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Death from Starvation-Death from Heat and Cold-Death by Lightning.

Death from Starvation.-The symptoms of and post-mortem appearances in death from starvation, whether the system be deprived suddenly or gradually of food, are essentially the same. Advantage is often taken of this fact by those in charge of so-called "baby-farms," where, to save expense, infants are slowly starved by food insufficient in quantity and quality, and where their death is attributed to the diseases common to infancy. Usually, in such cases, the true cause of death is overlooked, suspicion even being averted, as the length of time is so great that months often elapse before death is accomplished by the starving process. For this reason death from chronic starvation is so much more common than from acute starvation. Indeed, death from acute starvation occurs almost always accidentally, as in the case of those who are buried in a mine, or of those who are shipwrecked or lost on desert wastes. Starvation is very rarely suicidal. Lunatics and prisoners sometimes attempt to take their own lives by abstaining wholly from food; but, as a general rule, such attempts are unsuccessful.

Among the symptoms of starvation may be mentioned severe pain in the epigastrium, which usually passes away in a day or so, being replaced by an indescribable feeling of weakness, a sort of sinking. The face becomes pale and cadaverous, and there is a wild look in the eye. General emaciation follows, and an offensive odor is noticed about the body, which is covered with a brownish secretion.

The voice becomes weak, and muscular effort impossible. The intelligence can, with difficulty, be aroused. Immediately before death there is a decided fall in the temperature. Death takes place usually in from ten to twelve days, often accompanied with mania and convulsions. In death from starvation the most important changes noticed on post-mortem examination are the loss in bodyweight, the almost entire absence of fat and blood, and the loss in bulk of the most important viscera. The coats of the intestines are so thinned as to be almost transparent, the gall-bladder is distended with bile, and decomposition sets in very readily. As already mentioned, death from inanition or chronic starvation is characterized by the symptoms and post-mortem changes just described as resulting in death from acute starvation.'

Death from Heat and Cold.-Death from heat does not, as a general rule, become a subject of medico-legal investigation. As, however, in cases of death from sun-stroke, from exposure to the heat of engine-rooms, etc., doubts may be raised at the coroner's inquest, especially in the absence of witnesses, as to whether death was really due to such causes, and was not suicidal or homicidal, it is important that the medical examiner should be familiar with the symptoms and post-mortem changes presented in such cases. The symptoms of exposure to excessive heat, whether to that of the direct rays of the sun, or to that of 1 1 It is often stated that the quantity of food required by a healthy man doing work during twenty-four hours is as follows:

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If health, however, is to be maintained, fresh vegetables, fruits, tea, coffee, and sugar should be added from time to time to the above diet.

the peculiar atmosphere of engine-rooms and factories, saturated with moisture, and therefore interfering with the heat-regulating functions of the skin, vary from headache with drowsiness to complete insensibility, coma, and paralysis. In most such cases death appears to be due to paralysis of the heart. Among the post-mortem appearances which are not constant may be mentioned congestion of the brain and its membrane, serum in the ventricles, congestion of the heart, lungs, and viscera. In some cases, however, there is anæmia of the brain.

Death from cold is usually accidental, occurring, for example, in drunkards who have fallen asleep in the snow, or in persons who have lost their way in woods or in snowdrifts. Death from cold is, however, not unfrequently homicidal. Thus, newly-born infants are often intentionally frozen to death by exposure to the air of a very cold winter night. Death takes place very quickly under such circumstances, infants having but little power to resist cold. Young children have been frozen by being immersed in vessels of ice-water. Lunatics have died of exhaustion after too long exposure to the cold showerbath, administered as a punishment for misbehavior. In all such cases the temperature of the air, the season of the year, the time of day, the place of exposure must be all taken into consideration by the examiner.

The post-mortem changes in death from cold are not characteristic. Among the most noticeable are the general pallor and stiffness of the body, the irregular and diffused red patches on different parts of the body, even in such as are not dependent, the unusual accumulation of blood on both sides of the heart, and the congestion of the viscera. In all cases of death supposed to be due to cold, it is important to determine whether the body, when found,

was putrefying, since, as putrefaction is prevented by freezing, it would be a strong proof, if a body were found putrefied in ice or snow, that death was not due to freezing, but that the freezing had occurred after death.

Death by Lightning.-Death by lightning is of medicolegal interest from the fact that in the case of bodies found dead in remote places and bearing marks of violence death has been attributed to murder rather than to lightning. The effects of death from lightning vary considerably in their intensity. Frequently the hair is singed, the skin deeply burned or punctured, the clothes burned, the boots torn open. If such articles as watch-chains or coins or knives happen to constitute part of the circuit, they will be usually found melted or half melted. In some cases the body may be uninjured, and yet the clothes burned or entirely torn off. In other cases the clothes may entirely escape, and yet the body may be much burned. In death from lightning the brain and its membranes are usually found congested, the brain being frequently disorganized. The stomach, intestines, liver are usually congested. The heart does not present any marked alteration. The lungs are, however, usually congested and full of mucus. Rigor mortis frequently sets in immediately after death. In such cases the body is found in exactly the same attitude as when it was struck. The coagulation of the blood is retarded. On the other hand, putrefaction is accelerated.1

1 For post-mortem appearances presented in cases of death by electrocution or from the accidental application of electricity, see Taylor, op. cit., p. 470; Richardson: Medical Times and Gazette, May 15, 1869, p. 511; Allan McLane Hamilton: System of Legal Medicine, New York, 1894, vol. i. p. 134; vol. ii. p. 367. Bullard: "The Medico-Legal Relations of Electricity," Medical Jurisprudence, Forensic Medicine, and Toxicology, by R. A. Witthaus and Tracy C. Becker, vol. ii., New York,

Death by lightning is usually instantaneous, being due to shock. But in some cases death is delayed, being then due to some affection of the brain or spinal cord, such as epilepsy, paralysis, effusion of blood, tetanus, etc. The effect of a stroke of lightning, as well known, is very capricious. Of three or four persons sitting under a tree one or two only may be killed, the others escaping. Persons are reported as having been killed while sitting under a low tree, notwithstanding the presence of tall trees, a lightning rod, and an iron bridge near by. Should the question ever arise as to whether death was due to a stroke of lightning, such facts as there having been a thunderstorm at about the supposed period of death, the peculiar appearance of the deceased, the co-existence of burns and wounds, the finding of half-melted buttons and coins, would strongly point to that conclusion.

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