In another case reported by Dr. Straus,[19] a man sixty-five years of age, was extracted alive from a coal mine, in which he had been imprisoned for twenty-three days. During the first ten days he had a little dirty water, but for the last thirteen days nothing whatever. When taken out he was in a condition of great weakness and emaciation and died after three days, notwithstanding all efforts made to preserve his life.
Cases of prolonged abstinence often occur among the insane, who, under the influence of delusions, or in order to destroy their lives refuse all food. Dr. Willan relates the case of a young man, who, through delusions, refused all food but a little orange juice, and who lived for sixty days on this alone.
Of course such persons, if under the observation of a physician, could be fed forcibly, but through the ignorance of friends or relatives it not unfrequently happens that medical aid is not invoked in time, and serious symptoms, or even death itself, may result. The time at which this last termination ensues varies according to the kind of insanity with which the patient is affected. A general paralytic deprived of all food dies sooner than a healthy person. An insane person suffering from acute mania also resists inanition badly, but one the subject of melancholia often endures the total deprivation of aliment for a long time. Esquirol[20] cites the case of a melancholic who did not succumb till after eighteen days of complete abstinence, and Desbarreaux-Bernard another in which life was prolonged for sixty-one days, but in this case a little broth was taken once. Desportes[21] refers to the case of a woman subject to melancholia who continued to exist during two months of abstinence, during which she took nothing into the stomach but a little water.
It would be easy to go on and quote other instances occurring among prisoners, shipwrecked persons, those suffering from diseases which prevented food entering the stomach, others lost in deserts, forests, etc., in which life has been prolonged for considerable periods. Such cases are, however, quite exceptional. An interesting instance occurring under one of these heads may, however, be cited as an example.
M. Lépine[22] reports the case of a young girl nineteen years of age who swallowed a quantity of sulphuric acid. As a consequence a stricture of the œsophagus was produced. Three months after the act, liquids alone passed into the stomach; emaciation was extreme and the countenance pallid. Four months subsequently, that is, seven months after swallowing the acid, the obliteration of the œsophagus was complete, and nothing whatever could be swallowed. The patient lived for sixteen days after all food or drink was prevented reaching the stomach. During the last days of her starvation she complained only of thirst and not of hunger. The prostration was extreme and the temperature greatly lessened. A tendency to sleep was present, and there was a subdued delirium. On the last day of life there was more excitement; the conjunctivæ were red, the pulse thread-like, and the skin cold. It is not stated whether or not attempts were made to feed this patient by injections into the rectum of nutritious substances, or by the use of baths containing such matters in solution. It may, however, safely be taken for granted that efforts of these kinds were made, and if so, the unusually long period during which life was sustained is explained.
In all the cases in which life was extraordinarily prolonged there was either not a total deprivation of food and drink, or there was a state of muscular inaction present particularly favorable to retardation of the destructive changes in the body which abstinence produces. It may be asserted that in ordinary cases absolute deprivation of food and drink cannot be endured by a healthy adult longer than ten days, and death generally ensues before the end of the eighth day. It is said that women sustain abstinence better than men. Young persons and the aged certainly resist with less power than those of the middle period of life. Dante was aware of this fact when he made the children of Ugolino die before their father, the youngest first, the oldest last.
Even though there be a total deprivation of what may strictly be called food, some of the cases already cited show that if water be taken life is preserved for a much longer period than would otherwise be the case. Thus a negro woman, according to Dr. J. W. Francis,[23] believing herself to be bewitched, abstained from food for three weeks, but during this period took two small cups of water, to which a very little wine had been added.
In a case reported by Dr. McNaughton[24] a longer resistance was maintained.
"The subject of this case was a young man, aged twenty-seven, who for three years immediately preceding his death almost constantly kept his room, apparently engaged in meditation, a Bible his only companion. At the latter end of May, 1829, his appetite began to fail; he ate very little, and on the 2d of July he declined eating altogether. For the first six weeks of his fast he went regularly to the well, washed himself, and took a bowl full of water with him into the house. With this he occasionally washed his mouth and drank a little; the quantity taken during the twenty-four hours did not exceed a pint. On one occasion he went three days without taking water, but on the fourth morning he was observed to go to the well and drink copiously and greedily. For the first six weeks he walked out every day, and sometimes spent the greater part of the day in the woods. He retained his strength until a short time before his death. During the first three weeks he emaciated rapidly; afterwards he did not seem to waste so sensibly. Prof. Willoughby visited him a few days before he died. He found the skin very cold, the respiration feeble and slow, but otherwise natural; but the effluvia from the breath, and perhaps the skin, were extremely offensive. During the greater part of the latter week of his life the parents say there was a considerable discharge of foul reddish matter from the lungs. To this perhaps the offensive smell referred to may be chiefly attributed. The pulse was regular, but slow and feeble, and the arteries extremely contracted. The radial artery, for example, could be distinctly felt like a small, hard thread, communicating almost a wiry feel.
"The alvine evacuations were rare; it is believed that he passed several weeks without any, but the secretion of urine seemed more regular. He died after fasting fifty-three days. On dissection the stomach was found loose and flabby. The gall bladder was distended with a dark, muddy-looking bile. The mesentery, stomach and intestines were excessively thin and transparent. There was no fat in the omentum."