TORTURE TECHNIQUE PHYSICAL FINDINGS AND NOTES ON THEIR DETECTION Forcible immersions of head in water often contaminated with urine, faeces, vomit or other impurities (“wet submarine”, “pileta”, “latina”) Signs of drowning/near drowning; faecal or other debris in the mouth, pharynx, trachea, oesophagus or lungs. In survival, pneumonia Many other forms of positional torture, tying or restraining victims in contorted, hyperextended or other unnatural positions Fractures, dislocations, injuries to ligaments, tendons, nerves and blood vessels, both recent and old Blunt abdominal trauma while lying on a table with the upper half of the body unsupported (“operating table”, “el quirófano”) Abdominal bruises, back injuries, injuries to abdominal viscera including rupture. Intramuscular, retroperitoneal, intra-abdominal haemorrhage Hard slap of palm to one or both ears (“teléfono”) Rapid increase of pressure in ear canals causes ruptured ear drum(s); after time, these will appear scarred. There may be injuries to the external ear. Use otoscope Whipping Multiple depigmented, linear hypertrophic scars surrounded by a zone of hyperpigmentation are most likely the consequence of whipping. Exclude plant dermatitis Forcible removal of a fingernail or toenail Acutely, laceration and bruising to the nail bed and skin of the distal phalanx; other injuries associated with restraint. Later, an overgrowth of tissue may be produced at the nail fold forming a pterygium. Lichen planus is the relevant differential diagnosis, and this is usually accompanied by other skin lesions. Fungal infections produce thickened yellowish crumbling nails Burns Cigarette, hot objects acutely result in characteristic burns (after time, these cause atrophic scars with narrow hypertrophic and hyper-pigmented periphery. Spontaneously occurring inflammatory processes lack this characteristic marginal zone); when the nail matrix is burnt, subsequent growth produces striped thin deformed nails, sometimes broken up in longitudinal segments Electric shock (wires connected to a source of electricity; e.g. “cattle prod”/“la picana”: pointed electric instrument, metal on the tip) Electric shock to hands, feet, fingers, toes, ears, nipples, mouth, lips or genitalia. Gels or water often used to prevent detectable burns. The appearance is of burns and depends upon the age of the injury. Immediately: red spots, vesicles and/or black exudate. Within a few weeks: circular reddish macular scars. At several months: small, white, reddish or brown or hyperpigmented spots (picana) Heated metal skewer inserted into the anus (“black slave”) Peri-anal or rectal burns Repeated blunt trauma to the soles of the feet (and occasionally the hands or hips) (“falanga”, “falaka”, “bastinado”) May be missed on cursory external examination; even if signs are present, swelling and not bruising may be the dominant appearance. Closed compartment syndrome may lead to muscle necrosis (aseptic), or vascular compromise of toes or even the distal foot. Fractures of carpal and metatarsals can occur. The aponeurosis and tendons may be torn. After time, irregular scars involving the skin may occur Sexual assault Sexually transmitted disease; pregnancy; injuries to the breasts or genitalia All the signs of penetration of vagina, anus or mouth and their differential diagnoses 48 The Minnesota Protocol on the Investigation of Potentially Unlawful Death (2016)