has been suffering from
rheumatism for three years, and his arms and legs have been
stiff and painful ever since the commencement of the attack.
Treatment by superheated dry air commenced July 29. This
patient had in all thirty-six baths, his highest temperature
during bath being 100'4, while the highest bath temperature
was 250. The bath was changed from arm to leg, and knee
to wrist, at the option of the patient. He had to be carried
to and from his bath until his nineteenth bath, when he was
able to walk back to his own ward. His last bath was on
November 19, and he left the hospital on the 21st, quite
cured of all pain and uneasiness, but some stiffness of joints
remaining.
CASE 16.
Annie E., aged 19, states about two months ago she
developed rheumatism in the knees and ankles, spreading
soon afterwards to the arms and wrists. She had vapour
baths, which had no appreciable effect. Tallerman treat-
ment by bath commenced July 13 ; had seven consecutive
baths, the baths alternating between legs and arms ;
patient's highest temperature during baths, 99*8 ; highest
temperature of bath, 225. Left hospital July 20 quite
cured.
CASE 17.
Michael T., aged 33, has been suffering from rheumatism
since the beginning of July, 1896, his knees being chiefly
affected. Admitted to this hospital August 5, and kept
under general treatment till September 17, when super-
heated dry-air baths were commenced. During early treat-
ment he had to be carried to and from bath. At
termination of sixth bath he was able to walk. He had
in all sixteen baths, his highest temperature during baths
being 100-4; highest temperature of the bath, 250. Left
hospital September 11, 1896, quite recovered.
CASE 18.
Isaac S. was always healthy until June, 1896, when he
had a severe attack of rheumatism. Was in hospital
abroad for three weeks, and, feeling somewhat better, came
60 The Tallei*man Treatment.
to Liverpool. Admitted to this hospital August 7, suffering
from a fresh attack on top of the old. Treated with sod.
salicyl., vapour baths, joints painted with iodine liniment,
but patient did not seem to get any better. Began Tallerman
baths August 20, 1896. Patient had fourteen baths, was
carried to first, second and third baths, but afterwards able
to walk ; his highest temperature in bath 100 ; highest
temperature of bath 245. His last bath was September 5,
when he was free from all pain, stiffness only remaining.
He was found dead in bed October 24, without any previous
complaint.
CASE 19.
John C. ; aged 35 ; admitted to this hospital October 19,
1896, suffering from rheumatism in right hand. His first
bath was on November 5, and the last November 19, having
had four baths. Highest temperature in bath 99 - 8 ; highest
temperature of bath 250. Left hospital November 21,
1896, quite recovered.
CASE 20.
Robert B., aged 45 ; admitted to hospital October 27,
1896, suffering from rheumatism, having had a previous
(and only) attack in the autumn of 1887. Rheumatism
confined to hands and knees. Baths commenced Novem-
ber 17, and ended December 14, having had ten baths in
all. Patient's highest temperature in bath 100'8 ; highest
temperature of bath 260. Left hospital January 6, 1897.
with only an occasional twinge of pain in hand.
CASE 21.
Thomas M.; aged 37 ; admitted to hospital, suffering from
rheumatism of both knees for twelve years. Had soda lotion,
etc., for three weeks, but only a slight improvement. Had
only four baths when he expressed himself cured. Patient's
highest temperature in bath 100 ; highest temperature of
bath 220. Left hospital December 8, 1896.
CASE 22.
John E., aged 42, states that he is suffering from rheuma-
tism of right leg, and has been so for two and a half years.
Admitted to hospital April 30, 1896. Bath treatment
commenced July 28, finished November 14, having had
twenty-two baths. His highest temperature in bath was
101 '2 ; highest temperature of bath 235. Left hospital soon
after last bath, feeling much easier and able to walk a great
deal better since commencing bath.
Rheumatism. 61
CASE 23.
Edwin B., aged 48, states he had a sharp attack of
rheumatism when 26 years of age ; six years elapsed before
a second attack, and he has never been free from rheuma-
tism since. Was treated at Bath Mineral Water Hospital,
and after six mouths was discharged apparently well. Has
been in this hospital three or four times, always with
rheumatism. Readmitted July 30, and Tallerman bath
treatment commenced August 17, 1896. He had eight
baths, and expressed himself greatly improved by treat-
ment. Patient's highest temperature in bath 100 ; highest
temperature of bath 256.
CASE 24.
Joseph J. C., aged 54, states he has suffered from rheuma-
tism since boyhood. A dmitted here June 26, suffering from
rheumatism, principally of hands. Baths commenced
August 29, and finished September 5. Had five baths ;
fingers better able to bend them freely. Patient's highest
temperature in bath 99*4 ; highest temperature of bath
235.
JOSEPH MAGUIRE, Resident Medical Officer.
CASE 25.
Treated at the Royal Portsmouth Hospital. Under the
care of MR. D. WARD COUSINS, F.R.C.S.
I. C. ; aged 24. Carpenter. Invalided from Royal
Engineers for chronic rheumatism. Has been unable to
work for some months on account of pain in right wrist.
Considerable thickening round wrist -joint. Range of
motion limited and grasp very feeble. Attempts to move
joint caused considerable pain.
First Operation, October 18. Forty minutes; 240 F.
Hand and arm treated by superheated dry air. After
twenty minutes, patient stated that he was quite free from
pain.
Second Operation, October 20.
Patient states that since the last operation he has suf-
fered much less pain. The grasp is stronger. Range of
motion increased, and the pain accompanying it is less.
Placed hand in cylinder for forty minutes at 240 F.
Thickening round joint decreasing.
62 The Tallerman Treatment.
Third Operation, October 23.
The thickening round the joint has much decreased.
Can now grasp firmly with the hand, and is almost free
from pain. Hand placed in cylinder for thirty minutes at
260 F.
Fourth Operation, October 25. Forty minutes ; 260 F.
Thickening almost gone. Pain very slight. Patient
was, unfortunately, not able to attend any more. The
improvement, however, was most marked, the thickening
being all absorbed, the range of movement and strength of
grasp being considerably increased, and when seen on
November 2 he could flex and extend the wrist-joint almost
to the full extent without any pain, whereas before the
treatment the movement was limited in extent and accom-
panied with severe pain.
T. H. BISHOP, M.B., C.M., House- Surgeon.
H. W. MORLEY, M.R.C.S, L.RC.P., Assist. H.-S.
CASE 26.
Treated at the Livingstone Cottage Hospital, Dartford.
Under the care of T. F. CLARKE, M.D.
Muscular Rheumatism. F. B., aged 20 years, has
suffered off and on from muscular pains for the last five or
six years. These pains have not been confined to any one
part of the body, but have been more or less general.
The present attack commenced about four weeks ago, the
pains being confined to and between the shoulders.
The occasional exacerbations of pain are very severe, and
begin to affect the general health.
On March 28, 1896, the right arm was placed in the hot-air
bath for forty minutes, the temperature of the bath reaching
250. After the application she felt quite free from pain
for the next twenty-four hours, and even then the pains
were very slight to what they had been before.
Further applications of the hot-air bath were made on
March 31, and April 4, 8, 11, and 13. The pains did not
altogether disappear : they would cease for a day or two and
then return, but to a very limited extent.
If still further applications could have been made I feel
convinced that the rheumatism would have soon dis-
appeared altogether, but ihe patient was obliged to leave
Dartford.
Rheumatism. 63
July 24, 1896. This was the last occasion on which I
met Miss B., when she told me that a day or two after the
last application of the bath in April the pains entirely dis-
appeared, and had never returned since ; and that she had
never experienced immunity from pain for so long a period
since she was first attacked with rheumatism some five or
six years ago.
CASE 27.
Treated at the same Hospital as Preceding Case.
Chronic Rheumatism. E. G., aged 64 years, has a very
rheumatic history, both parents having been great sufferers.
Her first attack occurred twelve years ago, when all the joints
on the right side were affected. Since then she had been
laid up every year, but in 1894 she had two severe attacks.
At the present time most of the joints are more or less
chronically enlarged. She had been unable to do any work
for the last few months on account of the increased swelling
and stiffness of the right shoulder-joint, not being able to
raise the arm to a right angle ; and also on account of the
right elbow-joint being stiff and causing much pain on
movement.
On March 18 the patient's right arm was placed in the
hot-air cylinder for forty minutes, the temperature of the
bath reaching 280. On the limb being removed from the
bath the patient was able to extend and flex the elbow to
the fullest possible extent without the least pain, and also
to raise the arm well above and to the back of the head
without pain.
The application was repeated on March 22 and again on
March 25, and after this the patient was enabled to do field
work, a thing she had not done for a considerable time.
It was thought advisable to persevere with the hot-air
treatment occasionally, so she had further baths on
March 31 and April 11 ; the free and painless movements of
the joints, however, continued in every way satisfactory.
September 5, 1896. About the middle of May this
patient had a return of the pain and swelling in the right
shoulder and elbow joints, brought about from doing hard
field work in wet weather. Under simple ordinary treat-
ment the symptoms soon abated, and she was again able to
resume work. I need hardly remark that if the hot-air
bath had been at hand I should have immediately made
use of it ; but this case certainly points to one important
64 The Tallerman Treatment.
fact viz., that the good results following the application of
the hot-air bath are more or less permanent.
CASE 28.
Treated at St. Bartholomew's Hospital. Under the care of
MR. WILLETT, F.R.C.S.
The next case in which the bath was used was that of a
woman about 45 years of age, who had been one of my
in-patients twelve months previously for acute rheumatic
inflammation of the wrist-joint. Her attack had been a
very severe and prolonged one, and the whole hand and
forearm had been throughout kept at rest. Eventually
the patient recovered. But she came recently complaining
of stiffness in her hand. Flexion and extension, pronation
and supination of the wrist-joint were very good. Active
mischief in the wrist-joint had entirely passed off, but
secondary stiffness of the fingers had resulted. She had
the bath treatment for two months very regularly, but I
must own that the result of its use in this case greatly dis-
appointed me. I regarded it as the best test case of the
series, for her condition was that of a rheumatic joint which
had entirely recovered, leaving only stiffness of fingers and
hand, resulting from the long-continued immobility. It
seemed to me to be exactly the kind of case to be cured.
The original affection may, however, I think, have been
more diffused and extensive than had been diagnosed, and
so perhaps, in addition to synovitis of the wrist-joint, there
had been teno-synovitis of the sheaths in front and behind
the wrist. But from whatever cause, I cannot doubt that
fibrous adhesions within the sheaths had resulted, or that
this accounted for the little benefit that was observed after
two months of treatment. I have seen that patient within
the last fortnight, and I am bound to confess that she
seems not in the least degree benefited by the prolonged
bath treatment.*
This is an interesting and instructive case, on account of
the failure of the treatment and the explanation suggested
by Mr. Willett.
* Clinical Journal.
Rheumatism. 65
CASE 29.
Treated by A. ROBERTS, M.D.
Chronic Rheumatism. Mrs. F., aged 35, had swollen
wrist and fingers for two years, since last confinement, but
had not been treated medically for the rheumatic joint.
Patient was unable to wring clothes with her hands, and
they were very painful to the touch ; there was little or no
power of grasp.
The right hand was placed in the Tallerman apparatus
at a temperature of about 150 and raised to 230. The
left hand that was outside the cylinder was carefully
examined by the medical gentlemen present, and found to
be stiff, swollen and painful, similar to the right.
The operation extended over forty minutes, with the result
that all the pain had gone from both hands and the swelling
of the wrists very much relieved.
Mr. Tallerman's engagements compelling him to return
to town, he was induced to leave the apparatus behind, in
order that the patient might be further treated. Next day the
improvement was found to be maintained, and she was able
to knead her bread and cake and wring clothes without
pain, which she had been unable to do for some time.
There was also considerable power of grasp. A week later
she was treated for the second time, and for the third and
last time a few days later. She is now practically cured.
The cure was effected by the bath treatment solely, as, this
being a test case, not any medicine or other treatment was
used.
CASE 30.
Treated at 50, Welbeck Street. Under the care of
DR. CROSS, B.A., M.D.
Mrs. C. ; aged 54.
History. In August, 1893, the disease first developed,
and patient was ill for three months ; the knees, wrists and
elbows were swollen and painful. This was followed a few
months later by a slight attack, and in February, 1896,
there was a severe attack, during which all the joints
became affected. Patient was at this time an inmate of
Middlesex Hospital ; she was subsequently sent to a
Convalescent Home at Brighton, where she derived great
benefit from bathing in hot sea-water. On April 20 and
24 patient again consulted me, her hands being still swollen
and painful. I saw her again at the beginning of August,
66 The Tallerman Treatment.
and advised her to try the Tallerman treatment, as her
hands continued painful and comparatively useless, the
shoulders were so stiff and painful that she was unable to
raise her arms above her head, while the knees were painful
and swollen, preventing her walking any distance. Patient
attended at the Tallerman Institute from August 10 to 18.
On examination, August 10, 1896, it was found that
the right shoulder was extremely painful and movements
limited; hands swollen, stiff and very painful, unable to
flex the fingers of either hand to the palm, and there was a
lump on the top of right wrist ; knees swollen and painful
when walking and in going up and down stairs. Consider-
able pain in lower part of back. Patient has great difficulty
in lifting or carrying anything, and has bad nights, the
pain preventing her from sleeping.
First operation, August 10, 1896. Right arm treated ;
the movements, after treatment, of the arm and shoulder
were normal and free from pain, and patient could close
both hands (she had not been able to do this for many
months) ; the lump on the wrist was very much smaller,
and the swelling over the knees had decreased.
After the fourth operation, August 18, 1896, patient
reported that she was now quite free from pain, that the
hands and arms were much stronger, and that she could
lift and carry quite well ; she can go quickly up and down
stairs without pain ; the lump on the wrist is hardly visible ;
she sleeps well and feels much better in herself. It was
therefore thought unnecessary to treat her further.
Patient was treated at an average temperature of 240 F.
for forty-five minutes, the body temperature being raised
1, and the pulse beat increased from 12 to 16.
The skin acted profusely during each operation.
Mrs. C. called on me on August 28, and stated that she
still kept free from pain. I found that she could flex
both hands perfectly and raise her arms well above her
head without pain, and the weakness of the legs had
disappeared.
CASE 31.
Treated at the Tallerman Free Institute.
Chronic Rheumatism. Mr. W. ; aged 60. Pensioner.
The disease commenced six years ago, attacking arms,
elbows and shoulders, and finally settled in left ankle and
foot. Patient had undergone treatment at Guy's, St.
Thomas's and Charing Cross Hospitals.
Rheumatism. 67
On examination, the left ankle and foot were consider-
ably swollen and limited in movement, and there was
extreme pain and difficulty in walking.
First operation, April 14, 1896. There was great pain
in the ankle-joint before it was placed in the cylinder, but
after treatment patient could walk with very little pain.
After third bath it was noted that the ankle was reduced
to normal, and patient reported that all his joints were
quite free from pain. The treatment was continued.
Eighth operation. The improvement having been con-
firmed, and complete mobility of the joint restored, and all
pain having subsided, patient was discharged.
Average time of each operation, fifty minutes.
Average temperature attained, 230. ,
BODY TEMPERATURE. PULSE BEAT.
Before After Before After
Operation. Operation. Operation. Operation.
98-0 99-2 68 80
98-4 99-2 72 88
98-2 99-2 80 80
98-0 98-6 72 76
98-4 99-2 76 96
98-4 99-4 76 84
98-4 99-4 68 80
98-8 99-2 72 88
CASE 32.
Treated at the Tallerman Free Institute.
Chronic Rheumatism. M. P. ; aged 58. Housewife.
Has suffered on and off for five years. There was pain
throughout both legs, the left leg being the worse. The
knees and ankles of both were very swollen and extremely
painful.
The hands, especially the fingers, were somewhat affected,
being painful at times ; there was no swelling. At one
time patient had been unable to walk, but could walk now
with a little assistance.
First operation, April 28. After treatment, and on
measurement, the knee was found to have been reduced
half an inch, and patient could move it with much less pain.
After third bath, patient reported that she had been able
to kneel, which she had not been able to do for five years,
viz., since the commencement of the disease. She also said
that she was entirely free from pain.
5 2
68 The Tallerman Treatment.
Notwithstanding the improvement, it was thought ad-
visable to continue the treatment, as there was some slight
contraction of the left leg.
After tenth operation it was found on measurement that
the knee had been reduced 1J inches, and that with the
slightest possible pressure the leg could be fully extended.
Patient reported now that she could walk without assist-
ance, felt stronger, and that her general health had been
greatly benefited.
Average time of each operation, forty-five minutes.
Average temperature attained, 250.
BODY TEMPERATURE. PULSE BEAT.
Before After Before After
Operation. Operation. Operation. Operation.
98-4 99-4 88 100
98-4 99-6 92 102
98-8 99-0 92 106
99-0 100-0 88 96
98-6 100-0 92 104
98-4 99-8 88 96
98-4 99-8 92 104
98-0 99-6 88 96
98-2 99-2 92 106
98-6 99-2 84 96
CASE 33.
Acute Rheumatism. J. O. ; aged 20. Occupation,
clerk.
Family History. No phthisis. Mother suffered from
rheumatism.
Previoiis History. No serious illness ; always enjoyed
good health.
Patient's account of present illness : On December 1,
1896, whilst writing noticed his right hand becoming pain-
ful, hot, and swollen ; left off writing and placed it under
cold water tap for a few moments. Next morning finding
hand still swollen and painful, saw Dr. Carter, who
diagnosed ' Rheumatism,' and treated him with salicylates
and salines. At the end of fourteen days, finding his hand
no better, he went to St. Mary's Hospital ; there he was told
that he was suffering from tubercular disease of the wrist-
joint ; his hand was put in a splint, belladonna applied, and
iron given internally. Patient was recommended to go
into the country for a few weeks. At the end of one month
splint was removed, the wrist and fingers were stiff, but the
Rheumatism.
69-
pain was gone ; at the end of two months he returned to
work, he was able to hold his pen and, with difficulty,
write. After a few weeks the pain and swelling returned.
June 20, 1897. Patient consulted me in respect to his
hand. On examination I found it hot, perspiring freely,
extremely painful and swollen. The wrist -joint could
neither be flexed nor extended, the metacarpal and
phalangeal joints allowed but very slight movement.
Patient stated that after writing a few minutes his fingers
became so painful and stiff that it was impossible to
continue.
Having recently seen very great relief and good done by
the use of Mr. Tallerman's superheated dry-air baths in a
case of acute gout, I determined to ask Mr. Tallerman to
undertake this case, which he very kindly did.
The following table shows the progress of the case whilst
undergoing Mr. Tallerman's treatment :
Temperature
Date. of Bath. Duration.
July 3 290 45 minutes
July 5
July 6
July 8
July 9
July 12
July 13
July 16
July 19
July 20
July 22
July 23
280
280
280
280
260
250
260
260
260
260
260*
1 hour
1 hour
1 hour
1 hour
1 hour
1 hour
1 hour
1 hour
1 hour
1 hour
1 hour
Remarks.
On withdrawal, no pain in
hand, even upon full
manipulation.
Some increase of move-
ment in wrist. Fingers
less painful when
writing.
Increase of movement.
Patient says he has had no
pain since last bath. No
swelling.
No return of pain. Fingers
much more flexible.
Patient can flex fingers to
palm himself ; increase
in wrist movement.
Patient has been writing
a good deal, and wrist
is stiffer.
Patient has given up situa-
tion.
Fingers and wrist decidedly
more flexible.
No return of swelling or
pain ; free movement in
fingers.
Ditto ditto.
Ditto ditto.
On July 25 I saw the patient, and found that there was
normal movement in metacarpal and phalangeal joints, but
70 The Tallerman Treatment.
that there were evidently some adhesions in wrist-joint ; all
pain and swelling had disappeared.
Remarks. It must be admitted that the effect of these
baths upon this case has been extremely satisfactory, and
I have no doubt but what, had they been applied earlier,
the still remaining slight stiffness in the wrist would have
been prevented, and we should have had as free movement
in this joint as we now have in the fingers. The almost
immediate removal of all pain is very marked, and renders
this form of treatment extremely valuable, as it is also
from a diagnostic point of view. In this case there was
some difference of opinion as to whether it was tubercular
or rheumatic ; the result, after treatment, leaves no doubt
but what it was a case of simple rheumatism.
E. CHINSON GREENWOOD, L.R.C.P., M.R.C.S.
CASE 34.
Treated at the Tallerman Free Institute, Blackfriars.
Subdcute Rheumatism Cure in One Operation.
D. L. ; aged 41. Builder's labourer. Patient has been a
sufferer from rheumatism for fourteen years, and has been
treated at St. Bartholomew's and St. Thomas's Hospital
with very little benefit. He has lost nearly four months'
work this year. The last attack was in the right wrist,
when he was unable to work for seven weeks. During a
thunderstorm on Monday, July 19, it came on again in the
left ankle. The pain was so great that he could not bear
to put his foot to the ground. In this condition he came
to the Institute on Friday, July 23, on a coster's barrow,
as shown in the photograph. After one operation he was
able to put his shoe on and walk without pain. He re-
turned to his work on the following Monday.
Duration of bath, 60 minutes.
Pulse. Body Temperature.
Before ... ... 60 ... 99
After ... ... 96 ... 100'4 C
October 14. He has remained at work ever since. His
wife states that he is quite free from pain, and was never
better in his life.
CASE 34.
To face p. 70 I.
CASE 34. After treatment.
To face p. 70 II.
s
K
o
I
2
EH
CHAPTER IV.
GONORRHCEAL RHEUMATISM.
THE following eight cases show that the hot-air treatment
is remarkably effective in this troublesome disease. (See also
Reports by Dr. Dejerine and Professor Landouzy, p. 145.)
In mild cases it promotes an extremely rapid cure ; in severe
ones it cuts short the mischief and prevents permanent dis-
ablement. Mr. Willett's case is particularly striking. The
man was getting into a very bad condition, and no improve-
ment took place until he was subjected to the Tallerman
treatment, under the influence of which he rapidly recovered.
In view of recent disclosures concerning the health of the
Indian army and the large number of men disabled by
gonorrhceal rheumatism, a method of treatment both rapid
and effectual deserves the serious attention of the military
authorities. Why is it not tried at Netley Hospital ?
CASE 1.
Treated at St. Bartholomew's Hospital. Under the care of
MR. WILLETT, F.R.C.S.
This case was that of a man named James L., 26 years
of age, a plumber, suffering from urethral synovitis. One
month he has had discharge, for two weeks and a half
pain in the left knee, afterwards in the right ankle and
both feet. On admission his left knee, right ankle and
both feet were swollen, tender and hot, but there was no
marked redness. There was no cardiac murmur and no
sweating. The temperature was raised 2 to 3. Past
history : Rheumatic fever twenty years ago. During the
first two weeks after admission he had much pain in the
knees, ankles and feet continuously, but varying in in-
CHAPTER IV.
GONORRHOEA! RHEUMATISM.
THE following eight cases show that the hot-air treatment
is remarkably effective in this troublesome disease. (See also
Reports by Dr. Dejerine and Professor Landouzy, p. 145.)
In mild cases it promotes an extremely rapid cure ; in severe
ones it cuts short the mischief and prevents permanent dis-
ablement. Mr. Willett's case is particularly striking. The
man was getting into a very bad condition, and no improve-
ment took place until he was subjected to the Tallerman
treatment, under the influence of which he rapidly recovered.
In view of recent disclosures concerning the health of the
Indian army and the large number of men disabled by
gonorrhoaal rheumatism, a method of treatment both rapid
and effectual deserves the serious attention of the military
authorities. Why is it not tried at Netley Hospital ?
CASE 1.
Treated at St. Bartholomew's Hospital. Under the care of
MR. WILLETT, F.R.C.S.
This case was that of a man named James L., 26 years
of age, a plumber, suffering from urethral synovitis. One
month he has had discharge, for two weeks and a half
pain in the left knee, afterwards in the right ankle and
both feet. On admission his left knee, right ankle and
both feet were swollen, tender and hot, but there was no
marked redness. There was no cardiac murmur and no
sweating. The temperature was raised 2 to 3. Past
history : Rheumatic fever twenty years ago. During the
first two weeks after admission he had much pain in the
knees, ankles and feet continuously, but varying in in-
72 The Tallerman Treatment.
tensity. His joints were all stiff'. His temperature was
raised usually, frequently to 101. He was relieved by
blisters. The movements of the joints improved.
About February 20 he was placed in the hot-air baths.
From that time his improvement commenced. He left the
hospital at the end of March. The movements of his
joints were greatly improved, and all active inflammatory
condition passed away. His knees and ankles and right
shoulder were slightly painful, but the movements were
nearly natural. This was an extremely severe case of that
form of rheumatism, and one which, I think, might have
left him crippled by adhesions, although he would have got
well in time ; yet no improvement took place until one ankle
and knee were placed in the cylinder, and from that time
convalescence commenced. I feel convinced the bath
treatment greatly accelerated recovery, and probably pre-
vented some serious organic changes in the joints. That
patient was five weeks under treatment.*
The accompanying photographs show the completeness
of the cure.
