THE USE OF DRY HEAT OF~HTGH“TEMPE* 
TURE IN THE TREATMENT OF CHRONIC 
JOINT AFFECTIONS, WITH REPORT 
OF CASES 
William E. Wirt, A. M., M. D., Ph. D. 
BY 
Professor of Orthopedic Surgery in the Cleveland College of Physician and 
Surgeons. 
Something over three years ago I began experimental 
work in the use of dry heat in the treatment of chronic 
joint diseases. I was led to believe that a high temperature 
could be borne from my studies in physics, and from a 
knowledge of the high temperature borne by iron-workers. 
My first report on the subject was made in a paper read be- 
fore The Mississippi Valley Medical Society, in October, 
1895. 
The apparatus used in applying the heat consists of a 
copper cylinder open at both ends, having four holes in the 
circumference for ventillation. Fitting into each end of the 
cylinder is a wooden ring or disc, to which is attached a 
hood which encircles the limb subjected to the heat. This 
hood, which is made of double coated rubber cloth, is drawn 
firmly about the limb by means of puckering strings, and 
in this manner retains the heat in the cylinder around the 
joint. 
My first cylinder was made of one piece of copper 
rolled into the shape of a cylinder. Naturally I have made 
a number of modifications since making the first cylinder, 
one of which changes is to make the cylinder of two halves hinged together, thus allowing the limb to be layed into the 
apparatus, and then the upper half is closed upon it. 
A recent modification is to have the lower half of the 
cylinder double with an air space between the two, or rather 
an inner half cylinder of an inch less in diameter, with a* 
half inch flange which is set down into the lower half of 
the cylinder. By this means the temperature is more equal- 
ized between the lower and upper halves—the hot air be- 
tween the two cylinders is carried up against the upper half 
of the limb. 
Heat is applied underneath the cylinder by means of a 
small gas stove on the Bunsen-burner principle, i. e. gas and 
air mixed. I have used oil lamps, gasoline and the alcohol 
flame, but when it is possible I prefer to use the gas flame. 
In the practicable application of the apparatus I have 
found it necessary to encase the under third of the limb in 
cotton, which is held in place by loosely tied tapes. This 
was found necessary from the fact that the high tempera- 
ture used caused such profuse perspiration from the joint 
that the moisture ran from the skin in drops, which falling 
to the bottom of the cylinder was instantly turned into 
steam, scalding the patient. The cotton takes up this pre- 
spiration, and the hot air quickly dries out the cotton. The 
cotton being applied, the limb (the knee for example) is 
placed into the apparatus, and the upper half of the cylin- 
der is then swung shut, and the hoods are, by means of the 
puckering strings, drawn tightly around the calf and the 
thigh. The cylinder sets in a frame work at about the 
height of an ordinary chair. The patient’s foot is placed in 
a chair and raised to such a height that the calf touches 
nothing about the cylinder but the rubber hoods. If neces- 
sary, the patient may sit on a pillow in order to raise the 
thigh free from the wood rings in the cylinder. Every- 
thing being ready the gas is turned on and lighted. The 
joint is kept in the heated apparatus from thirty minutes to 3 
one hour, and the heat is used as often as three times a week, 
or in some instances daily. 
The temperature ordinarily used is from 250° to 300°. 
In some cases I have carried the temperature ashigli as350° 
to 400°. In one case on two occasions the bulb of the 
thermometer lay in the cotton at the side of the limb one 
inch from bare skin, and registered the extreme tempera- 
ture of 450°. On the other hand I had blisters on two 
patients where the temperature registered was below 300°, 
and neither of the patients complained of the heat being 
excessive. 
Heat and cold have been used for many ages to allay 
inflammation, but the moist heat, the form generally used, 
only permits a range of temperature seldom above 140° F. 
Very high temperatures have been used in the form of the 
cautery, but only for a moment of time, and its effect does 
not in any way parallel the effect of prolonged use of a 
temperature of 300 degrees. 
The influence of these agents just named is determined 
firstly, by their power to modify the circulation ; secondly, 
by their pow7er to increase the lymphatic circulation; 
thirdly, by their modification of the secretions, and fourthly, 
by their action on the nerve supply to a part. 
