Such cases are met among young children neglected or abused by parents or those in whose care they may have been placed, or among the alienated or sick in the care of cruel or unsympathetic attendants.
Infants placed with “wet-nurses” or found in the so-called “baby farms” also furnish cases which fall under this head.
A careful examination into the collateral circumstances of the case, together with the results of a careful post-mortem examination, usually render a positive answer to this question possible.
POST-MORTEM EXAMINATION.
The dead body exhibits appearances quite characteristic.
Emaciation is very marked and sometimes reaches an extraordinary degree, surpassing that of prolonged and wasting diseases.
In extreme cases the fat entirely disappears throughout the body; the omentum and mesentery are entirely devoid of it, as well as the subcutaneous and intermuscular cellular tissue. The muscles are atrophied and the heart is sometimes considerably reduced in size; the liver and kidneys in some cases show great reduction of volume. The spleen also is small and often softened.
The stomach and intestines usually display an extensive thinning of their walls, so much so that their contents may be distinguished through them; their calibre also is frequently found to be diminished, though occasionally they may be distended with gas. Usually they are empty, or contain only a small quantity of bile and fecal matter. In some cases various foreign substances which have been swallowed by the victims to appease hunger have been found in them.
The thinning of the walls, so constantly noted, has been considered as a specially characteristic symptom of starvation.[965]