THE 
VALUE OF RESPIRATORY GYMNASTICS 
In Maintaining the Integrity of the Lungs, 
and as an Aid in the Treatment 
Diseases of these Organs. 
EDWARD O. OTIS, M. D., BOSTON, 
BY 
Medical Director op the Young Men’s Christian Union Gymnasium, 
Visiting Physician to the Free Home for Consumptives, 
Member op- the American Climatological 
Association. 
BOSTON: 
DAMRELL & UPHAM, Publishers, 
283 Washington Street. 
1896. 
BOSTON: 
DAMRELL & UPHAM, Publishers, 
283 Washington Street. 
1896. 3. J. PARKHILL A CO., PRINTERS 
BOSTON THE VALUE OF RESPIRATORY GYMNASTICS 
IN MAINTAINING THE INTEGRITY OF THE 
LUNGS, AND AS AN AID IN THE TREAT- 
MENT OF DISEASES OF THESE ORGANS.1 
BY EDWARD O. OTIS, M.D., BOSTON, 
Medical Director of the Young Men’s Christian Union Gymnasium, 
Visiting Physician to the Free Home for Consumptives, Member of 
the American Climatological Association. 
In the differentiation of medical work and the 
minute attention which is accorded to each organ of 
the body, the function of respiration seems, in a 
measure at least, to have escaped the careful attention 
granted the other vital processes. One consults his 
physician and is interrogated by him to see, for exam- 
ple, if bis kidneys are acting properly or his heart is 
in order; if his digestion is well performed and his 
diet correct; or his hepatic secretion normal; but fre- 
quently neither thinks to ask if the breathing is ade- 
quately performed — a function which is of such vital 
importance, not only for the integrity of the pulmon- 
ary tissue itself, but for the well-being and health of 
the whole body. Upon the efficient performance of 
this act, we know, depends largely the condition 
of the circulation, assimilation and excretion, as well 
as the process of combustion, the greater or less com- 
pleteness of which depending also upon the greater 
or less perfection of the respiratory act. And fur- 
ther, so far us the lung tissue itself is concerned, it 
responds very delicately to the manner in which it is 
used or disused. Full and free respiration of pure air 
strengthens the pulmonary tissue and nourishes it 
with well-oxygenated blood ; its vitality is increased 
1 Read before the Boston Society for Medical Improvement, Feb- 
ruary 10, 1896. 2 
in direct proportion to its work, exactly as is the case 
in muscular activity ; the resisting force of the lung 
tissue is also increased. On the contrary, inadequate 
and partial respiration, such as so many persons of 
sedentary habits and indoor occupations are accus- 
tomed to, throws into disuse more or less of the lung 
tissue and reduces to a minimum the respiratory func- 
tion. In consequence of this the nutrition becomes 
defective and the tissue weakened, becoming an invit- 
ing soil to disease and the bacillus. The deprivation of 
the pulmonary exercise furnished by the articulation 
of words is said to be the cause of the frequency of 
pulmonary tuberculosis among deaf mutes, and I can 
readily believe it. Among the inmates of the Con- 
sumptives Home almost all, with the exception of 
teamsters, were of indoor occupations, which meant 
as a rule, insufficient respiration.- 
“ There is no apparatus,” says Lagrange,2 “ where 
we can verify in a more striking manner the law that 
‘ action makes the organ ’ than in the respiratory; no 
organ is so rapidly modified as the lung in accommo- 
dating itself to the more active working which is de- 
manded of it.” We all know that it is the apices of 
the lungs which offer the least resistance to the inva- 
sion of the tubercle bacillus, because they are the por- 
tions of the organ which remain habitually inactive 
in the inadequate breathing of sedentary life. Time 
and again have I heard the click or rule at the apices 
of the lungs on full inspiration in examining candi- 
dates for the gymnasium, which indicated that this 
portion of the organ was ordinarily inactive, and 
never have I detected it when the person has been in 
the habit of taking deep inspirations. 