CASE 2.
Treated at the Royal Victoria Hospital, Montreal. Under
the care of PROFESSOR JAMES STEWART.
GONORRHCEAL ARTHRITIS OF THE RIGHT KNEE OF FOUR WEEKS' DURA-
TION INABILITY TO WALK OR EVEN STAND AFTER THE THIRD
BATH HE WAS ABLE TO WALK ABOUT THE WARD WITHOUT ASSISTANCE
AFTER THE TWENTIETH BATH HE WAS DISCHARGED FREE FROM
PAIN, AND WITH GOOD MOVEMENT IN THE JOINT.
J. L., aged 22, was admitted to the hospital on
December 18, 1896, complaining of pain and swelling in
the right knee, with inability to walk.
The history of the case is briefly as follows : In October,
* The following letter was afterwards received from this patient :
' 111, Rosoman Street, Clerkenwell, E.G.,
' July 1, 1894.
' DEAR SIR, I take the pleasure of writing to let you know that I
am the patient mentioned in the Clinical Journal by Mr. Willett, in
his lecture J. L. ; aged 26 ; plumber ; and since leaving the hospital
the pains in my shoulders and knees and ankles have all left me, and
I thought right to cah 1 at the hospital and let Mr. Willett see me, and
I feel now as strong and as well as ever I was; and as Mr. Willett
stated, I might have been crippled by adhesions, or probably suffered
from serious organic changes in the joints, I offer my sincere thanks
for the treatment of the bath, and if anybody wishes, they can see me
at any time. I remain, yours truly, ' J. LATHAM.'
CASE 1. After treatment : showing free and painless movement.
To face p. 721.
CASE 1. After treatment : showing free and painless movement.
To face p. 7211.
CASE 1. After treatment: showing free and painless movement.
Tojacip. 72111.
CASE 1. After treatment : showing free and painless movement.
To face p. 72 IV.
Gonorrhceal Rheumatism. 73
1896, he contracted gonorrhoea, and up to the middle of
November had a profuse urethral discharge. At this time
the knee suddenly became much swollen and intensely
painful ; the conditions lasting about three weeks, when it
became less painful, but was still swollen and very stiff.
There was no constitutional disturbances other than rapid
loss of flesh. Of his personal history nothing was ascer-
tained save that he had used alcohol and tobacco to
excess.
On admission, the patient was found to be unable to
stand without support, and could not walk at all. The
knee could be flexed and extended but a short distance,
while there was uniform enlargement of the tissues about
the joint, but no increase in the synovial fluid. No other
joint showed abnormally. The urethral discharge contained
gonococci.
The treatment, as in the previous case, was the Tallerman
superheated dry air. After the first application a decided
improvement was noticed, while after the third the patient
was able to get about the ward without assistance. In all
he had twenty applications, and on discharge, January 27,
1897, there was free movement of the joint and practically
no pain in walking. Although there still remained some
enlargement and deformity about the joint, his general
health had much improved, as evidenced by a gain in
weight of 14 Ib. during the period of treatment.
CASES 3-5.
Treated at the Laennec Hospital, Paris. Under the care
of PROFESSOR LANDOUZY.
CASE o.
Gonorrhoeal Rheumatism. Bertha B. ; 16 years old.
Gonorrhoea, followed by diseases of the large joints.
Watery blisters on "the soles, exceedingly painful to touch
and rendered walking difficult. The right knee only was
affected ; there was pain, flexion almost to a right angle,
and functional impotence. After eleven days and without
good result, the Tallerman treatment, superheated dry air,
was tried. At the end of three operations the pain had
completely disappeared; the knee will be fully extended
again. The appearance of pain in some of the joints
necessitated the continuance of the treatment. At the end
of ten baths the patient was completely cured and left the
hospital.
74 The Taller/nan Treatment.
CASE 4.
Gonorrhceal Arthritis of Several Joints; Talalyia. M. ;
27 years old. Severe gonorrhoea, on the third day of which
severe pains appeared in the left heel, followed by general
pains in the knee and right elbow. Severe talalgia.
Unable to walk. After the second bath the pain had
completely disappeared, both in knee and heel, and the
patient walked about all the afternoon. After the third
bath the patient left the hospital of his own accord.
CASE 5.
Infectious Arthritis (Gonorrhceal ?) of the Right Wrist.
Louis J. ; 36 years old. Several attacks of gonorrhoea, but
at long intervals. The actual illness, which was not
coincident with any urethral incident, began in a painful
attack of rheumatic fever, which affected exclusively the
right hand and wrist. This part was attacked by a
moistness, an intense swelling, hard, inflamed, and slightly
painful under pressure. The movements of the fingers
were scarcely noticeable. The flexion and extension of the
hand and wrist were entirely impossible. Slight atrophy
of the forearm. This joint disease of a somewhat inter-
mediate nature had resisted all therapeutic methods for
about three months. We then tried the superheated dry-
air treatment.
After the eighth bath the swelling was considerably
diminished. The fingers and wrist regained their flexibility ;
so much so that the patient was able to write a four-page
letter, and write it well.
CASE 6.
Treated at Charing Cross Hospital. Under the care of
MR. J. H. MORGAN, F.R.C.S., Sen. Surgeon to the Hospital.
H. J. M. ; aged 23. Postman. Second attack of gonor-
rhoeal rheumatism in knees, ankles, and wrists. After
various treatments had been tried, the superheated dry air
was used for the right knee and left wrist. This treatment
was commenced on February 6, and was continued daily,
the knee being treated until the 14th, when the wrist also
was treated. Patient left hospital on March 16, and his
cure was apparently much accelerated by the bath.
CHARLES GIBB, Surgical Registrar.
Gonorrhceal Rheumatism. 75
CASE 7.
Treated at Charing Cross Hospital. Under the care of
MR. WATERHOUSE, F.R.C.S.
A. B. ; aged 24. Gonorrhceal wrist. Terminating in
rapid cure.
CHARLES GIBB.
CASE 8.
Shown at the Brighton and Sussex Medico-Chirurgical
Society by DR. HEDLEY.
Subacute Articular Rheumatism (' Urethral Synovitis'};
a second attack. Patient can walk tolerably well, but is
very perceptibly stiff. Articular symptoms are of six
weeks' duration. Knees chiefly affected, right somewhat
swollen, painful on movement or pressure. Left slightly so,
ankles similarly affected in a less degree, pain under tendo
Achilles. Right knee placed in a Tallerman cylinder at a
commencing temperature of 160 F., gradually increased to
240 F. Duration of operation forty-five minutes. Repeated
in two days. On termination of third such procedure, the
patient volunteered the statement that it was ' the better
leg of the two.' Though this relative improvement did not
last, an actual improvement did. After a fifth operation,
fifteen days from the first, it was not considered necessary
to continue the treatment, inasmuch as the symptoms had
nearly disappeared, the improvement being apparent not
only in the limb directly acted upon, but in all the affected
joints. A general diaphoresis had in each instance accom-
panied the local application. It is to be remarked that the
symptoms were never severe, and that before the hot-air
applications they were already improving under other
treatment ; but it seems tolerably evident that the progress
of cure was at least hastened by the measures in question.
CHAPTER V.
STIFF, PAINFUL AND ANCHYLOSED JOINTS TUBER-
CULOUS AND TRAUMATIC INFLAMMATION -
SYNOVITIS WITH EFFUSION STIFFNESS AFTER
FRACTURES AND OTHER INJURIES PERIOSTITIS.
TWENTY cases of inflammation, other than rheumatic or
gouty, and of injury, resulting in pain, stiffness, and anchy-
losis, are here given. It will be seen that the pain always
yields to the treatment, and stiffness in a great measure.
Where fibrous anchylosis exists, greater freedom of move-
ment is often gained without forcible measures ; and when
those are adopted the subsequent progress of the case is
much more rapid than it would otherwise have been. In
simple cases of acute inflammation absorption is greatly
promoted.
CASES 1-6.
Treated at the Hospital for the Ruptured and Crippled,
New York. Under the care of V. P. GIBNEY, M.D.
CASE 1.
Firm Fibrous Anchylosis after Tuberculous Ostitis of
the Knee. A boy 10 years of age was admitted to the
hospital in August, 1890, with a knee extensively suppur-
ating, and one that required a partial arthrectomy as an
immediate measure of relief. He was discharged in July,
1893, with two sinuses discharging and a range of 15 of
motion. His angle of greatest extension was 175, lacking
5 of being perfectly straight.
He was readmitted in June, 1896, with his knee locked
at an angle of 140 that is, nearly midway between a right
angle and a straight line. The sinuses had closed. Under
Stiff and Painful Joints, etc. 77
traction his deformity was overcome by repeated stretchings,
frequently with an anaesthetic. For two or three months
he has worn no brace, except a perineal crutch.
On November 27, his knee could be extended to 180,
and could be flexed to 176. He was placed in the
Tallerman apparatus ; pulse, 92 ; temperature, 98 - 2 F. He
remained in the bath forty minutes. The highest tempera-
ture reached was 225 F. At this time his pulse was 116;
temperature, 99'6 F. On removing his limb from the
cylinder, it could be easily flexed to 168, which was a gain
of 4.
November 29. Second bath. Temperature, 98'2 F. Time
in apparatus, fifty minutes. Highest temperature, 250 F.
A gain in motion of 4.
November 30. Highest temperature, 260 F. Under
treatment fifty minutes. Gain of 3 in motion.
December 1. Highest temperature, 262 F. Forty
minutes in bath. Gain of 3.
December 2. Body temperature, 98'8 F. before treat-
ment ; immediately after treatment, 1004 F. The bath
was 260 F. Knee flexed to 158 before, 155 after.
Duration, fifty minutes.
December 3. There was a gain of nearly 2 F. in body
temperature. The bath itself was 260 F., forty minutes in
duration. A gain of 7.
His seventh bath occurred to-day. Gain of 1 in body
temperature. Highest temperature in apparatus, 280 F.
He has worn no apparatus since the treatment was begun,
has used the limb, and, while his range of motion has not
increased over 20, the motion is much more easy. He has
been free from pain, and there has been no reaction what-
ever from the use of the limb. His would seem to be an
excellent case for very slight motion under an anaesthetic,
followed immediately by the use of the bath.
CASE 2.
Fibrous Anchylosis in a Tuberculous Knee. No suppura-
tion. A boy, 7 years of age, admitted June 12, 1896. His
disease dates from August, 1895. He has worn a protection
apparatus since June. There was, at the time he came
under treatment, no sign of abscess. On July 29 it was
noted that his leg was perfectly straight, with a small range
of motion say 15. No signs of active disease. His case
was selected as one for experiment, although it was very
78 The Tallerman Treatment.
doubtful whether the active disease was fully arrested. I
was desirous of learning the effect upon a knee of this kind.
At the date of his first treatment, November 27, his knee
could be moved over a small arc, 5. The bath lasted fifty
minutes; temperature, 250 F. Without any force there
was a gain of about 3 in flexion. His bodily temperature
was raised 1'5 F. at the fourth bath, 1 F. at the fifth, and
a little less than a degree at the sixth. The highest
temperature of any one bath was on this date, and it
reached 280 F. There has been a gain of about 12. No
force has been employed, no apparatus used, and, while the
knee presents a little fulness, he has had no pain.
CASE 3.
Anchylosis of Deformed Knee, Result of Tuberculous
Disease. A girl 14 years of age was admitted to the hospital
in October of the present year, with a history of tuberculous
disease extending over a period of six years. She has had
two years of bed treatment. At the time of her admission
it was impossible to extend the leg beyond 130. There
was no motion allowed at the knee, and any efforts to move
the joint elicited great pain. We made an attempt to
correct by means of splints, and succeeded in gaining a few
degrees, but the treatment was very painful, on one or two
occasions requiring an anaesthetic. After two or three
baths were given in the cylinder, we found that no gain
was made in the correction of the deformity, and that she
was just as sensitive if any attempt at motion was made.
On December 3, under nitrous oxide, I moved the knee
over an arc, say, of 15 or 20, bringing it into a better
position, and at the same time breaking up a number of
adhesions. Coming out of the gas, she complained bitterly
of pain, and the knee was at once put into Tallerman's
apparatus ; the highest point reached was 280 F. It was
fully ten minutes before she got relief. The temperature
of the bath on entering was about 180 F. It required
100 F. more to give her the necessary relief. A simple
posterior splint was applied on removing the limb. She
did not require an anodyne during the night, and her night
report was very good. It may be safely said that the
excruciating pain which follows an operation of this kind
was lessened by the use of the Tallerman apparatus. It
would have been better to have put the limb in at the
temperature of 280 F., and then raised the heat to 300 F.
Stiff and Painful Joints, etc. 79
These three cases of tuberculous bone disease in children
may be taken as fair samples of the good effects which one
may expect from the superheated dry-air treatment.
The case which I am about to report now, I think,
illustrates its advantage in convalescent cases of hip-disease.
CASE 4.
Subacute Arthritis of Knee, Traumatic, with a Small
Range of Motion and Pain on Use. A medical gentleman,
27 years of age, in January, 1893, while skating, fell with
knee sharply flexed. From that time up to this present
report he has been under the care of Dr. Lewis A. Sayre,
who has made use of various appliances ; and in addition to
Dr. Sayre's care, the patient has subjected himself to various
methods of treatment at the hands of different physicians
without obtaining a cure. From time to time he has been
nearly well, and would then get a fall or an injury of
some kind, which would bring on relapse. At the time he
came under the Tallerman treatment (December 1) he
had a range of motion from 10 to 15 ; but beyond this
limit the knee pained him a good deal. There were no
infiltration, very little tenderness on handling, and no
bony enlargement. He was on crutches, wearing a splint,
anterior and posterior. He has had four treatments by the
hot-air bath, and at the expiration of every treatment he
feels much better, is able to use his limb with more ease,
and the range of motion is just a little increased. He
expresses himself as very much encouraged, because he can
use the limb more freely about his room, can bear his
weight on it with less pain and distress than heretofore,
and it would seem that an excellent result can be obtained.
CASE 5.
Convalescence in Tuberculous Ostitis of the Hip in an
Adult : Joint Free from Deformity, but quite Stiff and
Painful on Use. A gentleman, 22 years of age, was placed
under my care by Dr. Robert F. Weir on November 25,
1887. He was hearty and robust-looking, was an athlete in
college, and four years prior to this date he had sprained
his hip while playing baseball. There was a little stiff-
ness at first, but this soon passed off. It was a year later
before any signs of discomfort appeared. He then found
it difficult to participate in his exercises, and rest was
enjoined. At the time I saw him he was just recovering
80 The Tallerman Treatment.
from an attempt at correction of deformity and removal of
adhesions. A diagnosis of ostitis of the hip was readily
made, and he was placed under protection treatment. This
has continued to the present time. Abscess has formed,
been opened and finally closed ; a second one appeared and
then disappeared. In the last two years I have endeavoured
to induce him to go without his apparatus, but whenever he
made the attempt pain would oe excited, he would rest,
poorly at night, and he had been quite loath to do away
with the traction. He has had the benefit of the best
climate, and no pains have been spared to keep his
health in excellent condition.
December 3. He expresses himself after the third bath,
now, as very much encouraged. Slept better last night
than he has for a long time. The limb can be held much
more freely than I have ever seen it. He has not been
using his brace since November 30. He is bearing his
weight on the limb and walking about the floor without any
discomfort.
December 4. At the meeting this evening he states that
he has less dread and apprehension of using his limb. He
finds more security when he steps upon it ; can lie in bed
and swing the left limb around, with leg extended, in a
pretty good range, without fatigue or pain. The range of
motion is increased a little. During the treatment his
temperature went up from 98*4 to 101'8 F. His pulse,
which was 70 at the beginning, was 96 at the close.
CASE 6.
Traumatic Arthritis without Rheumatism or Gout.
This is a patient 70 years of age, kindly referred by Dr.
Robert F. Weir, from his service at the New York Hospital.
The history obtained is that he was thrown from a car
about a year ago, his left knee being the joint injured.
The pain has increased from the time of the injury. The
stiffness also has increased. He claims that the treatment
by fixation, cautery, and such other applications as have
been made from time to time, have been ineffectual in
arresting the progress of the disease. At all events, he is
unable to walk, except by assistance. The range of motion
is less than 10. Thero is considerable tenderness on
handling the limb. He is subjected to the Tallerman
treatment, at a temperature of a little over 200 F., for
fifty minutes, and on removing him from the cylinder,
the house-surgeon, Dr. Kenerson, moves the limb, and is
Stif and Painful Joints, etc. 81
satisfied that an increase of 15 in motion has been
gained.*
CASE 7.
Treated at the Children's Hospital, St. Michael's Hill,
Bristol, at a demonstration.
W. A. ; aged 47. Left knee painful and stiff after an
accident two years ago. Can bend knee, but only to a
small extent and with pain.
One bath ; temperature 245 ; duration forty-five minutes.
After the bath patient could bend his knee without any
difficulty. He said all pain was gone, and he could walk
with perfect comfort.
E. C. WILLIAMS, M.B. Cantab.
CASE 8.
Treated at St. Bartholomeiv's Hospital. Under the care
of MR. WILLETT, F.R.C.S.
Cecilia L., aged 17, was admitted into President Ward
on January 16 suffering from painful knee, believed to be
a subacute tubercular affection. In June, 1893, she had
been in President Ward under Mr. Cripps, and the limb
was then brought into a good position and put up in
plaster of Paris. Some enlarged cervical glands at that
time were also removed, and hence there is good reason for
believing that the diagnosis of tubercular affection was
correct. In the meantime she had been from time to time
treated by reapplication of plaster of Paris splints, and
once leather splints were moulded to her knee, and worn
for a time. Recently there had been an exacerbation of
pain and swelling, and for this she was readmitted. She
was of the rather dull, sleepy type of patient. There was
some backward displacement of the tibia, with a tendency
to rotation of the tibia inwards rather than outwards.
The patient usually lay, not on the affected side, but upon
the opposite side, and rolled her limb inwards. This, of
course, kept the crucial ligaments tight, and also prevented
backward and outward displacement. On January 17, on
account of localized pain, an icebag was applied ; and in
February a ten-pound weight was adjusted, position re-
maining good. On February 3 the limb was again put
* Head before, and demonstration given to, Practitioners' Society,
Xew York, December 4, 1896. I am indebted to Mr. Lewis A.
Tallerman, of London, for the opportunity of using the apparatus in
the cases here reported. V. P. G.
6
82 The Tallerman Treatment.
into plaster of Paris. It was taken out on the 9th. On
the 20th the hot-air bath, at a temperature of 170 F., was
used for half an hour. This did not seem to increase the
movement, but did seem to diminish the pain. Ultimately
she left the hospital wearing a Thomas's knee-splint. The
leg was straight and firm and much less painful, and her
general state of health was improved. This patient had
the bath on only two or three occasions. Probably the
affection was rather too acute, or, if not so, the patient was
of that neurotic type in whom it is difficult to tell whether
the pain is real or imagined. But it did not, on the whole,
seem a very fair test case for the bath treatment; she
complained so greatly of it that it was soon abandoned. I
think she only had some three baths in about two weeks.
CASE 9.
Treated at the North-west London Hospital. Under the
care of MR. MAYO COLLIER, F.R.C.S.
L. B. ; aged 12. Tubercular knee-joint. Had been kept
at absolute rest in plaster of Paris for upwards of seven
months. On removing the splint the disease was found to
have disappeared, leaving little or no movement, any
attempt to increase it causing severe pain.
After six operations the movement had increased 45 to
50 ; there was no grating in the joint, and the patient
could walk freely and well ; no forcible movement was
used.
CASE 10.
Treated at the Livingstone Cottage Hospital, Dartford.
Acute Synovitis of Knee-joint. G. L. ; aged 63.
Labourer. Strained his knee-joint three weeks ago when
at work as a bricklayer ; the joint quickly began to swell,
and he has been incapacitated ever since.
I saw him for the first time on March 25, when I found
the right knee-joint slightly distended with fluid ; there
was no increase of heat, but great pain was caused on
manipulation or on attempting to stand.
The patient was treated by the superheated dry-air
apparatus the following day, the right leg being kept in
the cylinder for forty minutes, and exposed to a tempera-
ture of 250. On removal, the joint could be manipulated
with but little pain.
A second application was made on March 29. In the
Stiff and Painful Joints, etc. 83
interval the swelling of the knee-joint had almost entirely
disappeared, and the pain had been very trivial. After
this second application the joint could be moved quite
freely, and without causing any pain.
Two days afterwards the patient was able to resume his
employment.
A further point noticeable in this case was in regard to
the feet. These had been operated upon in infancy for
talipes from all appearances equino-varus and there had
always existed a considerable amount of stiffness about
the joints. This was relieved to a most marked extent by
the hot-air bath applications.
September 5, 1896. The improvement in this case con-
tinues.
CASE 11.
Treated at the Royal Portsmouth Hospital. Under the
care of MR. D. WARD COUSINS, F.RC.S.
Chronic Traumatic Synovitis. J. L. ; aged 49.
Labourer. Chronic synovitis of knee-joint over two years.
History of injury, by fall. Before the superheated dry-air
treatment was commenced, other methods had been resorted
to for several months without producing any satisfactory
results. Knee considerably swollen; kept always in a
position of considerable flexion ; gave pain on movement ;
and also when at rest very limited range of movement.
Disease had made considerable progress and affected the
bones, in addition to the synovial membrane of the knee-
ioint. The treatment was continued for the whole of the
month during which the apparatus was available, and
in all the hot-air bath was applied nineteen times. On
cessation of treatment the circumference of the limb,
measured above the patella, over it and below it, had
diminished by half an inch at each point. Range of move-
ment also slightly increased. Pain undoubtedly consider-
ably relieved.
T. H. BISHOP, M.B., C.M., House-Surgeon.
H. W. MORLEY, M.R.C.S., L.R.C.P., Assist. H.-S.
CASE 12.
Treated at St. Bartholometu's Hospital. Under the care of
MR. W. J. WALSHAM, F.R.C.S.
T. "NV. Builder. Potts' fracture one year ago. Joint
painful, and bones in bad position.
62
84 The Tallerman Treatment.
Osteotomy of tibia and fibula, with removal of wedge-
shaped piece of tibia.
Position much improved ; pain on walking still.
This patient complained greatly of the pain on moving
ankle-joint.
He was treated by the Tallerman hot-air method ;
altogether he had six or seven baths. The movement in
the ankle remained unaltered, but he expressed himself as
much better as regards the pain. This improvement, he
has since informed me, has continued.
MARTIN JONES, M.R.C.S., House-Surgeon.
CASE 13.
Treated at St. Bartholomew's Hospital. Under the care of
MR. W. J. WALSHAM, F.RC.S.
J. J. ; aged 35. Fractured leg. Treated plaster of Paris.
Condition. Joint stiff (ankle) ; painful on forced move-
ment. He was treated twice or three times by the hot-air
bath. He was much improved ; movement gave him much
less pain, and he walked with much greater comfort.
MARTIN JONES, M.R.C.S.
CASE 14.
Treated at the Royal Portsmouth Hospital. Under the
care of MR. D. WARD COUSINS, F.R.C.S.
S. 0. ; aged 50. Fell downstairs six weeks ago, and
sustained severe sprain of wrist ; wore a splint for six
weeks, and then consulted a doctor, who advised her to
undergo treatment in hot-air cylinder. Came to hospital
on October 8.
On examination, the wrist and fingers were found to
be extended perfectly stiff, and attempts at passive motion
caused great pain. Patient herself could not move any of
the fingers, but could touch base of index-finger with the
thumb. She was reluctant at having the adhesions first
broken down under an anaesthetic, so that it was deter-
mined to try the effects of the Tallerman treatment without.
First Operation. October 9.
Hand and arm placed in cylinder for forty minutes at
temperature of 240 F. After fifteen or twenty minutes
she said she could move her forefinger slightly. On with-
drawing the hand from the cylinder it was found that the
Stiff and Painful Joints, etc. 85
lingers could be moved slightly without much pain, and
she could herself touch the tip of her index-finger with her
thumb. Although before the treatment she complained of
great pain on attempting to flex the wrist, after the bath it
was partially flexed, and several adhesions broke with an
audible snap, the patient experiencing but little pain.
Second Operation, October 11. Forty minutes at 290 F.
Movement in fingers and wrist still greatly increased.
Patient could touch the tips of all her fingers with her
thumb. Some more adhesions in wrist were broken with-
out much pain.
Third Operation, October 13. Thirty minutes ; 280 F.
Movement in fingers and wrist markedly increased. She
can now flex all her fingers into the palm, and has a good
range of motion in wrist-joint.
Saw patient again on October 28. She can now make a
fist, and move her wrist-joint freely. Is greatly pleased at
the result of the treatment, and has resumed her household
duties. Pain on movement is but trifling.
