In aneurism of the larger arteries the vessel wall is dilated and thinned, and rupture is liable to occur at any time from increase of the blood pressure or obstruction to the circulation produced by sudden movement, or otherwise. The most favourable result of treatment which can be anticipated is thickening of the diseased vessel by the deposit of coagulated fibrin from the blood. The coagulability of the blood varies with its composition, and is favoured by increased density of the blood and by structural changes in its albuminous ingredients. To a limited extent this process can be aided by diet. The feeding of patients with gelatine has been recommended, on the ground that gelatine increases the firmness of clotted blood, but it is so altered in the process of digestion and absorption as to be of no practical value for aneurism.

The real object to be attained in the dietetic treatment of aneurism is to reduce the volume, and consequently increase the density of the blood. The latter does not necessarily increase its coagulability, however. This method of treatment was originally formulated by Bellingham and Joliffe Tufnell, of Dublin, and it is now described by the latter's name. It is only less rigid than the very old method of Valsalva, who gave half a pound of pudding morning and evening, and nothing else - practical starvation! In conjunction with the dietetic treatment absolute rest of the patient is enjoined; he should lie horizontally in his bed, and not be permitted to make exertion of any kind, and mental strain and emotion should be carefully guarded against. He should be fed by a nurse, and not allowed to sit up at any time. By rest alone the rate of the heart beat is materially slowed, and this is favoured also by the reduced diet. The artery, in consequence, is distended less and less often and is submitted to less pressure.

The exact treatment recommended by Tufnell is as follows:

Tufnell's Diet

Breakfast

Two ounces of bread with a little butter and two ounces of milk.

Dinner

From two to three ounces of meat without salt and four ounces of milk; for a portion of the milk an ounce or two of claret may be substituted.

Supper

The same as the breakfast.

This extremely rigid diet is apt to be rebelled against by most patients, but it serves as a basis for the commencement of other treatment, and if it be found impracticable to adhere to it, the quantity of food will have to be slightly increased. It may be necessary to double the quantity of milk and increase the amount of bread or vary it with crackers or some light form of starchy diet. The fluid, however, is in all cases to be restricted as much as possible. Patients usually complain bitterly of thirst, and while it is more desirable to restrict the fluids than the solids in the dietary, the thirst may be alleviated somewhat by the use of acidulated drinks, such as sour lemonade, dilute phosphoric acid in cinnamon water, etc. The danger which menaces the patient and the object of his treatment should be clearly explained to him and his co-operation secured in the effort for his relief. It is customary to employ iodide of potassium and morphine in moderation for their sedative action upon the circulation and the system generally. Many cases are of syphilitic origin, and they are particularly benefited by the potassium iodide.

Upon this reduced diet improvement in physical signs of the aneurism - such as diminished pulsation and intensity of bruit and lessened pain - is occasionally quite decided. In favourable cases improvement may be looked for at the end of a week, and if the dietetic treatment is persisted in for six weeks, the benefit may be considerable. Tufnell himself reports several cases in which the aneurismal sac became lined with a thick coating of fibrin.

There are many cases of aneurism outside the province of surgical treatment which are incapable of relief from any diet, but the method above described is decidedly worth a trial in an otherwise hopeless condition. I have several times known it to produce considerable lessening of pain, dyspnoea, and other symptoms, but it requires firmness and perseverance to carry it out successfully. The curative results have, unfortunately, not verified Tufnell's original claims, and as pointed out by Loomis, if the method is too rigidly and too long enforced - for six or eight weeks - an extreme degree of anaemia may develop and leave the patient worse off than before. If the Tufnell diet is not prescribed, non-stimulating food only should be allowed, consisting chiefly of simply cooked fresh vegetables and fruits, with but little meat. Anything likely to produce flatulency or gastric dyspepsia should be carefully avoided, and strong alcohol must be forbidden.