This question of proper respiration becomes one of 
2 Dr. Fernand Lagrange : La Medication par l’Exercice, Paris, 
1894. 3 
exceeding and especial importance to the person of 
sedentary habits and occupation, which is the condi- 
tion perforce of a large proportion of our city popu- 
lation. The little round of the city dweller’s life is 
one of limited movement and slight bodily activity. 
A short walk frequently comprises all the exercise he 
takes, aud even this is often “ more honored in the 
breacli than in the observance.” The modern eleva- 
tor, even, is often a curse in disguise, for walking up 
stairs, which Sir Andrew Clark was so fond of pre- 
scribing for his patients, is, I believe, an excellent 
form of exercise as well for the respiration as the 
heart. Indeed, when one reflects upon it he will be 
struck with the similarity of the life aud its results of 
the sedentary individual, who takes little or no exer- 
cise and eats and perhaps drinks too much and the 
stall-fed ox or the pate de foie goose ; in both cases 
over-feeding and inactivity are the causes which lead 
to fat deposition and infiltration of the organs with a 
continual surplus of the products of incomplete com- 
bustion. Now the lungs suffer from this abnormal 
life quite as much as the liver and other organs; the 
lung tissue is only partially aud inadequately brought 
into play, aud, consequently, poorly nourished. The 
supplementary respiratory muscles are rarely or never 
called upon to do their important part in the act of 
respiration, and, in consequence, they atrophy aud 
become incapable of action, like any other disused 
muscle of the body. As time goes on, the portion of 
the lungs which takes part in respiration becomes 
more and more reduced, aud a large number of pul- 
monary vesicles become inactive. Whenever such a 
person is called upon to undergo any unusual exer- 
tion, like ascending several flights of stairs, climbing 
a mountain or riding a bicycle, he finds his breathing 
embarrassed, he suffers from a “ thirst for air,” for 4 
the air cells in use cannot furnish the necessary oxy- 
gen. On the contrary, if he is in the habit of taking 
such exercise as calls into play the reserved pulmon- 
ary vesicles, then these cells are always ready to per- 
form their function whenever any unusual exertion is 
demanded. And further, even in a state of repose 
these so-called reserved cells take part in respiration ; 
one’s “ordinary” lung capacity is larger, as I have 
frequently proved by the spirometer; the respiration 
is slower and fuller, and finally, this fuller respiration, 
introducing a larger amount of oxygen, produces a 
better hematosis and increases the general activity of 
the organic functions. 
Now good breathing came naturally to man in his 
original state, for he was intended to be an active ani- 
mal— to run and climb, to bend aud twist his body, 
to stretch and extend his arms and, in brief, use all 
his muscles; and as long as he followed nature in this 
respect his lungs had full play and the respiratory 
muscles were maintained in a state of efficiency. So- 
called civilization, or at least city civilization, has so 
modified all this, that one’s life has resolved itself into 
a mental hunt for subsistence rather than an active 
bodily one. The natural life with its bodily activity 
has become an artificial one of more or less bodily 
immobility, and what nature unconsciously did to pro- 
mote and maintain proper respiration must now be 
done by conscious effort and artificial methods, like 
gymnastic and athletic exercises and training. True, 
a man could live in tolerable health in this inactive 
condition, only half filling his lungs, if he were al- 
ways sure of remaining in it, but he never knows 
when an emergency may arise which will require the 
respiration which well-trained lungs can only give, be 
it an unwonted exertion, an acute disease, or exposure 
to a tubercle bacillus when the nutrition happens to be 5 
poor or the system depressed. And further, the sense 
of physical well-being is much greater when the res- 
piratory tide is full and strong, as the experience of 
all of us will testify after some exercise which makes 
large demands upon the “ wind,” as bicycling, for in- 
stance. As the late, lamented Baron Posse8 has so 
well said, “ To breathe well means to live well, to 
live longer and to live better.” 
Having then determined the necessity of full, free 
respiration, what are the means to obtain it? First, 
there are the indirect ones, in the form of general ex- 
ercise, gymnastics, athletics, and all forms of muscu- 
lar exertion, provided it is energetic enough. Of 
course, the result is obtained by a greater demand for 
oxygen and a greater production of carbonic acid, 
which requires more energetic respiratory activity. 
