Starvation

Dr. prakash Panjiyar

Dept. of forensic Medicine
&
Toxicology
NAIHS
 Definition

• Starvation is defined medically in two parts

that is: The act or process of starving and the
condition of being starved, while ‘Neglect’ is
defined as – to fail to give due care, attention,
or time to someone an adult/ a child
especially.
 Types
A. Acute : sudden and complete stoppage of
food.

B. Chronic: gradual, prolonged and continuous

deficiency.
 Causes
1. Famine
2. Being trapped in mines, pits and landslide
3. Neglect on the part of the parents or
guardian.
4. Willful withholding of food & willful refusal
to take food.
 Signs & Symptoms
A. 30 to 48 hrs. feeling for hunger and hunger pain.
B. Followed by pain epigastrium which is relieved
by pressure.
C. 4-5 days general emaciation and loss of
subcutaneous fat.
D. Absorption of subcutaneous fat.
E. Progressive loss of weight.
F. Skin : dry, lusterless, loose, rough, thin inelastic
G. Face: eyes- sunken, glistening, pupils dilated,
lips dry and cracked, cheeks bones-prominent.
H. Tongue: dry, furred, coated and thirst is intolerable.
I. Saliva: thick and scanty.
J. Voice: weak and whispering
K. Abdomen: concave, prominent ribs, and hip bones
L. Bowel: constipated initially & at late stage diarrhea
and dysentery is common.
M. Renal: oliguria, urine- turbid, increased
concentration and specific gravity, with evidence of
acidosis is seen.
N. Temperature: subnormal.
O. Cardiovascular system: pulse slow, hypotension, &
on exertion- paroxysmal tachycardia.
P. Limbs: thin, flaccid with loss of muscular
power
Q. Intellect remains clear and in some cases
delusion & hallucinations of sight and
hearing may be present.
R. Before death body has offensive odour.
S. Death occurs when 40% of original weight of
the body is reached.
 Fatal period

• 10-12 days: total withholding of food & drink.

• 6-8 weeks or more if food alone is withhold.
• 7-10 days in neonates.
• Life is threatened when more than 40% of the
original body weight has been lost, though the
speed of loss also matters. 80-90% body fat
should be lost along with 20-25%body weight
should be lost for death to occur.
 Mechanism of death in starvation
• Starvation –- depilation of energy occurs-- at first
rapid mobilisation of protein occurs- converted by
liver into glucose to supply energy to brain and
nervous tissue– then lipolysis occurs in second
phase- synthesis of ketone bodies are done– which
are used by skeletal, heart muscles and CNS
including Brain as source of energy– as the fat
stores get depleted then again breakdown of
protein occurs, causing metabolic disturbance and
death.
 Chronic Starvation
• The changes are as follows:
I. Loss of well being, hunger and hunger pains.
II. Mental and physical lethargy with easy fatigue.
III. Progressive loss of weight in 6 month.
IV. Polyuria, Hypothermia, hypotension, oedema
cachexia & pigmentation of skin present.
V. Reduced resistance to infection causing,
diarrhea, dysentery, tuberculosis.
 Fatality

• 40% loss of body weight.

• 70-90% loss of body fat.
• 20% loss of protein.
 Factors Influencing Fatal Period
1. Age: Extreme of ages suffers most.
2. Sex: Females withstand starvation for a
longer period.
3. Condition of the body: Fatty healthy body
withstand starvation better.
4. Temperature : Excessive cold or heat hastens
the death due to starvation.
5. Physical exertion: active physical exertion
hastens death.
 Cause of death
1. Circulatory failure
2. Exhaustion
3. Infection
4. Dehydration
5. Hypothermia
 Postmortem Appearances
A. General Appearances:
I. Face – pale, skin inelastic and pigmented.
II. Hair- dry lusterless brittle and nails are brittle.
III. Depressed fontanelles.
IV. Pressure sores are present on the dependent
parts of the body.
V. Early appearance and disappearance of rigor
mortis.
VI. Putrefaction sets in at once and progresses very
rapidly.
 B. Internal Findings
I. Muscles are atrophied and darker due to
lipochrome.
II. Loss of fat in subcutaneous tissues, Omentum,
mesentery and internal organs.
III. Stomach contracted, atrophy of all coats,
mucosa stained with bile.
IV. Intestinal mucosal atrophy, ulceration present.
V. Pseudo-dysentry– bowel contains offensive
watery fluid and gas.
vi. Others Organs: pale, atrophied, degenerative
changes, necrosis seen.
vii. Gall bladder: Distended with bile
viii.Spleen shrunken.
ix. Blood: volume reduced, anemia.
x. Edema, peritoneal effusions
xi. Brain: soft, pale.
 Medico-Legal Aspects
• Dx. – history, postmortem findings
• Exclusion of diseases that causes loss of weight.
• Starvation & neglect.
• Right to life and forced feeding- according to
Constitution of Nepal, does not include the right
to die, and as such arrest and forcible feeding of
persons going on hunger strike is lawful.
Loss of weight and acidosis with ketone bodies in
urine are the criteria for forceful feeding.
• Mode of death.
 Accidental starvation
• Occurs during– famine, trapped in Pits, Mines,
Landslides, and Air crash.
• Due to ignorance to provide enough food or
provide food of right kind as seen in drug
addicts or they desire for drugs than food.
• In stricture or cancer of the oesophagus,
ankylosis of jaws.
 Suicidal starvation

• Hunger strike or fast unto death.

• Lunatics and hysterical women may refuse to
take food.
• Anorexia nervosa.
 Homicidal starvation

• Victims are usually an infant, or any other

person as aged, feeble-minded.
• Illegitimate children
• ‘Baby-farmer’– children are starved by their
parents or guardians – if possible do
radiography examination on this childrens.
• On the average, 1 person dies every second as a
result, either directly or indirectly, of hunger –
4000 every hour—100,000 each day– 36 million
each year– 58% of all deaths (2001-2004
estimates).
• On the average, 1 child dies every 5 seconds as a
result, either directly or indirectly, of hunger—700
every hour 16000 each day– 6 million each year–
60% of all child deaths (2002-2008 estimates).
Thank you all