TORTURE & CUSTODIAL DEATH

Q) Write a note on torture?

A) (A) Definitions
(I) General Definition - Torture (Latin tortus, to twist) is infliction of intense pain (e.g. from burning, crushing, wounding etc) to punish,
coerce, or afford sadistic pleasure.

(II) World Medical Association in Declaration of Tokyo (1975) defined torture in relation to detention and imprisonment as - Torture is
deliberate, systematic or wanton infliction of physical or mental suffering by one or more persons acting alone or on the orders of any
authority, to force another person to yield information, to make a confession, or for any other reason.

(III) Definition in use today is as per the UN Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment of
December 10, 1984, which entered into force in June, 1987. As per this Convention, torture is defined as “Any act by which severe pain or
suffering, whether physical or mental, is intentionally inflicted on a person for such purposes as obtaining from him or third person
information or a confession, punishing him for an act he or a third person has committed or is suspected of having committed, or intimidating
or coercing him or a third person, or for any reason based on discrimination of any kind, when such pain or suffering is inflicted by or at the
instigation of or with the consent or acquiescence of a public official or other person acting in an official capacity. It does not include pain or
suffering arising from, inherent in or incidental to lawful sanctions”

(B) Who can commit torture - Torture may be carried out by (1) Criminal and terrorist groups, and (2) By the police or other security force
personnel during the detention and interrogation of prisoners and suspects.

(C) Objective of torture - Objects of torture are (1 ) To obtain confession (2 ) For interrogation and obtaining information (3) to obtain
testimony incriminating others (4) to take revenge (5) To spread terror in a community, (6) to destroy personality of individuals
[brainwashing] who raise voice against unjust rule, (7) for sadistic reasons

(D) Methods of Torture : -

(I) Physical Torture :-

(1) Animal bites - Causing an animal to bite the victim. Rats may be used to torture a victim by encouraging them to attack and eat him
alive (Rat torture).

(2) Beating: - Beating is the commonest form of torture. Beating can be from head to toe. It can be without external objects – fist, slapping,
kicking. Instrument used - blunt instruments like belt, bicycle chains, lathi, metal or wooden bar, whip etc.

(i) Bastinado or Falanga [also known as falaka, falaqa, foot whipping] - The victim may be suspended upside down and then beaten on the
soles by blunt instruments such as sticks, clubs or rifle butts]. Favored by perpetrators, because (a) Extremely painful and debilitating [there
is clustering of nerve endings in the feet] (b) Foot being weight bearing organ, injuries take long time to heal (c) leaves few physical marks.
(d) Detection - Deep dissection of soles may be necessary.

(ii) Poking the victim with a baton or rod is common.

(iii) Beating buttocks: Literally, this is called 'passing the board'. A victim is forced to the ground and beaten viciously with a board, club or
baton.

(iv) Beating on the abdomen while lying on a table with the upper half of the body unsupported (‘operating table’ or ‘el quirofano’).

(v) A pole is placed on the back of victim and is pressed down with great weight and then rolled up over the legs and the body (‘the roller’
or ‘belena’).

(vi) Telefono (Ear torture): Repeated and simultaneous slapping of both the ears by open hands of the torturer. Effects - may cause (a)
rupture of the tympanic membranes (b) injury to inner ear.

(vii) Examination of victim of beating – (a) Beating/flogging results in scars, bruises, lacerations and fractures at different stages of
healing and which have not been treated medically. Many of these weapons leave a characteristic patterned bruising (including tramline
bruising, finger grip or slap mark) on the skin.

(b) Target and injuries produced - Back [Most common] - abrasions, contusions, lacerations are produced. Abdomen - rupture of viscera
may occur. Head - head injury, skull fractures, intracranial hemorrhages
(c) Detection in the living - via ultrasound. Detection in the dead- Bruising in the back is not seen superficially because of thick fascial planes
[same is true of soles also]. Deep dissection is necessary to reveal bruising. Aseptic necrosis may be seen.

(3) Forcing the person in abormal positions: It can be:

(i) Prolonged standing (‘el planton’) like in the 'Army Corps' posture or body-folding or on one leg. Forced standing: Types (a) standing on
both feet (b) On one foot [could be in hot sun to increase pain]. It is Called Planton in Latin America and stoika in the Soviet Union. An
attractive option for torturers because like water torture,it leaves no marks. Effects are (a) Swelling of the ankles and feet to twice their size
within 24 hours (b) moving becomes agonizing (c) Development of large blisters (d) Increasing of the heart rate and fainting.

