Popular Science Monthly/Volume 36/February 1890/Long Fastings and Starvation
By M. CHARLES RICHET.
WHAT takes place in an animal deprived of food may be explained by recurrence to the comparison between the animal and the machine, which, though very old and commonplace, is still exact and almost inevitable. In the machine, the burning of carbon gives rise to heat and force; animals also, burning carbon, develop heat and force. The same is true of plants, for they likewise disengage heat and force; only the plant disengages very little, and the animal much of them. While the plant is stationary, fixed to the ground, the animal is forced to move to find food. We might, indeed, say that all its wonderfully complicated organism is in substance only an apparatus attached to the stomach. The lower animals are hardly anything else than a stomach adapted to motion; and the animal is improved as its means of seeking food everywhere and at a distance are perfected. The animal goes out in search of food because it feels a want hunger. Nature, in fact, distrusts the intelligence of her children, and for that reason has given to all living beings instincts and wants; and has armed them all, without exception, with the sensation of hunger, to provoke them to seek nourishment. Without this irresistible feeling no being could live.
The sensation of hunger is a painful feeling of uneasiness and weakness. It is a general feeling, but is localized apparently in the stomach. Many ancient authors regarded it as a local sensation. Some said that the gastric fluid became more acid and produced a burning feeling in the stomach; others, that a contraction of the stomach took place. But, although the sensation of hunger is related to the stomach, it is really general. While it is sometimes alleviated by swallowing earth and stones, such inert substances may deceive it, but do not appease it. It has, moreover, been experimentally determined that the feeling of hunger is not abolished after cutting the pneumogastric or sensitive nerve of the stomach.
So, in thirst we feel a dryness in the back part of the throat. The local sensation is deceptive, for thirst does not depend upon any condition of the mucus of the pharynx. It is caused by the exhaustion of the watery elements of the blood. It is therefore removable by injections of water, and by bathing, when water is absorbed by the pores.
If hunger is not satisfied, it disappears after a certain length of time. The most intense suffering is endured during the first twenty-four hours, after which the pain diminishes. The characteristic phenomenon exhibited by an animal subjected to starvation is the constant diminution of weight. I have made many experiments on this loss, comparing animals of various sizes, and have determined that the function of dehydration—or reduction of weight—is in direct relation with the size of the animal; and I believe that I can deduce a great rule of comparative physiology that the activity and intensity of all the functions are determined by size. Carnivorous animals appear to bear fasting better than herbivorous kinds. The latter eat nearly all the time, and are ill when they have to stop; but carnivorous animals, in the wild state, are often forced to endure abstentions of considerable length; and a fast of several days is almost a physiological condition with them.
When we examine the phases of the loss of weight of a starving animal, we find that it loses much during the first days. Then a moderate drain sets in. Again, in the last days considerable loss takes place, and this is the forerunner of death.
Cold-blooded animals can support inanition during a prodigiously long time. M. Vaillant has told me of a python weighing seventy kilogrammes that lived twenty-three months without eating; M. Colin, of a rattlesnake that lived twenty-nine months. Redi mentions a tortoise that lived eighteen months, and a frog sixteen months, without food. When we have frogs in our aquariums waiting to be experimented upon, we never feed them and they never starve. Dogs can endure abstinence, on the average, of thirty days; cold-blooded animals, twice as long. They are capable of this, because their tissues are consumed more slowly, and do not require so frequent renewing. With both classes the fatal limit is reached when the loss of weight amounts to forty per cent. This point is reached by the warm-blooded animal ten times as quickly as by the cold-blooded one, because its nervous system is ten times as active. The relation of the nervous system to the intensity of the chemical exchanges of vital action is shown by the existence of hibernating animals, or warm-blooded animals which periodically become cold-blooded. Becoming torpid at the approach of the cold season, their breathing and circulation become slow, their motions weaker, their eyelids close, they fall into their winter sleep, and their temperature descends to about 40° Fahr.
The nervous system is the great inciter of nutrition: when it is vigorous or excited, the digestion is active, the breathing rapid, and the temperature high; and the loss of weight and the possible duration of abstinence follow the same rule.