T. H. BISHOP, M.B., C.M., House-Surgeon.
H. W. MOBLEY, M.R.C.S., L.R.C.P.
CASE 15.
Treated at the Royal Portsmouth Hospital. Under the
care of MR. D. WARD COUSINS, F.RC.S.
H. W. ; aged 12. Stiff fingers after a fracture of fore-
arm three months ago.
First Operation, October 3. Forty minutes; 265 F.
Considerable improvement ; fingers much less stiff.
Second Operation, October 4. Thirty minutes ; 240 F.
The stiffness of the fingers has greatly improved ; can
fully flex the fist, and fully extend all the fingers with the
exception of the little and ring, which cannot be quite
straightened.
Third Operation, October 9. Thirty-jive minutes ; 230 F.
All the fingers can be fully flexed and extended without
pain. When last seen (November 2) his hand was perfectly
well.
T. H. BISHOP, M.B., C.M., House-Surgeon.
H. W. MORLEY, M.R.C.S., L.R.C.P.
86 The Tallerman Treatment.
CASE 16.
Treated at the Royal Portsmouth Hospital. Under the
care of MR. D. WARD COUSINS, F.R.C.S.
E. B. ; aged 31. Stiff fingers after collis fracture nine
weeks ago. All fingers are semi -flexed. Unable to
straighten them herself, and attempts to forcibly extend
them cause severe pain.
First Operation, October 4. Forty minutes ; 250 F.
After the bath the fingers could be further extended
with less pain ; straight splint applied.
Operation repeated on October 9, 11, and 16; on each
occasion for thirty minutes, at temperature of from 240 to
265 F. At the end of the treatment she could freely
extend the fingers without pain, and she has now resumed
her occupation, and is quite well.
T. H. BISHOP, M.B., C.M., House-Surgeon.
H. W. MORLEY, M.R.C.S., L.R.C.P.
CASE 17.
Treated at Charing Cross Hospital. Under the care of
MR. MORGAN, F.R.C.S.
W. D. Injury to hand. Under treatment twelve weeks.
When the wound was healed there remained stiffness at
wrist-joint, and also metacarpo-phalangeal and inter-
phalangeal joints. Massage for some six or eight weeks
improved matters to a degree, but it was thought advisable
to adopt the superheated dry-air treatment by the Taller-
man process. This was done for three weeks, with a
marked improvement as result.
C. LOCKYER, M.R.C S., L R.C.P., House-Surgeon.
CASE 18.
Treated at the Livingstone Cottage Hospital, Dartford.
Injury to Metatarso - Pkalangeal Joint. R. M. ;
aged 16. Domestic servant. About three months ago a
heavy tea-tray fell on her left foot, causing severe pain over
the metatarso-phalangeal joint of the second toe, which
was considerably increased on movement or pressure. She
was obliged to give up her situation in consequence.
The case came under my care a month after, when, find-
ing the pain as acute as ever on the patient standing or
bearing her weight on the foot, I put the foot up in a plaster
case. This was continued for a fortnight, but soon after
Stiff and Painful Joints, etc. 87
removing the case the painful condition returned. Paint-
ing iodine over the joint had no effect.
On April 12 the patient's foot was placed in the hot-air
bath for forty-five minutes, the temperature of the bath
reaching 240 = .
On removal she could bear her full weight on the foot
without pain, and pressure over the joint and flexion of
the joint caused no pain.
I saw the patient again a fortnight later, and found the
pain had not returned, and she was anxious to again go out
to service.
August 20, 1896. There has been no return of the pain,
movement of the foot being quite free and causing not the
slightest discomfort.
CASE 19.
Treated at the same Hospital as Preceding.
Stiffness after Fractured Humerus. A. C., aged 16,
fractured his right humerus four weeks ago, since when it
had been kept in splints.
On removing the splints there was slight stiffness of the
elbow-joint, and considerable stiffness at the shoulder, the
slightest movement causing great pain.
The right arm was placed in the hot-air bath on April 13,
four weeks and five days after the injury.
The application was continued for about forty minutes,
and the temperature of the bath was raised to about 260.
Immediately afterwards the limb could be moved freely
both at shoulder and elbow without causing any pain, and
the patient has had full and painless use of that arm ever
since.
September 5, 1896. This patient has had full use of the
right arm ever since, and without pain.
CASE 20.
Treated at the Liverpool Infirmary.
Periostitis. John G., aged 43, admitted to hospital
suffering from periostitis around ankles, October 26, 1896.
Boracic fomentations and Mclntyre's splints applied, but
no relief experienced. Tallerman baths commenced
November 14 and continued till 28th. Had eleven baths.
Patient's highest temperature in bath 99'4 ; highest
temperature of bath 250. Went to town December 1,
quite well, and able to walk ; no pain.
CHAPTEK VI.
GOUT.
EXCELLENT results have been obtained, as will be seen from
the following eighteen cases, both in acute and chronic
gout. In acute attacks inflammation and pain are reduced
with extraordinary rapidity, while in chronic gouty con-
ditions the morbid products in the blood are effectually
eliminated by the skin and the kidneys. On this head we
cannot do better than quote the observations made by
Dr. Sibley in a paper published in the Lancet on July 10,
1897. His remarks, together with a series of ten cases,
are here produced. The other cases include an interesting
one of saturnine gout, treated at the Philadelphia Hospital:
' A few remarks are necessary with regard to the mode
of action of this treatment. The heat applied locally to
the inflamed gouty part causes an increased circulation
in the area, bringing a larger quantity of blood to the seat
of the lesion, and at the same time taking away a larger
quantity of blood, probably more or less saturated with the
bodies causing the local deposits. These deleterious products
being hi the general circulation, so to speak, dissolved out
of the seat of the inflammation, should in the normal
course of events largely find their way out of the body
through the kidneys ; hence all should be done during the
course of treatment to assist these organs to act as freely
as possible. Some interesting observations on this part of
the subject have recently been made in the clinics of
Professor Landouzy, at the Laennec Hospital, and Dr.
Dejerine, at the Salpetriere Hospital, in Paris, who are
Gout. 89
experimenting with the Tallerman treatment, the results of
which were published by Dr. Chretien.* They found, for
instance, that in one case of ordinary gout the daily
elimination of uric acid, which after the fourth bath was
57 centigrammes, rose after the ninth bath to 89 centi-
grammes ; and in another case of arthritis the daily co-
efficient of urea had changed from 20 grammes 97 centi-
grammes before treatment to 25 grammes 50 centigrammes
after the treatment had been administered. They also
found an increased excretion of all the salts, especially the
chlorides. This increased excretion through the kidneys
is probably the explanation of the great benefit of the hot-
air treatment in cases of gout. The results in the French
hospitals were obtained entirely by this external method,
and without the exhibition of drugs of any kind. I feel
no doubt of the great benefit this treatment will show in
cases of what are described as "constitutional goutiness,"
without necessarily any local objective lesion.' Lancet,
July 10, 1897.
CASES 1-10.
Treated at the North-icest London Hospital. Under the care
of DR. KNOWSLEY SIBLEY.
CASE 1.
Acute Gout. The first case was a man, aged 65 years,
who came under observation on June 3, 1896. The patient
had suffered from acute attacks of gout on and off for many
years, the attacks often lasting for several months. A year
and a half previously he had had a bad attack of pneumonia,
followed by a prolonged attack of gout in both feet and
one knee, which lasted for three months. The present
attack had commenced a few days before in the left elbow,
which became swollen and the skin tense, red, and very
painful ; the back of the hand was also swollen, the
knuckles being hardly visible, and the veins much engorged.
After the first treatment by the superheated dry-air bath,
the parts about the elbow were not so tense, there was less
oedema over the back of the hand, and the veins were not
so distended. The patient had a return of the attack in
the evening in the elbow, accompanied by severe pain ; after
* La Presse Merlicale. December 26, 1896.
90 The Tallerman Treatment.
treatment on the following day the elbow appeared less
inflamed, and could be moved better ; the pain was also
greatly relieved. On the evening of June 5 the arm again
became more painful, but the patient had a good night ; the
following day there was some effusion into the tissues below
the elbow. Treatment again produced considerable im-
provement of the parts. By June 8 the gout had quite
subsided in the elbow ; there was no pain or effusion left,
and the joint could be freely moved. During the night
the index-finger became inflamed ; this became more com-
fortable after treatment, and the swelling rapidly subsided.
The patient went into the country for a change. In April,
1897, the patient had remained quite well, and had been
free from attacks of gout since the treatment. During the
treatment he was taking alkaline medicine and a saline
aperient.
CASE 2.
Acute, Subacute, and Chronic Gout associated with
Eczema. This patient was a lady, aged 50 years, who
commenced this treatment on June 25, 1896. There was
no history of gout or rhematism in the family ; her father
lived to the age of 90 years, and her mother lived 73 years,
and suffered from eczema. Her paternal great-grandfather
lived to the age of 105 years. The patient when young
had excellent health till the first attack of gout, twenty-four
years ago, in the right great toe, when she was laid up for
a fortnight. From this time she had recurrent attacks of
acute gout every three or four months. For many years it
was confined to the feet. It first appeared in the knees
twelve years previously, and in the hands for the first time
seven years previously. The attacks had been much worse
the last six years ; she was often laid up in bed for from
six to ten weeks, and in acute pain. Five years previously
she had an attack of eczema in the feet, and this had
troubled her on and off ever since, never having dis-
appeared. Eight years ago the chalky, gouty deposit in the
right great toe broke down and discharged for twelve
months, and this place had reopened on and off several
times since. In October, 1895, the deposit in the left
index-finger discharged for four months, and about the
same time the left great toe also discharged. From
October, 1895, to June 25, 1896, the patient had been laid
up in bed, being unable to move because of pain, although
taking large quantities of medicine. The left index-finger
Gout. 91
was much deformed, and chalky deposit was seen beneath
the thinned skin. The little finger of the right hand
was also much deformed ; there was chalk-stone deposit in
the middle finger of the left hand. The left knee was
extremely painful and tender, movement was very limited
on account of pain, and there were some deposits to be
seen and felt on the anterior surface of the patella. Both
the feet were swollen and covered with an irritable form of
eczema, which, especially on the left, extended some way up
the leg ; both great toes were much deformed, tumid, and
inflamed, very red, and acutely painful ; they were both
dislocated outwards, and the left was discharging thick
pus and chalky matter, and looked very angry. There was
considerable puffiness about the ankles, and pain on the
slightest attempt at movement. There were deposits in both
ears. On June 25 the left leg was placed in the Tallerman
apparatus. The pain was soon relieved by the heat, and
when taken out she was able to move the limb freely,
and could even walk on it without pain ; the eczematous
condition was also better. The next day she reported that
she had slept all night, that the knee was almost well and
the foot much less painful, and that there had been no
irritation from the eczema, although for the first time for
four months she had not used any ointment. She had a
second bath, and was again much relieved. She returned
for a third bath on July 6, when she reported that she had
had another attack of eczema, which was very distressing.
After treatment the intense irritation was much relieved ;
the toe continued to discharge freely. The patient's foot
was too bad to allow her to come for treatment from July 8 to
July 22, when, after a bath, the part was much better, and
she felt very comfortable. By August 20 the patient had
had ten baths. The fourth finger was now decidedly
smaller, and the chalky deposit in the knuckle of the
second finger was dispersing. On the 25th the patient had
her eleventh bath, and said she was able to play the piano
for the first time for six months. On the 26th, after the
twelfth operation, the following note was made : ' The
various chalky deposits are decreasing quickly and becoming
much softer ; the fingers are more flexible, and the whole
hands are of a much better shape.' On September 2 the
patient informed me that she had been trying her voice,
and had found that it was quite restored; she had not
sung for eighteen months. She was also able to run up
and down stairs ; the hands continued to improve. On the
29th the patient had her twentieth bath. She had had a
92 The Tallerman Treatment.
bad cold, and on the previous day, after doing some
needlework, she felt a sudden sharp pain from the right
shoulder to the tip of the second finger on the right hand,
and this had become stiff and painful. Now the elbow was
also painful, the tissues about it being tense and swollen,
and tender to the touch. All these symptoms were much
relieved by another application of the hot air. The next
day she reported having had a good night, and there had
been no pain in the finger or elbow since ; she had been
able to dress herself. On December 16 the patient again
presented herself, not having attended since September,
owing to numerous domestic worries. She had been well,
with the exception of an attack of pain under the knees
and down the calves (? phlebitis) in November. At this
time the patient was fairly well in herself, but had some
gout about the ankles and heels ; the eczema had quite
disappeared from the feet. The right elbow was enlarged,
red, and painful. On the 24th the swelling about the left
elbow which was present last time had increased, and had
become extremely painful. On the 29th the patient reported
that her left elbow was much less painful for two days
after the last bath, but it had then again become worse ;
the right elbow had not since been painful. On the 30th
the left elbow was very red, swollen, and painful over the
olecranon process ; there was also a good deal of pain up
the arm (lymphatic), and also in this axilla. The pain and
congestion of the whole was much relieved by the bath.
The next day the patient reported that the elbow again
became painful during the evening, but she had had a
good night and was feeling much better. During the
next few days the left elbow kept very painful, and the
skin broke on January 5, 1897, and it then discharged
slightly. A day or two afterwards the right arm became
painful, then the left became still more inflamed, and the
patient had to keep in bed. She had had no sleep for
several nights, so she was taken in at the Tallerman
Treatment Institute for treatment on January 13. The
left arm, which was greatly inflamed and red from the
elbow to the middle of the arm, was placed in the cylinder,
after which the patient fell asleep. Having slept for three
hours, she awoke feeling much more comfortable. She
did not have a good night, the elbow discharged very
freely a thick chalky material, but in the morning the
swelling and inflammation had considerably subsided.
The whole condition rapidly improved during the next few
03
I
M
o
tc
CASE 2. Taken March 30, 1897 : showing marked improvement in condition of
left great toe and of hands.
To face p. 92-111.
CASE 2. After treatment : showing absence of any eczema or gout.
To face p. 92 -IV.
Gout. 93
days. By January 21 the patient was well, and she
returned home. The elbow had ceased to discharge, and
the movements of the joints were unimpaired. She stated
that the last time her finger discharged it continued to do
so for six months. In April, 1897, the patient had con-
tinued quite free from gout since January, and there had
been no return of the eczema ; her general health had also
greatly improved.
CASE 3.
Subacute Gout, Chronic Bronchitis, and Albiuninuria.
This patient, who was first seen on September 21, 1896,
had probably inherited gout from his mother's side of
the family. A painter by trade, he had had severe colic
fourteen years ago, and was 61 years of age. The first
attack of gout occurred ten years ago in the right foot,
when he was laid up for a fortnight ; a second attack came
on three years later, and for the last three years he had had
repeated attacks, especially in the ankles. When he came
to the hospital the right foot was swollen, very tender, and
painful, the skin being red and much inflamed ; both legs
were osdematous. Internal remedies were prescribed. On
October 12 the general condition was much the same. The
cough and bronchitis continued troublesome, with a good
deal of expectoration in the early morning. There were
general bronchial rhonchi, especially at the right apex.
The urine was clear, of specific gravity 1012, and contained
albumin. The second heart sound was accentuated. The
condition of the foot was much about the same, the patient
being hardly able to get about, and then only with great
pain. On the 13th the first hot-air application was given,
no change being made in the medicines. The foot was
much easier, and he could move it more fully after treat-
ment. By the 19th he had had three baths. The foot was
much better, and the bronchitis was also much improved ;
there appeared to be less albumin than formerly. He had
slept much better since the baths were administered. On
the 20th the patient stated that his foot felt quite well ; he
had no pain whatever. He took a mixture of gentian and
bicarbonate of soda all through the treatment.
CASE 4.
Acute Gout. This case of acute gout in a man, affecting
the left ankle, was greatly relieved by three baths.
94 The Tallerman Treatment.
CASE 5.
Acute Gout. A man, aged 43 years, was first seen on
November 13, 1896. His father died from rheumatism and
Bright' s disease. Gout occurred for the first time ten years
ago, and the attacks had been repeated at least once a year
ever since. This attack came on two days previously with
great pain, chiefly in the left foot. He was given an alkaline
mixture of soda and gentian and the hot-air baths. The
patient felt great relief from the first bath ; he could bend
the foot with comfort afterwards, and the pain was much
less. On the 15th the foot had been much better. There
was no pain, but some stiffness about the ankle when
walking. After another bath the foot felt quite well, and
the stiffness had disappeared and did not return. On
April 3, 1897, the patient wrote to say that he had not had
a return of gout in the feet, and had continued at work ever
since the previous November.
CASE 6.
Acute Gout. A man, 24 years of age, came under
observation on December 7, 1896. There was no family
history of gout or rheumatism. Fourteen weeks previously
the patient had suffered from inflammation of the eyes,
which lasted three weeks, followed by pain in the back, which
kept him in bed for three weeks ; afterwards the pain settled
in the knees, the left great toe, and then in the left hand
and arm. Between December 7 and 21 he had four baths,
and in addition a mixture containing bicarbonate of soda
and iodide of potassium. By January 4, 1897, he was quite
free from gout.
CASE 7.
Gout, Bronchitis, Heart Disease, Albuminuria. This
patient, who was a woman aged 65 years, came under
observation on November 23, 1896. Her maternal grand-
mother, who suffered from gout, died when over eighty,
and her mother died at 93 years of age. She was quite well
till 43 years of age, when she had the first attack of gout in
the left great toe. She had had frequent attacks since in
the feet, ankles, knees, elbows and hands. For the last
eighteen years she had also suffered much from bronchitis.
On December 8 she was admitted into the hospital. At this
time the patient was very weak and suffered much from
dyspnoea ; the pulse was rapid (120) and small ; the cardiac
Gout 95
dulness was increased ; there was a soft systolic murmur at
the apex and a much louder one at the base, which murmur
was readily heard in the vessels of the neck ; the heart
sounds were very feeble ; there were general bronchial
rhonchi over both the lungs. The urine was of specific
gravity 1010, acid and clear, and there was some albumin
present. The feet' were much distorted from old standing
gouty changes ; there was a large nodule in the left meta-
tarsal phalangeal articulation of the great toe. There was
very little movement in the knee-joints, and there was
thickening about the heads of the tibiae. The joints of all
the fingers were enlarged, and the fingers deflected to the
ulnar side. There was a large firm nodule over the right
olecranon, and hard nodules on the outer side of the
olecranon of the left elbow. The patient had had little or
no sleep for weeks, and the breathing was rapid and shallow.
On December 11, after the first bath, the patient seemed to
be a little easier. By the 14th the breathing was better
after the bath, but she had not slept much. By the 21st
the right hand was not so painful, and the cough was a
little easier ; the patient still felt very weak, and her skin
did not act well. She gradually improved, and left the
hospital on January 7, 1897.
CASE 8.
Subacute Gmit. This patient, who was a cab-driver, 38
years of age, was first seen on January 4, 1897. He was
treated in the same way as the patient in Case 6, being
given two baths, and by January 14 he was free from pain.
CASE 9.
Acute Gout. This patient, a woman, aged 62 years, came
to the hospital on February 22, 1897, and gave no family
history of gout or rheumatism. She had congenital absence of
the first, second and third fingers of the left hand. Eighteen
3 T ears ago she had her first attack of gout in the right great
toe, and she had had repeated attacks, often twice a year,
ever since. The present attack came on a week ago in the
left shoulder, then the right leg, and three days later the
right hand became involved. The whole hand was much
swollen, very red, and the skin much inflamed and acutely
painful ; there was some inflammation of the left ankle.
She also suffered from chronic bronchitis. The first
application of the Tallerman treatment was administered
96 The Tallerman Treatment.
on the 23rd, with the result that the hand was less swollen
and felt much easier after the bath. A second was given
on the 25th. The fingers continued to be very stiff, but
there had been much less pain in them. A third applica-
tion was given on March 1, when the patient said that she
had slept much better and the pain had been much
relieved. After this she considered herself cured, and
returned to her occupation on March 10.
CASE 10.
Acute Gout. This patient was a salesman, who came to
the hospital on March 21, 1897, suffering from acute gout
in both hands, which was quite relieved by three baths and
an alkaline mixture.
It is important to note that nearly all of the above cases
were treated as hospital out-patients, and that therefore it
was impossible to regulate or in any way control their daily
habits as to diet, etc. Most of the patients were also only
treated during an attack of gout. It was difficult to persuade
them to undergo treatment by the hot air between the
attacks, even with a fair expectation of keeping off a return
of the disease. For instance, in Case 2, although many
promises were made, something always interfered to prevent
the continuance of regular treatment. In spite of the con-
siderable shortening of the attacks and of the improvement
in her general condition, freely admitted by the patient,
only the return of pain would persuade her of the need to
continue with the hot-air applications. My experience with
these cases is that directly the pain subsides the patient
returns to work, and neglects to take medicine or the
ordinary diet precautions. The cases above described
contain examples of gout in its various stages, from the
most acute, through the subacute, to the very chronic,
these latter, sometimes with acute exacerbations, occurring
from time to time. Taking first the very acute attacks
(Cases 1, 4, 5, 6 and 9), in all of these the local intense
pain and congestion were almost immediately relieved by
the hot air ; very obvious difference in the appearance of the
part was seen after the application, and the relief from the
intense agony of an acutely inflamed gouty joint was most
marked. But gout, like rheumatism, is always prone to
reappear, and it was found in Cases 1 and 6 that the acute
inflammation in the part first affected rapidly improved
under the local treatment, and in the course of a few days
another deposit, but one not necessarily so severe, appeared
Gout. 97
in another part, sometimes the corresponding limb of the
opposite side. Treatment would again rapidly disperse this
second deposit, and in no instance did it afterwards follow
in another joint. It would seem that in nearly all the cases
the attack under the hot-air treatment was very much
shorter than the previous attacks which had been treated
only by internal remedies (Cases 1, 2, 4 and 5). Often,
in fact, the attack which previously had lasted for weeks
under this method lasted only for the same number of
days. In some (Cases 2, 6, 8 and 9) internal medicines,
such as small doses of colchicum and iodide of potassium,
were also given ; in others only a simple alkaline mixture
(with a slight aperient) was administered, as in Cases 1,
3, 5 and 10. Nevertheless, in all of these cases the relief
from pain and the rapid and complete disappearance of the
gout were most marked. Case 2 very well illustrates the
treatment of very chronic gout, with gouty or chalk-stone
deposits ; the deposit in one finger for instance, being so
bad that at one time the medical attendant had wished to
amputate the digit, and yet after several applications of
heat the deposit gradually disappeared, and so also the
deposits about the heads of the larger bones became dis-
tinctly lessened.
CASE 11.
Treated at the Laennec Hospital, Paris. Under the care of
PROFESSOR LANDOUZY.
Acute Gouty Arthritis (?) of Palms and Surrounding Joints
(Arthrite Hadio-Palmaire aigue goutteuse /). Maurice
G. ; 24 years old. A medical student. He gave a history
of hereditary arthritis (rheumatism, gout, etc.). He had,
when 16 years old, a severe attack in the toes of the left
foot. He appeared in the hospital with a red swelling,
inflamed and painful in the right wrist and hand, which he
could not use at all. The fingers were inseparable and
bent, the arm held in a sling.
After ten minutes in the apparatus the patient began
to feel his fingers move ; at the end of the treatment,
which lasted about fifty minutes, the pain had completely
disappeared ; the swelling was diminished, the movements
easier. Three hours afterwards the patient played the
piano without difficulty, and the next day he covered thirty
kilometres on his bicycle. Three days afterwards he had a
slight attack of pain in the left hand, which disappeared
completely after one treatment.
7
98 The Tallerman Treatment.
CASE 12.
Treated at the Philadelphia Hospital.
Saturnine Gout. Thomas Latham ; aged 46 ; birthplace,
England ; residence, Philadelphia ; occupation, worker in
lead; attending physician, F. A. Packard; resident phy-
sician, Kaymond Spear.
Mother died of asthma. Father died of old age. One
daughter living. Three brothers and two sisters living and
healthy. Has always been healthy. No venereal history.
No history of alcoholism. Has worked in lead for many
years. Since 1890 has had numerous attacks of gout,
which has affected the small joints in his feet and hands.
For past two years has been an invalid. Had suffered with
pains all through his body. Has numerous tophi, situated
in small bones of hands and feet. His heart is much
enlarged. His arteries show evidences of arteris and
capillary fibrosis. His urine contains albumin, at times
one-third bulk by boiling test, and some granular and
hyaline casts. On November 11, 1896, he was taken to the
College of Physicians and Surgeons and exhibited before the
County Medical Society. When exhibited he had an acute
attack of gout, involving point of great toe of right foot.
He had shooting pains through his body, a severe headache,
his grip was weak, and the joints of his feet, especially his
right, were immobile. He was placed in a Tallerman Hot-
Air Bath for forty minutes. After the bath the reddened,
angry joint of his great toe appeared white. The swelling
had disappeared. The joints of both feet were freely
movable. The pain had disappeared. His grip was much
stronger. His headache had left him. He said he had not
felt so well since he had been taken sick. On November 11
the man complained of headache and pains in his left leg
(the foot that had not been treated), also shooting pains
through the rest of his body. Was given another Taller-
man Hot-Air Bath. Before the bath the joint of the great
toe of his left foot was the seat of an acute attack of gout.