Now these are applicable not only to those in ordi- 
nary health but as well to those who suffer from 
some pulmonary lesion but at the same time are capa- 
ble of a certain amount of muscular effort — bron- 
chitics, the emphysematous in the intervals of the 
acute attacks, convalescents from pneumonia and 
pleurisy, and the tuberculous when not febrile. 
The following case is an illustration of the benefi- 
cial effect of breathing exercises in pulmonary disease. 
Miss C., the head nurse of the Consumptives’ Home, 
contracted while in service a pleuritic effusion of the 
right chest, presumably tubercular. The fluid filled 
two-thirds or more of the cavity. Aspiration was 
performed several times; and as soon as the patient 
could sit up, breathing exercises were instituted. 
The absorption of the remaining fluid and the expan- 
sion of the lung was prompt, and the process, I be- 
lieve, was materially hastened by the persistent use 
of the respiratory exercises. 
s Baron Nils Posse, G. M.: Special Kinesiology of Educational 
Gymnastics, 1894. 6 
The general exercises which are good for increasing 
the respiratory power are very numerous, as we 
know. Walking, however, I do not consider a very 
valuable one. “ A person who only works and 
walks,” as a recent writer on bicycle exercise says, 
“ hardly ever fills his lungs.” There is swimming, 
tennis, rowing, bicycling, skating, golf, running, jump- 
ing, hand-ball, mountain climbing, going up stairs, the 
cure de terrains of Oertel, dancing, singing, reading 
aloud, free-hand classwork in the gymnasium, and 
rope-jumping. I was recently told by one conversant 
with the training of boxers that rope-jumping was a 
common form of exercise with them for increasing 
the “ wind.” All exercises which bring the legs into 
violent action are especially good for the respiration, 
on account of the number and size of the muscles em- 
ployed. Secondly, there are the direct or local res- 
piratory exercises, those especially devised for training 
and developing the respiratory muscles and lungs. 
Now these direct lung exercises are also applica- 
ble not only to the well but to those who, from pul- 
monary lesion or general bodily weakness, are unable 
to undergo the more active general exercises, for 
they increase the efficiency of respiration, without in- 
creasing the need of respiration, creating the “ thirst 
for air.” Of course, all exercise is interdicted to 
those suffering from acute inflammation, the febrile 
state or serious hemorrhage. 
These especial pulmonary exercises are simple and 
yet efficacious: Standing erect in a well-ventilated 
room, or wherever there is pure air, with the hands on 
the hips and taking long deep inspirations and slow 
expirations, beginning at the bottom of the chest and 
filling up, so to speak. This, alone, done several times 
a day will often materially increase the lung capacity, 
as I have frequently verified. “Numerous observa- 7 
tions,” says Lagrange,4 “ prove that it is enough, volun- 
tarily to take a certain number of deep breaths every 
day, to produce in a short time an increase in the cir- 
cumference of the chest, which may amount to two or 
three centimetres.” 
In these breathing exercises the rhythm can be 
varied according to the following schedule :8 
(1) Slow and long inspiration and expiration. 
(2) Inspiration and expiration long and quick. 
(3) Slow and long inspiration, and long and quick expiration. 
(4) Long and quick inspiration, and slow and long expiration. 
(5) Short inspiration and long expiration. 
(6) Long inspiration and short expiration. 
(7) Short inspiration and expiration. 
(8) Inspiration by two or three stages or jerks, and expiration 
long. 
(9) Inspiration long and expiration by stages or jerks. 
(10) Inspiration and expiration by stages or jerks. 
In all these exercises one should breathe through the nose only. 
Then there are the various arm movements with 
their modifications, in connection with the deep 
breathing, slowly raising the arms to a horizontal posi- 
tion and then over the head until the hands meet, 
slowly and deeply inspiring while performing the 
movements, and expiring while lowering the arms, 
thus the supplementary respiratory muscles of the 
chest and shoulders are brought into action. 
Raising the arms and then carrying them back and 
down, describing a movement of circumduction. 
