Just how much drugs did they find in Marilyn's body during
the autopsy?
During the autopsy the toxicologist Raymond Abernathy found her blood
concentration of pentobarbital
{Nembutal} to be 4.5 mg percent. This converts to 45 ppm {parts per
million}. According to the PDR
{Physicians Desk Reference} the toxic amount of Nembutal in the blood
starts at 12 ppm and increases to
the "Usual Death Level" of between 15 to 40 ppm. This means Marilyn
had more Nembutal in her system
than the scale even shows. Almost 4 times the toxic level and three
times the minimum amount it takes
for death to occur. The autopsy shows 13.0 mg percent of pentobarbital
in the liver. This converts to 130
ppm or over 10 times the amount that the blood can handle.
Death usually occurs at 15 ppm, Marilyn was 45 ppm. A lethal dose of
Nembutal is between 2 grams and
10 grams in the average person. Marilyn was taking 100 mg capsules
so 2 grams would be 20 capsules
{or the minimum lethal dose}. So if Marilyn's blood shows to be 3 times
the lethal amount then that
would be 60 capsules. Now add in the amount that was found in her liver
to this amount.
The autopsy shows 8.0 mg percent of Chloral Hydrate in the blood. This
converts to 80 mcg/ml.
According to Micromedix the toxic level of CH starts at 30 mcg/mL and
goes to the lethal level of 100
mcg/ml. This means that she had almost 3 times the toxic amount of
CH and just under the lethal dose.
So she just almost had enough Chloral Hydrate in her blood to kill
her.
As far as amount of pills consumed. Marilyn was taking 500 mg capsules
of CH. A normal dose of CH is
between 500-1000 mg. The lethal does is considered to be 10 grams which
is 20 capsules. Marilyn had
roughly 80% of the lethal dose of 20 capsule amount in her blood so
she would have had to take 17
capsules.
So, how many pills would she have had to swallow to get this amount?
Using the above as a rule of thumb it would add up to 17-18 Chloral
Hydrate and roughly 60-70
Nembutal. Dr. Kay Cassell and INFORM using computer analysis figured
it would take 27-42 capsules to
reach the blood level she had and an additional 11-24 capsules to equal
the amount found in her liver.
Plus approx. 14-23 Chloral Hydrate capsules to reach the blood concentration
found. {no liver amounts
for CH were done}
How many capsules did Dr. Curphy {the head coroner} feel Marilyn
swallowed?
In his question and answer session with the press he stated she would
have had to swallow approx. 47
Nembutal and 17 Chloral Hydrate capsules.
Did Dr. Noguchi agree with this?
To an extent yes he did. In an interview for Omni magazine Dr. Noguchi
{who is a certified toxicologist}
stated "Monroe's liver actually had a level of stored barbiturates
three to four times that of her blood. Yet
her blood level was high enough -- equivalent to about forty or fifty
capsules of regular-strength sleeping
pills. For the average person, ten to fifteen are potentially lethal."
Wow, that is a lot of capsules. Did they find a lot of capsules
still undigested in her stomach?
There were no traces of either drug in her stomach.
Well I have heard that during drug overdose autopsies they don't
find any capsule residue
sometimes. Can this be?
Yes, it has happened. Except when they found no traces of pill residue,
they tested the 20 cc's {just less
than a shotglass} of mucoid fluid found in her stomach under a polarized
microscope and found no trace
of any refractive crystals from either drug. The polarized microscope
is still the type of microscope used
today to detect drug crystals. So no capsule residue and not even a
trace of any of the crystals.
Well how do you know this isn't common?
Joseph Mato who is a toxicologist at the LA County Coroner's Office
has stated:
"With death through oral ingestion, the concentration of drugs would
be highest in the stomach when
compared to stomach levels resulting from intramuscular or intravenous
ingestion". "It is nearly
impossible for a subject to die precisely at that moment when the entire
medication would be absorbed
beyond the stomach".
Is there any research on this type of death?