After the bath the pain had disappeared, and the joint
resumed a normal appearance. The pains in the rest of his
body had disappeared. The results of the treatment in
this case were remarkable, owing to the rapidity in the
disappearance of symptoms which until this time had re-
sisted treatment for the past two years.
Gout. 99
CASE 13.
Under the care of ARTHUR ROBERTS, M.D.
Acute Gout. A. H., aged 51 years, was suffering from
acute gout in both knees and feet, and left arm.
Had suffered for twenty years from gout, but up to now
had always been able to walk about on crutches. Had
been treated by medical men at various places, but received
no permanent benefit, nor had he ever at any time been
entirely free from the stiffness in the joints, though he
had often been better and worse.
Now he is completely laid up, and for several nights has
not been able to sleep owing to great pain.
I considered the case a suitable one for treatment by the
Tallerman Hot- Air Bath mentioned by Mr. Willett in his
clinical lecture at St. Bartholomew's ; and a cylinder was
obtained from London.
On June 4, 1895, the patient was treated for the first
time.
Before treatment : Temp. 99, P. 80, B. 20.
The left leg was put in the cylinder. Twenty -five
minutes later he could straighten the leg and bear pressure
on the knee without any pain. After the operation all the
pain was gone, both in left leg and also in the other leg and
arm.
Operation, forty-five minutes. Temp, after bath 99%
P. 84, B. 20.
Measurement of radial artery by arteriometer :
Before, 1'8 mm.
During, 1*9 mm.
After, 2'4 mm.
All these observations were taken in the recumbent position.
Patient said he ' felt very much better, and the bath
was worth all the expense and trouble.'
Second treatment, June 5, 1895. Left leg in forty-five
minutes. Patient finds all his pain gone. The pain had
not returned since last treated.
Arteriometer :
After twenty minutes, 1*9 mm.
After bath, 2'5 mm.
Third treatment, June 6, 1895. Pain has not returned.
Bight leg was placed in the cylinder.
72
100 The Tallerman Treatment.
Arteriometer :
Tj fEieht, 2'8 mm.
Before tLeft, 3-5 mm.
A ,, /Eight, 3'5 mm.
3r |Left, 4-0 mm.
This showed that the effect of the bath was to increase
the calibre of the radial artery, and the improvement was
not only in the leg, but also in the general system.
Fourth treatment, June 8. The left arm was placed in.
I was not present on this occasion.
Arteriometer before bath :
Eight radial, 2'5 mm.
I saw patient after the bath, and he reports continued
improvement. Patient says that he has never had any
treatment that has produced such a profound and beneficial
effect on his system before. He is delighted with it.
The duration of the operations averaged about forty-five
minutes, and the temperature 240 F.
Case still under treatment (June 8, 1895).
ARTHUR EGBERTS, M.D.
CASE 14.
Treated at the North-west London Hospital. Under the
care O/MR. MAYO COLLIER, F.E.C.S.
"VV. E. E. ; aged 57 years. Goods guard, L. and N.W.E.
Patient sprained his right ankle whilst at work on August 11,
by striking it against a stack of iron.
On the day after the injury he had a typical attack of
gout in the great toe of the injured foot, and stated that he
had been unable to sleep for two nights, and was in great
pain.
On examination the right ankle and foot were very
much swollen, the joint filled with fluid, and the entire
surface reddened and shiny. Acute tenderness was present
over the whole foot, especially over the tarso-metatarsal
joint of the great toe ; all movements were painful, and the
foot could not be put to the ground.
First Operation, August 14. Forty minutes.
After the bath, the pain and tenderness to pressure and
movement had gone from the ankle-joint, and the pain and
tenderness in the great toe were much modified.
Gout. 101
Second Operation, August 15. Thirty minutes.
Patient had passed a good night, and after the operation-
he was able to stand.
Third Operation, August 20. Thirty minutes.
On examination there was no pain or tenderness on
movement or pressure, and the patient was now able to
walk. Some redness still remained.
Fourth Operation, August 21. Forty minutes.
Swelling almost gone ; no pain or tenderness.
Fifth Operation, August 23. Forty-five minutes.
The patient having reported that he had been able to
walk for twenty minutes without pain, and all effusion
having disappeared, the ankle and great toe being now
freely movable and without pain, he was considered in a
fit state to resume his ordinary duties, and was discharged.
Note. The temperature in this case was maintained at
from 230 to 240 F., and the result obtained was most
satisfactory. The pain was relieved almost at once, the
effusion rapidly disappeared, and the patient was cured of a
bad attack of gout with a severe sprain hi twelve days.
J. F. SARGEANT, M.E.C.S., M.R.C.P.
CASE 15.
L. N., a gentleman, aged 53, who for some years past
has been subject to occasional attacks of gout, had in
April last a sharp seizure in one ankle. After the first
bath of one hour the pain was gone, and he was able to
put his foot to the ground. The treatment was repeated on
the two following days, and he then returned to business.
B. MEREDITH EOWE, M.E.C.S.
Up to this date there has been no return, or other attack.
CASE 16.
Treated in South Charitable Infirmary, Cork.
Mrs. M. K. Gout in great toe ; synovitis of ankle two
months' duration. Had to give up work and was confined
to bed. Unable to sleep. After first bath was able to
sleep ; after second walked to infirmary ; after eight baths
was completely well.
' I have much pleasure in stating that Mrs. M. K., suf-
fering from gout and chronic inflammation of ankle-joint,
was completely cured by Tallerman Hot- Air treatment.'
JOHN REID, M.B., B.Ch., Senior House-Surgeon.
102 The Tallerman Treatment.
CASE 17.
Treated at the Laennec Hospital, Paris. Under the care of
PROFESSOR LANDOUZY.
Gout . X. ; 40 years old. Arthritic. Several attacks
of genuine gout. Has tried all methods of treatment and
has obtained only incomplete and passing results.
Persistent pain in the great toe and in the metatarsal
joints of the right foot. Walking inconvenient, painful and
often impossible. Swelling and hypertrophy of the affected
joints. Measurements of the affected parts before the
treatment : Eight knee, 37 centimetres ; left knee, 41
centimetres ; right instep, 27 centimetres ; left instep, 25
centimetres.
Treatment with the Tallerrnan apparatus.
Disappearance of pain at the first bath. It returned a
little, only to disappear permanently after eleven baths.
Movement restored. Swelling of the left knee and right
instep reduced. Measurements after the sixth bath :
Eight knee, 36J centimetres ; left knee, 39 centimetres ;
right instep, 25 centimetres ; left instep, 24J centimetres.
Thus there was a reduction of 2 centimetres in the left
knee and of 2 centimetres in the right instep. The patient
is still under treatment.
CASE 18.
A. E. ; aged 60. Cotton spinner. Suffering from acute
gout in both feet, toes and ankles, both knees, and index-
finger of right hand. All these joints are swollen, tense with
effusion, exquisitely painful and immovable. The present
attack has lasted about a fortnight, during which time he
has had little or no sleep on account of the pain.
History. Thirteen years ago suffered from shock, the
result of a railway accident, and four days afterwards had
his first attack of gout. Began with pains in the head,
followed in a few days with pain and swelling in the ball
of the great toe of the right foot. From this time till
present date has had periodic attacks once or twice a year.
November 21. In spite of treatment, the pain was so
severe that I asked Mr. Tallerman, who very kindly con-
sented, to treat the patient in the Tallerman Superheated
Dry- Air Bath, with the following remarkable result :
Before the operation the patient lay helpless upon his
back, having a drawn and anxious expression, absolutely
unable to move, except his left arm, and his right arm only
from the shoulder. Temperature 100'6, and pulse 92 full.
OASE 17. Before treatment : showing swelling of left knee and right great toe.
Tojace p. 1021.
CASE 17. After treatment : showing reduction of swelling of left
knee and right great toe.
To face p. 10211.
Gout. 103
The left leg was put into the cylinder, and the tempera-
ture raised from 150 to 220, whilst the rest of the body
was enveloped in a blanket. In ten minutes he was asked,
' Have you any pain ?' when he thought for a moment, and
said, ' No ; the heat seems to have absorbed the whole of
the pain.' After thirty minutes he was able, slowly and
without pain, to move the fingers of his right hand so as to
make a loose fist. At the end of forty minutes he was
taken out of the cylinder. During the operation he per-
spired profusely, and his pulse had risen to 108, whilst the
temperature was up to 101'6. Twenty minutes later
temperature had fallen to 100 and pulse 92. He was
able to move both his ankles slowly, and had some degree
of flexion in both knees, which, however, were still very
tense. In about two hours the pain returned, and was
very severe for about twenty minutes, when it disap-
peared, and he slept eight hours with one break of about
ten minutes.
A second bath was given the following day, when it was
noted that the temperature rose from 100 to 100*6, and
the pulse from 96 to 104. This bath was given for forty-
five minutes, during which the temperature was raised
from 160 to 220.
November 26. Patient convalescent ; has had no return
of the pain; able to be up in his room for six or seven
hours.
December 10. Eight knee painful and stiff, temperature
99-6 and pulse 88.
December 14. All pain gone. Patient downstairs.
Pulse 80, temperature 98 '2 ; able to walk up and down
stairs without inconvenience, though slowly.
Only two baths could be given, as Mr. Tallerman had to
return to town and could not leave the cylinder, otherwise
I feel sure the convalescence would have been much
shortened.
Jos. G. G. CORKHILL, M.B., etc.
CHAPTEE VII.
SCIATICA, LUMBAGO, LOCAL PARALYSIS, WASTING,
WRITER'S CRAMP, AND CHOREA.
THE striking effects of the hot-air treatment in reducing
pain have already been sufficiently commented on. Sciatica
and similar affections therefore suggest themselves as
particularly suitable for treatment, and the results obtained
fully bear out that expectation. Some very severe and
obstinate cases are here shown to have yielded readily,
after other remedies had totally failed. As Dr. Sibley
says : ' Very intractable cases of sciatica usually pass into
the hands of the surgeon, who performs nerve stretching,
often with very little good result. It seems likely that
these cases will likewise in future be cured by this less
drastic means.'
The two cases of partial paralysis included in this chapter
are examples of another kind of nerve affection, which offers
an extremely promising field. It is a pity that no more
notes are as yet available, but other cases of paralysis and
wasting of limbs have already been treated with the most
happy results, and there is obviously scope for a wide
extension of usefulness in this direction. Particular atten-
tion is drawn to the case of writer's cramp (Case 13).
Patients' letters (of which a great many have been received)
are excluded from this book ; but an exception has been
made in favour of Mrs. Walford, the distinguished
authoress, who has been allowed to tell her own story,
because of the literary interest attaching to her account.
The accuracy of her description is vouched for by the
Sciatica. 105
medical man under whose care the treatment was con-
ducted ; its raciness and vigour speak for themselves.
CASE 1.
Treated at the Laennec Hospital. Under the care of
PROFESSOR LANDOUZY.
Sciatica. Louis D. ; 32 years old. True sciatica had
begun two months before, suddenly, on rising in the
morning, and had resisted all therapeutic methods (chloride
of methyl, blisters, salicylate of soda, sulphur baths, iodine).
Unable to walk. Standing even very painful. Severe pains.
Lasegue's symptoms.
Three Superheated Dry- Air baths ; complete disappear-
ance of pain. The patient left the hospital cured.
CASE 2.
From the same Clinique.
Sciatica. Louis C. ; 38 years old. The illness began
in 1890, following a severe injury of the outside of the left
thigh and hip. The pain returned in April, 1896.
Extremely severe pains along the great sciatic nerve,
with radiations into the ankle and heel. Pain on pressure
on the sacro-iliac joint. No new growth in the abdominal
region was revealed by pressure in the region of the rectum
and atrophy of the left leg. Various treatments tried
without result. Salicylate of soda in large doses, siphonage,
injections of chloroform. The patient took five baths.
Under their influence the pain was much lessened, but did
not disappear entirely. The patient is, however, able to
walk, although limping a little. The sacro-iliac joint
remains painful to the touch. Slight return of pain at the
end of fifteen days. Pvesult incomplete, as was to be
expected from the undeterminate nature and rather peculiar
character of sciatica.*
CASE 3.
Treated before the Practitioners' Society of New York. By
V. P. GIBNEY, M.D.
Chronic Sciatica, irith Recurring Acute Attacks ; very
obstinate. The patient is a man, 50 years of age, who was
referred by Dr. John J. Eeid for this treatment. He had
an attack fourteen years ago, lasting three months. The
present attack has lasted four months. The pain is referred
* La Presse Medicale, December 26, 1896.
106 The Tallerman Treatment.
down the course of the limb, which is tender on pressure.
He walks as if the limb were deformed, but the range of
motion is quite free. He complains a great deal if he
stands with the limb or walks with it. He is subjected to
the bath this evening, during the meeting of the society, and,
at the expiration of fifty minutes, temperature 260 F., he
expresses himself as feeling much better and able to use the
limb more freely. The immediate effect, therefore, is good.
V. P. GIBNEY, M.D.
CASE 4.
Treated by DR. A. EGBERTS.
Nurse Y. This was an old case of lumbago and sciatica
with swollen knee. The right leg was treated for forty
minutes at a temperature up to 240 F.
Result. The patient was much improved and the pain
manifestly lessened.
CASES 5-8.*
Treated at the North-west London Hospital. Under the care
of DR. SlBLEY.
CASE 5.
Sciatica : duration seven months. The patient was a man
aged 56 years, who came under observation on July 16,
1896. His father, who died aged 75 years, suffered from
rheumatic gout. The patient's brother also suffered from
rheumatism. The patient had had rheumatic gout in his
toes when 20 years of age, and had had muscular rheu-
matism occasionally ever since, but never very severely.
He was in St. Thomas's Hospital for thirteen weeks in
1887 with nephritis and dropsy, and afterwards was an
out-patient. For the last seven months he had had
sciatica in the right leg, which had prevented him following
his occupation. He was under a private practitioner for
five weeks, and then became an in-patient in University
College Hospital for a fortnight, but derived very little
benefit ; he had been attending as an out-patient till three
weeks previously, but had gradually become worse. There
was no albumin in the urine. He could walk a little, but
with great pain and difficulty, and was able to raise the
right leg but a few inches off the ground ; there was much
tenderness over the course of the sciatic nerve on pressure.
On the 16th the right leg and part of the thigh were im-
mersed in the cylinder for an hour at a temperature of
. * From the Lancet, August 29, 1896.
CASE 5. Sciatica (taken July 16, 1896), before treatment: showing limit
of patient's ability to move. This is the highest point to which the
limb could be raised, and the movement was accompanied by pain.
To face p. 1061.
CASE 5. Sciatic (taken July 20, 1896): showing patient's ability to
move the leg after the third bath.
To face p. 10611.
Sciatica. 107
240 F. He was photographed with the leg raised as
high as possible before and after treatment. The pain was
much relieved, and he slept well that night, which he had
not done for weeks. On the 17th the patient walked nearly
five miles for treatment without much difficulty, and the
hip was placed in the apparatus for forty-five minutes at a
temperature of 250, and the patient felt much better after-
wards. On the 20th, after the third operation, he reported
that there was a little pain above the right knee ; the rest
of the pain had quite gone ; he could kneel, and he slept
well. The treatment was stopped. On the 28th the patient
had had no more pain ; he had walked without a stick for
the first time for six months, and he could flex the right
thigh as high as the left. There was some stiffness about
the knee, probably from having walked with a stiff joint for
so long.
CASE 6.
Sciatica. On July 27, 1896, a man aged 51 years came
under treatment. He was a native of the West Indies.
He had attended the Royal Free Hospital for debility a
year previously, and had suffered from pains in the back
and thighs since. Fourteen days before he had had a
sharp attack of sciatica on the right side, and after a week
he was compelled to give up work. He rubbed the part
with embrocation, which had taken the skin off without
giving any relief from the pain. An alkaline mixture and
aperient pills were prescribed. On the 28th, the pain being
no better, the patient was put into the Tallerman pelvic
apparatus, after which the pain was much less. By the 30th
he had had two baths ; all the pain had gone from the hips
and thigh, but there was still some pain in the front of the
right tibia. On the 31st there was no return of pain in the
thigh, but some in the lower part of the right leg. Another
bath was given, and this time the right leg was put into the
cylinder, after which the pain quite disappeared.
CASE 7.
Lumbago and Sciatica : duration six weeks. On July 9,
1896, a man aged 26 years came under observation. There
was no family history of rheumatism, but there was phthisis
on his father's side. The patient had had hip-joint disease,
and excision was performed on the right side when he was
18 years of age. He had now had sciatica and lumbago
108 The Tallerman Treatment.
for six weeks, and was prescribed an alkaline mixture. On
July 16 the pain was much the same. On the 20th the
right leg was placed in the cylinder, after which the pain
was much better. On the 21st the bath was repeated, with
a completely satisfactory result. On the 23rd the patient
had had no pain since the last bath. On August 6 he
continued to be quite free from pain, and had returned to
work.
CASE 8.
Neuralgia following Herpes. The patient, who came
under notice on July 13, 1896, was a woman aged 65 years.
She was stated to have had influenza two years ago, which
was followed by dropsy in the hands and feet, with which
she was laid up for twelve weeks. Ten days previously to
her coming under treatment an eruption came out over
the left side of the neck, which followed three days' throbbing
in this region. The case was rather a severe one of herpes ;
the blebs were unusually large and confluent over the left
side of the neck, extending on to the face in front of the
ear, up behind the ear, just into the hairy scalp, and slightly
over the clavicle. She was given some starch and boracic
powder to dust on, and a quinine mixture to take internally.
There was albuminuria. On the 20th she was going on
well, the eruption having nearly disappeared. On the 27th
it was noticed that for the previous five days the patient
had suffered severe neuralgic pain all over the region of the
eruption ; this had prevented her from sleeping at night ;
she was apparently in great pain and much depressed, and
was crying. On the 28th the pain was just the same.
The left arm up to the shoulder was placed in one of the
hot-air cylinders. In forty minutes all the pain had gone,
and, although some returned the same evening, she had a
very fair night. On the 29th there was still some pain, but
not so bad ; the bath was repeated, during which process
the pain again quite disappeared. On the 30th there had
been little or no pain since the bath on the 29th, and the
patient felt much better, and had had a very good night's
rest. On August 6 there had been no return of the pain.
CASE 9.
Treated at the Liverpool Infirmary.
James W. states that about five weeks ago he felt pains
gradually spreading from left hip to left knee; went on
working for about a fortnight, but had to lie up at home
Paralysis. 109
for a week ; getting no better, he came to this hospital
August 4, 1896. Was treated medicinally until August 18,
when the Tallerman treatment was commenced. The
patient had eleven baths, having one every other day. His
highest temperature during bath was 100 ; highest tempera-
ture of bath, 245. Left hospital, September 19, quite well.
JOSEPH MAGUIRE, Ees. Med. Officer.
CASE 10.
Shown at the Brighton and Sussex Medico-Chirnrgical
Society by DR. HEDLEY.
Paralysis and Tactile Insensibility following Injury.
J. B., aged 35, states that in September, 1892, he received
some very severe ill-treatment, consisting chiefly of blows
on the face and head. He was taken to the Sussex County
Hospital, where he remained unconscious for thirty-six
hours. It appears that the entire right side of the body
was found to be paralyzed and anaesthetic.
His condition much improved under treatment, and he
was discharged December, 1892, attending as an out-
patient up to May, 1893. Since then he had not had
treatment excepting ' penny shocks from an electrical
machine,' until June 26, 1894. On that day i.e., one year
and nine months after the accident he came under the
observation of the writer. His condition was then as
follows :
He said his hand and leg were both getting worse, and
he was altogether ' going back.' His right leg was cold,
and in walking perceptibly ' dragged.' Knee-jerk exagger-
ated on that side. ' Squeeze ' of right hand, 40 Ib. ; of
left, 55 Ib. There was some contracture of flexor tendons
of fore, middle, and ring fingers. He said the hand felt
' stiff' and 'numb.' He could not pick up pins. Tactile
sensibility much impaired. Of the other ' sensibilities,'
those of pain and temperature were both diminished.
Muscular sense did not seem to be impaired. The elec-
trical reactions presented no feature of interest. Under
general electrical treatment, especially by the alternating
current bath, motor-power improved, and under faradic
brushing tactile sensibility began slowly to recover itself.
In view, however, of recent experiences, it was considered
probable that in the application of hot air at high tempera-
tures would be found a means of powerfully aiding the
action of the faradic brush in stimulating the receptive
organs situated in the skin. The affected hand was therefore
110 The Tallerman Treatment.
placed in the cylinder for forty minutes at a temperature
of 160 F., which on six occasions was gradually raised to
245 F., and on one occasion to 295 F. The immediate
result on each occasion was, as the patient expressed it,
that the hand felt less ' numb,' more ' alive ' and ' supple '
than before. The points of a pair of compasses could be
felt at decreasing distances. The hand has become cor-
respondingly useful. He could write better, pick up pins,
etc. Besides this quickening of cutaneous sensibility, the
hot-air process, aided by manipulation, has materially
relaxed the contractions, and the writer cannot help think-
ing that it has also in other ways improved the motor-
power of the limb.
CASES 11 AND 12.*
Shown at the North-ivest London Clinical Society by
DR. SIBLEY.
CASE 11.
This patient had suffered from malnutrition of the leg
after ligature of the femoral artery and injury to the nerve.
He was in the hospital under Mr. Durham from Septem-
ber, 1895, to July, 1896, with an abscess in the popliteal
space which eroded into the popliteal artery. This was
ligatured, and afterwards the femoral had to be tied on
account of haemorrhage. There appeared also to have
been considerable injury to the popliteal nerve. When he
first came under Dr. Sibley's treatment in October of last
year, the leg was cold, very blue, and much withered.
There was considerable impairment of sensation in places,
especially about the foot, complete anaesthesia of the great
toe and inner side of the foot ; there was also perversion of
sensation, the ankle was very stiff, and the patient could
hardly walk. By March 15 the patient had had eighteen
baths. The limb was much stronger, and he was able to
get about comfortably; the feeling in the foot was much
improved, and the limb remained constantly warm. The
general nutrition of the part had also improved.
CASE 12.
The next case was one of malnutrition of the hand, due
to severance of the nerves of the wrist. The patient re-
ceived a severe cut across the wrist- joint in October last
year, which was followed by loss of sensation in the last
* From the Clinical Journal, April 28, 1897.
Writer's Cramp. Ill
three fingers, and the hand could not be used for anything.
The first bath was given on January 4, and the patient
stated that some feeling returned after the second bath,
and remained for a few hours, but was lost again after-
wards. On February 16 he had had six baths, and was
able to use his hand a little. Sensation had also returned
to a considerable degree in the fingers.
CASE 13.*
Treated at 50, Welbeck Street.
Writer s Cramp. It was kindly meant, but it grew a
trifle monotonous. I could not meet an acquaintance, or
receive a letter, without being confronted by the sympathetic
inquiry, ' How is your poor arm ?' And as the ' poor arm '
was never a ha'porth the better, and I had gradually grown
philosophical on the subject, I should almost have pre-
ferred not quite, perhaps, for human nature has a secret
craving for the very sympathy it affects to despise still, I
say, I could almost have preferred others forgetting what I
had myself ceased to think about. The poet says :
1 Tis well that man to all the varying states
Of good or ill his mind accommodates ;
He not alone progressive grief sustains,
But soon submits to inexperienced pains.'
Even so had the present writer come to ' submit/ and
would probably have gone on ' submitting ' to the end of
time, but for the piece of good fortune now about to be
narrated for the benefit of others in a like case, who have
calmly surrendered themselves to what they feel to be the
inevitable, but who may now take heart of grace, and look
forward to a deliverance as unexpected and extraordinary
as my own.
Let me, therefore, tell my tale. About three years ago,
after nearly twenty years of busy authorship, and at the
close of a prolonged strain, I became aware of a somewhat
sudden failure of strength in my right hand and arm,
joined to uneasiness in the joints of the elbow and wrist,
which sometimes extended even to the shoulder. This
increased as time wore on, and under medical advice a
course of baths and waters, first at Bath and then at
Buxton, was undertaken ; but although my health was
benefited, and, indeed, was never greatly affected by the
local ' worry,' the writing-arm was untouched. I then
* From the Court Circular.
112 The Tallerman Treatment.
sought the advice of various well-known authorities there
is no need to mention names : I tried them all not except-
ing the one, whose name will rise at once to your lips, and
though he did indeed effect what none of the rest had, a
partial cure, enabling me to release the now thoroughly
weakened and enervated arm from its sling, and to use it
for every other purpose than the one for which it appears
to have been primarily intended that remained unattain-
able as ever. I could not do any literary work whatever
without the aid of a secretary. Furthermore, I had fits of
severe neuralgia in the shoulder-blade of the other arm,
occasioned, I was told, by sympathy. (N.B. A curious
and not altogether satisfactory mode of evincing such. I
do not recommend it.)
