Partial asphyxiation is very frightening for the victim and torturers have used many methods of causing it. These include putting plastic bags or other sealed objects over the head, holding the head under water, and forcing objects into the mouth, such as a wet cloth. Sometimes chilli pepper, petrol or sewage are added. Victims can be exposed in a confined space to smoke or tear gas. Many survivors will give an account of a persistent dry cough for a few days or weeks afterwards, probably as a result of inhalation pneumonitis (inflammation of the lungs). Some survivors say that they have been asthmatic since such an incident, but it would be very difficult to demonstrate causation. Examination of the lungs, and respiratory function tests are usually normal.
Lesions on the trunk, as in all parts of the body, can be accidental or self-inflicted, or a consequence of torture. The late effects of whipping and beating with sticks can include lines of hyperpigmentation as well as scarring. Sometimes torturers embed small pieces of metal in whips, or hammer nails through sticks, and these can leave a distinctive appearance.
Striae distensae (stretch marks) are most common on the abdomen (especially after pregnancy), the lower back, the upper thighs, and around the axillae. They are hypopigmented lines in which the skin might be folded. They must not be confused with scars from whipping. In striae, the skin is intact. They can be evidence of significant weight loss, for example in detention.
Survivors of torture frequently complain of non-specific pains, and the chest is a regular site for them. On examination there is rarely anything significant to find, except perhaps some tenderness of the chosto-chondral joints (joint between the rib and the sternum (breastbone)). The pain is often helped by sympathetic physiotherapy. Patients with acute rib fractures should be examined thoroughly to ensure that there is no damage to underlying tissues.
Back pain is also common in survivors of torture, and there may be some local tenderness in the lumbar spine. However, these findings are non-specific and common in the general population. Fractures of the vertebral pedicles (the parts of the vertebra going away from the main body) may result from direct blunt force and in some instances radiography of the vertebrae may indicate recent or healed fractures.
Incision wounds to the abdomen can be mistaken for surgical wounds, including those from surgical drains, and vice versa. If the wound was not sutured properly, this increases the likelihood of it not having been made surgically. The location of the wound is always helpful. Renal failure due to crush syndrome may be seen acutely following severe beatings, severe burns and electrical torture.
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