Man is subject to the same conditions in case of fasting or starvation as warm-blooded animals; and the influences of size, age, and nervous constitution are similar upon him. This is illustrated, in respect to age, in the legend of the family of Ugolin, in which the youngest child died first, at eight years of age, and the other children followed, while the father did not die till three or four days after the death of the last of them. So, in the wreck of the Medusa, the children died first on the raft, the old men next, and the adults last. We might have supposed that the old men would have resisted better; but while they may, perhaps, bear moderate fasting with less inconvenience than more active persons, they are less able to endure starvation. New-born infants are less capable of resistance than adults; but the young of animals—puppies and kittens—are more hardy than we would be ready to suppose. Experiments on new-born children have shown that they can offer considerable resistance to external influences, provided they are well fed. Their mortality is principally due to a deficiency of alimentation called athrepsy, infants dying of which present the same lesions as starved animals. Their fat is exhausted, while the weight of their nervous system is not reduced. Another feature of the starvation of infants is a relative increase in the globules of the blood by dehydration; not that the number of globules is greater, but the proportion of them to the whole volume, a considerable portion of the water having disappeared.
The duration of the possible fast is considerably influenced by fever. That is supposed to determine the production of poisons which stimulate the nervous system and intensify the process of denutrition; so that under its influence, as has been observed in experiments on animals and in man, the weight diminishes more rapidly than under starvation alone.
The influence of drinking is also noticeable. Of two dogs observed by M. Laborde, one died in twenty days; the other, which could drink at will, was still living at the end of thirty-seven days. There are also examples on the other side. Falck's dog went sixty-one days without drinking or eating. Starving dogs usually drink but little, as if warned by instinct not to drink more than they have to. Water, in fact, expedites the wasting of the tissues and accelerates the drain of the salts in the organism. Hence, by drinking, we excrete more chloride of sodium, phosphates, urea, etc., so that, although in general animals deprived of water do not live as long as those which can drink, there is some difference between those which can drink a little and those which drink a great deal. The last die sooner.
There is always less suffering when it is possible to drink; for it is a characteristic of privation that thirst torments more than hunger, and those who have told of what they have suffered on such occasions have usually emphasized this fact. But I do not believe that the hour of death is much delayed by the ingestion of drinks.
In considering cases of fasts endured by men, we have to distinguish between the experimental fast, carefully arranged for and limited to a certain number of days; the fast which I call charlatanish; and the compulsory fast, which is inflicted upon persons who have been surprised by accidents, such as shipwrecks or land-slides, or who have been left in the wastes of the desert.
Experimental Fasts.—Mr. Ranke, a German physiologist, felt no great inconvenience for forty-eight hours, and his worst sufferings were in the earlier stage. His symptoms were great muscular weakness, impossibility of sustaining prolonged movements, fibrillary shiverings, and headache. The most striking phenomena were insomnia with nightmare and throbbing in the head. Beginning nineteen hours after he had taken his last food, he determined by experiment what was his daily diminution of weight, and the rate of consumption of carbon and nitrogen per kilogramme and per hour. He found that the consumption of carbon was twenty times that of nitrogen; that he lost in weight about 1·2 gramme per kilogramme per hour; and that he produced fourteen litres of carbonic acid per kilogramme per hour. The last number is important. In the normal condition we produce eighteen litres of carbonic acid per kilogramme and per hour. As Mr. Ranke's case was not one of illness or any kind of weakness, the question arises as to the purpose served by these four litres of surplus carbonic acid. The most obvious answer is that they are a luxury. In some experiments which I made, the rate of production by my subject, while fourteen litres during the fast, rose by one third after he had eaten a hearty meal, and his respiration increased in a like proportion.
In the cases of the celebrated fasters Tanner, Succi, and Merlatti, while it may be hard to prove that there was no fraud, the precautions taken against it seem to have been ample to make it extremely improbable. They, moreover, all endured their fasts under special conditions. Merlatti ate a fat goose, bones and all, before beginning; Succi took a drink to which he attached great importance. The diminution of weight was less considerable than in the other subjects mentioned, but in Merlatti's case the whole amounted to twenty-seven per cent at the end of the fifty days, and there was great danger of a fatal result from the enfeeblement of the nervous system. The faster persisted in going on to the end, after being advised to discontinue the experiment, and vomited immediately after taking the first food. Nevertheless, he presided at a banquet given in his honor, and fully recovered in two months. Cetti, whom M. Senator put on an experimental fast of ten days, and who drank all the water he wanted, lost more weight during the first than during the second five days.
In view of other facts showing less capacity to endure long fasts, we have to conclude that such persons as Tanner, Succi, and Merlatti performed their experiments under exceptionally favorable conditions. They had no severe weather to face, no concern about their fate, and knew that they had only to make a sign to have a savory repast brought to them. Quite different is the situation of persons who have been buried, for example, under landslides. Cut off from the rest of the world, they know that no help can come to them for the moment, but that to reach them tunnels must be bored and large masses of earth and stones removed. Long privations of food have often to be suffered under such conditions. Berard mentions men who were confined for fourteen days in a damp cellar. Licetus was shut up for seven days. The miners of Bois Mousil were confined for eight days after a landslide, without suffering greatly.