This state of things having gone on for two years, it was
time for some fresh development to take place, and accord-
ingly, last November, during a wet week in which everyone
complained of more or less rheumatism, I started a stiff
knee, which was painful whenever unbent, made me walk
lame, and dread going upstairs. In connection were divers
lesser rheumatic aches and pains.
' Are you not doing anything to get rid of your rheuma-
tism ?' observed a friend one day. ' It appears to grow
worse, and with the winter before you, it is rather a gloomy
prospect. What do you say to trying the new hot-air cure ?'
What 1 said need not here be related. Fill it in, dear
reader, for yourself, for I was marvellously disinclined to
try any new cure, whether of earth, air, fire, or water, just
as disinclined as you are, perchance, and every whit as
sceptical. My friend he is one whose opinion I greatly
value heard me out patiently, and then argued the point.
Finally, I agreed to glance at the little book on the inven-
tion, and having done so, the day was his own. If ' she
who hesitates is lost,' he or she who reads the varied and
marvellous accounts of cases treated by Mr. Tallerman,
testified to by some of our highest medical authorities, has
no loophole of escape left for unbelief, or indolence, or
neglect. The cure for rheumatic affections is to be had,
and those who wish to be cured can be, if they choose.
This fact impressed on my mind, I presented myself one
autumnal afternoon at 50, Welbeck Street, having previously
made an appointment, and then and there had my first
so-called ' bath.' Let me try to explain what took place.
It was so very much less formidable than I had anticipated,
that the narrative may encourage others as doubtful, as
shrinking as myself.
Writer's Cramp. 113
I was shown into a pleasant back-room, with a skylight
window and a blazing fire, where ranged round about were
eight or ten large copper cylinders somewhat resembling
miniature railway engines presided over by a bright young
nurse, who at once conducted me into a small adjoining
dressing-room, bade me disrobe, and rehabille myself solely
in the flannel dressing-gown brought for the purpose. That
done, I stepped forth again into the ' railway-shed ' how
cosy and cheerful it looked, with all its shining brass and
copper, that dismal afternoon ! and Mrs. Nurse at once
proceeded to seat me in a comfortable arm-chair wheeled
up to the mouth of one of her cylinders, already prepared
for the purpose. She then carefully placed the limb to be
treated within the copper chamber. The cylinder was then
closed at the other end, and I was encased in blankets,
given a tumbler of water to drink (either hot or cold,
according to taste, equally promotes the action of the skin),
my pulse was felt, my temperature taken, and the operation
had begun. The thermometer, indicating the gradual
increase of heat within the cylinder, rose and rose; the
patient grew very warm (without, however, experiencing
the slightest pain or uneasiness), and three-quarters of an
hour passed.
Throughout the whole period of the bath, and even when
the thermometer attached to the hot-air chamber stood
at 250, there was only a comfortable glow in the veins,
with a pulse increased by a dozen beats, and a temperature
sent up two degrees !
For be it observed that the whole system is affected
through the member whichever it be which is encased
in the heated chamber, while yet the patient, breathing a
cooler atmosphere, experiences none of that lassitude and
inclination to headache familiar to those who have under-
gone courses of Turkish and hot-air baths. It will also be
remembered that a moist atmosphere of 115 degrees is the
highest that can be endured. I repeat, then, that I ex-
perienced neither weariness nor discomfort during the hot-
air application, and only a lively curiosity to know the
result.
And this was the result that the stiff knee, on being
withdrawn from the cylinder, bent and unbent, and was
moved and twisted about by skilful hands, without the
slightest difficulty, and without a twinge of pain.
I then quickly dressed, and after remaining a short time
in the outer reception-room in order to cool down before
8
114 The Tallermari, Treatment.
facing the chill, misty, open air, walked away from the
door with greater ease than I had done since the attack
began. I was not completely cured, for, though much
lessened, I was conscious of a return of the difficulty in
straightening the joint, and accordingly another bath
speedily followed, this second application being attended
with such absolute and unqualified success that I have
never given the troublesome member a thought since.
That took place in the middle of December last.
Encouraged now to try issues with the hardened offender
my ' poor arm ' which still continued to receive its usual
quantum of sympathy and condolences, I agreed to make a
trial on its behalf, although with the secret reservation
that whereas it was comparatively easy to overcome a mere
passing ailment in a perfectly sound and healthy limb, it
would be another matter altogether to restore one to use
and strength which had already resisted the efforts of some
of the ablest medical men of our time.
I should, of course, be patient and just, but if at the end
of a course of six or seven hot-air baths well, it would
only be the old disappointment reappearing in a new form,
and, prepared for resignation, I began the course.
As the application was precisely similar to that already
described, I need not repeat what now took place. The
arm, in place of the leg, was encased within the heated
cylinder, and that was all.
Anxious to give the experiment every chance, I arranged
to take the baths on consecutive days, and after the first
four, so marked was the improvement that it almost seemed
as though the cure were actually effected. My fingers,
which had been rigid, could close easily, wrist and elbow
were supple as in days of old, and I could not only write,
but write with a hand that did not ache. It took, however,
three more baths seven in all to exorcise the fiend, as I
humbly hope for ever.
Nor is this all the treatment for my ' poor arm ' has
operated favourably upon my whole system. I was slightly
rheumatic all over. Since undergoing the hot-air cure I have
not felt a twinge of rheumatism, albeit this is the time of
year at which I am most subject to aches and pains. I feel
better in every way, refreshed, strengthened. I no longer
employ a secretary, but am fulfilling my literary engage-
ments with my own hand, and it seems to me that I can
do no less than make known to the many who have con-
doled in the past my claim to congratulation in the present ;
Writer's Cramp. 115
whilst in the hope that to other rheumatic sufferers this
idea of deliverance, which came as a revelation, may prove
a blessing, I append my name in full to this true statement
of facts.
L. B. WALFORD.
CASE 14.
Shoicn at the North-West London Clinical Society,
November 18, 1896.
Chorea Major, Rheumatism, Endo- and Peri-carditis. Dr.
Knowsley Sibley showed a boy, aged 13, who was admitted
into the hospital under his care on October 15. He had
been ill a fortnight, and was unable to stand, suffering with
very severe choreic movements of the whole body, especially
the muscles of the face and upper extremities. The head
was thrown back, pupils widely dilated, lips were pouting ;
there was considerable respiratory embarrassment ; in-
spiration was fairly good, but there was great difficulty in
expiration, several feeble attempts preceded a violent
expiratory sigh. The tongue was protruding from the
mouth, and almost bitten in half. The temperature was
103, and pulse 120. There was a faint systolic apex
murmur, accompanied by a slight pericardial one. The
next day the pericardial friction had considerably extended,
and could be heard all over the cardiac region. There
was also great difficulty in deglutition. The boy complained
of some pain in the knees ; there was no effusion or red-
ness of these. By the fifth day the temperature had
dropped to normal, and did not rise again, and nearly all
the movements except those of the forehead had subsided.
Now, at the end of a month, the child was, with the excep-
tion of the mitral regurgitation, well. The treatment had
been a mixture of salicylate of soda and digitalis every
six hours, and dry hot-air baths. On November 3 he
was put on strychnia and iron tonic. Clinical Journal,
December 16, 1896.
82
CHAPTER VIII.
SPRAINS AND OTHER INJURIES.
IT is well known that few minor injuries are so troublesome
as sprains, and that they have become extremely frequent
since the spread of bicycling. To those who live by manual
labour they are an extremely serious matter, and, of course,
they are also very common. A rapid cure is of the greatest
importance, not only to the workers themselves, but to
their benefit societies, and, under the new legislation, to
employers of labour. Their attention is therefore drawn
to the value of the Tallerman treatment in this class of
cases, as evidenced by the following notes :
CASE 1.
Treated at the North-West London Hospital. Under the
care q/'ME. MAYO COLLIER, F.R.C.S.
W. H. ; aged 11. Sprain of right ankle. Eight ankle and
foot swollen, tender, and painful, with great pain on move-
ment and inability to put the injured foot to the ground.
There was a good deal of effusion, both into the tendon-
sheaths and into the joint itself.
First Operation, August 13. Forty minutes.
On examination, after treatment, the pain was found to
have almost disappeared ; there was considerably less
effusion, and the foot could be put to the ground.
Second Operation, August 14. Thirty-four minutes.
Further improvement, with power to flex and extend the
foot.
CASE 2. Showing ability to stand with the whole weight of the
body on the injured foot.
To face p. 117.
Sprains and other Injuries. 117
Third and last Operation, August 16. Thirty minutes.
The effusion entirely absorbed ; patient walked well and
without pain, and was discharged as cured.
Note. The result of the treatment in this case was very
satisfactory, a severe sprain having been cured after three
operations in four days.
J. F. SARGBANT, M.E.C.S., L.R.C.P.
CASES 2 AND 3.
Treated at the North-West London Hospital. Under the
care 0/Mn. MAYO COLLIER, F.R.C.S.
T. Y., aged 22, butcher; W. J., aged 24, groom. Both
these cases were sprained ankles, with the usual severe
symptoms. Each was treated on five occasions with most
satisfactory results. The pain in both cases had disappeared
after the second operation, and the joints were quite sound
after the fifth.
CASE 4.
Treated by DR. EDOUARD CHRETIEN.
Contusion and Sprain of the Right Elbow. Bernard L.,
aged 33, sustained by a fall from his bicycle a severe
contusion and sprain of the right elbow. Flexion and
extension of the forearm were impossible. The movement
of the fingers caused a severe pain in the elbow -joint.
Unable to write. Functional impotence.
After the second Tallerman bath the patient wrote with-
out difficulty ; after the third the movements of the fingers
no longer caused pain.
CASES 5-13.
Treated at the Liverpool Infirmary.
CASE 5.
Mark M., aged 50, fell down some stone steps on June 19,
1896, and sprained right ankle. Admitted to the hospital
June 21. Ankle swollen and painful ; treated with evapo-
rating lotion and rest in bed till July 11. Bath com-
menced. Had in all sixteen baths, his highest temperature
being 99*6, and the highest temperature of bath 235. On
July 29 a blister found compelling patient to keep to bed
again. He took his discharge August 22, quite recovered.
Duration of bath sixty minutes.
118 The Tallerman Treatment.
CASE 6.
Patrick R., aged 35, fell off a parapet and sprained
left ankle. Admitted to hospital July 4, the night of the
accident. Treatment by Tallerman process commenced
July 9. Had five consecutive baths ; able to walk after
first bath. Patient's highest temperature 99'8 ; highest
temperature of bath 240. Left July 16, quite well.
CASE 7.
James J., aged 67, states he slipped and fell on July 6,
spraining his ankle. Admitted to hospital same day.
Eest in bed and evaporating lotion treatment adopted till
July 20, when bath commenced. Had five baths. Patient's
highest temperature during baths 99'8 ; highest tempera-
ture of baths 215. Left hospital quite cured of all pain.
CASE 8.
William M., aged 59, had his hand crushed between casks
on April 27, 1896, taking away the first joint of thumb.
He was admitted to the hospital April 30, when the entire
hand was found to be very swollen and very painful. It
was lanced on several occasions, and free exit given to any
pus. Boracic baths were constantly employed. Improved
gradually. Superheated dry-air baths commenced August 14,
to relieve stiffness and reduce size of joints. This patient
had fifteen baths, his highest temperature during baths
being 99'8 ; highest temperature of baths 265. He left
the hospital September 14, having regained the use of hand
and fingers.
CASE 9.
Patrick F., aged 56, states he sprained his ankle by
falling on January 16, 1897. Admitted here January 19.
Ankle swollen and very painful. Evaporating lotion and
Mclntyre splint. Tallerman bath started February 6, and
finished on the 16th. Five baths were given. Patient's
highest temperature in bath 99 ; highest temperature of
bath 260. Left hospital February 22, 1897. Walked well ;
no pain.
CASE 10.
Thomas W., aged 24, sprained his ankle by falling
while at work. Admitted here January 22, 1897, and limb
placed in Mclntyre splint. Evaporating lotion applied to
ankle. Baths commenced February 8 and finished March 2,
Sprains and other Injuries. 119
patient having had six baths. Discharged to town
March 25, slight stiffness only remaining. His highest
temperature in bath 99'4 ; highest temperature of bath
280.
CASE 11.
Eobert W., aged 38, admitted suffering from sprained
ankle, received January 27, 1897. Came here February 1,
and commenced bath treatment February 5 ; had another
bath February 13, and left hospital February 15, quite
cured. Patient's highest temperature in bath 98'4 ;
highest temperature of bath 255.
CASE 12.
Gabriel J., aged 44, had ankle poisoned about four
months ago ; after wound had healed ankle commenced to
swell and feel painful. General health not good. Had
two baths one January 27, 1897, the other on January 30.
Patient felt much relief. His highest temperature in bath
101 '2 ; highest temperature of bath 250.
CASE 13.
Samuel S. ; aged 24. Admitted February 5, 1897,
suffering from a stiff and painful foot, the result of a nail
penetrating the sole. Had three baths. Greatly im-
proved. Patient's highest temperature in bath 99*4 ;
highest temperature of bath 270.
JOSEPH MAGUIEE, Eesident Medical Officer,
CASE 14.
Shotcn at the Brighton and Sussex Medico - Chirurgical
Society by DR. HEDLEY.
Sprained Wrist. On September 28 a conductor in the
employment of the Brighton Omnibus Company fell from
the top of his bus, and injured his wrist. On the following
day he presented himself for treatment. The wrist was
red and very much swollen ; severe pain was complained of
up to the elbow, in consequence of which, during the previous
night, he had no sleep. No fracture or dislocation could
be detected. The hand and forearm were placed in the
superheated dry-air cylinder for forty minutes, at a com-
mencing temperature of 160 F., reaching gradually 240.
During the operation the man volunteered the statement
that his wrist and fingers were getting more movable and
less painful. On being released from the cylinder, he said
120 The Tdtterman Treatment.
that ' three parts of the pain had gone.' He was to
return on the following day. He did not do so ; but on
being seen at work on October 2, was questioned, and he
explained that he did not come simply because his wrist
was practically well on the day of the bath, and quite
well now. It would have been more prudent, however,
to have had it treated again at the time named. This
case presented the appearance of a really formidable
sprain; its rapid cure was very striking, and the result
of the treatment, both in point of quickness and complete-
ness, seems hi this instance at least far superior to that of
any method with which the present writer is acquainted.
Had there been fracture or dislocation as well as the
symptoms named, it seems not improbable that an applica-
tion of this kind would have proved a useful preliminary
to reduction and fixation.
Fracture and sprain from bicycle accident ; before treatment.
Fracture and sprain from bicycle accident ; after treatment : showing
ability to close the hand.
To face p. 1201.
CHAPTEE IX.
CHRONIC ULCERS.
ONLY a few cases are as yet available for publication,
but they are of a very encouraging character. The case
of varicose ulcers treated in Paris, and illustrated by
photographs, is interesting, because it shows the vast
superiority of the hot-air treatment over the ordinary
boracic acid compresses. Under the former the ulcer on
the front of the left leg cicatrized over without any enlarge-
ment, while the ulcer at the back of the right leg, treated
by boracic acid, shows an enormous extension of morbid
infiltration, coming right round to the front of the leg,
although it was originally the smaller of the two.
CASE 1.
Treated at the Laennec Hospital, Paris. Under the care of
PROFESSOR LANDOUZY.
P. C. Varicose ulcers : (1) on front of left leg, and (2) at
back of right leg ; one year's standing. (1) Treated by
Tallerman apparatus : after ten baths completely cicatrized.
(2) Treated by compresses of boracic acid : also cicatrized
after thirteen days, but the skin is exceedingly thin on the
face of the ulcer, and all round is a mass of cedematous
infiltration.
&, CASE 2.
Treated at the North-West London Hospital. Under the care
of MR. MAYO COLLIER, F.R.C.S.
E. W. ; aged 45. Staymaker. Suffered from chronic
ulcer of right leg for five years. Treated at North-West
London Hospital as out-patient without improvement, and
122 The Tallerman Treatment.
was in-patient at the Temperance Hospital for six weeks,
at the end of which time the ulcer was healed. Two years
ago it broke out again after a fall, and has since been
getting worse.
On examination, a large unhealthy ulcer, about the size
of the palm of the hand, was found in front of right leg,
just above ankle ; edges unhealthy, base covered with thin
white slough. Loss of tissue about T : V inch in depth.
Treated twice in superheated dry-air bath, each operation
averaging thirty-five minutes. The base was then found to
be much cleaner, and the margins showed signs of healing.
About fourteen days later patient seen by Mr. Mayo Collier,
who found that the lost tissue was replaced, the ulcer had
filled up, the margins showing further unmistakable signs
of healing.
J. F. SAKGEANT, M.E.C.S., L.E.C.P.
CASE 3.
Shown at the North-West London Clinical Society by
DR. SIBLEY.
This case was one of chronic ulcer on the leg of a man,
aged 60, who came under his care suffering from general
bronchitis and dyspepsia. The ulcers, two in number, had
existed more than a year, and were situated just below the
left internal malleolus, being about 1| inches in diameter.
There was a good deal of general osdema of the part, and
the leg was very painful. The patient was ordered some
boracic ointment; and as the ulcers were getting larger
instead of smaller, he was ordered the Tallerman treat-
ment on February 2. After two baths it was obvious
that the ulcers were healing, and the healing was com-
plete on March 1, by which time the patient had had
ten baths. The general nutrition of the whole limb had
also considerably improved, there was less oadema, and the
inflammatory area around the ulcers had disappeared. He
considered that the hot - air treatment compared very
favourably with the oxygen treatment for ulcers and other
diseases. Clinical Journal, April 28, 1897.
CASE 1. Before treatment, showing ulcer in front of left leg.
To face y. 1221.
CASE 1. Before treatment, showing ulcer at back of right leg.
To fact p. 122 II.
CASE 1. After treatment : Eight leg treated by boracic compresses ;
ulcer spread round to the front (see next photograph) ; left leg treated
by Tallerman apparatus ; ulcer healed.
To face p. 122- III.
CASE 1. After treatment by boracic compresses : showing enlargement
of the ulcer.
To face p. 122 IV.
CHAPTER X.
TREATMENT OF RIGID DEGREES OF FLAT-FOOT BY
THE TALLERMAN LOCALIZED SUPERHEATED DRY-
AIR BATH.
BY W. J. WALSHAM, F.E.C.S.
FOR the last fourteen years I have been accustomed to treat
the numerous cases of rigid flat-foot that came under my
care in the orthopaedic department of St. Bartholomew's
Hospital either by manipulation and massage or by
wrenching under an anaesthetic. For the last six months
or so I have substituted for this treatment the use of the
Tallerman Superheated Dry-air Bath. The class of cases
most suitable for manipulation and massage are those in
which, on taking the foot in two hands and making pressure
on the head of the astragalus with the ball of the thumb,
whilst at the same time adducting and inverting the front
of the foot, the muscles gradually yield, and the foot can be
made to assume its normal shape, the arch being com-
pletely restored for the time being. This manipulation,
however, is attended with acute pain, and on relaxing the
pressure the foot at once resumes the deformed position.
By repeating the manipulation, which on each application
becomes less painful, daily, or, better, several times a day,
for a week or two, the rigidity can generally be overcome,
especially if the patient can take rest during the treatment.
The foot is then in a condition for the flattening to be
permanently cured or relieved by exercise, combined with
some form of valgus boot. For this variety of rigid flat-
foot the hot-air bath is most useful. After the rigid foot
124 The Tallerman Treatment.
has been in the bath at a temperature varying from 270
to 280 F., or higher, for half an hour to three-quarters of
an hour, it comes out quite supple, and on taking it in the
hand, the arch can be restored without any pain or the
application of any force. After a few hours the rigidity
gradually returns, and the process, like the manipulation,
has to be repeated. The bath does not, of course, cure the
flat-foot, but merely, by getting rid of the rigidity, places it
in a condition to be acted upon by the exercises or other
means employed for its permanent relief. The advantage
of the bath treatment over the manipulative consists in the
entire absence of pain attending it. The bath should be
employed once or twice daily, the patient resting in the
intervals, until the rigidity has disappeared.
There is a more severe degree of rigid flat-foot, however,
in which the foot cannot be restored by manipulation, but
in which, nevertheless, the foot yields more or less com-
pletely to wrenching with the patient under an anaesthetic.
No hard and fast line can, of course, be drawn between
these two degrees, or, indeed, between the degree in which
the foot can be wrenched into shape under an anaesthetic,
and the still more severe form of rigid flat-foot in which
osseous changes have occurred, and in which nothing less
than an operation on the tarsus will suffice to restore the
arch. This last class of cases is, in my experience, very
rare. I have only met with two or three cases hi the last
fourteen years in which I have found that the foot could
not be corrected by wrenching, and in which I have con-
sequently been driven to more severe measures, such as
Ogston's operation. In the rigid cases (third degree, or
advanced flat-foot) in which manipulation does hot suffice,
the Localized Hot-air Bath is also useful, but only for the
less severe degrees of this variety. For the cases bordering
(if such an expression may be used) on osseous deformity
I have found an anaesthetic still needful. After the hot-air
bath has been employed in the milder forms of these rigid
degrees that will not yield to manipulation, the foot does
not come out supple, as it does in the cases that yield to
Rigid Degrees of Fiat-Foot. 125
manipulation, but on taking it in the hands it can, in many
cases, be easily made to take a better position, adhesions
being felt to give as when the foot is wrenched under
anaesthesia. The wrenching, however, after the bath is not
quite devoid of pain, but the pain is usually much less
severe than that. which is caused by manipulation of the
variety that yields to this method. In a few very severe
cases not much, if any, good has been obtained from the
bath, although it has been repeated on successive orthopaedic
out-patient days for many weeks.
For those who are not acquainted with the bath, it may
be said that it is an ingenious apparatus for keeping the
air really dry, so that a temperature from 250 to 300 F.
can be borne for an indefinite time. It consists of a copper
chamber, varying in size and shape according to the part
it is desired to treat, but generally taking the form of a
cylinder. The foot, knee, or the whole leg, including the
hip, may be placed in it, and similarly the hand, forearm,
or whole arm. The limb, or part of the limb, to be treated
is passed into the open end of the cylinder through an air-
tight curtain, which is afterwards secured in such a way as
to close the chamber completely. The distal end of the
cylinder is furnished with an ingenious arrangement which
plays an important part in keeping the air dry. The heat
is supplied externally by gas-jets or oil. The temperature
is indicated by a thermometer, the bulb of which is inside
the cylinder at the level of the limb, whilst the scale passes
outside, where it can be read off. The cylinder is furnished
with a double stopcock, which can be connected with an
air-pump and used either for drawing off heated vapour or
admitting medicated vapour. The limb rests at the bottom
of the cylinder on a metal cradle protected by asbestos,
which prevents all danger of scorching the skin by contact
with the heated metal. The patient can lie in bed or be
seated in an arm-chair during the treatment. The most
convenient way of using the bath is to heat the cylinder up
to 150 F. before inserting the limb, and then gradually
raise the temperature, the process of drying the air being
126 The Tallerman Treatment.
frequently repeated, which enables the patient to bear
exposure to a temperature of 250 to 300 F., or even
higher, without discomfort.
This striking result seems due to the system of ventila-
tion employed, since each time it is brought into play a
considerably higher temperature can be borne without
incommoding the patient, until the air again becomes
charged with moisture evaporated from the skin. The
plan of keeping the air dry is the distinctive feature of
the bath.
It may here be mentioned that the physiological effects
of the bath are : (1) Profuse perspiration of the part
treated. (2) Increased flow of blood through the skin of
the part. (3) Softening and relaxation of the tissues.
(4) General perspiration over the whole body, and a
raising of the temperature of the blood one or two degrees.
I have used the bath in many other affections than flat-
foot, as stiff and painful joints, sprains, rheumatic affections,
etc., but with these the present paper is not intended
to deal.
I now have notes of a number of patients with varying
degrees of rigid flat-foot who have been treated by the bath.
A few illustrative cases will suffice :
CASE 1.
Rigid Flat-foot Reducible on Manipulation. A. B.; aged
22 years. Stands all day ; both feet very rigid and painful ;
exercise cannot be done ; has been wearing a valgus-boot
for months.
February 25, 1895. Bath 260 F. for twenty minutes ;
both feet came out quite supple and completely restored.
March 4. Less pain ; feet again rigid ; bath 260 F. for
three-quarters of an hour ; feet quite restored ; all rigidity
gone.
March 11. Still unable to do exercise ; much less pain
in feet ; some rigidity ; bath 250 F. for half an hour ; feet
perfect ; suppleness returned ; placed in plaster in corrected
position.
