The Autopsy Report

Dr. Thomas Noguchi entered the Hall of Justice on the morning of August the 5th, anticipating a normal day at the Los Angeles County Coroner’s Autopsy Unit. Upon entering his office, he found a note on his desk which advised him that Dr. Theodore Curphey, the Los Angeles County Coroner at the time, wanted him to perform the autopsy on Marilyn Monroe. Dr. Noguchi was incredulous: certainly not the movie star. Additionally, he was surprised that he, and not a more senior examiner, had been assigned the case by Dr. Curphey. Thus, an occurrence which the autopsy surgeon called strange was the next anomaly that many conspiracists have used to allege malfeasance, asserting collusion by the coroner’s office to obscure the facts about Marilyn’s death. Assigning an incompetent person to perform her autopsy was the perfect way for the coroner’s office to orchestrate a cover-up and obscure the facts.

Still, Dr. Noguchi stated in his memoir that he was regularly assigned autopsies that might prove scientifically difficult because he was an assistant pathology professor at Loma Linda University Medical School and also certified in both clinical and anatomic pathology. So he assumed the autopsy that he was soon to perform, on a woman who simply shared Marilyn Monroe’s name, would prove to be a scientifically difficult one. In preparation, he began to read the investigator’s report. Based on what he read, the woman’s death appeared to be a routine suicide; so Dr. Noguchi assumed that he had received the assignment to perform the autopsy because Dr. Curphey expected conflicts with the investigator’s written report.

The heavy disinfectant smell of formaldehyde hung in the air of the autopsy room when Dr. Noguchi entered at 9:30 AM. He was confronted with the presence of John Miner, Deputy District Attorney at the time and chief of the district attorney’s Medical Legal Section. Miner’s presence usually signaled an important and special case awaited; but Dr. Noguchi was still unaware of the extreme importance and extremely special nature of the case he had been assigned. When Dr. Noguchi removed the sheet from the prone body where it lay on the autopsy table; and he was confronted with the lifeless remains of Marilyn Monroe, the movie star, he understood that he had been handed an awesome responsibil­ity: he knew the world would demand to know why the beloved actress had died at the young age of thirty-six. Even though Dr. Noguchi recognized the significance of the autopsy that he would soon perform, the conspiracists have universally asserted that the surgeon botched it.

Dr. Noguchi began by examining Marilyn’s body with a hand held magnifying glass, searching for evidence of hypodermic injection sites, which he did not find. According to John Miner, he assisted Dr. Noguchi’s injection site search.

Using the magnifying glass, Dr. Noguchi also searched for evidence of recent physical trauma, which he did not find, either, except for a slight ecchymotic area on her left hip and left side of lower back. He assumed that the bruise might have been caused by a clumsy encounter with a piece of heavy furniture; and too, the bruise was not very large. Many years later, another reason for this bruise would be floated by various conspiracists, a reason which will appear later in this text.

Marilyn’s body displayed fixed lividity, which appeared on her face, neck, chest, upper portions of arms and right side of the abdomen along with a faint lividity on her back and posterior aspect of the arms and legs. This faint lividity disappeared when Dr. Noguchi applied pressure to Marilyn’s skin. Obviously, she had died while lying on her stomach. Being placed face up for transport to the Hall of Justice explained the faint lividity on her back.

Dr. Noguchi noted the presence of two surgical scars, one on the right upper quadrant of her abdomen and one suprapubic.

An examination of Marilyn’s bones by palpation did not reveal any evidence of fracture. Dr. Noguchi’s examination of her skeletal system included her clavicle, ribs, vertebrae, pelvic bones and skull. He noted: Following removal of the dura matter from the base of the skull and calvarium no skull fracture is demonstrated.

Marilyn’s brain was normal and although the superficial vessels were slightly congested, Dr. Noguchi did not find any blood in her epidural, subdural or subarachnoid spaces or any other evidence of brain trauma. Marilyn’s head had not suffered the application of any blunt force.

While Marilyn’s appendix and gall bladder had been removed, Dr. Noguchi noted, her other internal organs were normal and in their proper positions although certain organs, her lungs and spleen, for example, displayed moderate to severe congestion and some edema, a result of death. Her thoracic and abdominal cavities did not contain an excessive amount of fluid or blood. Marilyn’s body had not experienced any sort of penetration by a knife or a bullet or any other sharp instrument, one that might have induced hemorrhaging.

