CHAPTER DEATH FROM STARVATION, COLD AND HEAT STARVATION Starvation of* inanition results from the deprivation of a regular and constant supply of food, which is necessary to keep up the nutrition of the body. Starvation is regarded as acute when the necessary food has been suddenly and completely withheld, and chronic when there is a gradual deficient supply of food. Symptoms.—In the protracted absence of food the acute jeeling of hunger lasts for the first thirty to forty-eight hours and is succeeded by pain in the epigastrium, relieved by pressure, and accompanied by intense thirst. Afterjour or five days of starvation general emaciation and absorp- tion of the subcutaneous fat begin to occur. Ihfi—eyes appear sunken and glistening, the pupils are widely dilated, the cheeks are hollow, and the bony projections of the face become prominent. The lips and tongue are dry and cracked, and the breath is foul and offensive. Ihe. voice becomes weak, faint and inaudible. The skin is dry, rough, wrinkled and baggyT emitting a peculiar, disagreeable odour. TKe pulse is usually weak and frequent, but sometimes becomes slow. The, temperature is usually sub- normal, the diurnal variation reaching 3.28°F. instead of Q.3°F. to 1°F. as in the normal body. The. abdomen is sunken, and the extremities become thin and flaccid with loss of muscular power. 'There is at first constipation, the motion being dry and dark, but later towards death diarrhoea or dysentery generally supervenes. The urine is scanty, turbid and highly coloured. The loss of weight is most marked and constant. The loss of two-fifths or forty per cent of the body weight ordinarily ends in death. The_ intellect remains clear till death though, in some cases, delusions and hallucinations of sight and hearing may be met with. Occasionally delirium and convulsions or coma precede death. It_should be remembered that in cases where there is a gradual deprivation of food, death may occur after a prolonged period from some intercurrent diseases, such as typhus, malaria, pneumonia, bronchopneumonia, meningitis, enteritis, tuberculosis, anaemia, etc. From observationsl made on the prisoners of war returning to England during the spring of the year 1945, on the Dutch shortly after liberation and on the inhabitants of Belsen Concentration Camp who suffered from chronic starvation due to shortage of food and even water for a prolonged period, it has been estimated that for the description of a clinical picture cases of starvation can be divided into two types, viz. dry types of cases and wet types of cases. Thejlrv cases were characterized by extreme emaciation and loss of weight varying from 39 to 50 per cent of the original'weight. In the severe cases the pulse was impalpable, the blood pressure unobtainable and the colour was grossly cyanotic. Slight oedema was seen on feet. Injthe_Het~cases there was gross oedema which affected feet, legs, arms and face and was frequently associated with ascites and pleural effusioias- Pyrexig^and watery diarrhoea were common in both the types of cases. IB Belsen Concentration Camp the men were eunuchoid in appearance and women in many cases had acquired male characteristics. There complete loss of moral standard and human kindness. Anaemia "was present. .------——.--------------------------. 1. Janet Vaughan, Medical Annual, 1946, p. 326; see also J. P. Bose, P. Mukerjee, Ind. Jour. Meet Re^ Vot M, Hay 1948^ p. 143.