Thus, then, in eases of organic nervous disease, no special rules are required as to diet, for we do not know of any diet which materially modifies the progress of those diseases. Still, there are certain conditions which occur in such diseases capable of being modified by special diet. It may be well to say a few words about some of those. In the early stage of hemiplegia, for example, whether it is the result of haemorrhage, thrombosis, or embolism, the diet must be light, easy of digestion, and - especially if some difficulty of deglutition exists - capable of being easily swallowed. If unconsciousness be present, liquids are the only kind of food that can be administered. Occasionally swallowing is quite impossible, and then recourse must be had to rectal feeding. When this is necessary, there must be a good rectal wash-out at least once in twenty-four hours, and it is best to give small enemata of not more than half a pint every six hours. These should consist of peptonized milk or peptonized beef-tea, and an egg may also be given in the enema. One ounce of brandy should be added if conditions are present rendering stimulation necessary, as is frequently the case when thrombosis is the cause of hemiplegia, or when any condition of cardiac weakness is present. Such rectal feeding sometimes serves to bridge over the time of unconsciousness, but the outlook is always bad if the patient is unable to take some food by the mouth within thirty-six hours of the onset of paralysis. As soon as consciousness is recovered, milk should be given first, and during some days a dietary of milk, egg and beef-tea is all that can be permitted. Mastication is often difficult, and when the time comes to try solid food, it must be remembered that the food often tends to lodge on the paralysed side of the mouth, and to remain there for some time.
When unconsciousness is not present, there is no difficulty in feeding the patient, and the only point to remember is that, at first at least, the food should be light, for the most part liquid, and chiefly milk. If there be no rise of temperature, recourse may soon be had to bread and butter, fish and chicken. It is well to refrain from giving red meat for at least a week after the commencement of the illness.
With reference to myelitis, of whatever kind, whether transverse or limited to the grey matter - polio-myelitis - it need only be said that the diet to be adopted in the early stage is the light, easily-digested food suitable for any feverish condition.
Reference has already been made to tabes dorsalis. There is no diet which seems to modify the progress of the disease in its essential characters. It must always be remembered that in many cases there is a natural tendency to a condition in which the disease ceases to be progressive, a condition in which, apparently, the supply of the poison causing the degeneration seems to be exhausted. In such cases, abundant, easily-assimilated food, like milk, is of great advantage, and this is especially true of cases in which there is, as is frequently seen, a great tendency to wasting. Many tabetics, if left to themselves, become excessively thin; yet if this tendency be early recognized, much can be done by the use of milk, cream, and fat bacon, and any other fats which can be taken and digested, to prevent the wasting going on to the undoubtedly harmful degree which it may attain. And in reference to tabes, it is well to remember the tendency, in certain cases, to the occurrence of gastric crises. Although it cannot be said that careful attention to diet will altogether prevent such attacks, yet it is undoubtedly true that any indiscretion may bring on a severe attack of vomiting, so that such patients have to be warned against the use of pastry, of much starchy food, or of anything in the nature of greasy or highly spiced food. Their dietary should consist of toast, fish, chicken, well-cooked meat, and very little vegetable. A little stewed fruit is sometimes advisable, and alcohol should be completely avoided. Yet, in spite of the greatest care, a crisis may come on in such a case, and as a rule it is not cut short by anything except morphia. Sometimes repeated small doses by the mouth are quite effective, but in the severe attacks, the use of the drug hypodermically is necessary. And when the vomiting has ceased, great care must be used in the resumption of food. It is advisable to put the patient, for the first two days, on milk in small quantities frequently repeated. Six, or even as little as four, ounces every two or three hours is usually quite enough, and during the first week after a crisis, milk and milk food should still remain the sole constituent of the diet. Sometimes, in spite of great care, there is a return of the vomiting after a day or two, but this tendency to the recurrence of sickness is certainly favoured by any indiscretion in diet.
There is one organic nervous disease in which diet is of much importance, namely, alcoholic peripheral neuritis. Although patients suffering from this disorder, when they first come under observation, are fat and apparently well nourished, occasionally they are emaciated quite out of proportion to the degree of paralysis. And even the fat ones not infrequently, after a few weeks of rest in bed and abstinence from alcohol, become actually wasted. In some of these cases, whether they are thin in the early stages or in the later, pulmonary tuberculosis may be actually present. It has been suggested that such a condition is possibly predisposed to by an actual neuritis of the vagus branches to the lungs : but whether that be so or not, there is no doubt of the fact that pulmonary tuberculosis is a not uncommon complication of peripheral alcoholic neuritis. Such a fact gives, of course, a very clear hint as to feeding, only the misfortune is that so frequently in such cases the appetite is capricious and the stomach irritable, so that it is very difficult to administer such food as is necessary, in sufficient quantity. It is often desirable to put such a patient on milk diet, and to gradually combine with such milk-feeding, the administration of good beef-tea, of fish, and, later, of well-cooked chicken or game, until the stomach is gradually brought to a condition in which it can tolerate a generous diet. Often the progress to this consummation is exceedingly slow, and such patients frequently dislike milk. But it must be persisted in, and when vigorous massage of the affected limbs is at last tolerated, such treatment will, of course, favour the administration of larger quantities of food. It is of the essence of treatment in such cases to try to keep up the weight. Occasionally one is disappointed with the result in a patient who came under observation, apparently of good colour and well nourished, but it must be remembered that such a patient has actually been living on alcohol, and taking very little food, so that the wasting which takes place under the changed conditions is only what might be expected. Yet it is essential in such cases to try, by such dietetic regulations as have been indicated, to prevent such wasting, and so remove what is undoubtedly a danger, namely, the tendency to the development of pulmonary phthisis. When this is definitely present, then the treatment of the peripheral neuritis should be combined, if possible, with the appropriate treatment for this condition.