Death from Starvation,

Cold & Heat

By
Brig. (Retd.) Dr. Riaz ul Haque
Chief Executive
Hamdard University Hospital
 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:
i. Famine,
ii. Trapped in pits, mines,
iii. Neglect on part of parents,
iv. Wilful withholding of food,
v. 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• If both water and food are completely withdrawn death occurs in 10 to 12 days
• If food alone is withdrawn death occurs in 6 to 8 weeks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
lost

Factors 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 exercise 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 fluid 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
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
dood
7. Starvation may be suicidal, persons fast voluntarily for the
pupose of exhibition, public attention
Medico Legal Importance Contd…

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 alwful (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.
 Death from Cold

Death from cold is accidental in majority of the cases.

It may be homicidal infanticidal where babies are
exposed to the cold for long durations. Children, old
people, ill-nourished persons and overworked
individual are more susceptible to cold than young
healthy adults.

Females general can tolerate more cold than males

because of the excessive position of fat.
 Symptoms

Local:
Locally there is injury and shock resulting in a decreased
circulation of blood with red patches called frost bites.

General:
Moderate amounts of cold are usually well tolerated.
Extreme cold results in general lassitude and stiffness of
muscles

Cause of death:
Lesser supply of oxygen to the various parts of the body.
 Post-mortem appearance
1. Rigor mortis is slow to appear and hence lasts
longer
2. Skin may become irregular with dark red
patches
3. Brain, lungs and other organs are congested.
 Treatment
1. The patient should be kept in a warm atmosphere.
Exposed parts could never be intensely heated as it
has chances of setting up gangrene.
2. Hot drinks should be started.
3. C.N.S. stimulants can be used.
4. For pain analgesics could be given.
 Death from Heat
 Death from heat happens when there is exposure of the
individual to excessive heat. The exposure could be to the
natural source, the sun or artificial source such as a hot
furnace or a badly ventilated factory. The effects could be in
any of the following form:

1. Heat exhaustion
2. Heat syncope
3. Heat stroke
4. Heat fatigue
5. Heat cramps
 Heat Exhaustion
 The attack may come on acutely or be a gradual one. When it
is of acute variety the patient collapses within a short while.
In cases where it is a gradual one the following
characteristics are noted:

a.) Headache
b.) Nausea and vomiting
c.) A sense of fainting
d.) Feeble pulse
e.) Shallow respiration
f.) Subnormal temperature
g.) Dim vision
h.) Recovery usually takes place. In rare case death takes place with
preceding cardiac failure.
 Heat Syncope

This is temporary cessation of circulation

resulting in a sense of fainting. Recovery is
the rule in such cases. Heat syncope is
induced by heavy exercise in summer.
 Heat Stroke
 Heat stoke is heat hyperpyrexia

 Symptoms:
a.) Prodormal symptoms like headache, giddiness, nausea
and vomiting may be felt by the patient.
b.) Face becomes red hot
c.) Temperature rises to 103oF or 104oF. In some cases it
may reach as high as 110oF
d.) The most corroborating event is the absence of sweating
which indicates the impairment of the mechanism of temperature
regulation. The skin is hot and dry.
e.) Pupils become dilated.
f.) Unconsciousness supervenes.
g.) Death is preceded by convulsions.
h.) Fatal Period: minutes to 3-4 days
 Heat fatigue

 This is a transient decrease in efficiency of the

individual when exposed to heat. In hot
climates this is a general phenomenon.
 Heat cramps

 Cramps are produced due to a deficiency of

sodium. In hot climates because of excessive
sweating the loss of sodium is more .. When if
not compensated leads to heat cramps.