(ii) Sitting (iron chair sitting) or forced to squat for a long time.

(iii) Forced straddling on a bar or wooden horse (‘saw horse’ or ‘el cabellete’) The victim is forced to ride a saw-horse shaped device,
which has a pointed edge across that top which causes perineal and scrotal hematoma, or tied up in an abnormal position for hours
(‘hogtie’).

(iv) Tiger bench - "Tiger bench" is a small iron bench app 20 cm tall. Victim's hands are tied together behind the back while his knees are
tied down to the bench. Some hard objects such as bricks are inserted under the tied legs, causing the legs to bend upward in an unnatural
way that causes them to break at the knees.

(v) Chepuwa – A Bhutanese torture technique. Both thighs and legs are tightly clamped with bamboo for a number of days. The 2 sides of
the clamps are pressed with torturer's legs or he may stand on the 2 sides of the clamps.

(4) Suspension
(i) Victim may be suspended by his wrists (‘la bandera’), ankles (‘murcielago’), arms or hair. May cause injuries to the parts used for
suspension
(ii) Person may be suspended head down from a horizontal pole placed under the knees with the wrists bound to the ankles (‘parrot’s
perch’, ‘jack’ or ‘pau de arara’). The entire assembly is suspended between two metal platforms forming what looks like a parrot's perch.
Causes headache, severe joint and muscle pain, as well as psychological trauma

(5) Heat injuries – Burns - Methods used (i) Application of (a) cigarette butts (b) heated solid body (c) hot iron
(ii) Dropping molten rubber on skin
(iii) Kerosene soaked rags wrapped around limbs and set on fire
(iv) Throwing (a) acid or (b) boiling water on the victim
(v) Black Slave - A hot skewer shoved up the anus. Causes perianal and rectal burns.
(vi) Foot roasting – Victim is immobilized. Red-hot iron plates are pressed to the soles of his feet.

(6) Cold torture - Victim is stripped naked and made to lie on (i) cold, damp floor (ii) slab of ice, (iii) Icy water is poured over head,
(iv) forced to strip naked and stand outside on a winter night, (v) forced to stand in snow or on ice with bare feet or submersing in ice-cold
water

(7) Suffocation - Dry submarino (submarino seco) - Near suffocation by pulling a plastic bag [usually a shopping bag sometimes containing
chillies and / or petrol] over the head and face

(8) Waterboarding (simulated drowning) consists of submerging the victim’s head repeatedly under water or in foul liquid, like sewerage
water. Forced suffocation and water inhalation cause the subject to experience the sensation of drowning. It has been referred to as ‘water
torture,’ ‘water cure,’ ‘el submarino’ (‘wet submarino’), ‘pileta’ and dunking. Feces [or other extraneous material] in lungs at autopsy.

(9) Electric torture - Also called cattle prod. Types (i) Picana: (a) victim is strapped to a wooden table and wetted to aid the flow of
current, (b) Current [DC, usually powered by an automobile battery] is applied to sensitive parts of the body eg head, temples, eyes, mouth,
teeth, tongue, breasts, nipples and genitalia
(c) a doctor is present to make sure that the victim has no heart problems and can survive the interrogation
(d) Effects - May result in the loss or fracture of teeth.
(ii) La parrilla (metal grill): Electric shocks given while the victim is tied to a metal bed frame.

(10) Irritant torture: Scratching with knife and sprinkling lime juice or chilli powder. Application of irritant substances to cause itching or pain
Irritating chemicals (e.g. chillies) may be inserted into the rectum or vagina, or applied on the eyes or external genitalia. After contact with
hemp (a plant), the skin immediately becomes inflamed, extremely itchy and painful. Victims are slapped, or stripped naked and thrown onto
a pile of hemp

(11) Force-feeding of saturated salt-water, vinegar, liquor, pepper, mustard oil, boiling water, urine or feces.