Standing erect and straightening up and finally rising 
upon one’s toes, deeply inspiring during this move- 
ment. Extending the arms in a horizontal position 
and carrying one of the legs back so as to offer a 
large base of support to the body. Lying on the 
back horizontally upon the floor or a table and raising 
the arms backward and over the head while inspiring; 
4 La Medication par l’Exercice. 
6 De Boulfemont: Manual de Gymnastique Eclectique. if lying upon a narrow table, the arms can describe ai 
circle about the head. The exercises with wands or 
bar-bells, which demand rather more exertion perhaps 
than the free-hand movements. In the Swedish sys- 
tem of gymnastics there are almost an innumerable 
variety of respiratory exercises, most of which, how- 
ever, are but modifications and combinations of a few 
simple movements, and most of them can be per- 
formed without apparatus. Then there are the gym- 
nastic devices and apparatus for increasing the lung 
capacity and developing the respiratory muscles; the 
so-called “ chest-developers ” and “ lung-expanders ” ; 
the “ chest-weights ” and “quarter-circle”; the high 
parallel bars and travelling rings; and the heaving 
movements of the Swedish gymnastics, which are usu- 
ally exercises of hanging and climbing by means of 
rings, bars, ladders and poles. 
Renz»8 describes the following apparatus for 
prompting deep respiration, which he makes use of 
with beneficial results in his clinics as well as in his 
private practice. To two hooks in the wall are at- 
tached cords, and to these a cross-bar much like a 
flying trapeze ; the height of the bar is adjusted to 
the height of the patient. This cross-bar is seized 
by the patient with outstretched arms, who leans 
forward, forming a curve with his body; the two 
points of support being the hands ou the bar and the 
toes on the floor. In this position of the body the 
patient is forced to take deep inspirations whereby the 
thorax is much expanded. The standing position is 
then resumed, and the thoracic muscles relaxed, when 
a deep inspiration is practised. These two move- 
ments are performed alternately from twelve to twenty 
times a minute. 
6 Dr. E. De Renzi: Pathogenese, Symptomatology und Behand- 
lung der Lungenachwindsucht, 1894. 9 
If the patient is too sick or too feeble to take any 
of these various exercises, either free-hand or with 
apparatus, he can be given passive respiratory exer- 
cise, much after the manner of the Sylvester method 
for producing artificial respiration. Sitting upon a 
bench or stool and leaning upon the chest of an atten- 
dant standing behind him, the arms are raised above 
the head synchronously with inspiration. With the 
lowering of the arms and pressure against the sides 
forced expiration is produced. This can also he 
practised in the recumbent position. 
Although the movements of inspiration are the most 
important in the respiratory act, yet expiratory exer- 
cises have their place. These are generally passive, 
like the act itself. One which Lagrange especially 
notes is the following: The subject lies flat upon 
the abdomen on the floor or a bench and raises his 
head and shoulders, thus contracting the extensor 
muscles of the vertebral column. In this attitude the 
abdominal muscles are stretched and prevented from 
contracting and pulling down the chest walls. In this 
position forced expiration is practised. In emphy- 
sema especially, expiratory movements are useful; 
these can be simple direct pressure upon the chest 
walls, with various manipulations of the thoracic mus- 
cles, or a peculiar Swedish movement also noted by 
Lagrange ; it has for its object the mobilization of the 
semi-ankylosed chest wall, which is a condition exist- 
ing in chronic emphysema. The patient is seated 
astride a narrow bench or his legs are held and two at- 
tendants seizing him by the shoulders rotate the trunk 
upon its axis, alternately from right to left and left to 
right, the object being to mobilize the vertebro-costal 
articulations and to restore movement to the chest 
walls. 
Besides all these methods of respiratory exercise 10 
there are certain machines or apparatus devised by 
Zander and Nycander. Some excite deep inspiration 
by passive movements for raising the ribs, others 
render the expiration more complete by compressing 
the ribs through the use of girths or straps which com- 
press the thoracic walls at the moment when the lungs 
empty themselves of air. The latter machines are 
said to render great service in pulmonary emphy- 
sema, where the expiration is always laborious and 
incomplete. 
