DEATH FROM STARVATION, COLD, HEAT, BY LIGHTNING AND ELECTRICITY
DEATH FROM STARVATION
Death from starvation may be due to the total withdrawal of food, to
prolonged insufficiency, defective quality, inability to swallow it,
and inability to retain it.
Death from starvation may occur during famines, amongst ship-wrecked
sailors, and persons entombed in mines or pits, and is due to sheer
privation. It may follow criminal starvation, wilful refusal to take
food as a form of suicide, and it has been noted in cases of hysteria
and lunacy.
It may result from mechanical hindrance to the entrance of food
into the body from ankylosis of the jaws, or its passage through
the alimentary tract from stricture of the œsophagus or stomach,
from cancer or cicatrisation after injury from swallowing corrosive
substances. Amongst other diseases, tuberculosis, malignant disease,
and diabetes mellitus are the chief which produce external appearances
of starvation.
In the withdrawal or deprivation of food for criminal purposes the
victims are usually old, helpless, or feeble-minded persons, or young
children.
Symptoms.--These depend on the previous state of nutrition. Starvation
may be regarded as acute when death occurs within fourteen days from
the withdrawal of food, chronic when at a longer period.
The symptoms of hunger vary: they are said to pass off in forty-eight
hours, but may last for several days acutely.
The body temperature falls below normal, and the fall may be two
or three degrees before death. The pulse gradually increases in
frequency day by day. The chief sign is loss of body weight. Chossat‘s
experiments on pigeons showed that when they were totally deprived
of food, the surplus fat of the body was lost first, then the fatty
coverings of internal organs, the interstitial fat of muscles last of
all; the muscles themselves also wasted. A peculiar odour like acetone
emanates from those who have been starved, and towards and after death
the odour is putrescent.
In addition to the above signs, there are anæmia, sunken, glistening
eyes with dilated pupils, prominence of bony projections, pale and dry
lips and tongue, parched mouth and throat, weakness of the voice,
sunken abdomen, wasted limbs, constipated bowels, urine scanty and
turbid. There are pains in the abdomen, relieved by pressure; great
thirst, a dusky, dry skin, occasionally purpuric eruptions, exhaustion,
ultimately delirium ending in death.
=Post-mortem Appearances.=--There is emaciation of the whole body, dry,
wrinkled skin of a brown colour; the muscles are flabby and wasted, the
abdomen sunken, the eyes red and open; this appearance is not common in
death from other causes. The mouth and throat are dry even to aridity.
The heart, lungs, and blood-vessels are collapsed, and contain but
little blood. The abdominal viscera are shrunken and without enveloping
fat. The omentum is devoid of fat, and clear; the gall bladder is full
of dark bile; the urinary bladder may be quite empty. The stomach
and intestines are collapsed, contracted, and empty, and the walls
extremely thinned.
=Diagnosis.=--The absence of any other cause of death--such as cancer
of the stomach, stricture of the œsophagus, &c.--and the previous
history of the case will assist in forming an opinion, care being
taken not to confound the results of wasting disease with those due to
starvation.
=Legal Relations.=--The question of death from starvation may be
raised in a case of infanticide by omission. Although rare as an act
of homicide, it must be remembered that the law does not require the
absolute deprivation of food to be proved, but only that the necessary
quantity and quality of food has been withheld; but malice at the same
time must be proved. In cases of infanticide by starvation, the mother
and not the father is responsible for the proper feeding of the child;
but in the case of an apprentice, the master and not his wife is bound
to supply proper food to such apprentice.