March 18. Feet very pliable in every direction ; have
retained their pliability ; can do all valgus exercises
Rifjid Degrees oj Fiat-Foot. 127
perfectly. To continue exercise and wear simple valgus-
boot.
CASE 2.
Rigid Flat-foot Reducible on Manipulation. C. D. ; aged
14 years. Both feet flat, painful and rigid ; cannot do
exercise.
February 25. -Bath 290 F. for half an hour ; left foot
well restored, soon becoming rigid again ; right foot only
partially restored ; left foot put in plaster in restored
position.
March 11. Bath 260 F. for fifteen minutes ; left foot
quite supple and restored ; right foot better ; can be almost
restored on wrenching.
March 18. Can stand on tip-toe and do exercise very
well ; right arch not so good as left. Bath 210 F. for half
an hour.
March 25. Does exercise very well; right foot still
improving; bath.
April 8. Both feet perfect ; arch and suppleness re-
tained ; to continue exercise ; baths to cease.
CASE 3.
Rigid Flat-foot Irreducible on Manipulation. G. H. ;
aged 32 years. Both feet very rigid and painful ; in-
capacitated for work.
February 18. Bath 250 F. for one hour ; both feet
became supple and arches restored.
February 25. Feet soon became rigid after last bath,
but both were found less rigid than before the bath. Bath
250 F. for half an hour ; feet perfectly restored ; put in
plaster.
March 4. Feet still slightly rigid. Bath 260 F. for
half an hour ; feet quite supple ; exercise begun ; plaster.
March 11. Less rigid. Bath 280 F. for half an hour;
feet quite supple ; exercise better done.
March 25. Feet much improved ; left foot very good.
Bath 250 F. for half an hour.
April 1. Still progressing ; does exercise fairly well ;
rigidity almost gone ; fitted with valgus-boot ; exercise
to be continued.
CASE 4.
Rigid Flat-foot Irreducible on Manipulation. C. J. B.;
aged 22 years. Right foot very rigid ; left foot scaphoid
and astragalus extremely prominent, probably bony changes.
128 The Taller man Treatment,
February 18. Bath 235 F. for half an hour ; right
foot completely restored ; left foot unaltered ; cannot be
wrenched into position ; both feet placed in plaster of
Paris.
February 25. Feet kept in plaster ; very rigid ; no bath.
March 11. Eight foot in good position; left same as
before. Bath 250 F. for half an hour ; left foot only ;
prominence of scaphoid slightly reduced.
March 18. Eight foot much improved ; left foot better,
but bones still prominent ; bath 240 F. for half an hour ;
bones further reduced ; whole foot more supple.
March 25. Left foot more pliable, but still rigid. Bath
240 F. for half an hour; bones incompletely reduced ;
from this date the foot further improved, but was not com-
pletely restored.
CASE 5.
Rigid Flat-foot Irreducible on Manipulation. S. S. ; aged
40 years. Eigid flat-foot of some years' duration; both
feet astragalus and scaphoid very prominent ; thickening
about Chopart's joint.
May 20. Bath 270 F. for half an hour ; pain less ; foot
could not be reduced ; rigidity slightly less.
May 27. Very little improvement. Bath 270 F. for half
an hour.
June 3. No improvement. Bath 270 F. for half an
hour ; little or no improvement ; plaster of Paris.
June 10. Feet still rigid ; wrenched under an anaes-
thetic ; improvement in position ; plaster of Paris.
Feet never completely restored, but the pain and dis-
ability much relieved ; to wear valgus-boot and leg-irons.*
* From the Transactions of the American Orthopaedic Association,
vol. viii.
A casual at the Free Institute.
To face p. 129.
CHAPTER XI.
FIRST ANNUAL REPORT OF THE TALLERMAN FREE INSTITUTE, THE
MISSION HALL, BLACKFRIARS, FOR THE TREATMENT OF THE
NECESSITOUS POOR OF THAT DISTRICT, BY THE TALLERMAN
LOCALIZED SUPERHEATED DRY- AIR METHOD (PATENT).
WITH the consent of the proprietary company and the kind
assistance of a local committee and honorary medical officer,
Mr. Lewis A. Tallerman opened a small institute at the above
address on March 31, 1896, James Pascal, Esq., presiding.
The committee gladly welcomed the assistance and means
to relieve and benefit the suffering humanity in the district,
so kindly placed at their disposal by Mr. Tallerman, and
provision was made for carrying on the work amongst the
poor and destitute afflicted with gout and rheumatism,
sciatica, lumbago, sprains, and other similar diseases, in the
hope that many would be rescued from their sad and hope-
less and crippled condition of pain and poverty, and, with
health restored, become again able to perform the duties of
life, and earn the daily bread for themselves and families.
I have now the pleasure to report these hopes have been
in some measure realized, and when the circumstances
which surround the sufferers are considered, the want of
proper nourishment, warm clothing, and their not too
sanitary housing, it must be considered in the highest
degree satisfactory that so much benefit has been obtained
in cases of such a chronic, intractable, and, by other
methods, incurable character.
During the year twenty-three women have been treated
and 215 baths given :
9
130 The Tallerman Treatment.
Two of the women have been treated once.
Three have been treated three times.
Two have been treated four times.
Three have been treated five times.
One has been treated six times.
One has been treated seven times.
Two have been treated nine times.
Two have been treated ten times.
One has been treated twenty times.
One has been treated twenty-two times.
One has been treated twenty-three times.
One has been treated thirty times.
Thirty-one men have been treated and 139 baths given :
Eleven of the men have been treated once.
Six have been treated twice.
Four have been treated three times:
One has been treated five times.
Two have been treated six times.
Two have been treated eight times.
One has been treated ten times.
One has been treated twelve times.
One has been treated twenty-three times.
One has been treated twenty-five times.
Of the women who have been treated, I might refer to :
Mrs. P., who for several years I have visited and seen her
crying with pain, with nothing to remove it. She came
and was treated ten times for pain in her knees, and has
been cured and free from pain ever since. She told me
after her first bath she had knelt down to say her prayers
for the first time for five years.
Miss L., a dressmaker, who lost her business through
having rheumatoid arthritis, and was scarcely able to walk
or lift a cup from the table for two years, and getting worse
every day. She came and was treated thirty times, and is
now able to carry a jug of water, sweep the room, and walk
with a firm step.*
* Four months later the patient wrote : ' I am now able to cut my
own food, to use my needle, and to wear leather boots, which I was not
able to do for nearly two years before having the baths.'
Miss L. Before treatment : showing inflammation of wrists and fingers.
To face r- 13C I.
Miss L. Before treatment : showing limited flexion of hands and deformity
of elbows.
To face p. 130-11.
Miss L. Before treatment : showing swollen and fixed condition of feet.
To face p. 13D III.
Miss L. After first operation : showing improvement in hands and feet.
To face p. 130-IV.
Miss L. After treatment : showing hands and feet
restored to nearly normal condition.
To face p. 130 V.
Miss L. After treatment : showing restored movement of hands and fingers, and
reduced swelling of feet.
To fate p. 130 VI.
The Tallerman Free Institute. 131
Mrs. L., a tailoress, has suffered with gout in all her
joints for four years after having been treated by doctors at
the dispensary without any benefit ; her legs, knees, finger-
joints and wrists most hopelessly ruined and useless. She
was treated thirty times, and is very much benefited
far more than could have been expected.
Mrs. W., my sister from Ipswich, after suffering for
about two months with rheumatism in hands, legs and feet,
which were sometimes very much swollen and painful,
came and was treated six times in about eight days. She
went home cured, and has had little or no pain since, and is
quite able to do her work. She was recommended by her
family doctor. She gave five shillings as a thank-offering.
Emily P., a tailoress, also came from Ipswich at the
earnest wish of the Crown Street Christian Endeavour
Society. She came in a bath-chair, not being able to
stand. She has suffered for ten years, and has been
unable to use her crutches for over four years. I permitted
her to come, but held out no hope even of relief. After
twenty baths it was found that all signs of sciatica had left
her, and also very much pain in her limbs. Her friends
were so much pleased with the results obtained that, after
assisting in the cost of travelling, board and lodging, they
gave eleven shillings as a thank-offering to the institution.
Frances S., a young girl aged 16, came to be treated after
having had rheumatic fever, which left her with pains in
nearly all her joints after having suffered eight weeks, when
she applied to Dr. Hill. He wisely refused to sign her form
until her heart was stronger. After two weeks she came
and had five baths, and was perfectly cured, and returned
to her work at Mr. Pascal's.
Alice E., another young girl, who was a servant at the
Eev. Tolfree Parr's, had suffered from rheumatism for about
three months, through catching cold. She came and had
seven baths, and was cured.
Elizabeth M., another girl, had suffered with rheumatic
fever and had been in the infirmary ; she had eight baths
and was cured.
Amongst the male patients we may refer to :
Mr. "W., who was one of our first patients. He had been
suffering from rheumatism in left foot and ankle, as well as
other parts of his body, for five years. He was cured with
eight baths, and has had no return since.
Mr. L., whom I found, in my visitation, lying on his
back in great pain. I knew him to be subject to rheuma-
92
132 The Tallerman Treatment.
tism for years ; he had been to the infirmary, leaving his
wife and children in the deepest poverty. I advised him to
come and be treated. He was treated only once, and went
to work the next morning ; he has had a slight attack since,
but has been able to work, with the exception of a few days,
ever since.
Mr. S., an assistant at a fried-fish shop, came suffering
with sciatica in right leg and ankle ; for about three months
he had been in the infirmary, and was going back because
unable to work. He had two baths, and has been able to
work ever since. I met him a few weeks ago, when he
thanked me for my kindness to him.
Mr. W., a scaff older, had suffered from gout in right foot
and leg and great toe ; he had only done three weeks' work
in three months. They were very much swollen and very
painful. He had only one bath, and went to work the next
morning. In about a month it came on in his left arm. I
gave him another bath, and he has been able to work ever
since last August.
Mr. D., a navvy, came from Lewisham. He was suffering
from sciatica, and unable to work. He told me the pain
made him sick ; he had suffered about four months, and
had tried many so-called remedies, also his club doctor,
with little or no benefit. He was treated ten times, and was
perfectly cured. He gave five shillings as a thank-offering,
Mr. P., a brother City Missionary, had suffered with
rheumatoid arthritis in his left arm and shoulder for about
four months ; he was unable to dress himself or raise his
arm. He had been under his private doctor's treatment
with no relief. I had to assist him to undress, but after his
first bath he was able to dress himself, and has done so ever
since. He continued to improve from the first under the
treatment. He had twenty-three baths and is now perfectly
cured, with the exception of a slight stiffness in his shoulder-
bone, which might have been removed if he had permitted
it to be wrenched, which his doctor advised him should be
done ; he has deferred this for the present, hoping it will
come right in time. I sent him to Dr. Sibley at the North-
West London Hospital, hoping he would do it for him, and
he kindly treated him as an out-patient.
John H. is a box-maker at Pink's jam-factory ; he was
taken with gout when he was going home from his work one
Saturday. He had no sleep, neither could he eat because
of the pain. I saw him on the Monday, and advised him to
have some baths ; he replied : ' I can't get there, for I can
Rheumatism : before treatment.
To fact p. 1321
Kheumatism : after treatment.
To face p 132-11.
The Tallerman Free Institute. 133
scarcely bear to touch the floor with my foot.' I suggested
that he should get a costermonger's barrow and have some-
one wheel him to the doctor's to have a form signed, and then
come on to the mission-hall in the morning. I then said :
'I will promise you that you will be able to walk home.' He
did so, and after the first bath he lost all pain and part of
the swelling, and he walked home. He had another bath
on the Thursday, when he lost the soreness, and went to
work on the following Saturday, and has been at work ever
since. This man had suffered about four years before,
when he drank very heavily, and lost a great deal of time
through not having anything to ease him. He has been
a total abstainer for some months.
Mr. S., a corn-porter and carman, had been unable to
work for twelve weeks through rheumatism in his knees.
After two baths he went to work again, but needed more
treatment. The pain came on again about a month after-
wards, when he came and had four more baths, and has
gone back to his work.
Mr. M., a carpenter, has suffered from rheumatism over
six years. At the time of the strike he went to live at
Aldershot for five years, and only worked about two years.
He returned to London about fifteen months ago, and has
only worked about eight months out of that time. He went
to work after his first bath, but has had two baths since
and is intending to have some more. When he came, his
right arm was stiff, but now he has almost perfect freedom ;
he is of course most thankful for the benefit he has received.
He has a wife and three children, and is a total abstainer.
There are other cases, both of men and women, who have
not received much benefit, but as a rule there is a cause for
it : some through poverty and having been unable to work
have to remain in the same surroundings in which they
became sufferers, living in damp and low rooms.
I have in every case observed the conditions upon which
the use of the treatment was granted, namely, that the Insti-
tution should be free to all the necessitous poor, and that it
should be quite unsectarian ; no one who has applied has
been refused, but all have been heartily welcomed. Catholics,
Protestants, and persons who make no profession of religion,
have shared the benefit without any question as to their
belief or unbelief ; still, as a London City Missionary and
as a servant of God, I have had many blessed opportunities
184 The Tallerman Treatment.
of religious conversation with the patients as well as with
other persons I meet with, which I trust, with God's blessing,
will result in their spiritual as well as temporal good. Most
of the patients have been those who, after long suffering,
pain, and inability to work, are in the depths of poverty,
some even without bread to eat.
A meeting of the Committee of the Tallerman Treatment
Free Institute for the use of the necessitous poor was held
on Friday, May 7, and a report of the work for the past
year was read. The Committee expressed their surprise
and delight at the number of cases treated, and that so
many were cured, especially so as the sufferers belong to a
class who stood so much in need of help. The following
resolution was passed, viz. : That the sincere thanks of the
Committee be conveyed to Mr. Lewis A. Tallerman for his
great kindness and assistance to the suffering poor.
CHAPTER XII.
MEDICAL REPORTS, ETC.
THIS chapter contains a series of public reports and de-
monstrations by medical men.
A number of private letters have also been received from
physicians and surgeons of the highest standing expressing
warm appreciation of the Tallerman treatment, but it is
thought that the publication of such letters might be mis-
understood, even when express permission has been given. 1
Only public utterances have therefore been reproduced.
Descriptions of the apparatus have been omitted from them
as superfluous, and also the cases by which they were
illustrated, these having already appeared under their
proper headings in preceding chapters.
I.
A CLINICAL LECTURE
On the Therapeutic Action and Uses of the Localized
Application of Dry Air heated to High Temperatures
in Certain Classes of Surgical Affections.
Delivered at St. Bartholomew's Hospital on Wednesday, May 23, 1894, by
ALFBED WILLETT, F.E.C.S.,
Surgeon to the Hospital.
GENTLEMEN, My lecture to-day is on ' The Therapeutic
Action and Uses of the Localized Application of Dry Air
heated to High Temperatures in certain Classes of Surgical
Affections/
136 The Tallerman Treatment.
It was only in January that I first heard of this inven-
tion, and I was startled at what I heard it could do. My
information, it is true, was not at first hand, and probably,
as usual, the story lost nothing in being repeated. But
this is what a medical friend told me.
He said a complete revolution, he had heard, had been
made in the treatment of all sorts of contractions and
of anchylosed joints. By the action of air heated to 250 or
300 F., any such affection, even a congenital club-foot
and that was particularized would, in the course of an
hour or so, become so relaxed and pliant, that the surgeon
could at once quite painlessly move it in any direction,
and effect an immediate cure of the deformity by restoring
the foot to its correct position.
Such is the story that was told me. I readily accepted
an invitation to witness those vaunted powers put to the
test ; and, accordingly, on January 23, at the courteous
invitation of Mr. Lewis A. Tallerman, I went to 1, Chiswell
Street with Mr. Walsham and Mr. Paterson, my house-
surgeon. There were some three or four other medical
men present. Of the few patients collected two were
selected for trial. The first was a middle-aged man
with subacute synovitis of the knee. Increased heat,
slight effusion, and some pain existed. This was increased
on attempting to move the knee, which was held semi-
flexed, having a range of active movement of only 10-15.
He could only walk, or rather, I should say, hobble, with
the aid of two sticks, on the toes of the affected limb. In
this condition he was placed in a cylinder like the one we
have here. When taken out of the bath, after some thirty
or forty minutes, the knee was straight, all pain had left
him, the foot was on the ground, and he walked almost
briskly out of the office. I heard that in a few days' time
he returned to work. This result naturally made a con-
siderable impression on me, for I know of no treatment
that could have brought about so rapid a cure. The case,
no doubt, was not only curable, but well on the road to
recovery. At the time I said that in hospital I should
Medical Reports, Etc. 137
have anaesthetized the patient, manipulated his knee, and
then brought it straight ; but even so I feel sure that many
days would have elapsed before he would have been well,
whilst here the man had been apparently almost cured in
little more than half an hour, not only quite painlessly, but
by a process that one might almost call that of luxurious
ease.
The second case was equally satisfactory that of a woman
of about 45, with both hands crippled by chronic gout.
The fingers were all kept slightly flexed. Before going
into the bath she could neither straighten nor flex them.
It appeared that slowly, for upwards of a year, she had
been drifting into this condition, and now she could do
but little for herself. Only one hand, the right said to
be the worst was put into the bath. After fifteen minutes
she volunteered the statement that her fingers seemed to
loosen, and soon after she could oppose the thumb to all
the fingers, which for many months she had not been able
to do. After half an hour the hand was removed from the
bath. I saw her open and close her hand readily, while
the left, which had not been treated, remained in the same
fixed position. Of the subsequent state of this patient I
have heard nothing. Both these patients were entirely
comfortable aU through the process. If they felt the bath
too hot, air was readily, for a second or two, admitted, and
then a higher temperature could always be borne. The
patients perspired freely, and when the limbs were taken
out of the bath they were very red and moist.
Subsequently, I was asked if I would test the efficacy of
the bath at this hospital, and having obtained the consent
of the authorities, I have done so, and desire now to put
the results before you.
*****
In offering some comments on this invention, I must say
at once that I can only express a very guarded opinion at
present, mainly because my experience is still very small ;
yet, small as it is, I have no hesitation in saying it is
distinctly encouraging. In the cases that have been treated
138 The Tallerman Treatment.
in President and Pitcairn Wards I was anxious to try the
bath in an assortment of diseases, and also to test its action
purely and simply. In the next place, the process occupies
roughly an hour for each patient, and some of the patients
were undergoing the bath treatment for the entire two
months. Mr. Tallerman kindly gave his valuable services
in supervising its administration ; hence, during the two
available hours of the afternoon, with two baths going, it
was not possible, as a rule, to treat more than about four
patients a day, and of these some were under Mr. Walsham's
care.
It seems to me that the points for consideration are these :
1. What is the effect of exposing a part, such as a hand
or foot, to such temperatures as 250 to 300 F. (a) upon
normal parts ; (6) upon certain diseased tissues ?
2. Is any therapeutic effect produced by such tem-
peratures alone : and, if so, in what classes of diseases ?
and, again, is the result likely to prove temporary or
permanent, partially or completely curative ?
3. Are there cases in which air baths of high tem-
perature can be advantageously employed in association
with other methods of treatment, for example, where
articular adhesions have been broken down ?
4. To what depth from the surface is the direct influence
of this dry hot-air bath exerted ?
5. Is the body generally acted on or affected, either
favourably or prejudicially, by the topical use of heated air
as in this bath ?
I will now, in turn, direct your attention to each of these
several points.
As to the first of these questions, I have come to the
conclusion that in principle this apparatus for applying
dry hot air locally has on the member or limited part of
the body so treated an action similar to that of the ordinary
Turkish bath on the whole body, that is to say, it induces
sweating diaphoresis. I speak now only of the principle
involved in the action of this heated cylinder, and not of
the degree, nor of other differences, such as that in the
Medical Reports, Etc. 139
cylinder treatment ordinary air is inspired, while in the
Turkish bath the air breathed is greatly heated. In a
Turkish bath the temperature in the first room called
the tepidarium is from 113 to 117 F. ; in the second, or
calidarium, it is from 132 to 140 F. Although there are
recorded instances of the higher temperatures being respired,
still, probably the temperature attained in this cylinder
from 250 D to 300 F. is much too great to render its inspira-
tion anything but hazardous at all events, for such average
individuals as frequent Turkish baths. But just by so
much as the temperature of the cylinder is greater than
that of the Turkish bath, by so much will its sudorific
effects be increased. In the next place we note that the
part, foot or hand, issues from the bath very much the
colour of a boiled lobster ; the flow of blood in the skin is
obviously, and that in the subcutaneous tissues probably,
increased greatly. The third effect noted is what we may
term its anodyne influence. In most cases, not merely is
pain relieved, but often it will be entirely removed. This
is shown in many ways. The patients invariably experience
relief. Then they will use the limbs with much greater
freedom. Movements that excited pain before can be per-
formed after the limb is placed in the bath without pain.
Again, in cases of breaking down of adhesions under gas
the patient is in great pain afterwards ; but let the limb
be placed in the heated cylinder and the pain is greatly
lessened, as also is the secondary stiffness, due to extravasa-
tion and inflammation round the torn tissues. On the
other hand, there is none of the excitement, amounting in
some individuals to distress, from breathing the hot air
of the Turkish bath before free perspiration breaks out.
The patient with arm or leg in this cylinder seems through-
out in the most absolute comfort, only now and again
complaining of the heat being almost too great a complaint
which is instantly removed by manipulating the apparatus.
If such are the results observed from the baths in
healthy persons, its therapeutic influence in certain affec-
tions is obvious, and, I think, clear to demonstration.
140 The Tallerman Treatment.
The next consideration, therefore, is, To what class of
disease is this plan of treatment likely to be serviceable ?
I can only speak of its use in surgical affections. Of these,
sprains, stiff joints those where movement is more or less
limited callous limbs, flat-foot, gonorrhceal rheumatism,
and possibly some skin affections, are the most likely to be
benefited. The cases I have recorded show a fair selection
of these.
On the third point, as to its being an adjunct to surgical
treatment, I have only to repeat what I have already said,
as to the great assistance this hot bath affords after break-
ing down articular adhesions, both in relieving pain and
lessening the tendency to recurring stiffening. I think
that, in addition to these, the bath may be occasionally
useful as an adjunct to the electrical treatment of certain
paralytic cases, and generally useful, I think, before massage
to wasted muscles.
As to the extent of action, the cases recorded seem to
show conclusively that the direct influence of air heated to
this high degree does not extend much, if at all, beyond
the skin primarily. That secondary effects are shown, I
readily admit, such as relaxation of muscles which have
been irritated or excited to tonic contraction ; but for over-
coming firm fibrous articular adhesions I am sure this hot-
air bath gives the surgeon no direct help, or, putting it in
other words, whilst increased power in active movement is
nearly always gained, there is no immediate marked in-
crease in the range or extent of motion.
On the last point mentioned, I think there is evidence
that the effect of the bath is not confined solely to the part
acted on, for the temperature of the patient is raised usually
nearly one degree; true, this elevation of temperature alone
would not prove anything, for excitement will often send
up temperatures ; but the entire skin becomes relaxed, and
perspiration occurs freely over the body. Besides, patients
unite in saying that with subsidence of pain in the part
treated pain is lulled in other joints. I hope some physician
will be induced to try the hot-air system in selected medical
Medical Reports, Etc. 141
cases. By analogy I think that in rheumatic arthritis, gouty
attacks in arms or legs, sciatica, lumbago, and perhaps
in some spinal cases, good results might be anticipated.
In conclusion, I would summarize my remarks by saying
that when employed for contractions in recent affections or
subacute inflammatory diseases, such, for example, as may
follow upon simple synovitis, cases, that is, which would
yield readily, and without force, under an anaesthetic, I
feel confident that the therapeutic action of this dry hot-
air bath to the part will be both marked and rapidly
curative. In permanent contractions or fibrous anchyloses
the result of old-standing arthritic diseases, the direct
therapeutic action is soon exhausted. It will be well that
the cause and extent of the disease, so far as actual patho-
logical, i.e., gross alterations of structure, are concerned,
should be ascertained at once, because if articular or cap-
sular adhesions exist, valuable time would be wasted in
attempting to cure such cases in this hot-air cylinder.
Sooner or later the adhesions will have to be forcibly broken
down under an anaesthetic ; but such having been done,
I think recovery will in many cases be hastened by the
subsequent use of the heated cylinder ; whilst in such
permanent deformities as congenital club-foot, contracted
scars after burns, and bony anchylosis, it is absolutely use-
less to suppose any effect whatever could result. It would
be sheer quackery to advise its use in any such condition.
*****
In so many surgical cases should this hot-air bath
treatment prove serviceable, that I hope it will not be long
ere one is available at any time in this hospital, and also
that we have a nurse trained to its use.
From the 'Clinical Journal,'' May 31, 1894,
by permission.
142 The Tallerman Treatment.
II.