Two leading specialist in the field of psychoactive drug-induced deaths,
psychiatrist and neurologist
Louis A. Gottschalk and toxicologist Robert H. Cravey were pioneers
in developing the Standard Uniform
Rating System in 1972. Their findings published in their book Toxicology
and Pathological Studies on
Psychoactive Drug_Induced Death, enumerate autopsies of over 1500 frequent
drug users. Each and
every autopsy of a death caused by oral ingestion included drug analysis
of the stomach contents in
EVERY case large concentrations to lesser amounts of the specific drug
taken orally were found in the
stomach. Dr. Cravey is quoted as saying "In EVERY case of a drug overdose
through oral entry I have
ALWAYS found drugs in the stomach". Notice the right column showing
stomach concentrations:
Is there a chart I can compare Marilyn's blood level to any of
these subjects?
Yes, this chart will show you the average amount of blood concentration
that were found in their subjects.
Notice underlined in red you will see the amount it took on average
to kill these people. Marilyn had
twice the drug concentration in her blood that these subjects had on
average. Notice it took less
Pentobarbital to kill a person when others drugs were taken with it.
Do you know the amounts of each subject as compared to Marilyn?
Well then all those drugs must have already been digested into
the small intestine. Did they check
there?
They did check the first stage of the small intestine called the duodenum.
This is where the drugs would
have mainly started to secrete into the blood stream. They found no
traces of refractive crystal there
either. Here is the part of the actual autopsy referring to this:
Did Marilyn even have this enormous amount of drugs on hand?
It is possible, but she would have had to been saving them from months
before. According to the
pharmacy invoice and the pill bottles found on the scene we only have
proof that she had 25 Nembutal
capsules available to her that last week. Dr. Engleburg stated in 1962
that he gave her a prescription of
Nembutal a few days before her last bottle of 25 but the pharmacy records
don't agree with this. He said
the bottle dated Aug. 3rd was a refill but that bottle had a new order
number so it wasn't a refill. If she did
have the Nembutal from a few days earlier then the amount she had on
hand would be 50 Nembutal total.
The pharmacy records can only account for 25. She did have more than
50 Chloral Hydrate on hand. So
no, she most likely did not have more than 25 Nembutal on hand.
So she didn't even have enough drugs on hand to take a handful
every hour of the day and it slowly
kill her then. Well let's say she did have a hidden stash of
Nembutal. Would they show up in her
stomach or small intestine if she took them a few at a time every
hour of that day?
The capsule residue might not but the crystal make-up of the drug would.
There was nothing else in her
stomach except that 20 cc's of fluid so it's unimaginable that they
couldn't find even a trace of any
refractive crystals in this fluid or on the lining of her stomach and
small intestine. Again refer to the chart
showing these subjects all had some trace of the drug in their stomach.
This chart doesn't even test the
small intestine which would show even higher amounts in Marilyn's case
if she would have consumed
this amount of capsules.
Maybe they just were not able to see the crystals with the equipment
they had back then?
The LA Coronor’s lab was well equipt at the time. The microscope they
used was a polarized microscope
which is the exact same microscope used today when looking for drug
crystals.
OK, let's go back to the day before. Maybe she took allot of the
Nembutal the day before and just
enough to kill her on the 4th?
The half-life of Nembutal is 15 hours in people with a high tolerance
to this drug. Half-life means the
amount of time the drug has done what it is supposed to do and half
has left the body. Marilyn had been
taking Nembutal for a very long time and tolerance can start after
just 2 weeks of taking this drug. Any
Nembutal that would have had any large affect on the blood concentration
in her system would have had
to have been consumed late morning or later on the 4th.
Is this the same with Chloral Hydrate?
No, Chloral Hydrate has a half-life of only 4 hours in people with
a high tolerance. Chloral Hydrate also
starts developing a tolerance after 2 weeks. Plus Chloral Hydrate has
a cross tolerance with Nembutal.
Barbiturates, alcohol and other sedative-hypnotics are all cross tolerant.
So a person with an high
tolerance to Nembutal would already have a high tolerance to CH.
How does tolerance happen?
According to “Barbiturates, their use Misuse and Abuse”: Tolerance
to barbiturates is of two types: drug
disposition tolerance, which develops when drug metabolizing enzyme
systems in the liver are activated
to destroy barbiturates, and pharmacodynamic tolerance, which means
that the central nervous system
adapts to the drug’s presence. So the liver increases the amount of
enzymes needed to remove
barbiturates from the blood and the central nervous system just becomes
used to the barbiturate.
Was it confirmed that Nembutal was the drug that killed her?
