LETTING RUMORS REST IN PEACE
(An Interview With Cyril Wecht) by Marijane Gray
“The dead may not speak, but they do not tell lies. And the rumors are silenced when science does its work.” – Dr. Cyril Wecht, Tales From The Morgue
The following contains descriptions of an autopsy in graphic medical detail. Please do not read further if you find such things disturbing.
Marilyn Monroe’s death has been the source of conspiracies, rumors, and outright lies for several decades. There are those that agree with the official investigative findings, that she died via intentional suicide; and contrarily there are those that believe things don’t quite add up and suspect something nefarious. There have been well thought out and valid arguments for both scenarios, but unfortunately the most press attention tends to go to whatever is most outrageous and scandalous. Was it the Mafia, was it the Kennedys, was it the housekeeper or the doctors, was it because she knew too much about aliens? From those that believe it was suicide, there remains the question of whether it was intentional or accidental. From those that believe it was homicide there has been speculation that she was injected, suffocated, poisoned, or given a drug laced enema. Ludicrous as some may sound, these are all theories that have been put forth over the years, and it’s not too difficult to find people who believe in them.
But what does the science tell us? What from the autopsy and toxicology results can be either supported or dismissed based on scientific fact?
Dr. Cyril Wecht is very familiar with controversial deaths. As both a forensic pathologist and an attorney, with a medical degree from the University of Pittsburgh and a law degree from the University of Maryland, he can offer a uniquely educated view on all aspects of high profile cases. He has consulted and provided expert witness on a who’s who of famous cases: both John and Robert Kennedy, Martin Luther King Jr., Elvis Presley, OJ Simpson, Sharon Tate, JonBenet Ramsey, and Anna Nicole Smith, among others. He has testified in over a thousand court cases, published over 500 professional papers and authored or co-authored 44 books. He has personally performed approximately 17,000 autopsies and consulted on an additional 35,000. If there is anyone who can offer some insight and clarification into the death of Marilyn Monroe, Dr. Wecht is the man to do it.
Dr. Wecht reviewed information from Marilyn’s autopsy and toxicology results and graciously offered his professional opinions on them. One must remember that the role of the forensic pathologist is to review the medical aspects of the case. Other areas are reserved for forensic psychologists or police detectives to put all the pieces of the puzzle into place to get the comprehensive story of someone’s death.
Marilyn Monroe had 4.5 mg of Nembutal and 8.0 mg of Chloral hydrate in her blood and 13.0 mg of Nembutal in her liver. Since the liver had a concentration of 130 ppm (parts per million), which is ten times the lethal dose, would she have passed out before the full amount could be absorbed?
DR. WECHT: You would pass out and become unconscious, but while still alive some physiological activity would still be taking place. There would be some continuing breakdown of the tablets or capsules, getting into the bloodstream and then the liver. The liver level would continue to rise as long as you are alive, and of course stops at death. It’s possible for the liver level to be higher, and it may not reflect what level it might have reached if the person had lived. That’s why quantitative analysis of the gastric contents, blood, bowel and urine are necessary to get temporal correlation. There should be segmental analysis from the stomach to the small intestine. You take six inches, you test that, you take twelve inches and test that. It raises an interesting point- Dr. Noguchi did take segments; portions of the small intestine and submitted them to the lab; why were those specimens missing? (1,2) see footnotes
Theodore Curphey, the chief coroner, estimated the amount of pills in her blood to be 40-50. 10-15 is a lethal dose. How long before death would the pills need to be taken to reach the levels in the blood (4.5 mg)and the liver (13 mg), considering the enzyme induction of a habitual user? Would it be faster or slower because of her tolerance level?
With an empty stomach absorption occurs quickly. On an empty stomach, you’d probably have most absorbed within an hour or less because there’s nothing to slow it down. With a habitual user, sometimes with certain drugs people develop a faster metabolism. It’s not that different from a morphine or heroin tolerance that develops with an addict. (3,4)see footnotes
Dr. Noguchi said “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 40 or 50 capsules of regular-strength sleeping pills.” Does this mean she literally had 3 times the blood amount in her liver, nearly 150 pills?
No, it wouldn’t be. You have a metabolic reaction in the liver. The drugs get transported to the blood after the gastric contents are absorbed. Then as you begin to have the circulation, before you die you linger on so the metabolism is markedly slowed. What’s in the liver is not being metabolized and fully excreted, so the larger level in the liver is due to the markedly slowed metabolism.
