Starvation may occur from the actual withholding of food or from the administration of unsuitable food.

Acute starvation results from sudden and complete stoppage of food.

Chronic starvation results from a gradual deficient supply of food.

 

Fatal Period :

If both water and food are completely withdrawn death occurs in 10 to 12 days

If food alone is withdrawn death occurs in 6 to 8 weeks or even more.

Newborns may survive for 7 to 10 days without food or water.

Death usually occurs when about 70 to 90% of body fat and 20% of body protein are lost.

 

FACTORS INFLUENCING THE FATAL PERIOD :

(1) Age: The very young and the old suffer the worst.

(2) Sex: Females withstand starvation for a longer period.

(3) Condition of the body: Fatty, healthy people stand starvation better.

(4) Temperature: Exposure to cold or excessive heat hastens death.

(5) Physical exertion: Active physical exertion hastens death.

 

Cardinal features of Starvation

Emaciation

Absence of fat from the body

Distended gallbladder

Extremely translucent intestinal canal. The walls of the intestine appear like tissue paper with atrophy of mucosa.

 

Differential Diagnosis of Starvation

• Malignant disease,
• Progressive muscular atrophy,
• Addison's disease,
• Diabetes mellitus,
• Tuberculosis,
• Pernicious anemia,
• Chronic diarrhea

 

Causes of Chronic starvation

• Famine,
• Being trapped in pits, mines, or landslides,
• Neglect on the part of the parents or guardians.
• Wilful withholding of food
• Wilful refusal to take food.

 

Causes of acute starvation

• Natural calamities like flood, cyclone, earthquake
• Accidental starvation inside mine, desert, landslide
• Hunger strike
• Homicidal starvation of unwanted infants, debilitated person
• Diseases

 

Cause of Death in Chronic Starvation :

Death occurs from exhaustion,

Circulatory failure due to brown atrophy of the heart, or intercurrent infection.

Dehydration and hypothermia contribute to death.

 

Symptoms of Acute Starvation:

In acute starvation, there is a feeling of hunger for the first 30 to 48 hours, which is followed by pain in the epigastrium which is relieved by pressure.

After four to five days of starvation. general emaciation and absorption of the subcutaneous fat begin to occur.

The eyes are sunken, pupils are dilated; the cheeks sink and the bony prominences become visible.

Bichat's buccal pad of fat is among the last subcutaneous adipose tissue to disappear.

The lips are dry and cracked, and the tongue coated and dirty

The skin is dry, rough, thin, inelastic, wrinkled, and pigmented.

Emaciation may be extreme. The loss of weight is most marked and constant.

Muscular weakness

Constipation is usual, but towards death diarrhea and dysentery are common.

The urine is scanty, turbid, and highly concentrated and shows evidence of acidosis.

The ribs are prominent, with concavities in the intercostal spaces and sunken supraclavicular fossa.

Death usually occurs when 40% of the original weight is reached.

 

As starvation continues, at the first rapid mobilization of protein stores occurs which are converted by the liver to glucose, which is mainly used to supply energy to the brain. After that, the main means of energy production is lipolysis. Adipose tissue releases free fatty acids. In the liver, they are the substrate for the synthesis of ketone bodies, which are used as fuels for skeletal and heart muscle and brain. As complete depletion of fat stores approaches, protein is again rapidly used as a source of energy.

 

Symptoms of CHRONIC STARVATION:

(1) Loss of well-being, hunger, and hunger-pains.

(2) Mental and physical lethargy and easy fatigue.

(3) Progressive loss of weight which is rapid in the first six months.

(4) Polyuria.

(5) Increasing cachexia, the body weight is reduced by about 40% of the normal.

Pigmentation and anemia.

(6) Hypothermia, peripheral vascular. stasis in cold and hypotension.

(7) Extreme lethargy, gross mental retardation, and loss of self-respect.

(8) Edema, first in the feet and lower Limbs.

(9) Reduced resistance to infection causing diarrhea, dysentery, tuberculosis, etc.

 

 

Postmortem Appearances

External finding

 

The body is emaciated. Bones & joint prominent

Muscle wasted

The hair is dry, lusterless, and brittle, and nails are also brittle.

The face is pale, the skin inelastic and pigmented.

Body weight - marked loss

Rigor mortis sets in and disappears early.

Subcutaneous patches of edema are seen around the ankles and inside the thighs.

Internal Finding

The stomach and intestines show atrophy of all coats and the mucosa is stained with bile. The walls of the intestine appear like tissue paper with atrophy of mucosa. There may be superficial but extensive non-specific ulceration of the bowel like those seen in ulcerative colitis.

The liver is atrophied and may show necrosis due to protein deficiency. Distended gallbladder with bile

The spleen is shrunken.

Fat is almost completely absent in the subcutaneous tissues and also in the omentum, mesentery, and about the internal organs, which is never seen in wasting disease.

The kidneys show atrophy of the nephron.

Blood volume is markedly reduced, and there is marked anemia.

The urinary bladder is empty. There may be evidence of some intercurrent disease.

 

Medicolegal Aspects of Starvation

 

1. Suicidal

Persons fast voluntarily, for the purpose of exhibition.

Lunatics(mentally ill) and hysterical women (uncontrolled emotions) may refuse food.

To attract public attention

Hunger-strike for injustice

 

2. Homicidal

The victim is usually an infant, or any other person, e.g., aged or feeble-minded are starved with evil intention.

Illegitimate children are frequently starved to death. Children starved by their parents or guardians is known as "Baby-farmer".

Illegitimate child - born of parents not lawfully married to each other

 

3. Accidental

Famine,

Being trapped in pits or mines, landslides, shipwrecks,

Stricture or cancer of the esophagus or ankylosis of jaw.

 In drug addicts, where the desire for the drug is more than the desire for food.

Psychiatric causes, usually of a paranoid schizophrenic nature or due to senile dementia,

 

 

Difference between Starvation & Cholera

	Starvation	Cholera
Stool	Watery stool	Rice-water stool, a watery stool with flecks of mucous
Stomach	Small & contracted. Mucous member is bile stained.	Not so
Gall bladder	Distended, contains dark inspissated bile	Normal
Heart	Small, due to brown atrophy	Normal
Skeleton	Demineralized	Normal
Amount of body fat	Marked deprivation of body fat	No deprivation
Loss of body weight	Marked loss (> 40% of body weight)	Not so
Micro examination	No causative organism is found	Vibrio cholerae found

 

Living skeleton:

40% loss of body weight is likely to cause death in most cases. Yet it was noticed that death during the 2nd world war in the concentration camp in Holland, the bodyweight of some victims due to chronic starvation were reduced to more than 15% of the original weight then the victim was termed as a living skeleton.