The administration of nourishment is influenced by various general symptomatic nervous conditions, such as spasm, paralysis, pain, especially affecting the parts concerned in mastication and deglutition, and by disturbances of special sense, especially of taste and smell, and otherwise when disgust is caused. In acute conditions of short duration, the exacerbation of spasm and pain, the danger of asphyxia in paralytic cases etc., may contraindicate feeding. In chronic conditions, nutrition must be maintained, if necessary by recourse to the feeding tube, rectal injection, local anaesthesia etc. (See discussion of mumps, tetanus, laryngeal ulceration etc.)

Various hallucinations and delusions may indirectly inter-fere with nutrition. For instance, a tumor pressing on the olfactory bulb so as to cause the hallucination of a disgusting odor, visual hallucinations of an analogous nature, delusions of unclean-ness, obsessions as that fasting is a religious duty, that the patient is under compulsion not to eat, delusions of persecution with fear of poisoning and various other false conceptions, may prevent the patient from taking needed food and drink.

Especially in melancholia, patients may obstinately refuse to eat and yet may submit to compulsion or may eat when fed by an attendant or may submit to or even voluntarily report for gavage.

Without any definite hallucinations or delusions or tendency to suicidal starvation, or apparent digestive disturbance, insane patients may fail to eat sufficiently on account of blunting of the senses of smell and taste, general lack of intelligence, or obtund-ing of the various reflexes upon which the cycle of individual muscular acts of ingestion depend.

Boulimia and coprophagia, both in the literal and extensive sense to include the eating and drinking of various disgusting substances are not infrequently noted in the insane. Boulimia may be due to a true though pathologic increase of appetite, to gastric dilatation, the sense of satiety being normally due to the stretching of the rugae of the stomach; or boulimia, like the reverse condition of hyporrhexia, may be due to lack of intelligence, the patient eating mechanically and not knowing enough to stop, or the patient may have in exaggerated form the prevalent lay notion that physical and mental strength may be increased by increasing the ingestion, especially of certain foods, thus boulimia may be a manifestation of delusions of grandeur.

Careful individual observation is necessary to insure that the insane patient takes a proper amount and variety of food and . drink and it must not be forgotten that the same care is required to guard against or to detect the presence of actual disturbances and diseases of the alimentary organs, including the teeth.

Even with such care, the average advanced age and lack of physical and mental exercise, will render the average diet of the insane below that of healthy adults so that criticism of the management on the ground of too rigid oeconomy at the expense of the welfare of the patients will occasionally occur.

(Note. It is impracticable to discuss in detail, the dietetics of every nervous condition according to a systematic symptomatic classification. The attendant should bear in mind both the symptomatic name of the condition and its underlying degenerative, inflammatory or specific pathologic basis and apply the appropriate dietetic principles. Only such nervous conditions will be considered by name as present special relations between disease and food, in the direction of cause and effect or disease and treatment. Certain analogies, not mentioned will be readily understood.)

Neuritis. Among the causes may be mentioned gout, whose relations to diet is discussed under the latter heading, various exogenic poisons, such as lead, arsenic and alcohol and possibly tea, coffee and tobacco when used to excess. These causes, being diffused, naturally tend to produce multiple rather than local neuritis and, according to some authorities, 70% of the cases of multiple neuritis are due to alcohol,.though the neglect of proper nutrition and exposure to cold are often operative rather than the alcohol itself.

In the treatment of neuritis may be mentioned the value of deep injections of physiologic salt solution, in amounts of about 100 c.c. as stimulating local metabolism and facilitating the removal of toxins and thus conforming to the broad conception of dietetics. The diet itself is important and should be along the following lines: avoidance of alcoholics, tea, coffee, tobacco etc.; avoidance of purins, oxalates etc.; liberal use of water and salts; administration of an abundant, bland, easily digested diet, not entirely lacking in meat but without viscera and consisting mainly of cereals, legumes, milk, cream, butter and eggs.

Beri beri, an infectious polyneuritis, has been discussed elsewhere. (Chapter XLI (Infectious And Parasitic Diseases. Infections Usually Occurring In Childhood).)

Neuralgia has been described as the cry of a starving nerve for food and it is supposed that there is a special call for phosphorus, both in the elemental form, as hypophosphites and phosphates, and in organic combination as lecithin.

While neuralgia is defined as a functional disturbance of the nerves, the term is undoubtedly often applied to a genuine neuritis, especially when the same nerve is chronically affected. In other cases, there is a distinct rheumatic or gouty condition, demanding appropriate diet.

Pacchytneningitis Haemorrhagica is especially common in drunkards. Other forms of meningitis are infectious, due to vascular lesions etc., and are to be treated according to the corresponding dietetic principles, usually as fevers in general, with special regard for paralysis, spasm etc., as already discussed.

Spinal Cord Diseases in general require the diet appropriate for fevers, degenerational diseases and those with enforced lack of exercise, jointly or respectively. Any food stuff likely to cause irritation of the urinary passages should be avoided and ordinary fruits and alkalies on the one hand, benzoic-acid containing fruits and vegetables on the other, should be used to prevent or counteract departures from the normal moderate urinary acidity, there being more often an indication for the latter, on account of the tendency to ammoniacal decomposition. (See discussion of urinary organs.)