The world’s symbol of sex possessed normal external genitals along with normal reproductive organs. Her tubes were intact and her ovaries indicated recent menstruation. Dr. Noguchi obtained a sample from Marilyn’s vagina; and although his report did not specifically mention the contents of Marilyn’s vagina, he reported to TIME magazine during a July interview in 1972 that he made slides of and examined the contents of Marilyn’s vagina under a microscope: he found no evidence that she had recently engaged in sexual activity as has been frequently alleged by various conspiracists and other writers (Vitacco-Robles v2:589). Norman Mailer, for example, implied that Marilyn was probably with a lover on the night of her death; and a few conspiracists have even asserted that Marilyn was sexually molested by her murderers immediately before they murdered her.

Dr. Noguchi’s examination of Marilyn’s digestive system became the point of a colossal controversy, used by the conspiracists to indicate that she did not die from ingesting capsules. The autopsy surgeon noted that Marilyn’s stomach was almost completely empty and contained only a brownish mucoid fluid; her stomach did not contain any pill residue, evidence of pill dye or undigested capsules; and when he examined a slide of the stomach fluid with a polarized microscope, he did not see any refractile crystals. More about this controversial issues appears at the end of this section.

Under his Anatomical Summary, Dr. Noguchi clearly noted: Marked congestion of stomach with petechial mucosal hemorrhage. Marilyn’s colon also displayed marked congestion and purplish discoloration along with light brown and formed fecal contents.

Dr. Noguchi obtained a sample of Marilyn’s unembalmed blood along with dissections of her stomach, liver, kidney and intestine for further toxicological study. T. Noguchi, M.D., Deputy Medical Examiner affixed his signature to a typed report, dated the 13th of August in 1962.

Dr. Raymond J. Abernathy, Los Angeles County’s head toxicologist, performed the toxicological tests on Marilyn’s blood and liver. The initial Report of Chemical Analysis arrived on the 6th of August; an amendment to the initial chemical analysis arrived on August the 13th. The toxicology reports and the fate of the organ samples that Dr. Noguchi obtained for additional toxicological testing also became a point of controversy, used by the conspiracists to indicate that the coroner’s office concealed and obfuscated the facts regarding Marilyn’s death, a sinister obfuscation planned and ordered by her politically powerful lovers and murderers.

Initial tests performed on Marilyn’s unembalmed blood sample indicated the absence of ethanol or alcohol, meaning Marilyn was not intoxicated, and the absence of phenobarbital; but the tested sample contained 4.5 mg% pentobarbital. Both phenobarbital and pentobarbital are barbiturates, but they are not the same drug: each drug is synthesized differently. Phenobarbital is the generic name of Luminal, primarily an anticonvulsant, while pentobarbital is the generic name of Nembutal, primarily used to treat insomnia. Additionally, phenobarbital is long-acting with a biological half-life of 86±32 hours while pentobarbital is short-acting with a biological half-life of 32±16 hours.

The August 13th amendment noted that Marilyn’s blood contained 8 mg% chloral hydrate and that her liver contained 13.0 mg% pentobarbital. Chloral hydrate, a sedative drug normally used for short term insomnia therapy, was also used to produce an alcoholic knock-out drink commonly known as a Mickey Finn. Chloral hydrate is removed from the body quickly and has a biological half-life of 9±1 hours.

I must note here that the concentration of pentobarbital in Marilyn’s liver was essentially three times the concentration in her blood.

Mg%, or milligram percent, denotes a measure of concentration, the mass of a chemical, given in milligrams, that is present in one-hundred milliliters of a solution, blood for instance. So 4.5 mg% means that barbiturates with a mass equaling 4.5 milligrams were determined by chemical analysis to exist in 100 milliliters of Marilyn’s blood which, of course, is meaningless to most persons, including me; but apparently the measurements reported by the toxicologist represented an unusually high concentration. The 8mg% concentration of Chloral hydrate in Marilyn’s blood and 13mg% concentration of pentobarbital in Marilyn’s liver apparently represented an unusually high concentration of those drugs. Since I am neither a pathologist, toxicologist nor a chemist, I cannot take issue with any of the numbers or the chemical analysis provided in Marilyn’s autopsy report; but the ever alert conspiracists have. Whether their criticisms of the chemical analysis has been justified remains to be seen. Even so, whether their criticisms of the chemical analysis have been justified remains to be seen. Along with the toxicological analysis, the initial chemical report provided a tabulation of other drugs and the quantities found at Marilyn’s hacienda. The second report amended the other drugs present and the quantities of each. Needless to say, Marilyn had more than an adequate amount of many drugs at her disposal to kill herself and enough drugs remaining to kill herself again.

