Starvation

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

Types:

1. Acute, results from sudden stoppage of food

2. Chronic results from gradual deficient supply of food.

Causes

Famine,

Trapped in pits, mines,

Neglect on part of parents,

Wilful withholding of food,

wilful refusal to take food

Symptoms:In Acute Starving• First 30 to 48 hr Pain in epigastrium• After 4 – 5 days general emaciation and absorption of subcutaneous

fat.

In Chronic Starvation • Loss of well being, hunger and hunger pains• Mental and physical lethargy and easy fatigue• Progressive loss of weight• Increasing cachexia • Hypothermia• Extreme lethargy, mental retardation• Edema• Reduced resistance to infections causing diarrhea, dysentery,

tuberculosis• Blood sugar, Proteins, chlorides, cholesterol are lowered

Fatal Period:• If both water and food are completely withdrawn death occurs in 10 to 12 days• If food alone is withdrawn death occurs in 6 to 8 weeks• Death usually occurs when about 70 to 90% of body fat and 20% of

body proteins are lostFactors in influencing the fatal period• Age – very young and old suffer the worst• Sex – females withstand starvation for longer period• Condition of body – Fatty and healthy stand starvation better• Temperature – Exposure to Cold or excessive Heat hastens death• Physical exertion – active physical exertion hastens death

Cause of Death:• Exhaustion• Circulatory failure due to brown atrophy of heart• Intercurrent infection• Dehydration and hypothermia contributes to death

Post Mortem Appearances:External examination:• In children, skeleton shows spinal curvature, rickets and

dental defects• Face is pale, the skin inelastic and pigmented• Edema around ankles and inside the thighs, in wet type

there is marked edema, ascites and pleural effusion• Eyes are sunken, cheek bones appear prominent • Hair is dry, lusterless and brittle• Tongue is dry and thickly coated • Nails are brittle and ridged• Limbs are almost skeletal • Ribs are prominent.• Abdomen is scaphoid • Fat of female breast and orbit spared till late

Internal Examination• Loss of adipose tissue from omentum, mesentry and perirenal fat

stores• There is atrophy of organs(except brain) with reduction in size, shows

changes similar to premature senility• Heart is small from brown atrophy • Lungs are pale and collapsed• Stomach and intestine shows atrophy of all coats and mucosa is

stained with bile• Bowel contain offensive watery fluiud and gas• Liver is atrophied show necrosis due to protein deficiency • Spleen is shrunken• Gall bladder is distended with bile• Kidneys shows atrophy of nephrons• Blood volume is markedly reduced• There may be some evidence of some incurrent disease

Brown Atrophy of Heart

Medico legal importance:1. Starvation may be the manifestation of self neglect 2. Diseases causing loss of weight(e.g., Malignancy,

progressive muscular atrophy, Addison's disease, Diabetes mellitus, Tuberculosis) should be excluded

3. Starvation may be homicidal, victim is usually infant, or aged

4. Baby-farmer is a condition in which children is starved by their parents and guardians

5. Starvation may be accidental if person is caught/entombment in mines, earthquake, or landslides

6. Signs of neglect and emaciation may be seen in drug addicts, where the desire for drug is more than desire for food

7. Starvation may be suicidal, persons fast voluntarily for the purpose of exhibition, public attention

8. Right to life as guaranteed under article 21 of Indian constitution does not include right to die, and as such arrest and forcible feeding of persons going on hunger strike is lawful( sec 309 IPC – attempt to commit suicide)

9. The world medical Association declaration on hunger strikers (1991) states that the ultimate decision on intervention or non-intervention should be left with the individual doctor

10.Psychiatric cause ( Paranoid schizophrenia, Senile dementia, hysteria) these persons may refuse to eat or spend money on food, clothes.