(12) Other physical tortures commonly done –

(i) Denailing — Forcible extraction of the fingernails and/ or toenails
(ii) Disfiguration - By throwing corrosives on face and other parts of the body
(iii) Finger torture: (a) A pencil or similar object kept between fingers, and they are squeezed hard (b) Twisting of fingers
(iv) Hair - may be plucked, or the victim may be dragged by the hair.
(v) Mutilation – Chopping of ears, fingers, nose etc
(vi) Teeth torture: (i) Forcing the victim to chew hard on pieces of metals or stones (ii) pulling away teeth by clips or forceps.

(vii) Ghotna involves rolling a wooden log or iron rod up and down the thighs, while the log is weighted by one or two policemen standing
on it. This causes rupture of muscle fibres and blood vessels. Severe pain and often unconsciousness and the victim are unable to walk for
several weeks. The ghotna may also be applied by placing it behind the knees and then forcibly flexing the legs over it.
(viii) Knee capping - Victim is shot through the knee joint. Common in Northern Ireland.

(13) Starvation

(14) Water torture - Victim is restrained and kept thirsty. Drops of water allowed falling over his forehead at intervals of 20-30 seconds.
Causes dehydration. If death is caused, features of dehydration prominent [e g. vitreous humor electrolytes abnormalities].

(15) Some important findings in a victim of physical torture –

(i) Battered body: Deaths usually result from severe closed blunt force head injuries with cerebral contusion and laceration, with or without
skull fracture. Blunt trauma to the abdomen is the second most common cause of death due to tearing of the mesentery or laceration of
internal organs.

(ii)
FINDINGS IN SOME SPECIFIC TORTURE METHODS
(II) Mental Torture
(1) Deprivation techniques - Victims are deprived of various necessities so that they are mentally tortured. These techniques include –
(i) Sensory deprivation, where the victim is deprived of various sensory stimuli such as light, sound, etc. The victim may be blindfolded,
hooded, kept in a dark room, etc.
(ii) Perceptual deprivation, where victims are deprived of perceptions so that they become disoriented and confused, for example, frequent
transfer of victim from one place to another while blindfolded, frequent disturbance of sleep, etc.
(iii) Social deprivation, where victims are deprived of seeing visitors or solitary confinement in a dark isolated cell.
(iv) Deprivation of basic needs, where victims are deprived of basic needs like food, water, medical facilities, clothes, comforts,
communication, etc.
(v) Sleep deprivation.

(2) Coercion techniques –

(i) Causing mental anguish by giving false information to victim regarding tragedy involving wife and children.
(ii) Mock execution - Victim is deliberately but falsely made to feel that his execution or that of another person is imminent
(iii) Threat of permanent, severe disfigurement to victim or his loved ones [e.g. wife, children]
(iv) Witness Torture- Victim is forced to witness the torture of another person or family members.

(3) The communication technique – Counter-effect technique, double blinding technique, disinformation, and distortion of perception and
conditioning of new reflexes. Victim is mentally tortured by giving a variety of confusing, contradicting and false information regarding
tragedy involving close relatives.

(III) Pharmacological Torture - Pharmacological torture involves use of psychotropic drugs or other chemicals to induce pain or other
discomforts and cause compliance with a torturer’s goals. Methods –
(1) Addictive drugs - Victim is forcibly injected with addictive drugs to make them dependent, and then denying the drug.
(2) Corrosives and irritants: (i) direct application of corrosives and irritants to skin to cause itching, pain and chemical ulcers (ii) Body is
scratched with knife and irritants [most commonly chili powder or lime juice] may be introduced in the wound.

(IV) Sexual Torture

(1) Infliction of injuries - to private parts. Suspending weights on scrotum and penis.
(2) Introduction of foreign bodies - in vagina and rectum
(3) Mutilation - of breasts and genitals
(4) Sexual assault, sodomy and rape, forced sex with convicts.
(5) Sexual torture - by trained animals
(6) Undressing before others, parading naked, photographing in humiliating position.