Other examples are afforded by shipwrecked persons. There is an interesting story of a party wandering on the ice-fields who were exposed to a terrible cold for seventeen days, in 1809, without other nourishment than water thawed from sea-ice. When found, their skin was sticking to their bones, their eyes were sunk deep in their orbits, and they had fetid breaths and earthy complexions, their skin was covered with a sooty scurf, and their tongues were black. This sooty aspect of the skin is a common symptom in great famines, such as occur in India and China.
We have many instances of individual fasts. An Italian seventy-seven years old, mentioned by MM. Monin and Maréchal, lived without food to the thirty-seventh day, only drinking occasionally a little brandy and water; then went to eating again without feeling any inconvenience. A man named Granie, condemned to execution, starved himself to death in sixty-three days. Antonio Viterbi, in 1821, allowed himself to die of hunger in order to escape the penalty of death. He had also resolved not to drink; but at one time, taking water in his mouth to refresh himself, he could not restrain himself and swallowed it. He had vertigo and nightmare, but suffered most from thirst, and died on the seventeenth day. This period, from seventeen to twenty days, represents the mean duration of life of a man in normal conditions who is starving. But Simon Goulart tells of one Hasselt who was found alive after having been shut up for forty days without food.
Succi and Merlatti were perhaps insane or melancholy. Persons who are taken in good health resist less effectively than maniacs. M. Lepine cites the case of a girl who had constriction of the œsophagus, who died after having lived sixteen days without food or drink. There is also the extremely interesting case of a German merchant who, having been unfortunate, went into the woods to starve himself to death, and died after eighteen days. He was still breathing when discovered. He had noted down his impressions daily. After five days he wrote: "If I only had fire, a little fire! How long the nights are—how cold they are!" On that day he drank. Three days afterward, cold water which he tried to drink made him vomit. A week after that he tried to go to the water, but his strength failed him and he stuck to his resting-place. During these eighteen days of suffering he therefore drank only once. These periods of nineteen, seventeen, and sixteen days, in persons not out of their minds, justify the estimate of twenty days as the length of the fast which will bring death to healthy persons under no nervous waste. But the time admits of a considerable extension among insane persons and those who have made preparations for their fast. Succi, who fasted thirty days, had been twice in an insane asylum. Cardan relates the case of a Scotchman who lived thirty days in a prison without eating. Devilliers, in the "Journal de Médecine," mentions an insane person who died after seventy-five days of partial fasting, in which he took only a few glasses of liquid—a little wine and bouillon. The amount of weight lost at death can not be closely determined, but may be estimated at about thirty per cent.
These conditions relate to sound or nearly sound persons. Respecting the stories told of diseased persons, we have to steer between a Scylla and a Charybdis of excessive credulity and excessive incredulity. A Prof. Licetus, of Padua, near the beginning of the seventeenth century, wrote a rather stupid folio in Latin, "On those who can live a Long Time without Food." It contains various chapters, on "those who live eight days"; "those who live a month"; "those who lived three months"; "those who lived from one year to eight years"; "those who lived more than twelve years"; and ends with the story of the seven sleepers of Ephesus, who went to sleep in the reign of the Emperor Decius and woke in that of Theodosius. We can more than doubt some of the stories of Licetus; but there are facts as remarkable as some of them, concerning long fasts by diseased infants and girls, which we can not question.
The excessively long fasts, whether experienced by men, women, or children, have usually been observed in hysterical persons—for it is now known that hysteria exists in men and children as well as in women. Taking up almost any of the numerous stories related by the old authors, we find manifest traces of hysteria in them. Here, for example, is "the memorable and prodigious history of a girl who for many years neither ate nor slept nor voided, and yet lived by God's admirable grace and virtue" (Frankfort, 1587). She was Catherine Binder, of Heidelberg, who at twenty-seven years of age all at once lost the taste for warm food (a hysterical fancy), and ate nothing warm for five years, when she was treated by a quack, and also lost the taste for cold food. She neither ate nor drank for seven years. While we may entertain some question respecting the accuracy of this affirmation, there is no doubt that the girl was nervously affected. She had been deprived of hearing and speech for three years; she had spasms when she tried to eat, so that she could not swallow; and, during two weeks that she was watched, she neither ate nor drank. Another girl (1586), religiously affected in her hysteria, was taken with an aversion to everything eatable, and a difficulty in swallowing, and lived for four years on nothing but water and, at long intervals, a little bread dipped in water. Apollonia Schrierer, of Berne (1604), lay physically insensible but wide awake day and night. She was kept apart from her mother and constantly watched by the officers for two weeks, during which she took no food. In the same book with this story is that of a girl of Spires, watched for twelve days, who was assumed to have lived for three years upon nothing but a few drops of water or wine, which she took in her lips. She was twelve years old, and slept most of the time. A girl of Cologne, who lived four years without food, fainted whenever they tried to put anything into her mouth. Passing over several other cases related by these old authors, which vary but little in their general features, we come to a number of cases recorded in medical publications of the eighteenth century, in all or nearly all of which the long fast is accompanied by some kind of disorder of the body or mind. In many of these instances, as in some of those described above, the fast was not absolute, but was occasionally relieved by the introduction of a few drops of milk or broth. Such a fast can be continued indefinitely—as in the case of a woman described by Vandermonde in 1760, who lived thus for twenty-six years.
