THE RESPIRATORY BRACE: 
A NEW APPLIANCE DEVISED FOR THE RELIEF OF 
ORTHOPNCEA. 
GEORGE F. FRENCH, M. D.? 
PORTLAND, ME. 
[Reprinted from The Boston Medical and Surgical Journal, May 3, 1877.] 
CAMBRIDGE : 
sctnte& at tftc oifcnr£i&e 
1877. THE RESPIRATORY BRACE : A NEW APPLIANCE DE- 
VISED FOR THE RELIEF OF ORTHOPNCEA.1 
GEORGE F. FRENCH, M. D., PORTLAND, MB. 
Difficulty of breathing so extreme as to require the erect posture, 
or orthopnoea, is a feature of various diseases, but all alike send the 
same dispatch to the nerve centres for more oxygen to aerate the blood. 
In some diseases, as in hysteria, the wires themselves are deranged, 
and the impression conveyed to the brain is exaggerated and fallacious; 
nevertheless the dispatch is believed at headquarters, and all the vital 
power of the heart and lungs, reinforced largely by the voluntary 
muscular system, is at once ordered to the rescue. 
Difficulty of breathing is made worse by the recumbent posture, on 
account of the pressure of the abdominal viscera, which gravitate against 
and interfere with the respiratory movements of the diaphragm. The 
erect posture, then, is most favorable for perfect respiration, but I be- 
lieve it will be conclusively proved by this paper that the recumbent 
position is not essential to the complete refreshment of the body. In 
health the advantage which would be gained in favor of respiration by 
the upright position is more than counterbalanced by the muscular power 
wasted in counteracting gravitation ; but if an appliance could be de- 
vised which would maintain the body erect without the slightest muscu- 
lar exertion, sleep would be as refreshing as in the usual recumbent 
position. The upright position long maintained is very wearisome and 
exhausting. The persistent holding of the body in any fixed position 
implies a proportionate expenditure of muscular power, and all active 
exertion superadded to this, such as we observe in every form of diffi- 
cult breathing, is as much more exhausting as it is laborious and painful; 
and when we consider that orthopnoea is often so extreme as to preclude 
sleep or nourishment, we can hardly estimate the depression of vitality 
which must ensue. The respiratory muscles languish, the heart propels 
the blood feebly, the nutrition of the body is in the same degree slack- 
ened, and the disease which has given rise to the orthopnoea, finding 
less resistance, tightens its grip at the throat of Nature. To one who 
has observed the effect of prolonged orthopnoea in cases of asthma this 
is no fancy picture. One of the most prominent features of every such 
1 Read before the Cumberland County Medical Society, February 28, 1877. 2 
The Respiratory Brace. 
case is exhaustion, and I believe I might add muscular exhaustion. 
The symptoms of non-aeration of the blood in asthma, as shown by the 
cyanotic countenance, do not manifest themselves till the muscles of 
respiration and circulation are exhausted ; and the ill effects of severe 
attacks of asthma, such as the dilatation of the right side of the heart, 
the oedema of the extremities, and the debility that results from such a 
paralysis of all the vital forces is traceable largely to muscular exhaust- 
ion. Next in importance, then, to the removal of the cause of any 
disease is the support of those forces which most effectually resist the 
disease, a universal maxim in therapeutics. In the orthopnoea of asthma 
the greatest outlay of strength is in muscular exertion ; the sufferer is 
conscious of this, and in every possible way economizes muscular move- 
ment. No avoidable word, look, or motion escapes him; that position 
is chosen which will carry on forced respiration with the least effort; 
the head is never moved when a turn of the eyeballs will answer, and 
the elbows are planted on the knees or table to secure an advantage in 
elevating the shoulders. Every means of abridging muscular effort in 
orthopnoea tends inevitably, then, to aerate the blood, to promote nu- 
trition and sustain life. A most terrible source of exhaustion in orthop- 
noea is the loss of sleep ; when the need of it becomes imperative, the 
sufferer nods first toward one side, then toward the other, which results 
in a waste of muscular effort to regain his equilibrium, this harass- 
ing process being kept up for hours, to the utter exhaustion of the pa- 
tient. If at such a time refreshing sleep could be secured, Nature 
might recruit her forces sufficiently to repel the attack or abridge its 
duration. The want of some means to diminish this waste of muscular 
strength and to afford sleep has long been a desideratum in the orthop- 
noea of asthma ; any appliance to accomplish this must hold the patient 
not only in an upright posture, but in an attitude most favorable to 
forced respiration, which is one with the shoulders elevated, the arms 
raised from the sides, and the head kept from falling. The character- 
istic attitude of one suffering extremely from asthma will furnish us a 
model : the shoulders are raised high and kept elevated, in order to 
avoid the tiresome repetition of the act; the arms are withdrawn from 
the sides of the chest to permit the free lateral expansion of the tho- 
rax ; and the head is thrown back that the air-passage may not be con- 
stricted. 
The appliance here exhibited is so simple as hardly to need any de- 
scription. It consists of a cross-bar, from the extremities of which hang 
two loops of strong elastic webbing for the support of the shoulders. 
