Pleurisy
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 seperates the two
sides of the chest and contains the heart, great vessels and other structures
which run through the thorax.
S ymptoms
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 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
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 colour with an
offensive odour, 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 , uraemia 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 1/2 hour 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 litres 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 toaxemia, 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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