From two prescriptions which equaled one-hundred and fifty Librium, fifty 5mg and one-hundred 10mg, which Marilyn had filled on June the 7th and July the 10th respectively, forty-four remained, twenty-seven 5mg capsules and seventeen 10mg. How many of the one-hundred and six missing capsules Marilyn might have ingested between June the 7th and August the 4th, twenty-seven days, could not and cannot be determined. Librium is the brand name for chlordiazepoxide, the first synthesized  benzodiazepine. While benzodiazepine is not specifically mentioned in Abernathy’s chemical analysis, in 1962, it may have fallen into the general category of barbiturate.

From a prescription for twenty-five 1½ grain (@100mg) pentobarbital, which Marilyn had filled on the 3rd of August, none remained. In high doses, pentobarbital can induce death by causing central nervous system depression leading to complete respiratory failure. It appears that Marilyn ingested at least 2500 milligrams of pentobarbital, Nembutal, on the 4th of August.

From a prescription for fifty ½ gram (500mg) Chloral hydrate, which Marilyn had filled on July the 25th, ten remained. She certainly ingested a portion of the forty missing capsules over the nine days between July the 25th and August the 4th; but the exact number could not and cannot be determined. It appears that Marilyn ingested a large dose of chloral hydrate on August the 4th.

Marilyn had twenty-four Phenergan remaining from a prescription for twenty-five, 25mg capsules, filled on August the 3rd. Phenergan is the brand name for the generic antihistamine promethazine which is used in the treatment of allergies and nasal congestion. Promethazine is also a respiratory depressant and can induce sleep.

Marilyn also had thirty-two peach-colored tablets marked MSD in a prescription type vial without label. The acronym MSD probably referred to Merck, Sharp and Dohme, a subsidiary of Merck and Co., one of the world’s largest pharmaceutical manufacturers. The peach-colored tablets were probably MSD’s triangular-shaped Triavil, a psycho-therapeutic agent for the management of psychoses and neuroses characterized by both anxiety and agitation including symptoms of depression. The drug is a potent tranquilizer and antidepressant with an anxiety-reducing sedative component. Triavil should not have been prescribed for Marilyn since she was already using barbiturates and antihistamines which depressed her central nervous system; but apparently, the coroner’s office was not interested in Triavil or how Marilyn came to have it in her possession.

At any rate, all of the drugs in Marilyn’s possession acted upon the central nervous system to depress respiration and were potentially lethal, particularly if ingested together due to their accumulative effect. Today, chloral hydrate is seldom prescribed in conjunction with other respiratory depressants, particularly pentobarbital, unless the drug’s interactions can be monitored closely by a physician or a well trained medical technician. Obviously, Marilyn’s intake of dangerous drugs was not being monitored at all.

Dr. R.J. Abernathy, Head Toxicologist for the Los Angeles County Coroner signed each toxicology report.

The number of critical homilies written after the coroner’s office published Dr. Noguchi’s autopsy findings, along with Dr. Abernathy’s toxicology reports, must number in the many thousands. Even today, over one half century after Marilyn’s death, questioning critiques appear in magazines and on websites across the risible and absurd network that is today’s sensationalistic media; but Walter Winchell must have been one of the first to question the autopsy as he serialized Frank Capell’s anti-Communist eyebrow-raising breath-taker in his column printed in the New York Daily Mirror. Marilyn’s autopsy findings, Capell through Winchell wrote, did not reveal barbiturates in her organs, only the tested sample of her blood. Since Marilyn died of an overdose of barbiturates, Capell asserted, traces of which were found only in her blood, it would seem that the drugs must have been injected rather than taken orally. Either that, or her body had been thoroughly pumped out to remove the traces of what killed her (Capell 69). In other words, since Dr. Noguchi did not find any remnants of the ingested capsules in Marilyn’s stomach, her stomach must have been pumped until it was completely empty.