The broad band encircling the head is steadied by guys stretching 
across on both sides to the upright elastic supports. The apparatus is 
suspended by a pulley or ring from the ceiling. The Respiratory Brace. 
3 
Figure 11 represents a patient resting with the brace applied under 
the shoulders. Whenever from the weight or helplessness of the pa- 
tient, or from the tedious duration of the case, the circulation in the 
aims is impeded, the support should be afforded by the elbows, as in 
(Figure 1.) 
(Figure 2.) 
Figure 2, in which the entire pressure comes upon the outside of the 
fore-arm. Usually, however, the degree of pressure under the arms 
requisite to sustain a person who is sitting is insufficient to interfere with 
the circulation. 
The merits of this appliance do not hang on theoretical consider- 
ations alone ; in a modified form, less complete than the present, I have 
used it in a variety of cases for more than a year. It invariably affords 
relief, and is incapable of doing harm. It is invaluable in many chronic 
diseases not attended with dyspnoea, affording a patient who is hardly 
strong enough to be got out of bed an opportunity to rest in an upright 
position without exertion, and gives the nurse every facility for rubbing 
the back or dressing a bedsore. Its value is manifest in those diseases 
in which it is desirable to counteract the ill effects of hypostatic hyper- 
cemia by friction and change of posture. Its adaptability to the treat- 
ment of spinal disease is obvious ; at the present time I have a little 
patient resting in it who is unable to wear the ordinary spinal brace. 
It would be an inestimable comfort as an attachment to the field am- 
bulance or any vehicle used for the conveyance of the sick or wounded. 
But its most signal value is in the orthopnoea of asthma ; in this disease, 
1 Eussell and Kichardson, Designers and Engravers, 194 Washington Street, near State 
Street, Boston. 4 
The Respiratory Brace. 
where emphysema and dilatation of the right side of the heart have 
supervened, the paroxysms are not susceptible of sudden interruption, 
but run a definite course, the severity and duration of which can be con- 
trolled by suitable remedies. But those remedies which most effectually 
subdue the asthmatic spasm at the same time induce sleep, and to put a 
patient to sleep who can breathe only in the upright position is obviously 
a hazardous procedure. Persistent orthopnoea always contra-indicates 
the free use of narcotics, because the somnolent state is unfavorable to 
efficient respiration. To enable an asthmatic, then, to sleep with per- 
fect comfort in an upright position not only recruits the sufferer’s 
strength, but 'permits the administration of curative remedies otherwise 
dangerous. 
This apparatus for orthopnoea renders sleep easy, safe, and compat- 
ible with the most efficient respiration. It saves and turns against the 
disease the muscular strength usually wasted. Bly affording the system 
the refreshment of sleep the vital current does not ebb, but assimilation 
and nutrition go on unchecked; the state of the general health being 
kept unimpaired, the disease is not reinforced by the usual ill effects 
which it produces in the shape of non-aerated, impoverished blood, in- 
anition, and nervous debility. The vital force thus saved always averts 
a hard struggle, and gives to nature a speedier victory. 
In conclusion, I will cite but a single case in illustration. Mr. D., 
aged forty-five, physically well endowed, has been an intense sufferer from 
asthma for more than twenty years. Up to within two years the at- 
tacks have been steadily increasing in frequency and severity. Usually 
as the system grows weaker the inroads of disease become more ter- 
rible. The less the resistance the more heavily falls the blow. An 
attack of asthma which a weak man would sink under a strong man 
may endure without exhaustion. Such has been the history of this case. 
When I first saw Mr. D. he was breathing very laboriously, even in a 
sitting posture ; the face was livid and slightly oedematous, and the feet 
and ankles were considerably swollen. He had the usual expression 
and attitude of one in a severe paroxysm of asthma. The intensity of 
the orthopnoea permitted him to take neither food nor sleep ; he had 
been thus spellbound nearly a week, and during the whole period had 
been unable to He down. Drowsy from exhaustion and a state border- 
ing on asphyxia, he would lurch backward and forward, and from side to 
side, as limp as a drunken man. One would hardly dare give a narcotic 
to a patient in such a condition ; indeed, it was not needed, for no sooner 
was the “ orthopnoea apparatus ” applied than he was sound asleep, and 
sleeping in an attitude favorable to efficient respiration. In about two 
hours he awoke, seemed much easier, and took some nourishment, when 
he again fell into a comfortable sleep, from which he did not awake till we 
roused him to take food a second time. His recovery from that paroxysm The Respiratory Brace. 
5 
was particularly satisfactory, and yet not so much so as in subsequent at- 
tacks, when we have been able to afford the relief earlier, and also to ad- 
minister suitable antispasmodic and hypnotic remedies which were no 
longer contra-indicated by the orthopnoea. Paroxysms which formerly 
lasted ten days or even a fortnight have been superseded by very much 
milder ones of three or four days’ duration, during which time the pa- 
tient has been able to sleep and take food. For the past seven months 
the attacks have not been attended with much exhaustion, and there has 
been no oedema as formerly. The . paroxysms are not only milder, but 
are becoming more and more infrequent, and the state of the general 
health is unexceptionally good.