Case of thoracic aneurism - death - autopsy : remarks on the treatment of internal aneurism / by Henry I. Bowditch, M.D.

  • Bowditch, Henry I. (Henry Ingersoll), 1808-1892.
Date:
[1866], [©1866]
Catalogue details

Licence: Public Domain Mark

Credit: Case of thoracic aneurism - death - autopsy : remarks on the treatment of internal aneurism / by Henry I. Bowditch, M.D. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

    9/18 (page 7)
    5th. A gentleman, ast. 30; a hunter and high liver; Octoberj 1855, Aneurism at the bifurcation of the aorta. In nine weekS; better; in six months, no pulsation remained. He then made over-exertion and needed venesection; again relief. Subsequently, other surgeons saw him and laughed at the idea of there being aneurism, and advised hunting, &c.; as before. In eighteen months the aneurism suddenly burst. 6th. Laborer, '9st. 30; in hospital, January, 1864 Abdominal aneurism. Pulse, 104 standing, 66 lying. Disease checked by treatment. Certainly these are very significant facts, even if there vrere many more in which there may have been less success. But let me now revert to the plan pursued, whereby these results were obtained. Dr. Tuffnell's treatment was, first, perfect rest in a recumbent position for two or three months, during which time the patient never raised himself, even to the semi-recumbent posture, but might turn carefully from side to side, and at times lie on his face to relieve his back. He was directed to have some one at hand to assist and to read to and talk with him. He was to be placed in a sunny room, and, if possible, where he could see somewhat of what was going on out of doors and be genA*ally amused. His bed was to be soft, and arranged properly for his stools, &c. Second, he was to have a restricted diet —viz., three meals per diem. For Breakfast, white bread and butter, | ij.; milk or cocoa, § ij. Supper, i ij.; or tea, § ij. -r,. C meat, broiled or boiled, § iii ; , i . Dmner, < , / i. j Z water or claret, | iv. ^ ( potatoes or bread, Snj-;* Total, i X. I viij. and no more (page 30, pamphlet). Under this course, Dr. Tuff- nell claims to have cured five out of six cases of aneurism of the aorta, and one of them large enough to project through the sternum. In reflecting upon the subject, the following suggestions naturally occur. Wherein consists the real difference between the plans fol- lowed by Valsalva and Dr. Tuffnell, save in the reasonable use of venesection by the latter ? Dr. Tuffnell says, the starvation plan spoken of by Valsalva, if employed with bleeding, would prevent the possibility of fibrine being renewed in the blood after it was re- moved by venesection. Yet he advises an equally starving plan when he orders such a diet as that given above. It is, in fact, the most annoying part of Dr. Tuffnell's principles of action. A few months since. Dr. H. J. Bigelow, of this city, was trying Dr. Tuff- nell's plan upon a patient at the hospital, and the patient eloped. Dr. T. expressly states that it would not be submitted to by one of his own patients, and he does not tell us how many others were unwilling to submit to it, although he intimates that there were some others.