The symptoms which result from completestarvationare characteristic, If food is suddenly withheld, the sensation of hunger gradually increases at first, becomes extreme, lasts for two or three days, and slowly disappears.It is accompanied by a gnawing pain in the epigastrium, which is relieved on pressure. The pain may disappear with the hunger, but it is followed by a sensation of extreme weakness or faintness, which is both local in the stomach and general throughout the body. The sensation of thirst, on the contrary, when all fluid is withheld, persists until death or until the subject becomes insane or unconscious.
When food is gradually withheld, urgent hunger may not be felt at all, but the longer and more severe the fast, the more difficult doesdigestionbecome. Thecirculationgrows feeble, the heart action rapid, the respiration shallow and possibly slow and irregular. There is apt to be some thirst, even thoughwaterbe supplied. If it be withheld, the torture becomes unbearable. Constipation may be succeeded bydiarrhoea, but it more often remains complete. The facies are typical, the expression is anxious and staring, the orbitalfatdisappears, and the eyes are greatly sunken and finally become glassy. Corneal ulceration may be present. General bodily emaciation ensues, the muscles are soft and reduced in size by more than one half, and the abdominal viscera to a similar degree, the skin becomes pale, loose, and, from change in the secretion of perspiration, emits a peculiar fcetor and acquires a clay-like colour. The feet and ankles may swell, owing to the enfeebled circulation.
The victims become so ravenous that all sense of taste gives place to the intense hunger. Upon one of the recent unfortunate arctic expeditions, on one occasion, theteabeing accidentally omitted from the kettle, dirty water was drunk by the starving men without recognising the difference. The secretions are altered, and become inactive. The urea excretion falls to one fourth the normal. The total volume ofbloodis diminished, andanaemiais extreme.
The bodytemperaturebegins to fall in the first day of the period of starvation, and continues falling, so that a loss of ten or more degrees below the normal of 98.60 F. may occur.
In extreme cases muscular action is no longer possible; there arevertigoand faintness on raising the head, the voice is lost, and gradually thenervous systemsuccumbs to languor and general prostration; the mind becomes more and more dull, listless, and even idiotic, the victim being unable to describe his condition or express his wants. He may have hallucinations,insomnia, and dreams, in which are often pictured scenes of plenty.
The sufferings produced by slow starvation distract the mind and render connected thought difficult. If long continued, the mind becomes unbalanced, and men who have been shipwrecked and left to wander in the open sea in rowboats for a long time without food usually become delirious, or even maniacal, within four or five days.
In 1874 three men and two boys were castaway for twenty-two days in an open boat. They had at first ten days' provisions, and subsequently nothing but old boots and jellyfish, and they fought violently with each other in the delirium which ensued (Chambers).
During prolonged starvation the most important organs of the body are nourished at the expense of others, especially of the skeletal muscles. For example, in ananimalstarved for thirteen consecutive days it was found that while the muscles lost 30 per cent in weight, the brain lost but 3 per cent and the heart but 2.5 per cent.
The ultimate effects of starvation are identical whether the process be gradual or rapid, occupying days or years, and death results when the body has lost six tenths of its weight. It may occur while the victim is in stupor or coma from cardiac failure or, possibly, in convulsion. The actual cause of death has by many been attributed to the loss of body heat. While this is undoubtedly a contributing factor, it is more reasonable to suppose that it is due to the general inanition of the muscles and nerves and the progressive enfeeble-ment of the heart action. The heart muscle not infrequently will be found to have undergone fatty degeneration. It is, however, true that in animals kept warm by artificial means the advent of death from starvation may be considerably postponed.
While undergoing starvation the blood is reduced in volume proportionately with the loss inbody weight, but it nevertheless maintains the balance of its normal average composition (Panum and Voit).
Hunger is not always a reliable guide as to the need of the system for food. Some dyspeptics are always hungry and eat more than they can digest. Hunger begets a habit of too rapid eating, and more food may be taken than is necessary, because it has not had time to be absorbed and reach the tissues before the meal is over. Moreover, hunger may be temporarily appeased by eating other substances than food, like bits of old leather, for example, which appear to act mechanically in the stomach. For this purpose men rendered insane by hunger will sometimes swallow all manner of useless and harmful substances, such as buttons, pieces of metal, pebbles, etc.
