Owing to the frequency of lack of control of the bowels, the diet should l)e regulated so as to prevent excessive decomposition by micro-organisms within the alimentary canal and so as to avoid diarrhoea or constipation. There should be one formed but not scybalous passage a day unless there is, on the one hand, an indication for a derivative effect through the bowels or, on the other, some special objection (for instance a fracture of a vertebra) to moving the patient except as absolutely unavoidable. In the former case, an abundance of water, fresh fruits and salines should be used, in the latter, the diet should be relatively dry and as free as possible from indigestible residue, for example eggs, peptonized milk, fine cereals, artificial milk foods etc.

Great caution should be observed in using excessive quantities of fats or sugars, or cellulose, including seeds, chaff and other dense vegetable tissues as in the fruits and coarse vegetables. It is far better to employ purpetrol, cascara and other laxative drugs.

Glosso-Labio-Lingual Paralysis involves motor function almost entirely. While the muscles of mastication, ordinarily so considered, are not involved, unless as a complication, the adjustment of the food between the teeth is interfered with by the paralysis of the buccal and lingual muscles so that mastication is imperfectly performed. The loss of saliva by drooling diminishes the preliminary digestion of starch - although this function is not ordinarily of much importance - as well as the reflex stimulation of gastric secretion. Deglutition is difficult and there is constant danger of inspiration pneumonia or even asphyxia from the entrance of food and drink into the respiratory passages. Thus, careful cutting, mashing and scraping of food, assistance in feeding and even the use of gavage may be required.

Cerebral Hyperaemia or Ischaemia may be determined by various circulatory disturbances, organic and functional and it is not always easy to distinguish these extremes by the symptoms. For well known histologic reasons, the arterioles of the brain are less amenable to regulation of calibre than those of the body generally so that factors which produce constriction of arterioles generally produce cerebral hyperaemia and vice versa.

Caffeine, theobromine and xanthin and its congeners, derived respectively, from tea and coffee, chocolate and purin-containing foods, have a general tendency to produce cerebral hyperaemia, stimulation of function and wakefulness.

On the coutrary, it has been pretty definitely proved by measurement of the time of response to sensory stimuli, ergograph tests etc., that alcohol never genuinely stimulates the brain, in spite of the fact that the person who lias imbibed thinks that he can act more quickly and think more brilliantly. However, there is reason to believe that, in spite of the dilated condition of the surface vessels, the compensatory quickening of the heart really produces a form of cerebral hyperaemia, so that small doses of alcohol may cause sleeplessness. It must also be remembered that, for mental and physical activity not requiring great accuracy or effort, the subjective feeling of stimulation, removal of inhibitory dread and inertia, does enable the individual to perform tasks that would be impossible without it.

What has been said of alcohol applies, to a less degree, to tobacco.

In emergencies in which wakefulness and mental activity are necessary, coffee is the remedy par excellence, closely followed by tea and chocolate, beef tea, and strychnine. Hot drinks, without reference to their active agents, by promoting the rapid absorption of liquid, fill the blood vessels and hence cause some degree of cerebral hyperaemia. It is scarcely necessary to caution against the unnecessary use of such stimulants nor to point out the need of securing compensatory rest as soon as possible. Their habitual use is disastrous though a considerable degree of tolerance is acquired.

A patient suffering with insomnia due to cerebral hyperaemia should take no stimulating beverage of any kind during the latter part of the day and the evening meal, especially, should be light and easily digested, even large quantities of water being deleterious on account of their tendency to produce vascular fullness. On the other hand, a light meal, as of bread and milk, egg on toast, or a few crackers with weak cocoa, may, by determining the blood to the stomach and, ultimately, the intestine, relieve the cerebral hyperaemia and induce sleep.

Cerebral ischaemia, with tendency toward syncope and hebetude is usually noted in severe grades of anaemia, in heart disease and in wasting diseases generally. The diet should be regulated accordingly.

Alternations of hyperaemia and ischaemia are especially likely to occur in functional vascular diseases and organic valvular heart lesions. Perhaps the most serious illustration is that of aortic regurgitation. With the head erect, the brain is, in the main anaemic and the patient often complains of drowsiness. But, in the recumbent posture, there is rather a cerebral hyperaemia and wakefulness ensues. While such patients require careful dietetic management along the lines mentioned, it can not succeed in overcoming the effect of the water-hammer pulse.

Apoplexy, either in the sense of arrest of circulation by thrombosis, embolism etc., or in the more common sense of cerebral haemorrhage, depends upon the general causes of cardio-vascular disease, among which diet has been mentioned as playing an important and, to a considerable degree an avoidable part.

After the rupture of a cerebral vessel, there is a general indication to secure a derivation of blood to the alimentary canal by catharsis, croton oil being preferred on account of its rapid and irritating action. While, to a certain degree, food fulfills this indication, it also tends to fill the vessels and stimulate the cardiac action so that a fast, with as little liquid as possible, should be instituted for two or three days.