In questions of survivorship, and in criminal cases, the medical
witness may be asked how long a person may survive after complete
withdrawal of food. Little is known as to the length of time required
to cause death by starvation, but it is certain that life may be
prolonged for some time without food, if water be allowed. Starvation
is less rapid in its effects if the body be kept warm. In a case
recorded in the _Lancet_, a man who had been shut up in a coal-mine
for twenty-three days, with only a little dirty water to drink, lived
three days after his liberation, and then died of exhaustion. In adults
the average is from seven to ten days without water. Tidy (_Legal
Medicine_, vol. i. p. 392) is of the opinion that the young die first,
then adults, and the aged last. Taking into account the enfeebled
vitality of the aged, it is more probable that the young or middle-aged
adult would survive the longest. Where water is freely obtainable, life
may be prolonged to the fifty-eighth day (_Foderé_, vol. ii. p. 276) or
even more.
Apart from age, account must be taken of the condition of the person in
reference to bodily health prior to the withdrawal of food.
The following tables, showing the average weight and height of
children up to twelve years of age, are from the Report of the British
Anthropometric Committee (1883):
Male Children
+------------+-----------+
| Age. | Weight in |
| | Pounds. |
+------------+-----------+
| At birth | 6.8 |
| One month | 7.4 |
| Two months | 8.4 |
| Three “ | 9.6 |
| Four “ | 10.8 |
| Five “ | 11.8 |
| Six “ | 12.4 |
| Seven “ | 13.4 |
| Eight “ | 14.4 |
| Nine “ | 15.8 |
| Ten “ | 16.8 |
| Eleven “ | 17.8 |
| Twelve “ | 18.8 |
+------------+-----------+
+------------+-------------------+-------------------+
| | Height in Inches. | Weight in Pounds. |
| Age. +----------+--------+---------+---------+
| | Female. | Male. | Female. | Male. |
+------------+----------+--------+---------+---------+
| One year | 27.5 | 33.50 | .... | 18.8 |
| Two years | 32.33 | 33.70 | 25.3 | 32.5 |
| Three “ | 36.23 | 36.82 | 31.6 | 34.0 |
| Four “ | 38.26 | 38.46 | 36.1 | 37.3 |
| Five “ | 40.55 | 41.03 | 39.2 | 39.9 |
| Six “ | 42.88 | 44.00 | 41.7 | 44.4 |
| Seven “ | 44.45 | 45.97 | 47.5 | 49.7 |
| Eight “ | 46.60 | 47.05 | 52.1 | 54.9 |
| Nine “ | 48.73 | 49.70 | 55.5 | 60.4 |
| Ten “ | 51.05 | 51.84 | 62.0 | 67.5 |
| Eleven “ | 53.10 | 53.50 | 68.1 | 72.0 |
| Twelve “ | 55.66 | 54.59 | 76.4 | 76.7 |
+------------+----------+--------+---------+---------+
Table of Ages, Heights, and Weights of Males and Females
from 13 to 30-35 Years of Age
+---------------+------------------------+-----------------------+
| | Males. | Females. |
| +------------+-----------+-----------+-----------+
| Years of Age. | Height in | Weight in | Height in | Weight in |
| | Inches. | Pounds. | Inches. | Pounds. |
+---------------+------------+-----------+-----------+-----------+
| 13 | 56.91 | 82.6 | 57.77 | 87.2 |
| 14 | 59.33 | 92.0 | 59.80 | 96.7 |
| 15 | 62.24 | 102.7 | 60.93 | 106.3 |
| 16 | 64.31 | 119.0 | 61.75 | 113.1 |
| 17 | 66.24 | 130.9 | 62.52 | 115.5 |
| 18 | 66.96 | 137.4 | 62.44 | 121.1 |
| 19 | 67.29 | 139.6 | 62.75 | 123.8 |
| 20 | 67.52 | 143.3 | 62.98 | 123.4 |
| 21 | 67.63 | 145.2 | 63.03 | 121.8 |
| 22 | 67.68 | 146.9 | 62.87 | 123.4 |
| 23 | 67.48 | 147.8 | 63.01 | 124.1 |
| 24 | 67.73 | 148.0 | 62.70 | 120.8 |
| 25-30 | 67.80 | 152.3 | 62.02 | 120.0 |
| 30-35 | 68.00 | 159.8 | 61.15 | 120.8 |
+---------------+------------+-----------+-----------+-----------+
Recapitulation of the Post-mortem Appearances of Death by Starvation
1. _In the Body generally._--Marked general emaciation of the body.