The Treatment of Rheumatic Affections by the Tallerman
Superheated Dry-Air Apparatus
(From the Medical Clinic of the Royal Victoria Hospital),
BY
JAMES STEWAET, M.D.,
Professor of Medicine and Clinic Medicine, McGfill University ; Physician to the
Royal Victoria Hospital, Montreal ;
AND
W. G. BEILLY, M.D.,
Senior Resident Physician, Royal Victoria. Hospital.
In December last Mr. Lewis A. Tallerman, of London,
gave two demonstrations of the method of using his hot-
air apparatus at the Koyal Victoria Hospital before a large
number of the practitioners of Montreal. Since then the
apparatus has been in constant use in the treatment of
various forms of subacute and chronic rheumatic affections.
The results on the whole have been very satisfactory.
Eelief to pain has usually followed, and in nearly all cases
there is soon noticed not only an improvement in the local
conditions, but also a marked change for the better in
general nutrition. In the present preliminary communi-
cation an account is given of three cases treated to a con-
clusion. In all it will be noticed that the results obtained
are much more marked and satisfactory than by any other
method at present known.
The Tallerman apparatus is made in various forms and
sizes suitable for the different joints or limbs to be treated,
viz., for the hand, arm, elbow, foot, leg, and knees, and
there is also one for the pelvic region. The hospital model,
the one mostly supplied to institutions, is constructed so as
to enable the treatment of the extremities and to obtain a
general effect upon the body.
Medical Restarts, Etc. 143
The highest temperatures at which patients have been
treated according to hospital reports are from 300 to
315 F., but the great value of the Tallerman treatment is
the ability to administer these high temperatures over a
period of upwards of an hour if necessary. Experimentally
a patient had been treated for more than two hours at a
temperature averaging 260 F., without any other discom-
fort than lassitude on the following day ; the skin was not
unfavourably affected or unduly sensitive, and it could be
rubbed briskly with a towel when released. The thera-
peutic effects produced are relaxation of the part, copious
and free perspiration over the whole of the body, enormously
increased circulation, and raising of the body temperature
from 1| to 4 F. This last effect, so contrary to the belief
hitherto held that the body temperature could not be raised
by a local application of heat, is remarkable, and, it is
the belief of Mr. Tallerman, will before long be shown to
have a very material and beneficial effect in the treatment
of diseases other than in the classes of cases which until
now have been subjected to it ; these are such cases as
rheumatism, acute, subacute, and chronic, acute and
chronic gout, rheumatoid arthritis, sprain, stiff and painful
joints, gout, rheumatic sciatica, lumbago, peripheral neu-
ritis, gouty neuritis, etc. Also before and after breaking
down of adhesions and kindred complaints.
The Tallerman treatment has been demonstrated at
some of the principal London and other hospitals, and
during the course of the three years' supervision to which
it has been subjected, it has been proved that the treatment
can be safely administered with benefit even where great
debility, weak action or valvular disease of the heart or
kidney disease are present. Eheumatic and other pains
are relieved, if not entirely removed, shortly after the
commencement of the first operation ; and the treatment
itself is not only absolutely painless, but so soothing as to
frequently lead to patients falling asleep if permitted whilst
under it ; hence the sleeplessness caused by rheumatic pain
is relieved, and patients are able to rest at night.
144 The Tallerman Treatment.
BRITISH MEDICAL ASSOCIATION.
A paper on Rheumatoid Arthritis, read by Professor
Stewart at the annual meeting of the British Medical
Association at Montreal, September 1, 1897, concluded as
follows :
' In my opinion the most valuable of all methods of
treatment is the use of baths of superheated dry air, after
the Tallerman method. It has been used hi twenty cases
of rheumatoid arthritis in the Royal Victoria Hospital
during the past nine months with gratifying results.
' The apparatus consists of a copper cylinder, of various
shapes and sizes. The model usually employed is suf-
ficiently long to admit a lower limb to some inches above
the knee. By means of valve taps the moisture from the
limb is expelled, so that the air in the chamber is kept dry.
The temperature in the chamber is kept usually from 240
to 300. The first marked effect is copious perspiration all
over the body. The pulse is increased from fifteen to thirty
beats, and the temperature is usually elevated from
1 to 2.
' In all we have treated twenty cases with the hot-air
bath. In fourteen of the twenty cases pain hi the affected
joints was present, and of a severe character. In the great
majority of the cases the relief was marked even after the
first bath, and after several baths the patient, except on
movement, was practically free from pain. As a result of
this relief, sleep, which usually before was greatly disturbed,
was possible. In addition, there was some apparent change
for the better in nutrition. In spite of losing daily more
than a pound in weight from the loss of fluid by perspira-
tion, the patient usually steadily gains in weight. Gains
of from three to four pounds weekly have been common.
As regards the effect on the affected joint, it is various,
depending on the amount of effusion and the degree of
anchylosis.
Generally a considerable increase in the mobility follows
after the use of a few baths. It cannot be expected that
Medical Reports, Etc. 145
restoration can take place in advanced cases, but before
much actual destruction takes place, there is every reason
to look for a decided check to the progressive character of
the disease.
III.
Report by Professor Landouzy of the Laennec Hospital, Paris.
August 3, 1897.
From what I have seen of the local application of hot air
by the Tallerman method and apparatus, both in my warda
at the Laennec Hospital and in my private practice, I am
enabled to say :
1. That the Tallerman method constitutes a real advance
in the local applications of hot air.
2. That this treatment is indicated in a large number of
acute, and a still larger number of subacute and chronic
affections, both of the limbs and the adjoining parts. In
these it seems to produce better results than the remedies
hitherto in use. In particular, cases of gonorrhoeal
rheumatism, of joint affection in chronic rheumatism, of
acute gout and sciatica, have been better and more rapidly
relieved, better and more rapidly reduced, than by the old
external remedies, whether used alone or in combination
with drugs.
3. That the indications and contra-indications of its use
require more precise definition, in order to determine the
important place which the treatment deserves to take in
the therapeutics of those painful affections of the joints
which are so common in the course of infectious and con-
stitutional diseases.
IV.
Report by Dr. Deje'rine of the Salpetriere Hospital, Paris.
August 7, 1897.
Among the cases of chronic rheumatism in my wards at
the Salpetriere, in which I have been able to appreciate
10
146 The Tallerman Treatment.
the good effects of the high-temperature treatment, I have
^observed the following, in which this method has given the
most remarkable results.
The patient was a young woman, 25 years of age,
suffering from unilateral infectious rheumatism of the left
side, the commencement of which dated from October, 1896.
I saw her for the first time four months after the beginning
of the illness, and it was the most severe case that I have
ever seen. The elbow, wrist, knee, and ankle-joints were
all greatly swollen, the sheaths of the tendons and serous
bursae much enlarged and excessively painful. She had
been unable to leave her bed for four months and a half.
On coming to Paris at the beginning of April she was
placed under daily treatment by the cylinder at 212, 230,
and 240. At the end of a few sittings the pains had
almost disappeared, and the swelling began to subside. At
the present time, August 7, 1897, after 62 sittings, the
patient's condition is greatly improved, and the joints have
returned to their normal size.
I consider, therefore, that in this case the results of the
treatment with superheated dry air by the Tallerman
method are most remarkable, and superior to everything
-else that I have seen used in similar cases.
V.
Paper by Dr. Edouard Chretien, of the Laennec and
Salpetriere Hospitals, Paris.
In December, 1895, Mr. Lewis A. Tallerman demonstrated
in the clinic of M. Oulmont, with which I had the honour
to be connected at that time, his method of treatment and
the effect produced by his apparatus.
This apparatus, designed more particularly for the treat-
ment of diseases of the joints, and employed in several
hospitals in England, has given the best results. Its
principle is to submit the affected part to a temperature
higher than has up till now been attainable.
Medical Reports, Etc. 147
Everyone knows that heat exercises a favourable influence
on pain. Hot compresses, poultices, sand-baths, vapour-
baths, etc., produce their effect beyond a doubt by the high
temperature attained, and everyone knows the wonderful
results obtained by their use in the treatment of neuralgia,
muscular rheumatism, and other forms of joint diseases.
But all these methods have their weak points. In some
the temperature obtained and the duration of the applica-
tion are insufficient, as in the employment of poultices and
hot napkins. In others the method of application itself is
defective, as in the case of Turkish and Eoman baths, when
the patient's whole body is exposed to the action of the hot
vapour, and he is forced to breathe it for a period more or
less long. The various apparati designed to obviate this
last drawback such as the box in which the body of the
patient is enclosed with the head outside have not given
the results hoped for.
On the other hand, most of these methods employed for
the application of moist heat are defective in principle,
because one cannot pass a certain temperature, which is
really not very high. The human organism can stand a
much higher temperature when the heat is dry than when
it is moist ; and we see, for example, glass-workers expose
themselves to the hot air of the kilns, which they could not
stand if it were saturated with water- vapour.
With the Tallerman apparatus, on the contrary, thanks
to its peculiar construction, we can apply hot dry air to
large portions of the body a whole limb, for example and
can attain temperatures in the neighbourhood of 300 F.,
or 141 C., or even higher. Observation has shown that in
cases where several joints are affected, the hot-air bath acts
not only on the joint enclosed in the apparatus, its influ-
ence is equally felt by the other affected joints, even those
on the other side of the body. The 'effect obtained is only
less marked. So when, for one reason or another, it is
impossible to treat the affected part directly, we have tried,
and successfully, too, to treat it indirectly, by placing the
corresponding sound limb in the apparatus. The effect is
102
148 The Tallerman Treatment.
not so marked, I repeat, but it makes a decided impression,
nevertheless.
The duration of each bath varies from about half an hour
to an hour. The temperature attained also varies greatly
at each treatment. It is well at the beginning of the
treatment to test the sensitiveness of the patient by letting
the temperature remain at about 100 to 115 C. After
that and at succeeding baths temperatures of 120, 130,
140, and even 150 C., may be used without incon-
venience.
When the bath is over the limb is taken out of the
apparatus, dried, and wrapped up. The patient, who during
the whole treatment has perspired abundantly, remains for
a certain time wrapped up and resting. The number and
frequency of the baths vary according to the case, its
gravity, the inaction produced on the patient, and the
results obtained.
When Mr. Tallerman placed his apparatus in our hands
and asked us to test it, he declared that he had employed
it in England to treat a great variety of diseases, such as
rheumatic arthritis, gout, sprains, acute joint affections,
stiff joints resulting from injuries or inflammations, gonor-
rhceal rheumatism, flat-foot, chronic and deformatory
rheumatism. Since then the list of diseases which it will
benefit has been greatly added to, and we can see still more
which it may benefit.
Among them are muscular rheumatism, acute S3 7 novitis,
sciatica, lumbago, tuberculosis, arthritis, certain forms of
neuralgia, peripheral neuritis, etc.
We must say, however, that the apparatus we are
describing can only be used, on account of its size and
shape, to treat the limbs, or, more properly, parts of limbs,
for it is impossible to introduce the entire leg into it up to
the hip. To enable the treatment of the hip, abdomen,
and spine, the pelvic apparatus has been constructed and
so designed that the treatment can be applied directly
to these parts. We will in a future issue describe this
second apparatus, which is still being experimented with
Medical Reports, Etc. 149
in England, and no model of which has yet reached
Paris.
The interest of M. Oulmont was excited by the results
obtained by the use of the apparatus in the English
hospitals in the hands of men like Willett, Herbert Page,
Ward Cousins, Walsham, Knowsley Sibley, and he asked
me to secure for him some patients upon whom we could
make a trial of the superheated air-baths.
My chiefs (maltres), Professors Landouzy and Dejerine,
to whom I had spoken of the apparatus, were equally
anxious to authorize its employment in their clinics in the
hospitals of Laennec and Salpetriere.
I will now describe briefly the results obtained in Paris
with a large variety of patients, both in the hospitals and
in private practice, and will follow that with some obser-
vations and reflections on this treatment, what it has done,
and the part it is destined to play.
Thus one can judge by these few cases described that the
effects obtained by the Tallerman apparatus in chronic
deformatory rheumatism, gonorrhoeal rheumatism, sprain,
sciatica, gout, and certain forms of joint disease of a more
or less well-known origin, have been remarkable enough to
merit publication. I speak only of these diseases because
these are the only ones which we have treated in Paris,
but the list of diseases treated in England is, as we have
seen, much longer.
The study of the cases treated has shown that altogether
the treatment has produced the following phenomena :
1. A perspiration, more or less profuse, not only on the
part treated, but over the whole surface of the body.
2. A marked reddening of the skin on the part treated,
indicating an intense dilatation of the bloodvessels.
3. The diminution and rapid disappearance, sometimes
almost immediate, of pain, as in cases Nos. 4 and 6.
4. The restoration of movement where the functional
impotence was due only to pain (cases Nos. 3, 4, 5, and 6).
5. A more or less marked acceleration of the pulse,
caused evidently by the peripheral dilatation of the blood-
150 The Tallerman Treatment.
vessels produced, which facilitates and strengthens the
action of the heart.
6. A temporary elevation of the body temperature.
How do these hot-air baths act? That is a complex
question, to which it appears difficult to reply at present.
It is easy to say that the prolonged application of a high
temperature produces an intense reaction in the affected
part. But that explains nothing, for is there anything
more obscure than what we describe by the word ' reaction '?
It would only be an attempt to content ourselves with a
form of word which explains nothing, as has already been
done in so many other cases.
The most evident result from this treatment, both to
patient and physician, is the disappearance of pain. But
we have applied cold also to the treatment of pain (siphon-
age, ice, chloride of ethyl and of methyl, ether sprays, etc.),
and warmth also (hot compresses, poultices, hot air, moist
and dry, application of pointes de feu, cupping, blisters,
injections of sterilized water), all acting in different ways,
aim at the same result the amelioration of pain.
If we compare all these processes, they have this in
common that, all being violent methods, they profoundly
disturb the statics and dynamics of the tissues to which
they are applied. I believe myself that that which we
speak of so obscurely as ' reaction ' in treatment for the
relief of pain is caused by molecular changes in the great
trunk nerves and their terminations. The excessive func-
tional activity which is indicated by the dilatation of blood-
vessels provoked by some of these processes, such as pointes
de feu, spraying and hot air, seems to indicate action in the
manner that I have mentioned, my object here being more
to state facts than to explain them.
What can we hope for from the superheated dry -air
treatment? What are the favourable and unfavourable
symptoms produced by it? There are no unfavourable
symptoms that I know of resulting from the application of
the treatment. Thus, as was proved by case No. 7, the
presence of a heart trouble did not forbid the use of the
Medical Reports, Etc. 151
Tallerman treatment; quite the contrary. In fact, the
diminution of the arterial tension caused by the peripheral
dilatation of the bloodvessels facilitated the heart action, as
was indicated by the immediate acceleration of the pulse.
As far as affections of the respiratory organs are con-
cerned, I have no personal experience. All that I can say
is, that in several of the cases published in the English
medical journals, the patients who presented themselves for
treatment had, in addition to their joint affections, chronic
bronchitis. That was so much helped by a course of these
superheated dry-air baths that the treatment has been
deliberately applied in cases of affections of the respiratory
organs, and with success.
There remain still the effects on the renal organs. The
English physicians are mute on this subject. I have care-
fully examined the urine of all the patients who were
treated in the Laennec Hospital and found no change
either in quantity or quality (sugar, albumen). That is a
point which has not, up till now, been cleared up.
A priori, it would not seem that the hot-air baths could
have any evil influence on the kidneys in their normal
condition. It would be a benefit, on the contrary, in
certain nephritic cases if they would, by diminishing the
muscular tension, diminish the diuresis.
The analysis of urine has not only been directed to the
discovery of modifications which could have existed before
the treatment : we have also sought to discover if the hot-
air baths influenced the quantity of matter secreted by the
urinary organs during the twenty-four hours.
In case No. 5 the urine was analyzed after each bath. It
showed only a very slight improvement in the elimination
of salts, particularly chlorides. The daily co-efficient of the
urine changed from 20'97 grains to 25*50 grains.
From this point of view, case No. 12 is most interesting,
for here, in a case of long-standing gout, the daily quantity
of uric acid eliminated rose from 57 centigrammes after
the fourth bath to 89 centigrammes after the ninth. The
patient being still under treatment, we cannot say now
152 The Taller-man Treatment.
how far this elimination of uric acid will go, and when it
will return to normal.
The field of diseases suitable for treatment by these
superheated dry-air baths is, as one can see, very large. It
comprises :
1. All the painful affections of the limbs, the diseases
which attack the joints, the diseases of the muscles, the
trunk nerves (sciatica, neuritis), and perhaps we can use it
in the treatment of wasting diseases, diseases of the bone
and of syphilitic origin.
2. Acute and chronic arthritic diseases, whether acquired
(gout, rheumatic fever, gonorrhceal, tuberculous) or here-
ditary. I do not wish to say that this treatment can cure
the deformities of old sufferers from rheumatism, their
fibrous adhesions or their muscular atrophies. But I
believe that it will abate them, and after treatment with
the hot-air baths we can with much greater ease and with
better results break the fibrous adhesions and restore
movement to the stiff joints. I believe that by associating
the hot-air treatment, electricity, and massage, we can, if
not cure, at least considerably ameliorate the lot of these
sufferers whom we see in the chronic disease wards, help-
less and deformed from rheumatism for ten, fifteen and
twenty years, and restore again the charm to their life,
something which no therapeutic agent employed up till now
has been able to accomplish.
As far as the joint affections are concerned, and more
particularly in tuberculous cases, it is possible that the
high temperature obtained by the Tallerman treatment will
give us good results. In fact, the Koch bacillus offers a
poor resistance to the action of heat, and the various
attempts at the treatment of local tuberculosis by heat
have been so encouraging as to merit continuance.
3. In the treatment of sprains, accidents which have
become frequent since the wide introduction of the bicycle.
4. In the treatment of certain atonic ulcers, where
healing is hindered and retarded by malnutrition of the
adjacent and surrounding tissues. The use of heat in the
Medical Reports, Etc. 153
treatment of such cases has been tried elsewhere, and
certain patients suffering from varicose ulcers have been
benefited by the application of compresses soaked in water
almost at the boiling-point. We have read of some English
cases in which chronic ulcers have been treated by the
Tallerrnan method with a success which we, unhappily,
have been unable to attain.*
5. Thanks to Mr. Tallerrnairs apparatus for the pelvic
region, lumbago can be treated as well as the diseases of
the hip and abdomen (coxalgia, sacrocoxalgia), (Brodie's
disease).
6. I mention here hysterical coxalgia, for I believe that
these hot-air baths can with benefit be added to the means
which have been used to treat the painful or paralytic
symptoms, both motor and sensory, of hysteria.
7. In conclusion, there is a disease with which a few
experiments will prove interesting. I refer to soft chancre.
If it is true that the Ducrey-Unna bacillus succumbs to
high temperatures, it is possible that we may obtain results
with the Tallerman apparatus which have not yet been
obtained in the treatment of soft chancre by prolonged hot
baths, hot applications, etc.
This is only a simple hypothesis, which it will be easy to
prove. The apparatus we have hitherto used allowed us to
treat the limbs or parts of the limbs only. Thanks to the
pelvic apparatus Mr. Tallerman has furnished to us, into
which the whole abdomen can be introduced, it will be
easy to experiment on soft chancres of the genital organs.
To sum up, the results obtained by the use of the
Tallerman apparatus, both in England, where it is in
everyday use in private and hospital practice, and in
Paris, have demonstrated a real progress in the therapeutic
employment of hot air.
Although the list of diseases treated by this local appli-
cation of superheated dry air appears somewhat long and
diverse, we must say that there is no intention to claim
that this treatment will cure all diseases. Such a preten-
sion has never been made.
See photos of cases since treated.
154 The Tallerman Treatment.
All that we can say is, that it seems to be destined to
render great service in the hands of the physician and
surgeon, for, on the one hand, it has taken effect on
diseases reputed to be incurable, such as chronic, deforma-
tory rheumatism, against which the physician up till now
confessed himself to be completely powerless ; and, on the
other hand, it has acted more quickly and with better
results than all other therapeutic methods in diseases
often intractable, such as sciatica, gout and gonorrhosal
rheumatism.*
VI.
Report from the North- West London Hospital.
The authorities of the North-West London Hospital
having, at the suggestion of Mr. Mayo Collier, kindly con-
sented to submit a series of cases to treatment by the
localized superheated dry-air bath, the proprietors of that
apparatus courteously placed one of their cylinders at the
disposal of the medical staff for that purpose, and I give the
notes and results obtained during the past two months. It
might not be out of place to refer here to the fact that
this apparatus was introduced to the medical profession by
Mr. Willett at St. Bartholomew's Hospital, in the wards
of which institution a variety of cases were treated for two
months, after which Mr. Willett detailed the results obtained
in a clinical lecture delivered on May 23 last. Acting upon
the suggestions thrown out by the lecturer on that occasion,
several medical cases were treated. The operation extends
over forty minutes, at an average temperature of from
240 to 260 F., and may be shortly described as follows :
The affected part is placed in the cylinder, which, to save
time, has been already heated to a temperature of 150, and
is then gradually raised. The system of heating and
ventilation admits of the air iri the cylinder being kept
* From La Presse Medicate, December 26, 1896.
Medical Reports, Etc. 155
practically dry throughout the operation, thereby enabling
a very high temperature to be borne by the patient, hi one
instance at St. Bartholomew's Hospital reaching 300, whilst
temperatures from 270 to 280 are by no means unusual.
Under treatment patients experience a sense of comfort,
probably due to .the high temperature exercising an
anodyne influence, which relieves the pain, or more often
removes it entirely ; even when adhesions have been broken
down, the pain is much modified if the joint is immediately
subjected to treatment. Some of the cases can hardly fail
to be of interest, being of that chronic character for which
so little can be done by ordinary medical treatment ; all of
them were selected for their severity in order to test to the
utmost the value of the apparatus. The majority were
cured, and the remainder exhibited such marked improve-
ment, that it is only fair to state that there was not a single
failure. Mr. Lewis A. Tallerman kindly gave his personal
attention during the treatment, and Mr. Mayo Collier
supervised the selection of the cases.
J. F. SARGEANT, M.E.C.S., L.E.C.P.,
Resident Medical Officer.
Editorial Comments by the 'Lancet.' It must be con-
fessed that the results obtained by the usual treatment
in cases of chronic stiffness of joints are far from satis-
factory, so that one is inclined to welcome all the more
cordially a recent therapeutic method which claims, and
apparently with justice, to remove, at least in part, this
reproach from surgery. The Tallerman Local Dry Hot-
Air Bath is an invention by which dry air at tempera-
tures from 250 to 300 F. is applied to a portion of the
body, such as hand or foot, knee or elbow, an arm or
leg. In May of last year Mr. Alfred Willett delivered a
clinical lecture at St. Bartholomew's Hospital on some
cases which he had treated by this method ; and the
present list consists of a series of eight cases in which this
bath was employed at the North-West London Hospital,
under the care of Mr. Mayo Collier. The bath itself
156 The Taller man Treatment.
consists of a copper cylinder, varying in size and shape
according to the part to be enclosed ; and instant relief can
be afforded the patient if the temperature causes any dis-
comfort. The cylinder is heated by gas-burners placed
underneath. Precautions are taken to prevent the skin
from coming into contact with the heated metal. Mr.
Willett's conclusions are decidedly in favour of the treat-
ment in certain cases, and his results may be summarized
as follows : The first effect of the heat is to induce a
copious diaphoresis, and the circulation of the blood in the
part is enormously increased, as is well shown by the bright
redness of the limb when removed from the bath. The
anodyne effect is often remarkable ; pain is generally not
only relieved, but entirely removed, so that the patient
expresses the great relief he feels, and moves the limb with
much greater freedom and with much less pain. The
cases that appear the most likely to be relieved by the
treatment are sprains, stiff joints (where there are no very
strong adhesions), flat-foot, gonorrhoeal rheumatism, acute
and chronic gout, chronic ulcers, and rheumatism. It
deserves also to be employed for its anodyne effect after
forcibly breaking down under an anaesthetic adhesions
which have formed in or around a joint ; if the limb be
placed in the cylinder, the pain, which is generally severe,
is greatly lessened, and the secondary stiffness is much
diminished. Mr. Willett was of opinion that but little
assistance would be afforded by this bath in overcoming
firm, fibrous, articular adhesions. ' Sooner or later the
adhesions will have to be forcibly broken down under an
anaesthetic, but, such having been done, I think the
recovery will in many cases be hastened by the subsequent
use of the heated cylinder.' In other words, while facility
in active movements is immensely increased, the range of
movement is not extended to any great amount. The
results obtained in the cases treated at the North- West
London Hospital endorse the favourable opinion of Mr.
Willett ; and the benefit to be derived in rheumatic arthritis
is shown in two cases, and in gout in one. The general
Medical Reports, Etc. 157
effect of the baths is marked, but apparently in no way
injurious. The entire skin is relaxed and perspires freely,
and pain is relieved in joints other than those enclosed in
the cylinder.*
TIL
Report of Meeting of Harveian Society.
