The several forms of cerebral haemorrhage may interfere with nutrition in a variety of ways. If coma is present, voluntary deglutition being suspended, great care must be exercised in feeding the patient. Liquid food is best given in teaspoonful doses, and the effect of each spoonful must be carefully watched to see that it is successfully swallowed before another is given, otherwise fatal choking may result from food passing over an insensitive epiglottis and larynx, when particles of food may be drawn into the lungs and excite local disease. Concentrated meat extracts, beef peptonoids, and peptonised milk may be given in this manner.

In extreme cases, when rigidity of the jaw interferes with feeding, or when paralysis involves the mechanism of deglutition, a long, slender catheter may be introduced through the nose and passed into the stomach, through which fluid nourishment is poured, after the manner of feeding patients suffering from melancholia. (See Melancholia, p. 621).

The rectum may also be utilized for nutrient enemata (p. 414). In unilateral facial paralysis without unconsciousness patients may be willing and able to swallow, but mastication is difficult or impossible. The food constantly gets into the buccal cavity behind the teeth of the paralysed side, and the tongue, perhaps also partially paralysed, dislodges it with great difficulty. The retention of food is accompanied by a copious secretion of saliva, which, dribbling from the depressed angle of the mouth, adds greatly to the discomfiture of the patient. All nourishment should therefore be given in fluid form, or in such finely divided state that it does not require mastication, and can be readily washed down with water. Milk, thick broths, purees thickened with macerated vegetables, long-boiled rice, sago, or barley with cream, custards, soft-cooked eggs, etc., may be given. The patient should be fed very slowly to prevent the food from running out of the mouth. The mouth should be frequently cleansed with listerine or a saturated aqueous solution of boric acid. In cases of hemiplegia without facial paralysis the patient can masticate and swallow, but the mental condition or loss of appetite makes the use of food which can be swallowed with the least possible effort desirable.

Convalescent hemiplegic cases which run a very protracted course naturally suffer from lack of exercise, and almost invariably become constipated. It is well in such instances to recommend simple and non-nitrogenous diet, containing laxative food, cooked fruit, and coarse cereals, to regulate the bowels. It is important to reduce arterial tension, to prevent, if possible, a repetition of the intracranial haemorrhage. Large draughts of fluid rapidly absorbed tend by adding to the volume of the blood, to temporarily increase the intravascular pressure. The blood vessels, however, show a very remarkable ability to maintain an average pressure of the fluid within them, and the possible danger from this source of an exclusive fluid diet may be averted by increasing the functional activity of the kidneys by diuretics and reducing the arterial tension by the remedies in common use, such as chloral, nitroglycerin, and the nitrites. When the tension is very high, it is well to give a non-stimulating diet without much meat, and milk should form the basis of it.

Alcoholic stimulants should be forbidden.