The skin is dry and shrivelled, sometimes more or less covered with
unhealthy-looking pimples, the muscles soft, reduced in size, and free
from fat. A peculiar fœtid acrid odour is given off from the body.
2. _In the Solid Viscera of the Thorax and Abdomen._--The liver is
small, the gall-bladder distended with bile, and the heart and kidneys
deprived of any surrounding fat. All the internal organs are shrivelled
and bloodless.
3. _In the Stomach and Intestines._--The stomach in some cases is quite
healthy, but more or less stained with bile; in others it is found
collapsed, contracted, empty, and the mucous membrane more or less
ulcerated. The intestines are thin, contracted, empty, and so shrunken
that the canal is almost obliterated. According to the late Dr. Duncan,
the intestines are frequently found inflamed and ulcerated.
DEATH FROM COLD
This form of death is rare in England, but is more common in countries
where the winters are severe. Anything that depresses the vital powers
renders the individual more or less susceptible to cold; such, for
instance, as drunkenness, previous illness, or deficiency in the amount
of food. The following _post-mortem_ appearances are given by Ogston,
who holds that they point, in the absence of any other obvious cause of
death, “if not with absolute certainty, yet with high probability,” to
death caused by cold:
1. An arterial hue of the blood generally, except when
viewed in mass within the heart; the presence of this
coloration not having been noted in two instances.
2. An unusual accumulation of blood, as in Quelmalz and
Cappel‘s cases, on both sides of the heart, and in the
larger blood-vessels of the chest, arterial and venous.
3. Pallor of the general surface of the body, and anæmia of
the viscera most largely supplied with blood. The only
exceptions to this were moderate congestion of the brain
in three cases, and of the liver in seven of them.
4. Irregular and diffused dusky-red patches--“frost
erythems”--on limited portions of the exterior of the
bodies, encountered in non-dependent parts, these
patches contrasting forcibly with the pallor of the skin
and general surface.
These signs are not so well marked in children as in adults. The late
Sir Benjamin Brodie considered that the effect of cold is to destroy
the principle of vitality equally in every part, and that it does not
exclusively disturb the functions of any particular organ. The fact of
a body being found frozen is no proof that death has been brought about
by cold.
Symptoms.--Exposure to severe cold produces loss of energy, lethargy,
followed by drowsiness, with an intense desire to sleep, which, if
gratified, passes on to stupor and coma. There may be delusions before
the coma. The primary cause of death is attributed to the lessened
dissociation of oxygen from the hæmoglobin to the tissues, and a
lessened power of the latter to utilise it.
=Diagnosis.=--The general appearance of the deceased, and the absence
of any other cause of death, together with the appearances just
mentioned, will assist in forming an opinion on this difficult subject.
The body lies as if in a deep and calm, sleep, without any external
appearance to guide us as to the cause of death, except perhaps a
swelling of the extremities, which has come on prior to death. If a
body be found buried in snow, and putrefaction present, death did not
in all probability take place from cold, provided that the cold has
been severe and continuous. Death from cold is generally accidental,
except in newly-born children, when it may be either accidental or
homicidal, according to circumstances.
When freezing of the body has taken place prior to the onset of _rigor
mortis_, the latter comes on after the body thaws. This, combined with
the other _post-mortem_ signs given above, affords evidence of the
strong probability that death had resulted from exposure to cold. In
view of the red colour of the skin being similar to that caused by
poisoning with CO, a spectroscopic examination of the blood should be
made.
DEATH FROM EXPOSURE TO HEAT
The results from exposure to excessive heat manifest themselves in
various ways. Any condition which may lessen the resistance of the
body to external heat predisposes to heat-stroke; such as privation,
fatigue, mental emotions, alcohol, over-eating, and especially previous
attacks of the disease.
=Sunstroke= occurs in those who work under the direct rays of the sun,
when the air is hot, still, and humid.
