Text-book of forensic medicine and toxicology

by R. J. M. Buchanan

Symptoms.—These depend on the previous state of nutrition. Starvation may be regarded as acute when death occurs within fourteen days from the withdrawal of food, chronic when at a longer period.

The symptoms of hunger vary: they are said to pass off in forty-eight hours, but may last for several days acutely.

The body temperature falls below normal, and the fall may be two or three degrees before death. The pulse gradually increases in frequency day by day. The chief sign is loss of body weight. Chossat‘s experiments on pigeons showed that when they were totally deprived of food, the surplus fat of the body was lost first, then the fatty coverings of internal organs, the interstitial fat of muscles last of all; the muscles themselves also wasted. A peculiar odour like acetone emanates from those who have been starved, and towards and after death the odour is putrescent.

In addition to the above signs, there are anæmia, sunken, glistening eyes with dilated pupils, prominence of bony projections, pale and dry lips and tongue, parched mouth and throat, weakness of the voice, sunken abdomen, wasted limbs, constipated bowels, urine scanty and turbid. There are pains in the abdomen, relieved by pressure; great thirst, a dusky, dry skin, occasionally purpuric eruptions, exhaustion, ultimately delirium ending in death.

Post-mortem Appearances.—There is emaciation of the whole body, dry, wrinkled skin of a brown colour; the muscles are flabby and wasted, the abdomen sunken, the eyes red and open; this appearance is not common in death from other causes. The mouth and throat are dry even to aridity. The heart, lungs, and blood-vessels are collapsed, and contain but little blood. The abdominal viscera are shrunken and without enveloping fat. The omentum is devoid of fat, and clear; the gall bladder is full of dark bile; the urinary bladder may be quite empty. The stomach and intestines are collapsed, contracted, and empty, and the walls extremely thinned.

Diagnosis.—The absence of any other cause of death—such as cancer of the stomach, stricture of the œsophagus, &c.—and the previous history of the case will assist in forming an opinion, care being taken not to confound the results of wasting disease with those due to starvation.

Legal Relations.—The question of death from starvation may be raised in a case of infanticide by omission. Although rare as an act of homicide, it must be remembered that the law does not require the absolute deprivation of food to be proved, but only that the necessary quantity and quality of food has been withheld; but malice at the same time must be proved. In cases of infanticide by starvation, the mother and not the father is responsible for the proper feeding of the child; but in the case of an apprentice, the master and not his wife is bound to supply proper food to such apprentice.

In questions of survivorship, and in criminal cases, the medical witness may be asked how long a person may survive after complete withdrawal of food. Little is known as to the length of time required to cause death by starvation, but it is certain that life may be prolonged for some time without food, if water be allowed. Starvation is less rapid in its effects if the body be kept warm. In a case recorded in the Lancet, a man who had been shut up in a coal-mine for twenty-three days, with only a little dirty water to drink, lived three days after his liberation, and then died of exhaustion. In adults the average is from seven to ten days without water. Tidy (Legal Medicine, vol. i. p. 392) is of the opinion that the young die first, then adults, and the aged last. Taking into account the enfeebled vitality of the aged, it is more probable that the young or middle-aged adult would survive the longest. Where water is freely obtainable, life may be prolonged to the fifty-eighth day (Foderé, vol. ii. p. 276) or even more.

Apart from age, account must be taken of the condition of the person in reference to bodily health prior to the withdrawal of food.

The following tables, showing the average weight and height of children up to twelve years of age, are from the Report of the British Anthropometric Committee (1883):