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STARVATION                                                         181

death has occurred rapidly from the sudden withdrawal of "both food and
water. It should also be remembered that the entire absence of fat
throughout the body is never seen in wasting diseases, such as tuberculosis,
diabetes, etc.

Internal.—The brain is usually normal, although it is sometimes pale
and soft. The meningeal vessels are congested, and there is frequently
some serous effusion in the ventricles. The heart is small in size, and the
muscle is pale and flabby. The chambers are generally empty. The lungs
are pale and collapsed, and exude very little blood, when cut. At times
the lungs may be cedematous, and may show hypostatic congestion at the
bases. The stomach is small, contracted and empty. It may contain
undigested food, if it had been given to the deceased shortly before death
in order to avert a suspicion of wilful starvation. The mucous membrane
of the stomach and upper part of the small intestine is more or less stained
with bile. The intestines are empty and contracted, but the lower portion
of the large intestine may sometimes contain hard, scyballous faecal matter,
and may often present more or less evidence of inflammation. These
hollow viscera show an extensive thinning and translucency of their walls
indicating thereby that no food has passed the stomach for a considerable
time. Sometimes ulcerations are found in their walls; these are very likely
due to irritation resulting from the injudicious ingestion of substances to
appease hunger. The liver, spleen, kidneys and pancreas are small and
shrunken. The gall bladder is usually much distended, and contains dark,
inspissated bile. The urinary bladder is empty.

On the 23rd November 1928, I examined the body of one Mussammat Samita, aged
about 20 years, who died on or about the 25th day after having received an injury in
the neck which completely divided the larynx and pharynx, so that no food could pass
down the throat. The body was thin and emaciated, and reduced almost to a skeleton.
There was no fat about the breasts which had all atrophied, leaving only the dark
nipples. Internal examination showed that the brain was normal and its membranes
were congested. The lungs were congested at the bases, and the root of the right lung
was pneumonic showing grey hepatization. The chambers of the heart -were empty.
The stomach was corrugated and empty, weighing 4 ounces. Its mucous membrane was
rough, corrugated and congested at places. The small intestine was shrunken and
emptv. The mucous membrane was Dale except at the lower part where it was con-
gested. The large intestine contained dry fsecal matter in its lower part. The liver
was small, weighing 34 ounces. The spleen was shrunken and weighed 3 ounces. The
kidneys were congested, each weighing 2 ounces. The gall bladder contained dried
bile, and the urinary bladder was empty.

Medico-Legal Questions.—These are—

1.    Whether death was caused by starvation.

2.   Whether the starvation was suicidal, homicidal, or accidental.

1. Whether Death was caused by Starvation.—One must always bear
in mind that there are certain pathological conditions, viz. malignant disease,
progressive muscular atrophy, Addison's disease, diabetes mellitus, tuber-
culosis, pernicious anaemia, and chronic diarrhoea, which lead to progressive
wasting and emaciation of the body. It is, therefore, very necessary to
examine carefully all the internal organs and to search for the existence of
any of these diseases while holding a post-mortem examination, before one
can give the opinion that death occurred from starvation. In the Penge
murder case of 1877 in which Louis Stannton, Patrick Staunton3 Mrs. Patricfc
Staunton and Alice Rhodes were sentenced to death for having killed fesr
starvation one Harriet Staunton, aged 35, the wife of the first-named
an agitation was started later in the medical press that death was
to starvation, but was due to tuberculosis, as at the post-mortem
" a slight deposit of a tubercular substance " was found " on the
of the brain "T and there was also " a tubercular deposit about 2
at the apex of the left lung ". It was also urged that the post-jBorite
nation had not been thorough, inasmuch as the urine had