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Pleurisy is an inflammation of the pleura, a
serous membrane which envelopes the lungs and also lines
the inside of the chest. It may be acute or chronic, and
milk or severe. The disease may be limited to one side of
the chest or it may include both the sides.
Like any other viral infection, pleurisy can occur in
small epidemics. The disease is quite common in young
children,but it is generally secondary to pneumonia and
usually follows the wrong treatment of the latter.
The membrane that cover the lung is called pleura. The
outer membrane, known as ‘ parietal pleura’
, covers the inner wall of the chest wall and the inner
membrane, known as the ‘visceral pleura’,
covers the substance of the lungs. There is a capillary
space between the two membranes, which is filled with
fluid and enables the lungs to move freely in the chest.
The parietal membrane is reflected from the chest wall to
cover the upper surface ofthe diaphragm, and in the
midline, it covers the mediastinum, the partition which
seperates the two sides of the chest and contains the
heart, great vessels and other structures which run
through the thorax.Symptoms
The onset of
pleurisy is sudden. It is generally marked by a sharp and
stabbing pain, which may be felt in any parh of the chest
wall or cover the diaphragm. Deep breathing or coughing
increases the pain. In many cases, the disease begins
with a chill, followed by congestion of the pleura and
later by fever. The degree of the fever determines the
severity of the disease.
The inflammation of pleura chokes the circulation within
the tissues. Breathing becomes difficult due to the
clogging of air circulation, and by pain and swelling
within the chest. Later an abnormal amount of fluid
collects between the two layers of pleura. It is called pleural
effusion. After absorption of pleural effusion or
after a drainage of the effusion, the pressure is
lowered, the pain is reduced , and the child feels
relieved. The child is sometimes affected by dry
pleurisy, a form where there is little or no effusion.
Thirdly the effusion may be circumscribed and mix with
blood, or be of a dirty brown colour with an offensive
odour, leading to much suffering.
Causes
The most common
among the immediate causes of pleurisy is that of ‘
common cold.’, followed by congestion and swelling
of the pleural membrane. Germs of putrefaction can be
located later in the ooze of serum from the tissue. The
disease may be a complication of pneumonia. In a few
cases, the disease may also occur in rheumatic fever,
uraemia and other conditions.
Treatment
The child-patient
should be kept in bed until the temperature becomes
normal and remains so for several days. At the first sign
of the disease, hot fomentations should be applied to the
chest directly over the painful area twice or thrice
daily. These should be thick and large, and must be
applied under the arm from sternum to spine while the
patient lies on the opposite side. The procedure for
these applications has been explained in the Appendix.
They should be continued till the pain is relieved. The
movement of Strapping the chest with tight muslin should
restrict lungs bandage or adhesive plaster. Ice bags
should never be applied to the chest in pleurisy. Radiant
heat may be applied to the chest after convalescence to
absorb exudate. Prolonged neutral immersion bath at night
three times a week will also be beneficial. The procedure
for taking this bath has been explained in the Appendix.
The child-patient should be given only liquid diet till
the acute symptoms are over. Orange juice mixed with warm
water will be especially beneficial. Minimum two or three
glasses of water should be given daily for the first few
days. The quantity of water should be gradually increased
to four or five more glasses each day. It would be
helpful if the child-patient is persuaded to take
hot-water enema daily during this period.
After the acute symptoms have subsided, the child-patient
should be put on an exclusive fresh fruit diet for
further two or three days. In this regime, he should take
fresh juicy fruits such as orange, apple, pineapple, and
papaya. Thereafter, he may be allowed to embark upon a
well-balanced diet according to his age. The emphasis
should be on whole-grain cereals, fresh fruits and
lightly-cooked vegetables.
Certain home remedies have been found beneficial in the
treatment of pleurisy. The use of celery
(Ajwain-ka-patta) is one such remedy. It is known to have
antispasmodic properties. The seeds of this plant are
also useful in treating this infection.
The use of the herb hog weed (punarnava) is beneficial in
the treatment of pleurisy. It helps remove catarrhal
matter and phelgm from the bronchial tubes. The powder of
the root can be taken in small quantities three times a
day.
Linseed (alsi) is also valuable in this disease. A loose
poultice of the seeds can be applied with excellent
results. The counter- irritant effect of the poultice can
be enhanced by dusting mustard powder over it.
As soon as the patient has gained slightly in strength,
he should undertake moderate exercise as a routine,
avoiding fatigue. Air bath, sun bath and dry friction
bath are of particular importance. If there is any
particular disease present along with pleurisy,whether as
a causative or as a complicating condition, the same
should also be given appropriate attention.
Chronic pleurisy should be treated in the same manner
with regards to diet and the application of the heat. All
efforts should be made to increase the vitality, reduce
toxaemia and restore normal freedom of chest movements.
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