Yes, the final report states "The barbiturate, previously reported
as a lethal dose has been positively
identified as Nembutal by the toxicologist". "The toxicologist discovered
in addition to the Nembutal
present there was also a large dose of Chloral Hydrate."
Is there any negative reactions between Chloral Hydrate and Nembutal?
No, they basically affect the body in the same manner. Taking both
drugs at the same time only increases
the depressive effects of the drug so it is just like taking more of
either drug. Neither drug has any
negative reaction on the liver that blocks enzymes.
I noticed her liver was a lot larger than an average human liver.
Did Marilyn possibly have liver
problems from taking barbiturates after so many years?
Most likely not. According to Goodman and Gilman “Hypnotic dose of
barbiturates do not impair liver
function; indeed, even the very large amounts of ingested daily for
long periods of time by chronic
barbiturate addicts do not cause liver injury.”
So was it odd that her liver was so much larger than a normal
human liver?
No, according to “The Pathology of Drug Abuse”, When death is due to
acute narcotic overdose, the liver
is, more often than not, enlarged and congested. In typical cases the
liver can weigh over 2,000 grams.
This would be the same with barbiturates. Marilyn’s liver weighed 1,890
grams. So this was typical.
Did they test the rest of the organs?
Thomas Noguchi {coroner} sent the blood, liver, kidney, stomach and
contents, urine and intestine to
Raymond Abernathy {head toxicologist of LA county} for testing. This
was done under the supervision of
Theodore Curphy {chief medical examiner of LA county}. In the digestive
system, only the stomach and
upper part of the small intestine were tested for drugs. No traces
were found so Abernathy didn't test any
further for drugs taken orally. Noguchi asked again for further tests
but the organs had already been
thrown away. If the lower part of the small intestine showed no traces
of orally taken drugs then the next
place to look was the kidney which is where unused orally taken drugs
would have ended up. This would
be the final part of the chain before leaving the body in the urine
or feces. If no traces were found in the
kidneys then it would prove Marilyn did not take any oral drugs.
Would Abernathy have any reason to hide this fact?
All of the toxicology tests were performed at UCLA Medical Center.
Both Abernathy and Dr. Greenson
were on the board there. Dr. Greenson was the last doctor to see Marilyn
and admitted to giving her
sedatives. If no orally consumed drugs were found then Dr. Greenson
would have been implicated.
Dr. Noguchi described her stomach lining as "submucosal petechial
hemorrhage diffusely". Would
this mean the large amount of barbiturates sitting in her stomach
caused bleeding?
Not exactly, Submucosal basically means just under the skin. Petechial
means small red spots just under
the skin caused by pinpoint bleeding which is what the Hemorrhage also
means. Diffusely means spread
around and not concentrated in one spot. So this was an area of irritation
and not bleeding as you would
think of it. Barbiturates are not irritating to the stomach but Chloral
Hydrate is very irritating. To quote
Goodman and Gillman "Chloral Hydrate is quite irritating to the skin
and mucous membranes.
Gastrointestinal side effects are particularly likely to occur if taken
on an empty stomach. Gastric necrosis
{damage to tissues} has occurred after intoxicating doses."
Nembutal as with most barbiturates are actually recommended to be taken
on an empty stomach. So the
irritation on Marilyn's stomach lining was most likely caused by Chloral
Hydrate.
How about the formed stool they found during the autopsy?
According to “The Pathology of Drug Abuse”, Narcotics decrease gut
mobility, resulting in severe
constipation or obstipation. At autopsy, much of the colon may be distended
with hard feces. This would
be the same with barbiturates.
Wait! I just watched a documentary on the Discovery channel where
they proved Marilyn was in
the state of mind to kill herself. Plus they proved it was only
24 capsules that killed her. It looked
pretty convincing.
Dr. Chamberland was the forensic psychiatrist who studied Marilyn's
state of mind. He determined she
was depressed enough to kill herself by the condition of her bedroom
because it had no pictures on the
wall or anything that said "I live here". What he didn't mention was
Marilyn was right in the middle of
redecorating her house completely. This included her bedroom and personal
bathroom. She had
purchased many items on her trip to Mexico to furnish her house with
and some of them arrived the day
she died. This included her night stand. The one you see in photos
was a temporary night stand and her
brand new one was in her garage. One of the other reason Dr. Chamberland
felt it was obvious she meant
to kill herself was the locked door. This information came from Dr.