(E) Sequelae
(1) Physical problems can be wide-ranging, e.g. STDs including AIDS, musculoskeletal pain, fractures, brain injury, post-traumatic epilepsy
or chronic pain syndromes. (2) Disfiguration of face
(3) Impairment of hearing and sight
(4) Psychological includes post-traumatic stress disorder (PTSD), phobia, sleep disturbances, irritability, aggressiveness, sexual problems,
suicide ideation, depression and anxiety disorder.
(5) Social sequele includes loss of job, stigma or rejection by society
(F) Examination of torture victim -
(1) ISTANBUL PROTOCOL (V.N. 1999) is the first set of international guidelines for documentation of torture and its consequences. The
doctor should obtain complete history from the patient about methods of torture. Symptoms and disabilities following torture are to be
recorded. Details of acute and chronic symptoms should be noted. The injuries should be recorded in detail and marked on body diagrams.
Photographs of injuries should be taken with a scale placed near the injuries. All the systems of the body should be examined completely.
X-rays should be taken and CT scans done to detect minute fractures and soft tissue injuries.

(F) Treatment - General principles of treatment are

(1) Rapport- Develop good rapport with victim to gain his confidence, (2) Empathize with victim and his family (3) Avoid situation or object
that remind the victim of traumatic event, (4) Treatment of relevant injuries, e.g. burns, fractures etc, (5) Psychotherapy, (6) Rehabilitation,
counseling and re-assurance should be provided.

(G) Investigation
(1) In live patients - Obtain complete history from patient and get relevant examinations like bone scintigraphy [bone scanning], CT
scan, X-ray done
(2) In dead victims - Whole body must be carefully examined. Deep tissues must be dissected [e.g. back, soles etc] to reveal hidden
bruises. Facial skin must be reflected to see injuries over the face.

(H) Medicolegal Aspects

(1) Torture is punishable in Indian law under following sections –
(a) S.330, IPC - Voluntarily causing hurt to extort confession, or to compel restoration of property is punishable with imprisonment up to
seven years, and also fine [Ex - (i) A, a police-officer, tortures Z in order to induce Z to confess that he committed a crime. A is guilty of an
offence under this section, (ii) A, a police-officer, tortures B to induce him to point out where certain stolen property is deposited. A is guilty
of an offence under this section, (iii) A, a revenue office, tortures Z in order to compel him to pay certain arrears of revenue due from Z. A is
guilty of an offence under this section, (iv) A, a zamindar, tortures a raiyat in order to compel him to pay his rent. A is guilty of an offence
under this section ]

(b) S.331, IPC - Voluntarily causing grievous hurt to extort confession, or to compel restoration of property is punishable with imprisonment
up to ten years, and also fine [ex - same as above]

(c) S.339, IPC - Provides definition for wrongful restraint. May amount to mental torture [Ex - (i) A obstructs a path along which Z has a
right to pass. A not believing in good faith that he has a right to stop the path. Z is thereby prevented from passing. A wrongfully restrains Z].
Punishment for wrongful restraint is imprisonment of one month, or Rs. 500 fine or both (S.341, IPC).

(d) Article 21 of Indian Constitution [Protection of life and personal liberty] - Supreme court of India in Francis Coralie Mullin v. Union
Territory of Delhi 1981 AIR 746, has said that “There is implicit in Article 21 the right to protection against torture or cruel, inhuman or
degrading treatment”. In this case, a British national Mullin was lodged in Tihar Jail and given inhuman treatments

(e) Prevention of Torture Bill, 2010 - was introduced in Indian Lok Sabha on 19th April, 2010. This was done to ratify the “Convention
against Torture and other Cruel, Inhuman and Degrading Treatment or Punishment”, adopted by the UN General Assembly on 9th
December, 1975, and signed by India on 14th October, 1997. The Bill has not been passed yet. It provides punishment for torture inflicted
by public servants. According to S.3 of the Bill “if a public servant intentionally does any act for the purposes of obtaining a confession
which causes (i) grievous hurt or (ii) danger to life, limb or health (whether mental or physical), he is said to inflict torture”. Punishment is 10
years and fine (S.4).

(I) Ethical aspects concerning the doctors with regard to torture –

(1) The Universal Declaration of Human Rights (UDHR), 1948 - Declaration adopted by the UN General Assembly on 10 December 1948
in Paris.
(a) Article 3 of Universal Declaration of Human Rights states “everyone has the right to life, liberty and security of a person”.
(b) Article 5 states “No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment”

(2) Article 21 of the Constitution of India guarantees “no person shall be deprived of his life or personal liberty except according to the
procedure established by law”.