No more graphic and pathetic account of the miseries of starvation exists than is found in the journal of Lieutenant De Long, commanding the expedition of the Jeannette, which visited the arctic regions in 1879-'81 (The Voyage of the Jeannette, Journals of George W. De Long, 1883). After leaving their sinking vessel the members of the expedition were exposed, at first in open boats, and later in their long sledge journey, to the most exhausting work and to intense suffering from cold and wet. They frequently dragged their sleds in severe storms for ten or twelve miles a day, while subsisting solely upon half a pound of stewed deermeat, with a little tea three times a day. This food being exhausted, they were obliged to consume themeatof their last remaining dog, which they ate fried. They subsisted upon this food exclusively for four days longer, having an allowance of but half a pound a day, and finally their last journey of twenty-five miles was performed with no other nourishment than a few ounces ofalcoholand an infusion made from some old tea leaves.
During this time their intense suffering from hunger was partially alleviated by chewing scraps of deer skin, which, from its bulk in the stomach, seemed to afford slight relief.
The alcohol being exhausted, they lived for another day upon a teaspoonful of olive oil, with a breakfast composed of an infusion made from the arctic willow (containing really no nourishment) and "two old boots." After this the men, becoming weaker and weaker, were unable to proceed farther on their journey, being driven back by intense cold and the difficulty of crossing the partially unfrozen rivers. Their feebleness gradually overcame them, until one by one they died of inanition. Four men survived for sixteen days upon absolutely no food whatever, and possibly their sufferings were even further prolonged, but the journal of their gallant and heroic commander ceased at this point, for he, too, died.
In the starvation which overtook the members of the Greely party on the Lady Franklin Bay Expedition, and caused the death of a large number of the company, attempts were made, as in the case of thejeannette expedition, to relieve the agonies of hunger by filling the stomach with indigestible material of various kinds. The skin sleeping bags were roasted or boiled and eaten, and even oil-tanned skin was consumed, while the sufferings of the men were aggravated by the presence ofgamein sight but out of reach. A few shrimp andlichenswere obtained and stewed with seal skin. At this time, although it was summer, the temperature was occasionally below the freezing point, but during part of the two years spent in the vicinity of Fort Conger it was sometimes - 40 or even - 60° F.
During the siege of Paris in 1871, when thousands of the inhabitants were reduced to starvation, it was found that a diet which was barely sufficient to support life consisted of ten ounces ofbreadwith one ounce of meat.
Inprisonsthe diet limit has often been reduced too low. It may be sufficient to maintain life, but if hard labour be inflicted, weakness, sickness, and death will inevitably follow. In an overcrowded prison a dailyrationof twenty-eight ounces of unbolted meal and five ounces ofbaconhas been known to cause death by slow starvation. As a means of discipline a starvation diet is sometimes enforced in penal institutions for a few days, and it is usually quite as efficacious as corporal punishment. A diet which is designed to effect its aim by monotony as well as reduction in quantity, but without reaching the limit of cruelty, is the following, which has been used at the United States military prison at Fort Leavenworth:

Breakfast

Hash or stew, 8 ounces; bread, 7.5 ounces.

Dinner

Soup, 8 ounces; bread, 7.5 ounces.
After twenty continuous days of this diet eight ounces of bread are allowed for supper. This diet has been found to make the most refractory men soon manageable. (See Diet in Prisons).

Treatment

The treatment of persons rescued from starvation must be conducted with the utmost care. The digestive system is so enfeebled that to allow them to yield to the cravings of returningappetiteis to insure immediate death by overburdening the stomach and circulation. The body should be kept warm and in absolute rest, and warm fluid nourishment in minute quantities - half tea-spoonful doses ofbeef peptonesor meat juice - may be given at intervals of fifteen minutes or half an hour. If novomitingor evil symptom results, small quantities of peptonisedmilkmay be tried at half-hour intervals. Alcoholicstimulantsin any quantity are to be avoided, but a few drops of brandy orwhiskymay be given from time to time in water. If the stomach is irritable,nutrient enematashould be employed. The following day the quantity of food may be slightly increased, but if emaciation is extreme and erifeeblement is pronounced, the patient must be kept upon a fluid diet for ten days or more. Easily digested forms of starchy food may then be added, such as dry bread,arrowroot, gruel, and the like.