Litman who was on the suicide team
that investigated why Marilyn killed herself {not IF she killed herself}.
What Dr. Chamberland did not
take into consideration was Eunice Murray stated more than once years
later that the door actually was
not locked. She even put this in writing in a questionnaire saying
the door was not locked. Plus it is easy
to believe Mrs. Murray and Dr. Greenson would have a skeleton key to
Marilyn's door as it was a simple
deadbolt lock that used a universal key. So if you take away the lack
of decoration and take away the
locked door, add in the fact that everyone interviewed on her last
day said she was in good spirits that
evening then there is no evidence she wanted to kill herself.
Now with Dr. Cozzi who was the pharmacologist in the show proving she
swallowed 24 capsules and just
killed herself. First Dr. Cozzi is an extremely sharp man and very
personable. After approx. 25 e-mails
back and forth I was finally able to understand how he came to his
conclusion that he tried to show in the
documentary. He showed me step by step how he arrived at his figures.
He did a very thorough job but he
wasn't given all of the facts before he started or he would have come
up with completely different figures.
Everyone has seen the mathematical equation he used to come up with
24 capsules. This is from the
show:
He used this formula from a book called "Handbook of Basic Pharmacokenetics".
It is an excellent,
technical book on how drugs react, absorb and are distributed in the
body. He used the parameters in the
back to determine using her body weight, height, age and many other
factors in determining how many
capsules were actually consumed. After the entire formula was used
we came up with 26 capsules. This
includes absorption which is how much of the drug is actually absorbed
into the bloodstream. The
multiplier he used for absorption (Vd) was 1. Anything multiplied by
1 equals that number so he
determined that 100% of the drugs she would have swallowed would have
ended up in her bloodstream.
When in actuality as much as 30% of oral barbiturates are waste. However
he did use a chart showing to
use the multiplier of 1 if the person who died from pentobarbital was
"drug naive" or in other words if
this was the first time this person had ever taken this drug before.
I don't completely blame Dr. Cozzi for this because from what he explained
to me he didn't know just
how much Nembutal Marilyn had consumed in the last few years of her
life and he assumed she was not
as tolerant as she actually was. A tolerant person can handle twice
as much as a naive person so this
would just about double his findings or make it closer to what Dr.
Curphy and Dr. Noguchi concluded at
47+ capsules. So if you use the Vd (Volume of Distribution) as 1 for
a person who never took Nembutal
before and a tolerant person can handle twice as much then that would
be 2. So if Dr. Cozzi’s had worked
with Dr. Curphy and Noguchi they would have all most likely come up
with close to 47 capsules to equal
the amount of Nembutal found in her blood.
Remember we discussed the main reason Marilyn could not have swallowed
the drugs was because of the
lack of crystals. Dr. Cozzi used a beaker to replicate a human stomach.
He then took samples of the
stomach at 10 minutes intervals to show how much Nembutal was soaking
into her system. He
determined at about an hour she would have had more than enough Nembutal
in her bloodstream to kill
her. Here is the beaker before the capsules dissolved and then again
after the hour was over and she
would have been dead. Notice how cloudy the water is? That is the Nembutal
crystals and how they
would have looked in Marilyn’s stomach after she died. The digestive
system stops after death so her
stomach should have had this many crystals in the 20cc’s of fluid found.
Plus this was only 24 capsules so
you can imagine how 47+ would look.
Let me get this straight...Marilyn's blood level had nearly 4
times the amount of drugs to kill her yet
they could not prove where these drugs came from or they didn't
even try to prove it. She would
have had to swallow twice as many capsules as a non tolerant
person to get the amount of drugs
found in her system so there is no way she could have accidentally
swallowed just a few too many
capsules. She could not have swallowed a few at bedtime, woke
up forgetting she already took her
bedtime medication and swallowed a few more. There was way too
much drugs in her system for
this to have happened. If she would have wanted to kill herself
and swallowed all of the Nembutal
she could find and all but 10 of her Chloral Hydrate, with this
amount she would have died long
before the entire amount had completely digested past her stomach
and completely past her small
intestine. So in simple terms it would have taken so many capsules
to kill Marilyn that there should
have been a lot of drug crystals found in her digestive system.
No crystals means she did not swallow
the drugs that killed her.
Exactly....