9 Identification of Human Remains
An important duty of coroners, medical examiners, and forensic
pathologists involve s the identification (ID) of deceased indi-
viduals. While this process does not usually present many diffi-
culties, the consequences of misidentification can be significant
and long lasting. The most common mistake involves the inad-
vertent misidentification of two bodies as each other. This type
of error is most likely to occur in cases of multiple deaths in
a single incident, particularly if the deceased individuals are of
the same gender and race, with similar ages and sizes. The
possibility of such errors is also increased in busy offices where
there are many bodies entering and exiting the facility on a daily
basis, particularly if there are not well-established identification
policies and procedures in place.
In many cases investigated by medicolegal death teams,
initial inquiries will produce a preliminary or tentative identifi-
cation. For example, important circumstantial evidence, such as
a drivers license found in the decedents possession, may point
toward the identity of the deceased. However, a definitive pos-
itive identification is required. This can be established by
a variety of means with the most common method being visual
identification by family members. Although this is most often
utilized, it must be recognized that it is not a scientific method,
and major mistakes have been known to occur. In addition, in
a number of cases visual identification is not possible. This most
often occurs when there has been facial disfigurement from
trauma, fires, or putrefaction.
The most reliable methods of identification involve a more
scientific approach where a unique feature of the unidentified
decedent can be compared to a likely match. This requires that
the features of both are compatible, with no significant features
that do not match. Examples of scientific methods of identifica-
tion include fingerprint comparison, dental comparison and
x-ray comparisons, and DNA typing. For each of these methods
(except for DNA typing) an antemortem (prior to death) record
must exist and be available for a successful comparison to be
made.
If identity cannot be established by any of the above pro-
cesses, then other features may be useful in helping to make
J.A. Prahlow, R.W. Byard, Atlas of Forensic Pathology, DOI 10.1007/978-1-61779-058-4_9,
# Springer Science+Business Media, LLC 2012
a positive identification. Examples of other features that can be
used include the location and appearance of various birthmarks,
scars, implanted medical devices, or tattoos. These may all have
features that make them unique to a specific individual, for
example, a particular tattoo with names and dates of family
members. Finally, the circumstances of the death may provide
useful information, for example, a single body in a burnt out
house owned by an individual who has not been seen since the
fire. Although this is the least certain method of positive iden-
tification, it is sometimes all that is available.
In a minority of cases a positive identification will not be able
to be made. This situation is more common in large metropol-
itan areas among transient or homeless individuals when no one
comes forward to identify the decedent despite the body being
visually recognizable. This problem is compounded if bodies are
badly decomposed or skeletonized, a situation that occurs in
rural areas. When the body is not able to be identified, forensic
pathologists will perform the full range of investigations so that
if a possible identity is subsequently suggested then all of the
necessary information and material for comparison will be
available. Such material includes total body photographs, fin-
gerprints, total body x-rays, dental charts and x-rays, and DNA
samples (blood, hair, bone, and teeth). Forensic anthropologic
assessment of skeletonized remains can also provide useful esti-
mates of the age, race, gender, and stature. On occasion,
a forensic artist may attempt a clay facial reconstruction over
an unidentified skull, or a computer image of the face may be
created, with publishing of such images to the public to find
anyone who may recognize the person.
In 2007, the United States National Institute for Justice initi-
ated the NamUS program in collaboration with forensic pathol-
ogists and medical examiners. This is a computerized database
that is amassing data on unidentified decedents from U.S. death
investigation agencies. The stored information includes photo-
graphs, dental records, x-rays, and unique external and internal
features, as well as items related to the possible date of death,
etc. The aim is to match cases from the NamUS and missing
persons databases, increasing positive identification rates.
200 9 Identification of Human Remains

. Fig. 9.1
Bodies recovered from fires may be burnt beyond recognition
 Identification of Human Remains 9 201

. Fig. 9.2
Badly decomposed bodies are typically not visually
identifiable

. Fig. 9.3
Depending on the injury type, severity, and location,
persons who are victims of severe trauma may not be
visually identifiable. This was the victim of a motor
vehicle collision
202 9 Identification of Human Remains

