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STARVATION                                                       183

has been lowered from fatigue, want of food, indulgence in alcoholic drinks
and previous ill-health, are less able to withstand the effects of cold than
healthy, well-nourished adults of temperate habits. Owing to a greater
deposit of subcutaneous fat—a non-conducting material—women are likely
to ensure cold longer and better than men. Dry cold is less harmful in its
effects than moist cold air.

Symptoms—Local.—These appear on the skin in the form of £iythe-
matous patches, called frost-bites (frost-erythems) and chilblains produced
by constriction of the cutaneous vessels which deprives the tissues of their
nourishment. The exposed parts, such as the ears, nose, fingers and toes,
are usually affected. The condition of frost-bite being a vital action can
never be produced after death.

General.—These are no bad effects from moderate cold. On the
contrary, it invigorates the body, and produces appetite and hunger ; but
exposure to severe cold continued for a long time produces deleterious
effects, especially if a person is not properly clothed to keep up the body
heat, and does not get sufficient food or exercise. The skin becomes pale
and numb; sometimes it assumes a dusky, reddish and livid hue with the
formation of vesicles. The muscles become so stiff, rigid and heavy, that
the patient is unable to move or raise his limbs. This condition is followed
by general lethargy, drowsiness and inclination to sleep which, if not
controlled, passes gradually into stupor, coma and ultimately death. Some-
times convulsions, hallucinations and delirium occur before death.

Cause of Death.—Death occurs from a lesser supply of oxygen to the
nervous centres and tissues, as haemoglobin is unable to part with it at a
lower temperature.

Treatment.—This consists in covering the patient with woollen garments
and placing him immediately in a warm bed. Hot water bottles should be
applied to the surface, and the warmth of the body should be gradually
restored by rubbing the limbs with flannel or hot towels. Hot coffee or tea
and other stimulants, such as strychnine, digitalis, and alcohol, should be
administered. Enemata of warm normal saline are very beneficial. It may
be necessary to treat nephritis and other inflammatory conditions, if they
arise after the reaction has set in.

Post-mortem Appearances—External.—The surface of the body is
usually pale, marked with irregular, dusky red patches of frost-erythems,
especially on the exposed parts, such as the tips of the fingers and toes,
nose, lips and ears. These do not appear on the dependent parts as in post-
mortem staining. Rigor mortis is slow to appear and hence lasts longer.
If a body buried in snow is found in a condition of commencing decom-
position, death is very likely not from cold, which prevents decomposition.

Internal.—The brain is congested with effusion of serum into its
ventricles. The heart contains fluid blood in both the chambers. The lungs
and other organs are congested. Owing to the combination of oxygen with
haemoglobin, the blood is bright red in colour except in the heart, where it
appears dark when viewed en masse.

Medico-Legal Aspect—Death from cold is mostly accidental, thougfct
very rare in India. Drunkards may be found dead in streets, when exposed
to cold on a wintry night. Death from cold may form a case for medico-
legal enquiry, as a newly born infant is sometimes murdered by exposure
to cold by depriving it of the necessary clothes. Questions of-responsibility
as to homicide may arise in cases where insane, aged, sick or wosmcled
persons have died from exposure to cold.

A newly-born male infant* two or three days old, was found dead iron*
at night in the compound of a bungalow at Agra.