Is there anything significant about the lack of refractive crystals in the stomach and duodenum?
Some people have argued, not without validity, that if you take that many in a short time should there not be refractive material recognizable at least microscopically? It might not be seen grossly, but if broken down through digestion, an argument can be made that when you take that many to produce the levels she had there should be residue no matter how minute. It does a raise a question I am interested in and puzzled by. I’ve dealt with hundreds of suicides and most people think you’ll find capsules and most of the time you don’t, because they don’t die right away. They live long enough to go through loss of consciousness, stupor, semi coma and coma. While you’re still alive the breakdown continues. Being unconscious on the way to death but not yet dead the stomach continues digesting, the gastric juices continue to break down. I’ve always had the question myself, taking that many capsules how could there not be some residue? This is why it would have been so important to see the levels in the missing specimens.
In regards to the empty stomach and lack of residue/crystals, is there any possibility that she could have vomited an amount that hadn’t been absorbed yet? Would vomiting remove evidence of the drugs from the stomach?
She could have vomited, that would get rid of much of the gastric content, but you don’t vomit so much that there wouldn’t be residue or crystals, at least a minute microscopic amount. No amount of vomiting literally cleanses the gastric mucosa totally so there’s no evidence of crystals. If she vomited a great amount that doesn’t fit with the large amount of drugs we find absorbed in the liver. Vomiting like that, there would be some in the laryngeal area, the bronchial tree, even a little aspiration. It would be found in the oralpharynx and so on but nothing like that was described.
The stomach showed petechial hemmorhaging. Would this have masked any refractive crystals or dye from the Nembutal capsules?
No, petechial literally means pinpoint, it’s not going to mask material. Not like a hemmorhage where you’re bleeding profusely. Petechial is literally small red dots, it’s not going to mask anything in the gastric mucosal lining.
Do you find it odd that the kidney and lower intestine samples were disposed of? What could we have learned from them if they had been tested?
The kidneys not so much as the intestines. We learn by getting quantitative levels from the blood, bowel, gall bladder, liver and urine to develop a timeline to know approximately in a range of how long it takes for a capsule to be absorbed, how long it takes the liver to metabolize. When you take pills, they get digested, continue on to bloodstream circulation, and get excreted by the kidneys. We could get an idea whether someone likely took everything at the same time. Instead of postulating, we could know what is undoubtedly true about what they take instead of some wild imagined thing that doesn’t have some common sense or logic. I see it happen, where you take one or two not intending to kill yourself. You’re uptight, you’re anxious, can’t sleep or are in a state of confusion. People don’t remember, did I take it or not take it? Often that’s not of any great consequence, but when you take drugs that have a central nervous response, that have a deep effect on the brain, and when you are emotionally upset, anxious, frustrated, your emotional psychological state spills onto what’s happening physiologically. Your senses get dulled, you’re more obfuscated, you wind up taking more. However….not 30 or 40 or 50! The basis of that is rational objective, the significance of testing the urine, the bowel, the blood is so you can get an idea if it was metabolized. If the drugs act quickly, it may not be in the urine. If you find a substantial amount in the urine, they lived for a certain time, enough time for the gastric response to absorption to metabolization, circulating the kidneys and being excreted.
If you find a significant amount in the urine, they lived for a while, as well as if it’s found in the segments of the small intestine. We always collect blood, bowel and urine samples routinely. Most of the time the answers are in the blood, but I make sure I have those samples if a question does arise. Why should this be missing? This is Marilyn Monroe, dammit! You know you’re dealing with drugs, you can rule out a heart attack or cancer or stroke. Dr. Noguchi did the right thing in collecting the samples, how the hell does a lab misplace these things? A suspicious death merits focused attention. This is a prominent case and has relevance, Noguchi sent the samples, did not show sheer negligence, so why the hell is this stuff missing from Marilyn Monroe of all people?
Something that’s been postulated, and with validity, is that she didn’t consume the drugs and was killed by injection. John Miner always postulated it was a suppository, I don’t believe that at all. Injection would not necessarily show, even with Noguchi going over every inch, if it was done with a very fine needle and hidden in the hair. Is it possible to get that kind of level of drugs with nothing in the stomach? There is a question raised there. I’m not saying it was an injection, but it certainly can’t be dismissed as scientifically absurd. It could even be a possibility of a combination thereof; if she took some pills and passed out and then was injected (if we’re going the route of homicide). She took an amount, and then it was added to with injection. If it was homicide, it’s not like you could keep jamming pills in her mouth. (5,6) see footnotes
Is it possible to get the same blood and liver toxicity amounts if the drugs were in liquid as opposed to pill form? Is there anything that could tell us for certain how the drugs were administered?