To make it a little plainer w?hat these effects are, I will 
go somewhat into detail. By the use of a temperature as 
high as previously named, say from 250° F, to 300° F., the 
prespiration of the local part is so great that if not absorbed 
by the under layer of cotton, it will roll off rapidly in drops, 
and the whole amount evaporated in an hour is quite large. 
The circulation of the blood is also greatly increased, which 
is very apparent on the surface, the part being reddened- 
and the arterioles dilated, as is seen in the blush of an ery, 
sipelas. The pain and stiffness are greatly relieved. 
Take for instance, an old case of gonorrhoeal rheuma- 
tism, or rheumatoid arthritis, and we find at all times there 
is more or less pain with considerable stiffness, and the mo- 4 
tions of the joint are accompanied with creaking sounds. 
At times there are exacerbations, when all these symptoms 
are considerably increased. It has been my experience in 
the use of the apparatus, that very soon after the tempera- 
ture in the cylinder is raised to 250° the patient feels en- 
tirely relieved of the pain, and on removing the limb from 
the apparatus after the treatment, it is found that the mo- 
bility of the joint is considerably increased, and the creak- 
ing sounds have greatly diminished, or entirely disappeared, 
The marked effect of the heat is especially noticeable at the 
time of an exacerbation, when the difference in the condi- 
tion of the joint before and after the treatment is consider- 
able. 
As illustration of the effect of the high temperature 
used, I will report several cases of my own, and quote from 
the letters received from several surgeons to whom I fur- 
nished the apparatus. 
Case 1. Mrs. S. A. M., age 29. Diagnosis, Arthritis 
Deformans. No history of gout; no history of?tubercu- 
losis. Mother of patient complained some of rheumatism. 
On January 3, 1893, knee became painful, swollen and hot, 
but not changed in color. Was laid up in bed for three 
months. Used crutches for a while. Has limped ever 
since original attack. Has had milder attacks since. 
Uimb about same as one year ago, but not so straight. 
Examination January 10, 1895. Knee swollen and in- 
creased in temperature. Fluctuation in joint. Outlines of 
knee changed somewhat. Ends of tibia and femur en- 
larged. Knee cannot be straightened beyond 160°. No 
marked spasm of muscles. Treatment: Used four appli- 
cations of the dry heat, two and three days apart, with con- 
siderable improvement. Flexion increased ten degrees. 
Knee less sensitive. Temperature used was 260° F., for 
forty minutes at a time. 
Case II. F. M., age 20. Diagnosis, Ankylosis from 
acute rheumatic attack. Patient had suffered much from 5 
rheumatism since her seventh year. Would get it in feet, 
knees and arms. Mother of patient has suffered from 
rheumatism for many years. In April, 1894, had a severe 
attack of rheumatic fever from exposure to wet and cold. 
Was very sick, and in bed for three and one-half months. 
Got up on crutches with right knee drawn up. Examina- 
tion February 19, 1895. Find barely preceptible amount of 
motion in right knee, any forced flexion or extension causes 
pain. Both knees of same temperature. Knee held at an 
angle of 105°. Normal motion in left knee following rheu- 
matism. Treatment: Application of heat of a tempera- 
ture of 290° F. for periods of an hour were used, with an 
idea that the adhesions in the joint might be loosened up. 
Finding that the adhesions remained firm after several ap- 
plications of the heat, the patient was placed under ether 
and the adhesions were broken up—the limb being put in 
plaster of Paris in the straightened position. Complete 
paralysis below the knee, both of motion and sensation, 
followed the straightening of the limb. After keeping the 
knee in the plaster for a short time, the knee and calf were 
again subjected to the high temperature heating apparatus. 
Quite an amount (30 degrees) of free motion was soon 
established, and the paralysis was reduced to the lower half 
of the foot. At this time the patient went into the 
country, and was lost track of. 
Case III. Dr. F. C. T. Diagnosis, rheumatism. The 
doctor had an attack of rheumatism during July of 1896. 
The usual treatment was carried out. When I saw him his 
knee was in plaster of Paris, and the doctor told me that 
for three or four weeks he had made no progress. He sent 
for me to ask as to the advisibility of using hot air. I 
recommended the treatment, and about a week later I 
applied the heat to his knee. On removing his knee from 
the plaster prior to the treatment, I found the knee much 
swollen and exquisitely sensitive and painful on motion. 
