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.
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.
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.
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.