. Fig. 9.4
Even if a fire victim has not been totally charred, they may be burnt
beyond recognition, and so a scientific method of identification
should be sought

. Fig. 9.5
For obvious reasons, skeletal remains cannot typically be identified
visually as there has been complete loss of soft tissue features that
determined antemortem morphology
 Identification of Human Remains 9 203

. Fig. 9.6
Another example of severe trauma resulting in facial distortion such that visual identification was impossible
204 9 Identification of Human Remains

. Fig. 9.7
Hospital identification bands are often
considered verification of positive identity

. Fig. 9.8
An identification photograph may be
shown to a family member to positively
establish the identity of a decedent
 Identification of Human Remains 9 205

. Fig. 9.9
Many offices routinely take fingerprints on all bodies. This is an example of a ten-print fingerprint card

. Fig. 9.10
Ink being applied to a decedents finger at autopsy
206 9 Identification of Human Remains

. Fig. 9.11
A fingerprint being taken from a decedent at autopsy

. Fig. 9.12
In certain decomposition cases, all or a majority of the skin of the hands and fingers may slip off. This image shows a hand without most
of the skin
 Identification of Human Remains 9 207

. Fig. 9.13
The degloved portion of skin that slipped off the hand shown in > Fig. 9.12

. Fig. 9.14
Skin of the fingers and hand being applied as a glove
208 9 Identification of Human Remains

. Fig. 9.15
Using a gloved hand, the pathologist or assistant can place his/her own finger inside the decedents finger skin and produce a fingerprint
that can be used for identification purposes

. Fig. 9.16
A fingerprint being produced via a degloved finger
 Identification of Human Remains 9 209

. Fig. 9.17
Above: An antemortem (before death) dental x-ray, received from the decedents dentist for comparison purposes. Below:
A postmortem dental x-ray performed at autopsy. Comparison of this x-ray to the antemortem x-ray allowed positive identification to be
made in this case. Note the unique shapes of the fillings, which appear as radiopaque (white) areas within the teeth
210 9 Identification of Human Remains

. Fig. 9.18
Besides x-rays, dental charts can be used to make positive identification. This is an example of a dental diagram created at autopsy, for
comparison with antemortem records
 Identification of Human Remains 9 211

. Fig. 9.19
A pattern of marked wearing of the teeth with no dental caries or fillings are characteristic features of tribal Aboriginal Australian
remains excavated from pre-European contact graves

. Fig. 9.20
A closer view of a markedly worn molar tooth from an archaic aboriginal burial in South Australia
212 9 Identification of Human Remains

. Fig. 9.21
Notching of the front teeth may be a marker of a long-term pipe smoker

. Fig. 9.22
When a body is not viewable for funeral purposes, dental charting and radiography can be made much easier by first cutting away the
skin and soft tissues of the face, thus exposing the underlying teeth. In the example shown, a dental x-ray is being performed
 Identification of Human Remains 9 213

. Fig. 9.23
Another example of a case in which the soft tissues of the face have been removed in order to better visualize the teeth

. Fig. 9.24
A maxilla (upper jaw) that has been cut away from the rest of the skull in order to better visualize, and more easily x-ray, the teeth.
It is vital that the maxilla is clearly labeled once it has been removed from the body. Loss of identifying labels created significant
problems with some of the body identifications during the South-East Asian tsunami
214 9 Identification of Human Remains

. Fig. 9.25
Despite extensive traumatic disruption, as in this case from a vehicle crash, dental identification may still be possible if fragments of
teeth can be retrieved

. Fig. 9.26
An x-ray being performed on a badly burned body
 Identification of Human Remains 9 215

. Fig. 9.27
Left: A close-up view of an antemortem (before death) neck x-ray, received from a hospital for comparison purposes. Right:
A close-up view of a postmortem neck x-ray corresponding to the antemortem film. Note that the unique shapes of the spinous
processes of the vertebral column in each x-ray are identical, allowing for positive identification