=Heat-stroke= or thermic fever affects those working in places which
are excessively hot and confined, as in glass-works, foundries,
stoke-holds, boiler-houses, sugar-refineries, paper-mills, &c.
=Heat exhaustion= and prostration are brought about in a similar
manner, but the effects are not the same, and usually transient and
less severe.
Sunstroke or heat-stroke may occur in two forms, the _asphyxial_ or
_apoplectic_, and the _hyperpyrexial_; it is also classified as sthenic
or asphyxial, and asthenic or syncopal.
_Asphyxial_ sunstroke or _heat apoplexy_ is probably the least
frequent; prodromal symptoms are headache, vertigo, disturbances of
vision, dyspnœa, and dry skin. In some cases sudden unconsciousness,
with or without convulsions, may occur, and death rapidly follows.
The coma may not be profound; there may be nausea and vomiting of dark
material, bounding pulse, stertorous breathing, contracted pupils, and
frequent micturition. The body exhales a “mousey odour.” There may be
involuntary dejection, with the same pungent odour, and very watery.
Delirium is present in some cases. The temperature may be subnormal,
or rise to 102° F., occasionally even to 106° F. When fatal, the coma
deepens, the pulse becomes rapid and feeble, and there is Cheyne-Stokes
respiration.
In _Hyperpyrexial_ cases the symptoms are similar to the asphyxial, but
the temperature may reach 110-115° F., and in profound coma death takes
place from asphyxia. A subconscious or automatic state, in which the
person may go on working, may precede the “stroke.”
In cases which are not so rapid, pneumonia, meningitis, cardiac and
respiratory paralysis may occur and prove fatal.
_Heat exhaustion_ may be more gradual in its onset, or come on
suddenly. Prodromal dizziness, faintness, nausea, headache, drowsiness,
epigastric and lumbar pains may precede the prostration and muscular
weakness. Fever supervenes, a rapid pulse, and in severe cases
collapse. Consciousness is seldom completely lost, and in favourable
cases is quickly regained. When there is marked prostration the heart
may fail.
The condition known as _heat prostration_ is a milder form, in which
there is little or no fever, and the circulation remains good.
After suffering from an attack of heat-stroke certain sequelæ have
been noted. The patients are rendered sensitive to slight elevations
of temperature, and, during warm weather, experience chromatopsia,
headaches, irritability, irascibility, and even delirium. Epilepsy
and insanity may persist during life. Fiske from his investigations
concludes that the habits of those working in hot atmospheres, and the
degree of temperature, are not nearly so important as the absence of
thorough ventilation as causative factors in the disease.
=Post-mortem Appearances.=--_Rigor mortis_ comes on early, and is
pronounced and disappears quickly. Putrefaction is early in onset. The
brain and cord, the lungs and spleen and splanchnic area exhibit venous
engorgement.
The blood is fluid, and the red corpuscles crenated. Extravasations of
blood may be present in the skin, the serous membranes, and cavities,
the superior sympathetic ganglia, and the vagi and phrenics. The left
ventricle is markedly contracted, the right dilated and filled with
blood.
Van Gieson records acute parenchymatous degeneration of the whole of
the cerebro-spinal nervous system, with chromatolysis of the cells.
Parenchymatous changes may be present in the liver and kidneys.
DEATH BY LIGHTNING AND ELECTRICITY
LIGHTNING
Death is not always immediate. Sometimes the clothes have been torn
off the body with scarcely any personal injury. _Metallic articles,
especially steel, worn or carried about the person become magnetic_ and
may be fused. The lesions which may be met with after lightning-stroke
are varied, and may comprise wounds of almost any description;
simple, compound, or comminuted fractures of bones; burns in the form
of streaks, patches, lines, or arborescent markings; ecchymoses;
singeing of the hair; impressions of metallic articles on the skin.
