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 mild or severe, the disease may be limited to one side of the chest or it may include both the sides.
This disease can attack people of all ages, from children right through to the very elderly. Like any other viral infection, pleurisy can occur in small epidemics.
The membranes that cover the lung are called pleura. The outer membrane, known as partial pleura, is applied to the inner wall of the thorax, 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. This fluid enables the lung s to move freely in the chest.
The parietal membrane is reflected from the chest wall to cover the upper surface of the diaphragm, and in the midline, it covers the mediastinum, the partition which separates 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 generally marked by a sharp and stabbing pain, which may be felt in any part of the chest wall or over the diaphragm. Deep breathing or coughing increases the pain. In many cases, the diseases begin 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 destroys the tissues and chokes the circulation within the tissues. Breathing becomes difficult due to the clogging of the circulation, and by pain and swelling within the chest. Later a liquid effusion escapes from the pleura, filling the open spaces in the chest cavity till the effect of the distension becomes oppressive. After absorption takes place or after the drainage of the effusion, the pressure is lowered, the pain is reduced and the patient feels relieved. It is sometimes dry pleurisy, a form where there is little or no effusion or the effusion may be circumscribed. The effusion may become gangrenous, or become mixed with blood, or be of a dirty brown color with an offensive odor, leading to much suffering.
Causes
The most common among the immediate causes of pleurisy is that of ‘catching cold ‘followed by congestion and swelling of the pleural membrane. It is a disease that is not caused by germs. There will be germs of putrefaction later in the ooze of serum from the tissue. The disease may be a complication of pneumonia, or pneumonia may be a complication of pleurisy. In a few cases, the diseases may also occur in rheumatic fever, uremia and other conditions.
Treatment
At the first sign of pleurisy, the patient should observe a complete fast, abstaining from all liquid and solid foods. Nothing should be taken except plain water, hot or cold, as desired. Water may have bad taste, but at least three or four glasses should be taken daily for the first few days. The quantity of water should be gradually increased to five or six or more glasses each day. It would be helpful if during this period of fasting, a full hot enema is also taken once daily.
A hot chest pack should be applied two or three times a day allowing it to remain for an hour or so each time. If the fever becomes high, the packs may be changed to cold ones. If, however, the reaction is not prompt and complete, it would be advisable to use the hot packs. Heat is always helpful for relieving the sharp pain associated with pleurisy. This should be applied for half an hour twice daily. The patient should practice deep breathing during this period. Adequate rest and abundance of fresh air are essential.
In cases of dry pleurisy, further relief from pain can be obtained by strapping the chest. Heat is not used when the tapping is employed. A neutral immersion bath at 100 F for one hour daily has also been found beneficial in the treatment of pleurisy.
After the acute symptoms have subsided, the patient may adopt a milk diet. In this regimen, he should take 250 ml. of milk every two hours on the first day, every 1 ½ hours on the second day, every hour on the third day and every three-quarters of an hour on the fourth day and onwards.
The quantity of milk should not exceed four liters daily. The patient may also take one orange daily along with the milk diet.
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 the 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 as to the diet and the application of heat.
All efforts should be made to increase the vitality, reduce toxemia, and restore normal freedom of chest movements. Several short fasts, at regular intervals, followed by milk diet may be necessary depending on the progress for complete recovery.
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