This ties in with nothing in the stomach and possible injection. Liquid is absorbed more quickly, you can get the same levels if you drink that amount. However, you’re not going to drink that accidentally in that quantity so if you do it makes a strong argument for suicide.
How long would it take to die if the drugs were administered via injection? Does the concentration of drugs in the liver rule out the injection theory?
Injection of a large amount causes unconsciousness in 30-60 seconds. From the blood to the brain, the significant amount that would have been required to give levels reported here are going to kick in within a minute, hit the brain in seconds. You would die fast. As far as the levels, it depends. If it’s intravenously, to get that level I would say not likely. If it was intramuscular or subcutaneous it will take longer; faster than gastrically but not as fast as intravenously. The other thing is that not everyone dies right away, they can linger on comatose. The metabolism continues. To produce the levels found, the amount would have been great. In about a minute you’d be unconscious but not dead. For four to six minutes you still have oxygen in your brain while you’re dying or unconscious. You can remain alive for up to six minutes because of oxygen in the brain being utilized.
In regards to the fixed lividity on the face, neck, chest, upper arms and right abdomen; and the faint lividity on the back and posterior arms & legs, what does this tell us about the time of death and about the body being moved?
Lividity begins to settle in two to four hours. It becomes fixed in eight to twelve hours, so when you move a body to another position, the livor mortis will be there relative to the body position when found. The lividity fixed on her front shows that she died prone, facedown. The minute the body was turned around until the autopsy was done forms a secondary lividity pattern. This clearly indicates that she was lying in a face down position for eight to twelve hours. 7:30 was last sign of life, found at 3:30, that lines up with it being eight hours. As far as the secondary lividity, the doctor examined her, turned her over to listen for a heartbeat, for breathing, etc. The secondary lividity is from checking for vital signs. That’s why a body is not supposed to be touched, the medical examiner should have been called immediately. I don’t see anything conspiratorial about that, just turning her over to see if she was still alive.
What’s odd is that she was in good spirits talking to Joe (DiMaggio) Jr at 7:30 and dying shortly thereafter. Sometimes you never know, sometimes suicide is inexplicable and unfathomable and anything can happen, but how is she happy to talking to someone and hangs up the phone and takes forty or fifty pills?
Full rigor mortis and fixed lividity were noted at 5:30 am and the liver temperature was 89 degrees at 10:30 am. What does this tell us about the time of death?
Rigor mortis settles in a couple hours,and becomes fixed after eight hours, so this fits in with her having died closer to the last known evidence of life, after the phone call with Joe Jr. rather than the time the housekeeper says she found her. Rigor mortis and liver mortis fit in closer to eight o’clock than three in morning when her housekeeper found her. The body temperature usually loses a degree or two the first hour, then degree an hour thereafter so 89 degrees fits. Based on this, she likely died right around eight o’clock, not far from eight o’clock at all. Certainly no later than nine pm.
Some speculate that she may have taken one or two pills at a time over the course of the day. Is this plausible?
If she took one or two over the course of the day, she’d taken them before and had tolerance, so if her conversation at 7:30 was normal and she sounded not the least bit under the influence of drugs I do not believe she would have died half an hour later. If she’d taken them before the phone call she already would have been dying. You don’t go from lucid consciousness, verbalizing clearly and all of a sudden half an hour later you’re dead. If you take it after 7:30, after the conversation, you don’t die in half an hour because they haven’t been absorbed. If she did take them orally, or however they got into her, they could have been taken going into the conversation because it doesn’t go that fast. It has to be absorbed by the stomach. Is it possible that she had already taken them before she got on the phone? We can speculate in a non scientific, psychological way. Was it a normal conversation? I know nothing about the content, how she sounded. If there was nothing to suggest depression or so on, it argues against suicide. It’s not impossible, but it doesn’t fit. This is more in the realm of psychology and common sense.
The undertaker arrived at 5:40 am and noted fixed lividity and full rigor mortis, yet the coroner report lists the time of death as 3:45, the death certificate has it as 3:40, and the mortuary report has it as 3:30. Why such discrepancies?