Apart from the lesions noted above, the following symptoms may be
present: deafness, blindness, paralysis, loss of memory, delirium,
and convulsions. Not infrequently those killed by lightning are found
in the same position that they occupied during life. The question may
arise as to whether the deceased died by lightning or violence. The
presence of a storm at the time when death is stated to have occurred,
and other attendant circumstances, will in most cases point to the true
cause of death. Metallic articles should be examined with regard to
their electric state. Dr. Honiball tenders this caution: “Be not too
sure that in every body found dead after a thunderstorm, and where no
marks upon it are found, that death was due to lightning-stroke, for it
may happen that death was due solely to cardiac syncope owing to sudden
and startling fright.”
=Post-mortem Appearances.=--Apart from the external injuries, when
present, _post-mortem_ rigidity comes on early. The head and neck
may be purplish in colour, the eyes partially open and suffused,
with variable pupils. The internal signs are not characteristic. The
membranes and vessels of the brain may be hyperæmic. The blood has been
said to be very fluid, but it may be coagulated. The internal organs
may be torn, bones may be fractured, and blood-vessels ruptured.
Industrial Electricity
With the increased use of electricity for motive power and illumination
instances of injury and even death have occurred, and probably will
become more frequent. One of the most important safeguards of the body
against the effects of electricity is its high degree of resistance,
especially if the body surface be dry. Moisture of the body surface
lessens the resistance and increases the liability to injurious effects.
The body is a bad conductor; it is said to be three million times less
than mercury, and fifteen million times less than copper; the nerves
conduct like metals. The danger of electric shocks depends upon the
amount of current passing through the body, the kind of contact, and
the insulation of the body at the time. Moisture of the body or clothes
will increase the effects of the shock. Much depends upon the quality,
duration, strength, and density of the current, and the direction in
which it passes.
The continuous current is less severe than the interrupted, and the
alternating is the most powerful in its effects. An alternating current
of 300 volts has caused death, and one of 1500 volts would certainly
prove fatal, whereas for the continuous current it would take 3000
volts to prove fatal.[13] Cases are recorded when with good contact
even so low as 65 volts has proved fatal. The Board of Trade forbids
the introduction into dwelling-houses of currents of more than 250
volts, unless for special purposes and with special permission.
[13] Cunningham, _New York Med. Journ._, 1890, p. 287.
As the current enters or leaves the body it may cause local injury.
Tetanic muscular contractions with pain, and pain from stimulation of
nerve endings in the skin with erythema may occur. Burns produced by
electricity may be accompanied by much local destruction of tissue and
slow healing.
There may be ascending neuritis from injury to nerves.
The shock may cause insensibility with pallor and stertorous breathing;
the skin is moist, the eyes suffused, and the pupils dilated.
Death is due to (1) inhibition of the medulla oblongata, or (2) direct
action on the heart muscle. According to the researches of Cunningham,
currents which traverse the whole body transversely or longitudinally
produce fibrillary contraction of the heart muscle. When the current
passes through the brain, medulla, and upper cord it may cause death
by respiratory paralysis. Those who have recovered from severe shock
describe the sensation as peculiar rather than painful.
_Post-mortem Appearances._--These include the local injury, if any,
at the point or points of contact, some hyperæmia of the internal
organs, œdema of the lungs, and fluidity of the blood. The general
appearances are those of asphyxia. Kratter considers that external
burns in association with subpericardial and subpleural ecchymoses, and
especially subendocardial petechiæ, also the presence of congestion of
the bronchi, strongly indicate death from electricity.
Minute hæmorrhages may occur in the meninges, and in the fourth and
other ventricles. Changes have also been described in the cells of the
central nervous system in experiments upon animals.
_Treatment._--The current should be switched off at once; the patient
should be removed from the conductor, the rescuer being protected with
some insulating material, the attempt should not be made bare-handed.
Stimulation, warmth, and artificial respiration should be resorted
to. After respiration has been re-established, friction should be
applied to the body. The treatment should be persevered in for several
hours. Signs of life may not be seen for two hours. Venesection may be
desirable.