(3) Thus right to life, liberty and security of a person are recognized as a fundamental right by the Universal Declaration of Human Right
(article 3) of 1948 and article 21 of the Indian Constitution.

(4) Principles of medical ethics relevant to the role of health personnel, particularly physicians in the protection of prisoners and detainees
against torture and other cruel, inhuman or degrading treatment of punishment (U.N. 1984)

(5) Medical torture - Involvement of medical professionals in acts of torture, in order to judge what victims can endure, and to apply
treatment when victim is about to die, so further torture could be inflicted later. Medical torture is against ethics for following reasons -
(a) Hippocratic Oath prevents it.
(b) Declaration of Geneva, 1948 - Doctors have taken pledge not to use medical knowledge to violate human rights

(c) Declaration of Tokyo, 1975 adopted by World Medical Association states that a doctor shall not –
1. Participate or be accomplices in the practice of torture or any form of cruel, inhuman or degrading procedures against individuals or fail to
denounce them when learning about them.
2. Provides means, instruments, substances or knowledge designed to facilitate the practice of torture or other forms of cruel, inhuman or
degrading procedures against individuals.
3. Be present during any procedure involving cruel or inhuman activities.
4. Forcibly feed any person on hunger strike who is regarded capable, physically and mentally, to have perfect judgment on the possible
consequences of his attitude. In such cases, physicians should let him know on the probable complications of prolonged fast, and in the
hypothesis of impending danger to life and treating him.
5. Use any procedure that might alter personality or consciousness, for the purpose of diminishing his physical and/ or mental resistance, in
the course of police investigation of any other kind.

(d) The World Medical Association will support and encourage the international community, the national medical associations and fellow
professional colleagues, to support a doctor and his family, in the face of threats or reprisal resulting from refusal to condone the use of
torture or other forms of cruel, inhuman, or degrading treatment.

(e) World conference on human rights, 1993 - Freedom from torture is a right which must be protected under all circumstances, including
in times of internal or international disturbance or armed conflicts.
 CUSTODIAL DEATH

Q) Write a note on custodial death & Special procedure for autopsy in custodial death?
A) (I) Definition of word ‘Custody’ – (1) The word ‘custody’ has been derived from Latin ‘custos odis’ meaning guardian.
(2) Black’s Law Dictionary describes it as ‘the care and control of ownership’/‘responsibility for protection and preservation of the
thing/person in custody’, etc.
(3) ‘Police custody’ does not necessarily mean formal arrest. It also includes some form of police surveillance and restriction on the
movements of the person(s).
(4) In the legal parlance, Custody is defined as any point in time when a person’s freedom of movement has been denied by law
enforcement agencies, such as during transport prior to booking, or during arrest, prosecution, sentencing, and correctional confinement.
(5) Persons held in custody by police or by prison authorities retain their basic constitutional rights, except for their right to liberty and a
qualified right to privacy.
(6) ‘Police detention’, however, requires that person has been formally arrested and detained. The word ‘arrest’ when used in the ordinary
and natural sense implies the apprehension or restraint or the deprivation of one’s personal liberty. When used in the legal sense in the
procedure connected with the criminal offences, an arrest consists in taking into custody of another person under authority empowered by
law, for the purpose of holding or detaining him to answer a criminal charge or of preventing the commission of a criminal offence.
‘Detention’ does not mean ‘imprisonment’.
(7) The word ‘imprisonment’ is always used in the sense of punishing a person, whereas ‘detention’ does not denote any punishment.

(II) Definition of ‘Death in custody’ –

(1) Death occurring in some form of custodial detention is commonly known as death in custody, such as police cell or prison. Death in
custody should include the following categories:
(i) Those occurring in prison or while in police custody.
(ii) Those caused or contributed to by traumatic injuries sustained, or due to lack of proper care, while in custody or detention.
(iii) Those in which the fatal injury resulted from police or prison authorities attempting to detain a person.
(iv) Those in which a fatal injury resulted on a person escaping or attempting to escape from police custody or juvenile detention.

(III) Circumstances of death in custody –

(1) Deaths in custody may take place due to varied reasons, which may include inadequate medical facilities, inadequate safety measures
of inmates and negligent behaviour of the prison authorities. However, cases of custodial violence/torture are also being reported and
thereby focussing public concern.