This is not a big deal, since nobody filling out these reports would know exactly when she died, they’d list the time that the doctor came and found her dead. The official time would be on the death certificate based on what they’d been told, they weren’t going to put down a calculation on the death certificate. They don’t do that, that comes later with testing, so they would just put down when the body was found. In cases of decomposition, where the body is decomposed too much to tell, they’d put down time of death unknown, but in a case of acute death you put down when the body was found.
The autopsy states “both lungs have moderate congestion with some edema (swelling) and posterior lungs have severe congestion.’ What does this indicate?
The congestion and swelling, the edema, is simply part of the dying process. As the heart beats in a diminished fashion, starts beating arrhythmically, blood backs up and causes pulmonary congestion. Edema is a common denomination of any kind of delayed death, whether heart attack, cancer, stroke or injury. You get a buildup of pulmonary congestion that is universal. The congestion in the posterior lung usually happens when death occurs in a supine position. That would go along with after her body was turned to check for signs of life, by way of gravity.
The autopsy states ‘right ovary demonstrates recent corpeus luteum hemorrhagicum’ and The left ovary shows corpora lutea and albicantia . Does this confirm that there was no pregnancy and that she had recently ovulated? How long prior to death did she have her menstrual cycle based on this information?
Corpeus luteum hemorrhagicum is a benign cyst. Corpora lutea and albicantia is a cyst that had been there longer. This doesn’t connotate any kind of sexually transmitted disease or pregnancy, they’re just cysts. As far as when she last menstruated or ovulated, there is no way of telling.
Marilyn entered the hospital for gynecological surgery on July 20, less than two weeks before her death. Some speculate that this was either repair for her endometriosis or that it was an abortion procedure. Would an abortion or other uterine surgery show evidence, such as scarring? Does the fact that nothing unusual was noted about the uterus rule out the possibility of abortion?
With the endometrial lining being as sparse as it was, it would not be consistent with an abortion. Based upon the description of the lining being .2 cm and grayish in color, my answer would be that there would be no evidence of having an abortion.The cysts on the ovaries have nothing to do with pregnancy, they’re related to menstruation. Menstruation reabsorbs the hemmorhagicum and the albicantia, which is an old scar of fibrous tissue. It has nothing at all to do with pregnancy.
The autopsy states that the colon showed ‘marked congestion & purplish discoloration’. Is this significant? What could have caused it?
The combination of congestion and discoloration proves that she didn’t die right away. The circulation to the bowel was being compromised, that lead to the discoloration. That finding is what led John Miner to the conclusion he arrived at which simply doesn’t fit. Remember, Miner was an attorney, not a medical examiner. The congestion and discoloration simply means there was a deprivation of the oxygen supply to the bowel. It’s a natural part of the dying process.
The autopsy states “fecal content is light brown and formed’. Can this rule out the death via enema theory?
If there’s fecal matter in the rectum, it wouldn’t be enema. Further back in the large bowel or the colon there could still be some there that wouldn’t come out with an enema, but this does argue against enema. The presence of fecal material definitely argues against enema.
The autopsy attendants noted swelling in the neck that was enough to distort the face prior to embalming so an incision was made at the back of the neck to relieve the swelling. Yet the autopsy says the neck shows no evidence of trauma. What would cause such swelling?
I’m not going to go with an attendant’s claim on that, I’m going to go with the doctor. You don’t make an incision to relieve swelling, that’s bs. There’s no reason for there to be swelling there. You don’t get rid of swelling by making an incision, it’s not fluid that flows. The fluid would be intracellular, an incision isn’t going to get rid of that. You don’t go with what the attendant says, you go with what the medical examiner says. You do not get rid of swelling by making an incision. In the neck area, that just doesn’t happen. I don’t believe that to be at all valid.
Photographer Leigh Weiner, who snuck into the morgue and photographed Marilyn’s body, has alleged that she was poisoned by cyanide due to a blue discoloration of her hands. Wouldn’t the blue discoloration be normal cyanosis seen in a barbiturate overdose death?
Cyanosis is deprivation of oxygen,it’s not specific for barbiturates. Some people become more cyanotic than others, but it’s nothing special related to barbiturates.
Between June 7 and August 3, she was prescribed 772 barbiturates, including 50 chloral hydrates on July 25 and another 50 on July 31 . Do you think her doctors should have been held accountable in her death?