. Fig. 9.28
A skull x-ray, showing the unique shape of the frontal sinuses, which represent radiolucent (darker) air pockets within the skull of the
forehead (arrows)
216 9 Identification of Human Remains

. Fig. 9.29
Another example of an x-ray of the frontal sinuses revealing a unique shape that can be linked to a particular individual

. Fig. 9.30
The top part of the skull that has been cleaned to show the typical air spaces that may be present in the frontal sinuses enabling
individual identification to be made
 Identification of Human Remains 9 217

. Fig. 9.31
The site of previous fractures with healing may be useful in identification. In this case a poorly healed fracture of the tibia and fibula of
the lower leg would have resulted in shortening of the leg and a history of walking with a limp
218 9 Identification of Human Remains

. Fig. 9.32
Sometimes underlying diseases of bone may be present, such as Pagets disease where there is prominent thickening of the skull. This
may have resulted in the decedent suffering from deafness

. Fig. 9.33
Skeletal remains from indigenous individuals may show a squatting notch on the lower part of the tibia (arrowheads)
 Identification of Human Remains 9 219

. Fig. 9.34
An x-ray showing orthopedic hardware that was useful in positively
identifying a decedent

. Fig. 9.35
A postmortem hip x-ray in a badly decomposed woman shows the
presence of an artificial hip
220 9 Identification of Human Remains

. Fig. 9.36
A photograph of the artificial hip removed at autopsy. Many such
implanted devices have unique serial numbers that can be traced,
through the manufacturer, to the individual

. Fig. 9.37
An x-ray at autopsy may reveal orthopedic appliances such as this
knee replacement. Comparison of this x-ray with those taken during
life may assist with identification
 Identification of Human Remains 9 221

. Fig. 9.38
Dissection of the knee shown in the previous > Fig. 9.37 reveals the metal and plastic implants
222 9 Identification of Human Remains

. Fig. 9.39
Once the pieces have been cleaned identifying numbers may be found. Although each piece may not have unique identifying number in
every country, the constellation of devices used in one person may be very useful in facilitating identification

. Fig. 9.40
Implanted medical devices, such as this cardiac defibrillator within the upper left chest, can allow for positive identification to occur at
autopsy via unique serial numbers contained on the device and within the medical records
 Identification of Human Remains 9 223

. Fig. 9.41
Sites of previous cranial surgery may be identified on
x-ray if there are metal screws or plates. In this case
a healed craniotomy incision has been found in a skull
at autopsy with a small metal plate

. Fig. 9.42
Another healed craniotomy site identified in
skeletonised remains. This is not a fracture
224 9 Identification of Human Remains

. Fig. 9.43
Large collections of bones may prove to be very difficult to positively identify. These were recently dug up in Berlin, Germany and date
from the Battle of Berlin at the end of the Second World War (Photograph provided courtesy of Prof Michael Tsokos, Charite University
Berlin, Germany)

. Fig. 9.44
Certain individuals may have congenital deformities such as these malformed toes that are a unique identifier
 Identification of Human Remains 9 225

. Fig. 9.45
Some types of injuries may leave subtle markings. The iris in this case has been stained brown in the upper part from a previous
perforating metal foreign body

. Fig. 9.46
Jewelry, such as this watch, can be quite valuable in making a positive identification particularly if it is unique or personalized (inscribed
with the individuals name); however, it must be recognized that basing a positive identification solely on such jewelry is not considered
scientific
226 9 Identification of Human Remains

. Fig. 9.47
The rings on these fingers provide useful circumstantial evidence of identity but more scientific methods to establish definitive
identification are required

. Fig. 9.48
Piercing sites can be considered further evidence for a positive identification, but should not be the sole criteria utilized as they are not
unique
 Identification of Human Remains 9 227

. Fig. 9.49
Dentures, such as those shown in the photo, can
be useful in ensuring positive identification.
Caution should be exercised, however, since it is
not unheard of for elderly individuals, particularly
those in extended care facilities and those who
are demented, to use other persons dentures