With the greatest care we got his knee into the apparatus. 6 
The heat was applied forty minutes at a temperature of 
270° F. The doctor soon declared that the knee felt better, 
and at the end of treatment on removal of the limb from 
the apparatus, the motions were freer and with less pain. 
The doctor continued the treatment two or three times a 
week for several weeks, at which time he felt well enough 
to go to Mt. Clemens. Here he received great benefit from 
their treatment, returning from Mt. Clemens able to walk 
fairly well with a cane. He again continued his treatments 
with hot air with decided benefit. 
I have several times talked with the doctor about the 
condition of his knee and the benefits of this treatment. 
He tells me that whenever his knee pains from any cause 
as twist of the joint or the oncoming of a storm, he gets 
out the apparatus and gives his joint a good heating with 
the result of relief from all pain. At the present time he 
is riding a bicycle and has good use of his joint, and has a 
practically normal gait. 
Case IV. Mrs. Anna T., age 66. Rheumatism in both 
hands—more marked in the left. Patient had a Colles 
fracture of the left wrist, which made the left hand more 
stiff than the right. Examination. The usual deformity 
of Colles fracture is found at the left wrist. The fingers of 
the left hand are considerably flexed, especially the fourth 
and fifth. The hand cannot be closed like the normal 
hand—in fact, only about one-third the usual motion is per- 
mitted. On attempting to extend the fingers, we find them 
blocked firmly, apparently by adhesions in the joint, instead 
of the stretching resistance found in shortened tissue. 
The same condition holds in the right hand, though not to 
so marked a degree. Nine applications of the hot air, at an 
average of 310° were used, for forty minutes at a sitting, 
followed by twenty minutes of massage and passive' motion. 
The treatments were given every other day, and at the end 
of the nine treatments the motion in all the joints of the 
fingers of the left hand were quite free, except in the little 7 
finger—here the motion was only fair. The patient and 
her daughter, who always accompanied her mother, were 
delighted with the results of the treatment. 
The following letter from Dr. Frank S. Milbury, of 
Brooklyn, N. Y., is self explanatory. 
On the first day of March, 1 a. m., 1894, when taking a 
chair down stairs, I slipped, flexing my left fore leg upon 
the thigh, and being a heavy man, weighing 205 pounds and 
about 5.11 tall, brought the joint on a sudden and heavy 
strain. Apparently, I felt something give way, the pain 
was very great, but being very busy professionally, and as 
my practice is confined exclusively to the eye, ear, nose and 
throat, and necessarily in the office, I attempted for a few 
days to attend to business, keeping off my feet as much 
as possible, believing that it was only a severe sprain, and 
would soon be well. However, in this, I was mistaken, as 
it grew rapidly worse, and in about eight days my knee 
was greatly swollen, and the pain very acute. I applied 
water as hot as could be borne for about fifteen minutes and 
then douched it with ice water—several gallons—after which 
I applied, with considerable friction, a palliative linament, 
and retired. This treatment was given night and morning, 
and always afforded great relief. The swelling and severe 
inflammation soon subsided. At the earliest possible moment 
I drove to New York to consult Dr. A. M. Phelps, 62 Bast 
34th St., and after a careful examination he stated that in 
the fall two of the semi-lunar cartillages had been ruptured. 
He ordered me to wear an apparatus so as to keep the knee 
stiff when walking, and flexed on sitting, but advised abso- 
lute quietness for a few months, which advice I followed to 
the letter. In addition to this he suggested the hot and 
cold applications followed by a brisk rubbing with a coarse 
towel, after which a chloral-camphor and morphia linament 
was applied and the knee wrapped with oiled silk, covered 
with flannel. The object was to generate heat and stimu- 
late the parts. Improvement was marvellously rapid, and 8 
I was soon about, probably too soon for my own good, as a 
chronic condition ensued. This was contrary to the advice 
of Dr. Phelps, whose untiring patience and skill .had placed 
me again on my feet and given me the use of my leg, but 
my business had become so impaired that I felt it absolutely 
necessary to look after it myself, instead of leaving it al- 
together in the hands of my assistant, who is a thoroughly 
good man in the work, but as you know, patients come to 
the principal. I wore the apparatus a little more than one 
year, and laid it aside. In spite of all we could do a rheu- 
matic trouble ensued, and my knee was in a bad shape, and 
I was laid up again. About this time I noticed in one of 
my medical journals a review of an article published by Dr. 