These celebrity doctors can be sycophant’s, just prescribing anything. Look at Anna Nicole or Michael Jackson. Sometimes they may get them surreptitiously, using different doctors, but these damn doctors are over prescribing. What was the purpose of two chloral hydrate prescriptions that close together? This is disgraceful. That son of a bitch should have been prosecuted like someone who sells heroin, what’s the difference? Actually, the person selling heroin doesn’t know the amount, doesn’t know what amount is lethal but the doctor is supposed to know these things! How does he think someone needs 700 sleeping pills, did he think he was handing out candy? I see special deaths, celebrity deaths, mishandled deliberately by cops, medical examiners, and so on all the time.
Should they have been held accountable? I think so. They went after Anna Nicole’s doctor, they took legal actions against the doctor. There are other cases I do know from my own experience, I perform around 400 autopsies a year and more than half are due to drugs. District attorneys make a lot of noise with the media but when it comes to following through and taking action against the doctors it happens very infrequently. Federal statues set forth criteria for when criminal charges can be brought against a doctor who prescribed inordinate amounts and this would be a classic example. Today especially, for someone with prominence like Marilyn, a DA would take action.
Why do you think that the doctors didn’t face charges back then?
It’s a different world now. The news media can be a pain in the ass nowadays, to the point of absurdity. While it’s reached a point, I think, of intrusiveness nevertheless there’s a lot in investigative journalism that’s good that did not exist at the time. Not to say there weren’t investigative reporters back then, there were. I do know that overall that things like Vietnam and Watergate created a new mentality. It moved from a wide passive acceptance of intelligent people being told something official, that was it. Now, if it comes from the government you automatically begin saying it’s false. It should have been done back then, but it was a different America. When it comes to the possibilities of Marilyn Monroe’s death and what really took place, when you have big people involved, these things happen.
There were powerful forces involved. They went after Dr. Noguchi because he opened his mouth. I don’t see conspiracies everywhere, but people have no idea, the power of the government is fantastic. All the things we do know about the government, can you imagine what we don’t know about? We think we know, and we praise and criticize investigative reporters. People will ask how do we know anything when all this time has elapsed, but we’re still learning. We’re still learning things from Vietnam, and World War II,so we can still learn about Marilyn.
Why do you think the manner of death was designated ‘probable’ suicide? Do you know of any other cases listed as ‘probable’ suicide?
I’ve never seen ‘probable suicide’ on a death certificate. You can express concern or doubt or hesitation, but science is dogmatic and rigid. If probable is written on a death certificate, it means undetermined. You check a box that says ‘natural, accidental, suicide, homicide, undetermined.” When you don’t know the manner of death for sure, you mark undetermined. I’ve never seen a probable suicide on a certificate before. When they have attempted to get records and info, these remain sealed. If it’s a suicide, it’s a suicide! You can cry, scream, yell, you can attack people for not treating her right. But from an official government standpoint,. what basis do they have to say we’re going to keep the records? What are you withholding? What is going on? Suicide is suicide. John Belushi, Heath Ledger, those were accidental deaths. I’ve never seen another case where it’s been marked ‘probable’.
Why do you think there was such a time discrepancy between finding the body and notifying police?
What purpose did they have to do that? The housekeeper, the two doctors, what are you screwing around for? Were they trying to cover up that she’s dead? They knew she didn’t die of a heart attack, so what are they so concerned about that they have to wait hours to call?
There has been speculation, including from an ambulance company, that Marilyn was found alive but unconscious. The ambulance driver alleges that her stomach was pumped. Would there be evidence of that? The driver also alleges that Dr. Greenson used a large needle to inject something into her heart. Obviously this would have left a visible puncture that would have been noted, but is there any validity to the theory that she was found alive and attempts were made to resuscitate her?
We know that’s not true. From my standpoint I’ll stick with science. With the amount of barbiturates, she would not have been alive at the time the ambulance came.
One more theory that has been posited is that she was smothered with a pillow. What clinical evidence would asphyxiation leave?
If someone is unconscious they won’t fight back but there is absolutely no evidence to suggest that. Asphyxiation is a cause of death. If that’s the case, there has to be circumstantial evidence to rule out everything else. With those high levels of barbiturates, there is no question of what the cause of death was. In this case, researchers and doctors have questions about the manner of death, whether suicide or homicide, did she forget she took drugs and kept taking more, those are questions with some semblance of logic and scientific rationale but to come up with asphyxiation from suffocation is totally absurd.
There have occasionally been people asking for her to be exhumed and reexamined. Do you think this would yield anything?
No, it wouldn’t tell us anything today. I would never suggest that it happen. As tempting as it would be to get involved, I would tell them it’s not warranted. Scientifically, there’s not a damn thing you can learn.