Tufnell's treatment of aneurism is a modification of the methods adopted by Albertini and Valsalva, who treated their patients by bleeding, rest and modified diet. Bellingham omitted the bleeding and devised the method of treatment in 1852, and it was continued by Tufnell, who published a monograph on it in 1875. The objects are the reduction of the force and frequency of the heart's action, and to favour the deposition of fibrin on the wall of the aneurismal sac. The coagulability of the blood is not increased. The treatment is only suitable for cases of saccular aneurism, unassociated with disease of the aortic valve, and for patients who are sufficiently intelligent to understand the importance of carrying it out strictly, and have sufficient strength of will to put up with its discomforts.
Valsalva kept his patients in bed for forty days, on a limited diet, and bled them frequently. Tufnell recommended 8-12 weeks recumbency. Bellingham's diet is much the same as Tufnell's.
Milk or tea, 2 oz. Bread, 2 oz.
Liquid, 2-4 oz. Bread, 1-2 oz. Meat, 1-2 oz.
Liquid, 2 oz. Solid, 2 oz.
Tufnell. Milk or cocoa, 2 oz. Bread and butter, 2 oz. Water or light claret, 4 oz. Bread or potato, 3 oz. Boiled or broiled meat, 3 oz. Milk or tea, 2 oz. Bread and butter, 2 oz.
Tufnell's diet contains 8 ounces of fluid and 10 of solids. These amounts need not be strictly adhered to. Thus, a suitable diet for a nine stone man would be meat 3-4 oz., bread 2 oz., potato 1/2 oz., butter 1/2 oz. A heavier patient might have double the quantity of all the different articles mentioned, except the meat. Occasionally the treatment results in complete cure. The patient should rest on a water bed and remain absolutely still, doing nothing whatever for himself, a restriction which few people have the strength of will to adhere to. The mouth may become so dry and parched that even the limited amount of solids cannot be taken. Sucking a pebble or button will relieve the thirst a little. Another great trial to the patient is painful micturition, because of the extreme acidity of the urine. It can be reduced by alkalies. Constipation must be relieved by oil enemata, if necessary. There is so little waste matter in the food that an action of the bowels once a week is sufficient. The heart and aneurism must be carefully watched. If the pulse becomes more and more frequent, the patient restless, and the dryness of the mouth so great that he is unable to take food, the treatment must be modified. It has largely fallen into disuse because good results are so infrequent. Hospital patients are particularly unsuited. The aneurism is usually dependent on atheroma from strain or syphilis, is frequently associated with aortic disease, and self-control, especially in the matter of drink, is lacking. Judging by the results of hospital treatment the diet is almost useless, and for this reason most physicians condemn it. The principle may be adopted to a less severe extent. Much benefit is derived from limitation of the fluids to about one pint and of food to half, or less than half of the usual allowance.