The present century furnishes numerous fairly well authenticated instances of extraordinarily long fasts, which were nearly always associated with some form of hysteria. We can not mention them all here, and omit those which are most frequently cited in the medical books. Anna Garbero is described by Ricci as having, after a sleep without eating of forty days, been taken, on the 8th of September, 1825, with an absolute repulsion against food, and thus continued till the day of her death, after a lethargic sleep of three months, on the 19th of March, 1828. The autopsy disclosed a contraction of the sigmoid flexure of the colon. One of the most extraordinary cases on record is that of the Dutch hysteric Angelina de Vlies, forty-one years old, who continued without food from the 10th of March, 1822, to 1826. She was subject to cramps and tremors, and was very weak, and not able to rise without help. Bourneville and D'Olier tell of an idiotic child who at two years of age lived three weeks, and at seven years twenty-eight days, on nothing but water and broth. In many similar cases, the patients have eaten occasionally, but only the minimum quantity indispensable for the maintenance of life. Thus, a woman cited by Laségue only ate during a year what an ordinary person would require for two days.
One of the characteristics of cases of this kind is the extraordinary perversion of appetite. An insatiable craving prevails in some of the patients, a loathing in others. Perversions of the sexual passion have also been remarked. With these fantastic tastes is associated an exceptionally strong and enduring power of resistance.
There was for a long time at the Salpêtrière a woman named Etchverry, who had hemiplegia on one side and contracture on the other. Her hysteria should apparently have provoked a general denutrition, but it did not. She would not eat, and had to be fed artificially. Her excretions were marked by an extreme deficiency of urea. There was no deception in her case, for she was under constant watch.
I have observed in a very precise experiment the diminution in the phenomena of nutrition in hysterics. M. Hannot and myself, studying two hystero-epileptic cases at the Salpêtrière, found that the patient in a condition of lethargy received only four litres of air into her lungs in sixteen minutes, and made only eight inspirations in thirty-six minutes. This marvelous slackening of the respiratory phenomena constitutes a real hibernation in man, resulting from the absence of stimulation of the nervous system.
Observations have been made of a disease of somnolence. M. Charcot has recently published an account of a case, and MM. Semelaigne and Gélineau have published another. An irresistible torpor takes possession of the patients, who fall into a sleep in which all the phenomena of nutrition are slackened, but the sleepers wake occasionally and take food or perform physical offices.
The fakirs of India, who allow themselves to be buried alive, belong to the same category. They submit to extraordinary mortifications, eat but little, abstain from meats, and use curious arts to empty their stomachs. Having hypnotized themselves, they rest almost without breathing. While much of this may be imposture, there are, according to Rousselet and Jacolliot, some well-authenticated cases of the kind. English sentinels were set around one fakir who was buried alive. When disinterred he was apparently dead, but was aroused and lived. I do not consider it necessary to question the correctness of the cases of lethargy and apparent death recorded in the books. A considerable depression of the nervous system accompanies all such phenomena, and the activity of the heart and the rhythm of respiration disappear at a certain stage of the disease.
There have not been many experiments on this subject made upon men. We have one, however, from M. Debove, on the influence of suggestion upon hysterics. On his indication to two patients that they should not eat or drink, they comfortably supported a fast of fifteen days, with only slightly proportionate decrease of weight, and they had had hardly any feeling of hunger at the end of the period. For comparison, M. Debove tried to impose a fast on a vigorous man, but was obliged to suspend it after five days. This subject lost at the rate of 0·8 gramme per kilogramme per hour, against 0·13 gramme in the hysterical patients. He was not susceptible to suggestion.
We draw from these facts that the functional exchanges are retarded in cases of hysteria. We do not yet know the exact influence of the nervous system. There is certainly a diminution of chemical activity in the tissues which produce heat and in the glands that furnish the secretions. This is not saying much, but it is something.—Translated for the Popular Science Monthly from the Revue Scientifique.