A meeting of this society was held on May 21, Dr. Gow
being in the chair.
Dr. Knowsley Sibley showed two cases of rheumatoid
arthritis successfully treated by the hot-air method. The
first, a woman 66 years of age, came under his care at
the North-West London Hospital in 1892, having previously
been under treatment at another hospital. At this time
she had considerable enlargement of all the fingers of both
hands. These were quite fixed and very painful. The
movements of the wrists were also very limited, so also
was the right elbow. The knees and shoulders were also
enlarged and painful. The patient attended for many
months, and, although a large number of drugs and
remedies were tried, she gradually became worse, and had
to give up her occupation. Then she was unable to dress,
and finally unable to feed herself, and was becoming more
hopeless every day. At this time August 1, 1894 one of
the Tallerman superheated dry-air apparatus was brought
to the hospital, and this new treatment was prescribed.
After the first application the pain was considerably relieved
and the joints showed some improvement. After the fourth
application the patient, who had been unable to follow her
business for many months, was again able to use her
needle. After the eighth application, with the exception
of the right index-finger, all the others could be flexed
without much difficulty. On August 24, after the ninth
operation, the patient reported she had resumed her
occupation, and she was able to walk up and down stairs
* From the Lancet, January 12, 1895.
158 Tlte Tallernian Treatment.
without pain. The patient continued under this treatment
till September 13, having then had twenty baths, when she
considered herself practically cured ; but as the apparatus
was still at the hospital, she had an occasional bath up to
the end of October, 1894. From that date to November,
1895, she continued at her work, and, with the exception
of minor ailments, suffered no inconvenience from her
former trouble. At this time she again complained of pain
and stiffness in the right hand, so three more baths were
prescribed; she again rapidly improved, and from that
time to the present has continued much as she now is, and
has not relapsed. The other case was a woman aged
69 years. For some years her hands had been painful and
the joints enlarged. She first came under Dr. Sibley's
care at the hospital on April 22, 1896. Her knees and
ankles were somewhat stiff and painful, but the hands were
chiefly affected ; all the finger- joints were much enlarged ;
she also suffered much from bronchitis and asthma. This
patient had now had fifteen baths, with the result that her
knees and ankles were much less painful and her hands
much less swollen ; so also her cough and general nervous
condition had greatly improved. Dr. Sibley explained that
the treatment consisted in placing one limb, usually the
most affected one, in a cylinder heated to about 150 F.,
and this temperature was gradually increased up to about
240. The limb was allowed to remain in for about forty
minutes. During this time the patient usually perspired
freely from the limb, and, in fact, from the whole body.
The temperature as taken in the mouth rises one or two
degrees, and the frequency of the pulse is also increased.
About a quarter of an hour after the limb is removed the
temperature returns to what it was before the treatment.
The pain in the affected and other parts was greatly
relieved, and the patient experienced a considerable feeling
of relief generally; especially it was noticed that the
bronchitic condition, which so often accompanies this
affection, was also much benefited.*
* From the Lancet, June 6, 1896.
Medical Reports, Etc. 159
VIII.
Report of Meeting of Philadelphia County Medical Society
The President, Dr. J. C. Wilson, was in the chair.
Dr. Horatio C. Wood presented to the society Mr. Lewis
A. Tallerman, who came from London with a letter of
introduction from Dr. Lander Brunton. Mr. Tallerman
delivered a short address on the Tallerman Patent Super-
heated Dry- Air Apparatus for the localized application of
dry air heated to a high temperature.
The efficacy of the apparatus was tested on two patients
from the Philadelphia Hospital one a case of saturnine
gout, the other one of lumbago. Dr. H. C. Wood said that
Mr. Tallerman is the inventor of a new method of treating
chronic rheumatism, rheumatoid arthritis, sprains, both
acute and chronic, and a large number of general inflamma-
tions and rheumatic affections. There have been published
in the journals, especially in the Lancet, a number of very
remarkable results, said to have been obtained by the use
of the apparatus of Mr. Tallerman, who will briefly state
the principles of its construction, and show its immediate
mechanism, and then it is proposed to put the apparatus
to the test on two patients whose treatment will require
from forty to sixty minutes, so that the results of the treat-
ment can be seen.
Dr. Frederick A. Packard demonstrated a case of satur-
nine gout that had been extremely obstinate to all forms of
treatment, in so far as his auricular symptoms were
concerned, and had at the time suffered from severe pain
in one of the big toes, which was constant in spite of all
that could be done. On learning of the Tallerman method
of treatment, Dr. Packard thought that the case would
be a good one for demonstration, because the man was
suffering pain in the big toe so that it could not be
touched or flexed, and also because he had tender nodes on
the hands, so that the effects on peripheral processes far
from the seat of treatment could be seen.
160 The Tallerman Treatment.
Dr. H. C. Wood, in answer to the question, ' Is not
moisture produced by the great heat and liability of scald-
ing present ?' said that the only moisture about the
apparatus is that from the limb, and this is said to be
got rid of. He presented a case of lumbago, in which it
was supposed the apparatus would afford marked relief.
After the demonstration Dr. Wood pointed out that the
man with the lumbago, who had moaned and groaned when
touched, and had been in the hospital a week without much
benefit, was, after the treatment, able to get up.
The case of saturnine gout had been under competent
medical care for some weeks, without much gain. The
man had not moved his toes for three months, but after the
treatment he was able to move the toes freely. In fifteen
minutes after the treatment was begun he could move
his toe, while the pulse went up twenty beats and the
temperature rose 1'4 ; the other man's temperature went
up about 1 in forty minutes, and his pulse increased nine
beats and gained very distinctly in fulness. The tempera-
ture within the apparatus was 260, and the pelvis was
kept in it for forty minutes. The patient with saturnine
gout stood a temperature of 260 for three minutes ; then
it had to be reduced to 255, w r hich he stood for some time.
Most of the time the temperature was 248.
Dr. H. C. Wood said that the immediate results achieved
by the apparatus were remarkable, and that it is stated on
the highest authority in England that permanent results
are reached ; so that the apparatus seems to be an im-
portant addition to our therapeutics in a class of cases that
have been exceedingly anxious and worrying to all.
Medical Reports, Etc. 161
IX.
Paper by Dr. Knowsley Sibley, in the ' Lancet,'
August 29, 1896.
Physicians have shown a marked tendency of late to treat
many complaints by what may be termed local or external
methods, in contradistinction to treatment by the exhibition
of drugs and internal remedies. Even many cases of heart
disease are now much improved, if not occasionally cured,
by regulated exercises and baths (Schott treatment). In
many cases this improvement has taken place without the
assistance of drugs of any kind. Undoubtedly many heart
cases which had failed to show any permanent benefit by a
carefully regulated course of internal medicines have been
greatly improved by the Schott treatment. It is not wished
in any way to depreciate the value of internal remedies,
which still prove of great use when combined with external
methods ; but the object of this paper is to emphasize the
fact that the external method is often the most powerful
and effective means of dealing with disease. Rheumatism
in its various forms has from times of ancient history been
treated by external applications, such as blisters, cupping,
leeches, hot sand, friction, warmth, and more recently by
massage, electricity, and the like. A large number of baths
and moist hot-air methods are at present in vogue ; in fact,
every fashionable health resort has its own particular kind
of charm in the form of a bath, with or without an electrical
current. But the one feature which at once appears fatal
to satisfactory results is that in all forms a moist and not a
dry heat is applied to the affected part. As a result, it is
impossible to obtain a really high temperature, as moist
heat of from 115 to 120 F. is unbearable, and much above
this produces scalds. So with all these older methods,
what seems to be the important element in the treatment
namely, heat of from 200 to 300 cannot be applied, or,
at any rate, not for a sufficient length of time.
The method about to be described was first brought
11
162 The Tallerman Treatment.
under my notice in August, 1894, when an apparatus
was supplied to the North -West London Hospital and
left for the use of the staff. I have tried the treatment
in a large variety of cases ever since, and now wish to
publish some of the results. This period of two years has
enabled me to form a definite opinion that the value of the
treatment is not merely a temporary one, but is of a more
or less permanent nature. The patient, suitably clad in
flannel to encourage free perspiration and prevent too much
radiation of heat from the body, whether seated on a chair
or lying in bed, suffers no inconvenience or discomfort from
the high temperature. The treatment lasts usually from
fifty minutes to an hour, and it is to this prolonged applica-
tion that the therapeutic effect to be described is, to my
mind, mainly, if not solely, due. When the part is first
put into the chamber the temperature is usually about
150, and this is gradually raised to 220, and thence up-
wards, in some cases to as high as 300. When the
treatment is required to act quickly as an anodyne, the
temperature is rapidly raised to 260 or 280. But under
ordinary circumstances, such as those described below, it
is gradually raised, and a general free perspiration breaks
out over the whole body ; at the same time the body
temperature is temporarily raised from a half to three
degrees, a physiological effect hitherto regarded as impos-
sible to be obtained. Also, the pulse increases in frequency
and to a less marked extent the respiration. A few minutes
after the operation is completed the pulse, respiration, and
temperature return to the normal or previous condition.
Usually about an hour after the pulse is found to be slower
and stronger than it was before treatment ; this was
especially noticed in some cases of weak and enfeebled
hearts. In cases accompanied with much pain this is
almost at once relieved, and under the influence of the
heat the parts soon become more lax and supple. When
the limb is first removed there is often a transient erythe-
matous blush. After the bath the whole body is briskly
and lightly rubbed down with a dry towel, and the limb
Medical Reports, Etc. 163
sometimes gently massaged with olive or other oil. The
patient then waits until quite cool before going out of the
room in order to avoid the risk of a chill.
It will be seen that this method differs materially in
the following points from a Turkish bath : (1) The tem-
perature is higher. . (2) The application of this temperature
is continuous for nearly or quite an hour. (3) The patient
breathes the air of the room, and not that of the heated
chamber. (4) The application of the heat is only local, the
most affected part being treated. It may here be remarked
that this local treatment has a general effect, and it is
evidenced by the result that, although the particular part
treated receives the greatest benefit, other parts of the body
affected, but not actually immersed in the chamber, also
much improve both with regard to pain and to increase of
movement. (5) The treatment does not tend to produce
cardiac depression even in the very feeble, or those con-
ditions of exhaustion which are in some cases apt to occur
when heat is applied to the whole surface of the body and at
the same time inspired. A Turkish bath is less stimulating
in its effects, and this local treatment may be confidently
recommended in cases in which the former would be quite
out of the question. (6) The portable character of the
apparatus enables it to be taken to the sick-room and used
by the bedside in cases where it would be impossible to
move the patient. (7) The local bath gives far more
successful results as a method of treatment.
*****
It must be admitted by those who have had much
practical experience of severe cases of arthritis deformans
how very hopeless these have generally been considered,
and what little chance of permanent good medical treat-
ment offers, that this treatment by hot air at a very high
temperature meets a general want. I must add I have
never seen results so immediate and satisfactory produced
by any other treatment. It is now two years since treat-
ment by the local hot-air bath was commenced in the first
case, and yet the patient continues comparatively free from
11 2
164 The Tallerman Treatment.
4he complaint, and even the deformity of the fingers has
; greatly disappeared. Very intractable cases of sciatica
usually pass into the hands of the surgeon, who performs
nerve stretching, often with very little good result. It
seems likely that these cases will likewise in future be cured
by this less drastic means. Another possibility of much
importance may be the prevention of many cases of the
morphia habit. Judging from the general physical im-
provement that all of the patients showed after under-
going treatment, it would appear that this method will be
found beneficial for cases of chronic bronchitis and for
some cases of chronic heart mischief. Many of the patients
have stated that their bronchitis was better than it had
been for years. I possess also evidence of the undoubted
value of this hot-air treatment in acute and chronic gout,
and hope shortly to publish a series of cases.
With regard to the physiology of the processes. Locally
(1), the heat produces dilatation of all the cutaneous vessels
and free circulation through the parts it is impossible to
say how deeply into the tissues this extends, but from the
results it may be judged to be some distance and at the
same time there is a marked stimulation of the nutrition of
the cutaneous nerves ; (2) there is free perspiration of an
acid sweat ; and (3) relief from pain, however produced,
is almost at once apparent. Generally (1), there is profuse
perspiration and dilatation of vessels ; (2) increase of the
rate of the pulse and force of the heart's action ; (3) increase
(slight) of the respiratory movements ; and (4) an increase
in the body temperature often of 2 or 3 F. The treatment
appears to lower the blood pressure of the body, and in
some way to increase the alkalinity of the blood, which
enables it to dissolve the uric acid from the tissues and
joints and get rid of this substance through the various
excretory organs. This is evidenced by the relief from
local pain and the removal of the frequent uric acid nerve
depression. Hence the treatment is of a tonic nature, and
bestows an increased general vitality upon the patient.
So far, although it is now two years since this new treat-
Medical Reports, Etc. 165
ment was brought under my notice and tried by myself, I
am not cognizant of any unsatisfactory result following it,
notwithstanding the fact that many of the cases have not
been very promising ones to do much with ; many were old
and debilitated people, and in some cases the objective
disease was attended by heart and other visceral complica-
tions. And what is of all importance with regard to satis-
factory treatment, the patients were in every case treated as
out-patients, and so there was no control over their habits.
In a clinical lecture delivered at St. Bartholomew's Hospital,
in which this new treatment was first introduced to the pro-
fession in this country, the lecturer described it as one that
was 'not only quite painless,' but might be 'almost called
that of luxurious ease.' My experience fully confirms the
soothing effect in this process of relieving disease accom-
panied with pain. Patients worn out through prolonged
suffering will frequently, if permitted, fall asleep whilst
under the operation. One of the most important therapeutic
effects is the sleep which usually follows the treatment,
particularly in cases of patients who have been prevented
by pain from getting any rest for long periods.
It does not come within the province of this article to
enter into the various surgical conditions in which this
treatment has been found efficacious. Papers on this
subject have already been published by Mr. Willett in
the above-mentioned lecture ; in ' The Deformities of the
Foot,' by Mr. W. J. Walsham ; in an article by the same
writer in the Transactions of the American Orthopaedic
Association, 1895 ; and also reports of cases treated at the
North-West London Hospital, which were published in the
Lancet of January 12, 1895. At the present time the above
cases may be of interest to those engaged in this treatment
and to those anxious to try it. Undoubtedly the writer's
experience points to the conclusion that the chronicity of a
case is by no means a bar to a successful issue. With
regard to rheumatoid arthritis, many forms of rheumatism
with chronic joint mischief, sciatica, lumbago, and, one
might add, some cases of neuralgia, neuritis, and chronic
166 The Tallerman Treatment.
bronchitis, there can be no question as to the great benefit
of the treatment. The record of the remarkable results
previously published obtained by this apparatus at the
North-West London Hospital alone embraces such a wide
field that this localized hot-air bath must be reckoned upon
in the future to play an important part in the relief of pain
and the cure of disease. Especially is it likely to prove
of great use in those forms of very chronic disease which
have hitherto yielded but little to any known medicine,
the sufferers from which are commonly sent in search of
Continental hydrothermic establishments, and usually,
sooner or later, fall into the hands of the quack.
X.
Report from the Liverpool Workhouse Infirmary from
July, 1896, to February, 1897.
During this period fifty patients underwent the localized
hot-air treatment, twenty-eight of them for surgical com-
plaints and twenty-two for medical. Of these fifty patients,
sixteen were cured, eighteen were improved, fourteen de-
rived no benefit, and the remaining two were unable to
continue the treatment owing to faintness. Of the eighteen
who were improved, five were considerably relieved and
thirteen only slightly so ; two of the latter, however, are
still undergoing treatment, and express themselves im-
proving with each successive bath.
Of the sixteen patients who were cured, eight were
treated from the surgical wards and eight from the medical
wards. Of those who were improved, nine were treated
for medical and nine for surgical complaints. Of the four-
teen who derived no benefit from the treatment, four were
from the medical wards and ten from the surgical wards.
Of those ten surgical cases two were ulcerated, indolent,
sore legs, which had resisted all previous treatment, and
were therefore tried with the bath. Strange to say, both
Medical Reports, Etc. 167
of these patients after the ninth or tenth bath became very
exhausted, and one developed gastric symptoms of a rather
serious character. Of the two who were unable to continue
the treatment, one was a surgical, the other a medical
patient.
All the cases treated from the surgical wards were, with
a few trifling exceptions, in the subacute stage, while
those from the medical were all, or almost all, of the
chronic type.
"With regard to measurements, it has been found that
out of the fifty cases treated, a decrease in the size of the
affected part (the difference of measurement being found
between the part affected previous to the first bath and
after the last) has taken place in twenty-one instances, no
change in thirteen, and an actual increase in nine ; of the
remaining seven, no notes were taken of measurements in
three cases, the two ulcerated legs and another two are
still undergoing treatment, and two were unable to bear
the process of treatment.
Out of the twenty-one cases where there was a decrease
of the affected part, nine derived little or no benefit, while
twelve were greatly improved or cured by the bath. Out
of the thirteen where no change of measurement in the
affected part was brought about by the bath, ten derived
little or no benefit, while three were greatly improved or
cured. Where there was an actual increase of measure-
ment after treatment by the bath, it has been found that
four were not improved much, if at all, while three were
either greatly improved or cured.
168 The Tatterman Treatment.
XI
Report from the Livingstone Cottage Hospital, Dartford.
By THOS. F. CLARKE, M.E.C.S., Etc.
The first two of the following cases (omitted here) were
submitted by me to Mr. Tallerman for treatment at a
demonstration of the Tallerman Local and Superheated
Dry-Air Bath, given at the Livingstone Cottage Hospital,
Dartford, on March 18, 1896.
Mr. Tallerman afterwards kindly allowed the cylinder
to remain at the hospital for a month, in order that
further opportunities might be afforded of testing the
therapeutic value of that apparatus in the continued treat-
ment of these and such other cases as might be considered
suitable.
From the observations I have made of this form of
treatment, I have found that, as a general rule, far better
results are obtained when the limb directly operated upon
perspires freely, and at the same time there is general
diaphoresis. This does not occur in all cases (owing to the
inactive, if not unhealthy, condition of the skin), until the
patient has been treated on several occasions. It did not
occur with the first case, and although, as I have sub-
sequently remarked, this was an extremely severe test-
case for illustration, I believe still greater improvement
would have followed as soon as free diaphoresis had been
attained.
One very noticeable feature during the application of
the hot-air bath was the effect produced on the heart : its
action, although slightly accelerated as the temperature of the
bath is raised, is rendered considerably stronger, and the pulse
becomes much firmer and fuller. This result is especially of
importance, as showing that patients in a very debilitated
Medical Reports, Etc. 169
condition may with safety be subjected to this form of treat-
ment.
There is no doubt a great future in store for this mode of
treating many cases, as its value has been amply proved in
such cases as acute inflammation of joints, severe sprains,
gout, many rheumatic affections, etc.
(Signed) THOMAS F. CLARKE.
April 29, 1896.
N.B. Since writing the above, I have had opportunities
of seeing all the patients whose cases I have recorded here.
In no single instance have the good results afforded by this
treatment disappeared, thus proving that the hot-air bath
exerts a more or less permanent effect.
September, 1896.
XII.
Letter to the 'Lancet' from F. Fitzherbert Jay, M.D.
To the Editor of the ' Lancet.'
SIR,
Referring to the report of cases by Dr. W. K. Sibley
in the Lancet of August 29 last which were treated by
the above method, I am glad to be able to confirm from
personal experience the curative effect of a course of only
four baths for chronic sciatica and lumbago, which had
begun to extend to the sound leg. In the severe winter of
1894 I had an attack of acute sciatica, which has continued
in a chronic form. Having acted as resident physician to
three hydropathic establishments, I had enjoyed consider-
able experience in the treatment of such cases, and was
enabled to apply the knowledge so acquired to my own
case. The relief obtained was but slight, and I had
difficulty in getting about, the pain at times being very
severe. I am glad to be able to record that I derived
170 The Tallerman Treatment.
benefit from the first hot-air bath of the Tallerman process.
Having now taken four, I am free from pain, and able to
walk three miles at a stretch. No ill effects or risk of any
sort are likely to attend a course of these baths, a slight
rise of temperature and increase of pulse being alone
indicated. The baths were taken at the Institution,
50, Welbeck Street, W., and I am indebted to Mr. Lewis
A. Tallerman for much kindness and attention.
I am, sir, yours faithfully,
(Signed) F. FITZHERBERT JAY, M.D., St. And.
CONSTITUTIONAL CLUB,
October 7, 1896.
APPENDIX.
NOTE BY THE INVENTOR.
THE TALLERMAN TREATMENT INSTITUTE,
50, Welbeck Street,
Cavendish Square, London.
November 9, 1897.
IN answer to the many inquiries and statements which
have been made with respect to the origin and invention of
the ' Tallerman Treatment,' it may be stated that the facts
connected therewith are as follows, viz. :
In May, 1893, I was asked by Mrs. E. D. T. Sheffield and
Mr. T. H. Eees to take an interest in an apparatus for
treating stiff joints by superheated steam, a method by
which it was stated a limb could be treated at from 250
to 300 F. On the 30th of that month an agreement was
entered into to test the efficiency of the apparatus, and
binding the parties to patent in the joint names any im-
provement or new invention any one of them might devise
for a similar purpose.
The investigation commenced by the treatment of my
own foot in the apparatus, a cylindrical-shaped Receiver,
the distal end of which was closed and steam-tight. Steam
was generated in a boiler communicating with the interior
of the Eeceiver by a pipe, through which I was informed
superheated steam was passing under pressure, and that
the temperature at which my foot was then being treated
was 280 F. The absence of any sensation of discomfort
or pressure which steam, superheated to such a temperature,
might be expected to produce appeared very remarkable.
Further investigation was postponed, to be continued at
172 The Tallerman Treatment.
Harrogate about a month later, when, thanks to the intro-
duction of Dr. Lever, the staff of the Bath Hospital were
good enough to consent to the apparatus being tested at
that institution. The net result of the investigation was :
1. To demonstrate that the impression as to the high
temperature obtainable was clearly erroneous. In the
presence of the staff and committee, a thermometer regis-
tering up to 212 F. only was placed in the Eeceiver. At
the expiration of about an hour, Mr. Eees expressed himself
satisfied that he could not raise the temperature in the
Eeceiver any higher. The thermometer was then examined
and found to register 160 F. only.
2. It was found that even this temperature soon became
unbearable to the patient, and either the limb was removed
or a reduction in the temperature was effected by sponging
the outside of the Eeceiver with cold water.
3. Further, it was elicited that the latter measure led to
condensation of the vapour, and that the hot water at
times fell on the enclosed limb. In this way Mr. Eees had
himself been scalded and also a patient.
4. That the apparatus was, in fact, a local-vapour bath,
that it did not carry out the object for which it had been
devised, and that its use was accompanied by considerable
risk.
The apparatus and boiler were forthwith returned to
London, and this method of treatment was never after-
wards used. Meanwhile, becoming greatly interested in the
problem of treating disease by heat, I turned my attention
to this branch of therapeutics, and soon became convinced
that a very high temperature could not fail to exercise a
markedly beneficial effect in various diseases if it could be
applied without pressure, and continuously over a sufficient
length of time on each occasion.
Applying myself to the subject, I succeeded in inventing
the present method known as the 'Tallerman treatment,'
and the contents of this volume show my views were not
incorrect. It will be noted that a patient was treated at
St. Bartholomew's Hospital at a temperature of 300 F.
Appendix. 173
(see Clinical Lecture, Clinical Journal of May 30, 1894);
two patients were treated at the Philadelphia Hospital at
310 and 315 F. respectively (see Notes) ; and it might be
stated that with regard to duration a patient has been
treated under medical observation for upwards of two hours
at a temperature varying from 260 to 270 F. In all the
foregoing cases the effect was soothing throughout ; in the
last there was lassitude on the next day, which was not
unexpected, but that was the only discomfort.
The evidence of the value of this new treatment in most
intractable and incurable diseases will be found in the
Reports and Case Notes ; and that a large variety of cases in
which the treatment up till now has not been used will
benefit by it considerably may confidently be anticipated
by anyone who will take the trouble to consider the
physiological and therapeutic effects it produces.
In accordance with the before-mentioned agreement, the
system and apparatus was patented in the joint names,
but is known as the ' Tallerman treatment,' and has been
in use since.
I think it only right to avail myself of this opportunity
to express my acknowledgments to the distinguished
members of the medical profession whose names appear in
this book for the pains they have bestowed on the investiga-
tion of my invention, and for the kind terms in which they
have recognised its merits. Had it not been for their
friendly encouragement, the prejudice I have encountered
in other quarters would have long ago compelled me to
give the thing up, and allow it to fall into the hands of
those who would have worked it as a commercial concern
independently, and to the detriment of the medical
profession.
LEWIS A. TALLERMAN.
RAII.I.IEBE, TINDALL AND COX,
AND 21, KINO WILLIAM STREET, STRAND
University of California
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