The exciting cause of apoplexy, either in the limited or broad sense, is very frequently a dietetic indiscretion. Overloading the stomach, distention of the stomach and intestine with gas from effervescent beverages or from fermentation, tend directly to increase intra-abdominal and intrathoracic tension and hence blood pressure. Either very hot or very cold ingesta may disturb the vascular tension and, whether the direct effect is to reduce or increase vascular tension, the oscillation may be the exciting cause of the formation of a thrombus, the dislodgement of a vegetation which becomes an embolus, or the rupture of a degenerated vessel. Coffee and tea and, more gradually, purin containing foods, act directly to raise arterial tension. Alcohol, while theoretically reducing arterial tension generally so as to lessen the amount of blood in the brain, may produce apoplexy either in the rebound or because of the antagonistic influence of a quickened heart beat or by a reflex rise from the psychic stimulation or from some effort to which the incipient intoxication leads.

The prophylaxis of apoplexy, from the dietetic standpoint is included in the general discussion of vascular and cardiac diseases. The patient should be warned, if necessary to his control, that there is scarcely any kind of dietetic error that may not lead to apoplexy, the "stroke " occurring with relative frequency at or shortly after a hearty meal.

Paralytic conditions in general, whether due to apoplexy or other condition, usually indicate a last for several days after their inception. The after treatment includes an easily assimilated, nutritious but rather low diet as for elderly persons unable to take much exercise. (See discussion of diet in the aged, in cardiovascular disease etc.)

The generally accepted indication for iodids may be fulfilled by iodothyrin, unless there is a concomitant exaltation of thyroid function when it is, at least, doubtful whether iodids should be given in any form.

The theoretic indication, often present, to raise blood pressure by hot drinks, caffeine-containing beverages, suprarenal extract etc., is relatively opposed by the danger of exciting fresh haemorrhage in paralysis due to this cause and adrenalin is probably especially contraindicated by its action in hastening vascular degeneration. However, it should be observed that the experiments establishing this action have imposed exaggerated conditions which may not be duplicated in the ordinary use of adrenalin. Due attention should be paid to possible complications in the heart, vessels, kidneys, liver, pancreas etc. The bowels and bladder may require dietetic management for the reasons mentioned under lesions of the spinal cord.

Chorea is often of rheumatic origin; indeed there is a tendency to regard rheumatism as the sole etiology of genuine chorea, as distinguished from other forms of tremor. At any rate, the diet should be as for rheumatism, with such modifications as the age of the patient, anaemia, the existence of pregnancy etc.may suggest.

Epilepsy is very frequently marked by indicanuria and other manifestations of alimentary sepsis and the frequency of the at-taikv can usually be much diminished solely by dietetic and other treatment directed toward the alimentary canal. Conversely, the treatment of epilepsey by bromids and borax etc., often depresses the digestive secretions, induces indigestion and consequent fermentation and putrefaction which are not only evils in and of themselves but which tend to precipitate epileptic seizures.

Aside from these considerations, epilepsy requires the avoidance of lea, coffee. alcoholics, decomposed or readily decomposable food, viscera rich in purins, and in fact of any food or drink which of itself, or in the process of digestion and catabolism, introduces any notable amount of any kind of toxic agent or which is capable of producing reflex disturbance by its bulk, temperature etc

It should be remembered that epileptiform convulsions may be due to delirium tremens, uraemia and various other forms of toxaemia It is held by many that epileptiform convulsions in children due to intestinal parasites, intestinal putrefaction etc., max lead to genuine epilepsy. Various forms of epileptiform con-vulsions may be indirectly due to dietetic errors and, on the other hand, somewhat amenable to dietetic treatment.

The routine dietetic management of the child, as previously discussed, thus has an important bearing on the development of epilepsy, chorea, hysteria etc.

Tetany, while often due to more or less frank disease or disturbance of the thyroid or the parathyroids. is in many instances, directly symptomatic of gastro-intestinnl irritation, notably in gastric dilatation in children. It is by no means impossible that-many cases diagnosed as cerebro-spinal meningitis, especially when recovery ensues, are of this nature.

Tetany has occasionally been observed to follow lavage instituted in the treatment of gastric dilatation and stagnation. While the introduction of the tube may be the exciting cause of the spasms and while the water used may facilitate the absorption of toxins beyond the reach of the tube, in the intestine, efficient treatment of the underlying cause is not to be abandoned.

Careful dietetic management of the underlying digestive disturbance, is both prophylactic and curative. If the indications are not too urgent, it is well to reduce the diet to water, bouillon and weak beverages for a few days and to clear out the bowels, before practicing lavage in cases in which tetany is to be anticipated.

Hysteria may, for therapeutic purposes, be divided into three groups: 1. those due to frank or disguised "cussedness"; 2. those due to grief, excessive fatigue, worry etc.; 3. toxaemic cases.

Cases of the first group may manifest various dietetic vagaries, including abstention from one, several or all foods, sometimes ascribed to religious influences. It is often exceedingly difficult to draw the line between genuine idiosyncrasy and hysteric aversions or alleged evil effects from food. While it is not worth while to try to dispel every false notion regarding food, any serious interference with nutrition or even the convenience of the family of the patient, should be met with moral suasion, more or less compulsory feeding or even gavage.