(2) A retrospective study of 277 deaths over the 6-year period (January 1990–December 1996) was conducted by Police Research Group
(PRG) in England and Wales. This paper categorized deaths into three groups:
(i) 63% were due to deceased’s own causal actions, i.e. deliberate self-harm and substance misuse comprising of 17 deliberate overdoses
before arrest and 73 self-hangings;
(ii) 29% due to medical conditions (the most common five causes of death were—heart problems, head injury, lung problems, epilepsy and
liver problems); and
(iii) 8% deaths were such in which another person’s actions might have been associated (including police restraint).
(3) Authors concluded that detention perhaps had little bearing on the death, and drew attention to the need for careful consideration of the
term ‘custody death’.

(III) Death during ARREST: Deaths occurring from physical restraints constitute an important controversial sphere in the investigation of
custodial deaths. Restraining someone may become necessary in certain circumstances, especially when dealing with a noncompliant or
violent person. Methods of restraint may be varied and at one occasion, more than one method may be employed. Methods may include
hand cuffing, arm restraint, neck holds, carotid sleeper, etc.

(1) Traumatic asphyxia may occur if the offender resists arrest, and a number of policemen fall upon him to overpower him. If there is a
struggle, blunt injuries sustained by the offender by the use of fist, arm or leg, riot stick, etc., by the police or from head injury from falls
against ground, wall, etc., may cause death.

(2) HOG-TYING (total appendage restraint procedure) is a type of physical restraint in which the person is placed in prone position with his
wrists and ankles bound behind his back and secured by a cord. The person may have difficulty in breathing or may become unresponsive.
Rarely, death may occur due to varying degrees of asphyxia with heart disease, sympathomimetic drug abuse, and the body's physiologic
response to stress and exertion. Death often occurs not during physical restraint but soon following the restraint.

(3) CHOKE OR CAROTID HOLDS: A choke (bar arm control) or a carotid sleeper hold, do not involve the use of a mechanical implement.
(i) IN CHOKE (BAR ARM) HOLDS forearm is placed straight across the front of the neck. The free hand grips the wrist and pulls it back,
which causes obstruction of the airway and carotid arteries and immediate unconsciousness. The hypopharynx is also occluded by
displacement of the tongue. Fracture of the hyoid bone or larynx may occur if great force is used. Rarely death may occur due to hypoxia
and release of catecholamines due to struggle, resulting in fatal cardiac arrhythmia, especially if the deceased consumed cocaine or similar
drug. Pressure on the carotid bodies can cause death by sudden cardiac arrest.

(ii) In the CAROTID SLEEPER HOLD (lateral vascular neck restraint), standing behind a person the arm is placed about the neck with the
antecubital fossa centered at the midline of the neck. The free hand grips the wrist and the arm is pulled backwards, which compresses the
carotid arteries and jugular veins but not vertebral arteries and the trachea. It causes transient cerebral ischemia. Consciousness is lost in
10 to 15 seconds. If pressure is released the victim regains consciousness in 10 to 20 seconds. The neck structures are not damaged.
Rarely death may occur due to hypoxia and release of catecholamines.

(4) Most deaths occur immediately after an arrest in which there is a violent struggle. Hypoxia may exacerbate pre-existing ischaemic heart
disease, resulting in myocardial infarction or cardiac dysrhythmias.

(IV) DURING LOCKUP:

(1) If the offender was severely intoxicated, he may die of acute alcoholic poisoning, or he may aspirate the vomit and die of choking.
(2) A person may have injuries that were sustained before he was arrested or sustained during arrest may die in custody.
Example – A suspect runs away on seeing police to avoid arrest and hits his head to a roadside electrical pole as he turns his head to see
the chasing police. In police lock-up the suspect complains of severe headache but police ignores it as malingering as there were no
external injuries. Consequently the suspect dies in police lock-up. Postmortem examination showed a large longitudinally running basal
fracture with accumulation of blood.
(3) The drunken offender may fall on a hard surface on the occiput. If on autopsy contrecoup injuries are found, it indicates deceleration
injury rather than an assault with a weapon.
(4) A person with illicit drugs in his possession may swallow the drugs to avoid detection on being caught, and may die suddently while in
custody.
(5) Physical injuries may also occur from falls in drug addicts used to amphetamine, cocaine or hallucinogens.
(6) Torture by kicking and stomping, or a backward blow from the point of an elbow on the face, neck, or abdomen, fist blows, etc., inflicted
with sufficient force can cause severe damage and death.
Example - case of a man, who was forcibly restrained by the police (allegedly after an assault during which he, probably, had been struck in
the abdomen). Owing to drunkenness, little did he realize his condition and remained for a few hours in the police cell. He collapsed while
going to the lavatory, never having complained of any abdominal pain. Autopsy revealed several litres of blood in the peritoneal cavity
occasioned through the several tears in the mesentery.

