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i didn't write this... credit for this article goes to my good friend Tony Plant! How did Marilyn Monroe Die? 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....