The dietetic treatment of cases of cerebral haemorrhage, thrombosis, or embolism must be regarded from two points of view: - (a) The immediate - the comatose stage, and after; (b) the remote - after partial or complete recovery.

The Comatose Stage, And After

Apoplexy occurs most commonly in well-nourished, full-blooded individuals, and for the first day or two there is no necessity for giving the patient any food. The intestine must be thoroughly cleared out by enema or otherwise, as this improves the state of the circulation. If consciousness does not return within thirty-six hours or so, the question of the necessity of administering food per rectum will have to be considered (see Rectal Feeding). As soon as consciousness is restored, feeding by the mouth should be commenced. This should for some days be restricted to milk only, or milk thickened with eggs, or cereals. Not more than 2 pints should be given in the twenty-four hours, and it should be given cold or lukewarm. As the patient improves the diet may be increased, but it should be kept as light, as easily digestible, and as non-stimulating as possible. For the same reason, all alcoholic drinks should as a rule be avoided. As these patients have usually a high blood-pressure, it is advisable to control the amount of liquid consumed, and care is necessary in regard to this.

After Recovery

The practitioner has now to consider and to direct his treatment to the cause of the apoplexy. Most frequently it is dependent on arterial sclerosis, chronic Blight's disease, often associated with high blood-pressure, and these conditions are in some measure amenable to dietetic treatment In effect, therefore, the dietetic treatment is that of chronic Bright's disease, the main essentials in treatment being: -

(a) All meat foods to be taken in very sparing amount, the diet to be largely lacto-vegetarian in character (see p. 520).

(b) The liquids to be restricted in amount, and more especially the liquids taken with meals; alcohol to be avoided.

(c) The diet to be light, and easily digested; all rich foods and stimulating foods to be avoided (see Light Diet, P. 548).

(d) The total amount of food to be taken to be proportionate to the age of the patient and to his condition otherwise.