Finally, we have massage of the respiratory muscles, 
which the Swedish physicians always prescribe at the 
same time that active and passive gymnastic move- 
ments are given. As will be seen, the number of 
exercises available to produce better respiration are 
very numerous and varied, but the underlying princi- 
ple is simple, namely, to bring into more vigorous play 
the muscles which expand the thorax, and at the same 
time excite deep, full, free breathing; to bring the 
vital force of the lungs to its maximum. It must be 
borne in mind that ali exercises of the thoracic mus- 
cles for the purpose of producing an increase in that 
cavity must at the same time be coincident with deep 
breathing; the amplitude of the respiratory move- 
ments must be increased; the lungs must push out 
from within as well as the thoracic muscles pull from 
without. Once having established a proper respira- 
tion by the use of some of the simple respiratory exer- 
cises and devoting a few minutes to it every day the 
habit of full and deep breathing is formed even when 
one is in a state of repose. And further, one is forti- 
fying himself against the possibility of disease of the 
lungs by thus maintaining the pulmonary tissue in an 
active, healthy and well nourished condition ; and there 
is no portion of the apices which from insufficient use 
and poor nourishment is a menace to the individual by 11 
offering a fitting soil to a wandering bacillus. In con- 
valescence from pneumonia and pleurisy with effusion, 
the importance of expanding and revivifying, as soon 
as possible, the lung, whose functional capacity has 
been diminished and whose nutrition has been de- 
pressed, can hardly be overestimated. As Lagrange 
truly says: “ In all the inflammatory maladies of the 
lungs there persists a tendency to stasis and passive 
congestion, to correct and obviate which no means is 
more efficacious than very ample and deep inspira- 
tion.” 
When the border line has been passed and incipient 
phthisis has been developed, respiratory exercises are 
a most important and precious means for restoring the 
weakened lung tissue and increasing its resisting 
power. The beneficial effects of the high altitude 
treatment are largely due to the fact that one is com- 
pelled to breathe fully and deeply in order to obtain 
the requisite amount of oxygen. 
In every well-arranged plan of treatment of pul- 
monary tuberculosis, where any exercise at all is 
allowable, pulmonary gymnastics, carefully arranged 
and adapted to the strength and condition of the in- 
dividual, should, I believe, be embraced. In the fa- 
mous sanitariums abroad, where such excellent results 
are obtained, they play an important part in the treat- 
ment. We may in the future obtain a serum product 
which will accomplish all that was hoped for from 
tuberculin; but one must not forget that large num- 
bers of consumptives are now being cured and restored 
to usefulness by means of the persistent application of 
nature’s remedies, sunlight, abundant alimentation, 
continuous out-door life, hydrotherapy and good 
breathing. The vis medicatrix naturae may not 
always give brilliant and rapid results, but when intel- 
ligently employed it is a method which rarely disap- 12 
points either the confiding physician or trusting pa- 
tient. 
BIBLIOGRAPHY. 
Lagrange, Dr. Fernand. La Medication par l’Exercice. Paris, 
1894. 
Butler, Glentworth K. New York Medical Journal, October 20, 
1894; also reprint. 
Posse, Baron Nils. The Special Kinesiology of Educational 
Gymnastics. Boston: Lee & Shepard, 1894. 
Augerstein, E. and G. Eckler. Home Gymnastics for the Well 
and Sick, translated hy B. Schlesinger. Boston: Houghton, 
Mifflin & Co., 1894. 
Renzi, Dr. E. De. Pathogenese, Symptomatologie und Behand- 
lung der Lungenschwindsucht. 1894. 
Otis, E. O. “Gymnastic Exercise as a Prophylactic and Cura- 
tive Remedy in Chest Diseases.” 
Translations of the American Climatological Association, vol. 
viii, 1891. 
De Bouffemont, Henry de Jarry. Manual de Gymnastique Eclec- 
tique. Paris, 1871. Two Volumes yearly, beginning- with the first Nos. in January and July. But 
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