(V) Deaths due to chemical restraint – A few deaths have been reported due to use of chemical agents to retraint people usually during
riots etc. This may include substances used for immobilization or drug administration. Irritant spray devices like chloroacetophenone (CN),
orthochlorobenzalmalononitrile (CS), oleoresin capsicum (OC), etc. have been used for such purposes.

(1) OC [Oleoresin capsicum] is a crude extract of hot peppers. On application to ocular membranes, it causes stinging, lacrimation and
blepharospasm, which may vary from involuntary blinking to sustained eye closure. Capsaicin in aerosol causes tingling, coughing and
shortness of breath to a varying degree. Immediate decontamination with soap and water (intact skin) or saline (vesiculated skin and eyes)
followed by symptomatic measures are usually successful in bringing back visual acuity and nasal breathing in a few minutes.

(2) ‘Chemical mace agents’ like CN [Chloroacetophenone] and CS [ Orthochlorobenzalmalononitrile] have also been in use. [These
chemicals, the so-called ‘lacrimators’, used to be employed for temporarily incapacitating/immobilising the enemy or the public. They were
popularly known as ‘riot control agents’. The eye damage is complicated by the method of delivery of these agents. The two most common
modes/forms of delivery were the pencil-like tear gas gun and the aerosol can, used by law enforcement agencies in the United States
under the trade name Mace.]

(VI) SUICIDE IN CUSTODY: The common method is hanging. Sometimes a poison may be consumed, or he may jump from a height, or cut
his throat or a large blood vessel.

(VII) Death may occur due to natural causes, usually cardiovascular. The emotional upset may precipitate an acute cardiac crisis in the
presence of severe pre-existing disease.

(VIII) Some methods of physical abuse may not leave any apparent marks of violence, such as hair-pulling, face slapping and blows to the
side of the head which may cause perforation of the eardrum. Blows to the abdomen may not cause any apparent mark. Pinching,
squeezing and blows to the testes may produce bruising of the skin and swelling and tenderness of testes. The soles may be struck with a
baton, ruler, etc.

(VIII) In many custody or restraint related deaths, physiologic processes have a prominent role in the death, which are not identifiable at
autopsy.
(IX) Death within few days of release from custody –
(1) There may be cases where the individual has died within a few days of release from police custody. Family of the deceased may allege
the death is due to custodial torture. In such cases autopsy plays a very important role in deciding if death is due to torture in custody or due
to some other reason after the release from custody.

(2) It is understandable that kicking, stamping, and punching, etc. over chest and abdomen lead to serious injuries and internal bleeding
without any external signs of injuries. Condition may be unrecognized especially when the victim is intoxicated

(3) Example - case report of autopsy findings in case of death of a person after 2 days of release from police custody – The autopsy did not
reveal any external physical injury. Internally, peritoneal cavity showed about 200 ml of greenish fluid. Toxicological analysis revealed
presence of ethyl alcohol in the contents of stomach, intestines, liver, spleen, and kidney. Histologically, lungs showed acute pulmonary
oedema and pulmonary haemorrhages with emphysema. Kidneys showed ischaemic acute tubular necrosis. Mesentery showed
haemorrhagic enteropathy with changes of peritonitis and fat necrosis (injury to the mesentery may damage local arteries without causing
severe bleeding, but may occlude or thrombose them; with infarction of the bowel as a consequence). Trauma to the abdomen due to
torture can lead to serious and intractable bleeding. Further, trauma to the upper abdomen can precipitate ‘acute pancreatitis (probably
through contusion of the acinar tissue and disruption of the duct system with the subsequent interstitial leakage of enzymes).