Wm. E. Wirt, of Cleveland, Ohio. I communicated with 
him, and he kindly described to me in detail his methods of 
procedure and apparatus. I immediately had one con- 
structed as near as possible to Dr. Wirt’s, but in compari- 
son it was no doubt very crude ; however, through it, I 
applied dry heat twice daily, as hot as could be borne, and 
a rapid improvement began, so after a few weeks my knee 
appeared nearly well, and with an occasional application for 
about one year longer, I abandoned all treatment, since 
which time I have been entirely free from all trouble. I 
attribute my improvement latterally to the “hot air,” and 
from the only experience I have had which is the best— 
my own—I consider the treatment perfectly logical, and a 
marked advance on other methods in vogue. I shall cer- 
tainly consider that Dr. Wirt was the means of giving me a 
useful leg again, and extend my sincerest thanks to him for 
his kind interest. 
Frank S. Milbury, 
215 Jefferson Ave., Brooklyn, N. Y. 
Cleveland, O., June 20, 1896. 
Dr. Wirt. 
Dear Sir: Dr. Gilchrist tells me that you have kindly 
offered to let us have your apparatus again for a few da>s, 9 
as we would like to give Thompson one more sitting before 
letting him go. * * * 
I will state that Thompson feels so much better that he 
speaks of leaving the Hospital on Monday, a thing he never 
suggested before the application of the heat. He said to- 
day that his left knee was bothering him a little again, so I 
guess we will give him another application on that leg to- 
morrow, with your permission. * * * 
Thanking you for your kind offer, I am, Doctor, 
Sincerely, 
Dr. L. P. H. Bahrenburg. 
The patient mentioned in the above letter was a man 
about 45 years old who was being treated for gonorrhoeal 
rheumatism. 
Bouisville, Ky., April 9, 1897. 
Dr. Wm. E. Wirt, Cleveland, O. 
Dear Doctor : Your letter of the 7th just to hand, and 
I hasten to answer same. My experience with the hot-air 
drum has shown me that the present one in use has many 
disadvantages, and to overcome these I have designed one 
of my own that I will eventually present to the medical pro- 
fession. The results of my work have so far been satisfac- 
tory, when it is followed by some radical measure such as 
general Hydrotheraphy, but otherwise its capacity is limited. 
I have, at present, some very interesting cases that are under 
my observation, but it is yet too soon to speak of its per- 
manency of result. Trusting this will prove of service to 
you, I remain 
Very truly yours, 
Curran Pope. 
I have modified the apparatus considerably since furnish- 
ing Dr. Pope the one he refers to. 
Boston, Mass., April 15, 1897. 
My Dear Doctor : Your letter has just been received 
and in regard to the hot air, it seems to me that it is a 10 
valuable adjunct in our department of medicine. I cer- 
tainly have been able to get results by its use that 1 could 
not have gotten in any other way, or at least in the same 
length of time. I have quite a large amount of apparatus 
and it is in constant use here at my office. 
Very truly yours, 
Joel K. Goedthwait. 
discussion. 
Dr. Davidson : I should like to ask the Doctor if he 
has applied for or secured a patent on the apparatus. 
Answer: No, sir. 
Dr. Davidson : I should also like to know how long he 
would continue the application. 
Dr. R. Harvey Reed : I take it for granted, from 
what the Doctor has said, that this apparatus is intended for 
the use of hot air where heat is indicated in cases of joint 
affection. I do not take it that he intends to use heat in all 
cases of joint affection. If he does, I certainly take issue 
with him. 
Dr. Wirt: I keep the part in the apparatus from half 
an hour to an hour, and I feel satisfied with a temperature 
of anything over 250°. Dr. Gibuey, of New York, reported 
in January or February, six cases in which he used 250° to 
300°. In regard to the cases, I use it in chronic cases. I 
would not use it in acute cases. 
Dr. Davidson : Would you use it in sprains ? 
Dr. Wirt : After the acute symptoms have passed off. 
I have used it in dislocations of the patella.