Starvation may occur from the actual withholding of food or from the administration of unsuitable food. It is of two types: (1) Acute, and (2) Chronic.
Acute starvation results from sudden and complete stoppage of food.
Chronic starvation results from gradual deficient supply of food. Starvation deaths may be due to (1) famine, (2) being trapped in pits, mines or landslides, (3) neglect on the part of the parents or guardians, (4) willful withholding of food, and (5) willful refusal to take food.
Cause of Death: Death occurs from exhaustion, circulatory failure due to brown atrophy of the heart, or intercurrent infection.
Fatal Period: If both water and food are completely withdrawn death occurs in 10 to 12 days. If food alone is withdraw death occurs in 6 to 8 weeks or even more.
Factors Influencing the Fatal Period:
Post-mortem Appearances: All organs and tissues show changes similar to premature senility. There is extreme emaciation and general reduction in size and weight of all the organs except the brain, which is sometimes pale and soft. Muscles are atrophied and darker due to increase in lipochrome. The fibres lose striations and become more uniform from granular degeneration. 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 fat of the female breast and of the orbit is spared till late. Subepicardial fat becomes replaced by a watery gelatinous material. In acute starvation, subcutaneous body fat is not lost completely. In children, the skeleton shows spinal curvature, rickets and dental defects. In adults progressive demineralization and osteomalacia are seen. Stress fractures may occur. The face is pale, the skin inelastic and pigmented. The face is pale, the skin inelastic and pigmented. Sometimes follicular hyperkeratosis develops. Subcutaneous patches of edema are seen around the ankles, inside the thighs, under the chin, cheeks and eyelids. Ascites is present in ten percent of cases. Trophic skin changes are common, the hair is dry, lusterless and brittle, and nails are also brittle. The heart is small from brown atrophy and the chambers are empty. The lungs are pale and collapsed, and exude very little blood when cut. Rarely there may be edema and hypostatic basal congestion. The stomach and intestines show atrophy of all coats and the mucosa is stained with bile. The walls of intestine appear like tissue paper with atrophy of mucosa. The bowel contains offensive watery fluid and gas. There may be superficial but extensive non-specific ulceration of the bowel like those seen in ulceration colitis. The liver is atrophied and may show necrosis due to protein deficiency. Spleen is shrunken. The gall bladder is distended with bile. 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.
Medico-legal Aspects: the exclusion of disease likely to cause loss of weight, e.g., malignant disease, progressive muscular atrophy, Addison’s disease, diabetes mellitus, tuberculosis, pernicious anemia, chronic diarrhea, is essential. Sometimes, it may be impossible to determine whether it was the cause or effect of malnutrition, .e.g., tuberculosis. If marked loss of weight and especially the absence of fat are found at autopsy, and there is no evidence of disease, a diagnosis, od death due to starvation can be made.
Suicide: Sometimes, persons fast voluntarily, for the purpose of exhibition. Lunatics and hysterical women may refuse food. Fasting may be undertaken by person to attract public attention, e.g., fast unto death, for rectification of grievances.
Homicide: 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.
Accident: Accidental starvation may occur during famine, being trapped in pits or mines. Landslides, shipwreck, etc. It may be due to ignorance which leads to a failure to provide enough food or to provide food of the right kind. It may also occur in stricture or cancer of the esophagus or ankylosis of jaw. Signs of neglect and emaciation may be seen in drug addicts, were the desire for the drug is more than the desire for food.
Either due to psychiatric causes, usually of a paranoid schizophrenic nature or due to senile dementia, some persons, usually old, refuse to spend money on food, clothes, etc.