(X) Autopsy in custodial deaths –

(1) The National Human Rights Commission (NHRC), a statutory body has directed the law and order agencies at the district level
throughout the country to report matters relating to custodial death or rape within 24 h of occurrence.
(2) Death in custody require effective handling and investigation as there may be allegations of death due to ill-treatment by law enforcing
agencies
(3) Meticulous autopsy coupled with thorough investigation of surrounding circumstances leading to death is necessary for assessment
towards accidental, suicidal, homicidal or ‘purely natural’ nature of death which is needed to dispel or sometimes confirm allegations that an
act of commission or omission on the part of custodians has led to or contributed to the death.
(4) With a view to prevent tampering of postmortem reports, the NHRC issued instructions to all the States to video film the postmortem
examination of all suspected cases of custodial deaths and send the CDs to the Commission. The Commission also decided to revise the
autopsy form to plug the loopholes and to make it more incisive and purposeful.
(5) Autopsy will be conducted by a board of doctors and not a single doctor.
(6) In such cases, it is desirable that at the time of autopsy, interested parties such as relatives or their representative and the police/prison
authorities be properly heard.
(7) To carry out another autopsy at a later date may not be free from hazards because the organs would have already been dissected and
samples obtained, wherever necessary. Further, with the passage of time elapsing death, bruises undergo changes including varied degree
of spreading and coalescing with surrounding injuries. There may, however, be occasion(s) when no clear answer can be approached
despite exhaustive exercises.
(8) Exhaustive notes must be made, including the description of how the deceased was identified.
(9) Incisions at autopsy of custodial death - .
(1) Meticulous scrutiny of front as well as back of the body is required.
(2) In addition to the usual Y-shaped front incision, backside of the body also needs be scrutinised especially against regions of shoulders,
buttocks, back of thighs and calf muscles, etc.
(3) Critically examining the body from front as well as back is necessary especially when there is a suspicion of crush injuries (probably
produced through moving a roller upon selected areas or through other means). In such a case, there may be considerable bruising and
crushing of the muscles including soft parts with minimal evidence of surface findings.
(4) Example case report - A victim (about 38-years male) had been apprehended under the Arms Act and died while under custody. At
autopsy apart from gross discoloration of skin surface (bluish-black, reddish at places) no trauma was appreciable. However, on exploration,
reddish black blood was present in the soft tissues and muscles of the whole of front and inner back of thighs and back of right leg.
Chemical examination revealed negative results. Serum myoglobin was estimated to be 108μg/L (normal <85μg/L). Histopathology revealed
massive necrosis of skeletal muscles (from different sites). Skin tissue (from different sites) showed necrosis and inflammation. Lung
showed acute pulmonary edema, and kidney showed acute tubular necrosis. Death was attributed to “acute renal failure due to
myoglobinuria caused by blunt force trauma to the lower limb muscles”

Elongated X-shaped incision on the back for

subcutaneous tissue dissection is carried out in
custodial death cases. This is useful to evaluate
the extent of blunt injuries which are usually
missed when superficial imprints are faint,
particularly when present on the skin and not on
overlying bone
(X) Measure recommended for prevention of custodial deaths and to reduce allegation on police:-
(1) Complete pre arrest medical check-up as per NHRC guidelines. This must include screening of diseases like HIV, HBV, Tuberculosis,
Diabetes, Hypertension and previous psychiatric illness.
(2) Custodial authorities should maintain proper registers regarding health issues of each inmate.
(3) A surveillance team of qualified persons under the supervision of collector/ executive magistrate consisting of physician, surgeon,
medico legal expert, and food inspector should be appointed to regularly inspect health care facilities, accommodation facilities and quality
of food supplied.
(4) Closed circuit television cameras (CCTV) should be installed in all cells and police lockups to have the check on the activities of inmates
and custodial authorities.
(5) Timely education and training program should be organized by custodial authorities with the help of nearest government medical college
to address the health issues of jail inmates and to increase health awareness. This should also include health check up by medical
professionals.
(6) Awareness cum training programs should be undertaken by NHRC to make prison inmates aware about human rights.
(7) Appreciating the problem of overcrowding of jail inmates, it is needed to increase number of jails to accommodate extra burden.