. Fig. 9.50
An intrauterine device found within the uterus at
autopsy can provide an additional piece of
information useful in making a positive
identification
228 9 Identification of Human Remains

. Fig. 9.51
The history of a recent toe amputation in this
decedent was one of several factors which allowed
positive identification to be made

. Fig. 9.52
A tattoo may represent one of several features of
a body that allows for positive identification
 Identification of Human Remains 9 229

. Fig. 9.53
The implantation of plastic balls under the skin of the penis with the tattoo
of a womans name may provide unique identifying information

. Fig. 9.54
Penile implants in conjunction with tattoos are also useful in identification
230 9 Identification of Human Remains

. Fig. 9.55
Tattoos of eyes over the buttocks are an
unusual design that may assist with
identification

. Fig. 9.56
Tribal tattoos such as the one depicted
here from the South Pacific may indicate
that the decedent came from a particular
cultural or ethnic group
 Identification of Human Remains 9 231

. Fig. 9.57
Tattoos may be extremely rudimentary indicating application at home or in prison. Certain prison groups, such as those from Russia or
the former Soviet Union, may have extensive tattooing providing a history of crimes committed, convictions and subsequent
incarcerations

. Fig. 9.58
Another primitive tattoo
232 9 Identification of Human Remains

. Fig. 9.59
On occasion, certain body parts such as the umbilicus may be incorporated into a tattoo design
 Identification of Human Remains 9 233

. Fig. 9.60
Modern fine line tattoos may be extremely sophisticated
234 9 Identification of Human Remains

. Fig. 9.61
Extensive whole body tattoos are found in certain criminal groups such as the yakuza from Japan
 Identification of Human Remains 9 235

. Fig. 9.62
Tattoos may survive incineration and may also be demonstrated more clearly in an area of burns if the superficial skin layers are removed

. Fig. 9.63
Humorous tattoos tend to be individualized
236 9 Identification of Human Remains

. Fig. 9.64
To assist in positioning radiotherapy
beams for the treatment of cancer small
dots may be tattooed onto the skin over
the tumor. In this case the tracheostomy
indicates that there was a cancer of the
larynx that was surgically removed. The
arrows point to radiotherapy tattoos

. Fig. 9.65
Identifying scars may be revealed more
clearly in decomposed bodies if the
surface layer of skin is removed
 Identification of Human Remains 9 237

. Fig. 9.66
Scarification in individuals from Africa may be very useful in identifying the specific tribal group that the decedent belonged to.
Symmetrical designs can be seen around the umbilicus and upper abdomen
238 9 Identification of Human Remains

. Fig. 9.67
Tribal scarification of the flank

. Fig. 9.68
Sorry scars on the shoulder and upper arm of an Australian Aboriginal male that were inflicted as part of traditional mourning
ceremonies
 Identification of Human Remains 9 239

. Fig. 9.69
Subincision of the penis is another marking that may be used to identify a traditional Australian Aboriginal male
240 9 Identification of Human Remains

. Fig. 9.70
Occasionally, skeletonized remains are examined at a medioclegal
death investigation office, but there is absolutely no indication of
the identity of the decedent, either by body exam or scene/
circumstance. After forensic anthropologic examination to
characterize the race/ethnicity, gender, and approximate age of the
individual, the forensic pathologist may choose to send the skull to
a forensic artist, who then attempts to reconstruct the facial features
of the decedent (see > Fig. 9.71)

. Fig. 9.71
A forensic artists facial reconstruction over the skull shown in
> Fig. 9.70. A photo such as this can be published, with the hope

that someone might recognize the person. If someone believes that

the decedent might be a particular person, then scientific methods
for identity can be undertaken
 Identification of Human Remains 9 241

. Fig. 9.72
In mass disasters all types of identification methods may be utilized. Here, a large number of putrefying bodies have been brought in for
identification following the 2004 Boxing Day Tsunami in Thailand

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