The dietetic treatment of aneurism has undergone many changes, and a good deal of difference of opinion exists as to whether the diet should be particularly modified or not. We think that the starvation regime, so strongly recommended by Tufnell, is certainly unsuitable in many cases, and in some we believe it to be distinctly harmful. At the same time, there is no doubt in our mind that, in very many cases, a certain amount of restriction in food and drink is most beneficial. We must not condemn such measures as wholly useless because they are not absolutely curative. In such a progressive, and almost invariably fatal, disease as thoracic aneurism it is well if we find any method of treatment which arrests progress for a time and relieves the patient of some of his pain and symptoms. The rigid Tufnell diet consisted of : Morning meal: 2 oz. of bread and butter with 2 oz. of milk or cocoa. Midday meal: 3-4 oz. of meat with 2-3 oz. of potato or bread and 3-4 oz. of water. Evening meal: 2 oz. of bread and butter with 2 oz. of milk or tea. Poor, half-starved, anaemic and debilitated patients, or those broken down in health by syphilis (and most are syphilitic), or again, patients with bad heart disease and failing compensation in addition to their aneurism, especially aortic cases, do badly under such starvation measures, and should not be subjected to any such regime. But even in such debilitated cases, and certainly in others better nourished, and still more so in plethoric cases, certain modifications and careful selection in both the quality and quantity of the food and drink taken will be found beneficial. In some weakly individuals it will be found that a wholly milk and farinaceous diet is best at first; and this in spite of the somewhat increased amount of fluid taken. Soon, as their powers of assimilation increase, a drier and more strongly nitrogenous diet may be substituted, but it must be understood that a diet rich in animal food is not recommended, because it is more stimulating to the heart, whilst our object is to obtain as quiet a circulation as possible. It must be remembered that just as we inculcate complete rest of body in such cases, so we must be careful not to put any unnecessary work upon the digestive organs, and, therefore, it is essential that all food should be carefully selected as to digestibility and given at such intervals as to allow a proper rest between meals.

Alcohol is not to be allowed in such cases, unless it be evident that digestion fails without the habitual stimulant. In such cases it must be our aim gradually to diminish the amount taken until the patient can do without it altogether. As anginal symptoms are so frequent in cases of aneurism, the reader is referred to what is said under that heading for further points in the dietetic treatment of aneurisms.