Capell also noted that Abernathy’s toxicology report did not support the Los Angeles Coroner’s formal statement and did not support the August 18th Herald Examiner article, which reported the presence of Chloral hydrate, a lethal dose. According to Capell, Abernathy did not test for Chloral hydrate; but Capell did not base his allegations on actual facts. He failed to mention that Abernathy tested Marilyn’s liver samples but failed to test samples of her other organs, the reasons for which I herein explain. Capell also failed to mention the toxicology report’s amendment of August the 13th, which indicated Chloral hydrate in Marilyn’s blood and pentobarbital in her liver, thereby contradicting his assertion that the toxicologist found barbiturates only in Marilyn’s blood and that her body had been thoroughly pumped clean. Also, using the noun traces, defined as an amount of a chemical constituent not always quantitatively determinable because of minuteness, to suggest that the amount of pentobarbital in Marilyn’s blood was virtually imperceptible, was certainly disingenuous; but revealing selective information in a disengenuous manner is a typical stratagem used by conspiracists: they exclude any piece of the puzzle’s finished scene that does not fit their predisposed beliefs or fit into their preordained landscape.

Years later, both Mailer and Slatzer offered their opinions. Mailer asserted in 1973 that Marilyn’s autopsy was casually performed and the pathologist never determined the time of her death. Quite possibly she died early that Saturday night, possibly at 9:00 PM; and quite possibly she died early the following Sunday morning, possibly at 3:00 AM. Besides, according to Mailer, the specific killing pill was not identified. Mailer’s assertions were not exactly accurate, since Abernathy tested Marilyn’s blood and her liver for the presence of specific drugs.

Robert Slatzer offered a more direct criticism and opinion in his 1974 book about Marilyn’s curious death, brazenly questioning the autopsy with accusations of suspicious gaps in the reports. According to Dr. Noguchi, Slatzer claimed that LAPD sources told the writer that the official autopsy report was a fake. The real report had been officially suppressed and Dr. Noguchi himself had generated and substituted a fraudulent report. It is certainly risky business to accept anything Robert Slatzer asserted; but if we momentarily accept Slatzer’s allegations, then obviously, in 1974, Slatzer believed the LAPD but doubted Dr. Noguchi.

In the final chapter of his 1974 publication, Chapter 21, Slatzer presented a question and answer interview with the Chief Medical Examiner for New York’s Suffolk County, Dr. Sidney S. Weinberg. Likewise, in his collected papers, Will Fowler included a copy of an undated letter the good doctor wrote to Slatzer.1

That letter actually contained Dr. Weinberg’s commentary regarding Dr. Noguchi’s work; but consistent with Slatzer’s other mendacious antics, he did not include, in Chapter 21, the personal and communicative portion of Dr. Weinberg’s letter, more than just likely because Dr. Weinberg began his letter to Slatzer advising restraint, cautioning Slatzer against making incendiary accusations or vilifying Dr. Noguchi’s autopsy as a masterpiece of inadequacy. Slatzer presented the question and answer interview in a manner suggesting that he had directly questioned the renowned medical examiner; however, that was not the case: George Carpozi, Jr. actually interviewed Dr. Weinberg. Notations in Fowler’s Papers indicated that Carpozi: 1) joined Slatzer’s literary conglomerate after Fowler withdrew; and 2) actually wrote Chapter 21 of The Life and Curious Death of Marilyn Monroe; and 3) also modified a few other chapters as well.2

And yet, in Slatzer’s 1992 reprise about Marilyn’s death, The Marilyn Files, his pronounced accusations concerning Dr. Noguchi’s autopsy took a completely different course: in 1992 the police were the guilty ones, the incompetent culprits and Slatzer’s opinion of Dr. Noguchi was radically different.

In his new and improved literary effort, Slatzer elevated Dr. Noguchi to the level of brilliant pathologist, one whose peers in the National Association of Medical Examiners ranked him at the top professionally and elected him president of their association. The pathologist’s skill, his talent and his integrity were unquestioned by the Coroner’s staff. Even Lionel Grandison, Sr. (Samir Muqaddin), who was employed by the coroner’s office at the time of Marilyn’s death, informed Slatzer that Dr. Noguchi’s reputation was unparalleled. Dr. Noguchi was a very thorough pathologist and considered to be the coroner’s most reliable and best surgeon. In fact, the general consensus was: to get the best autopsy, one with accurate information, call upon Dr. Thomas Noguchi. So, Slatzer concluded, revealing the secrets and the facts surrounding the blonde sex symbol’s death would be left to the talented pathologist’s scalpel. I’m confused: was Dr. Noguchi incompetent or was he a brilliant medical examiner? Was he casual or thorough? Did he file a falsified report or not? And too, if Dr. Noguchi was a brilliant pathologist, why did Slatzer never accept the brilliant pathologist’s autopsy and his related edict of probable suicide?

On November the 4th in 1982, during the threshold re-investigation, two attorneys from the district attorney’s office questioned Dr. Noguchi about the events of two decades past. They were interested in five points: 1) Marilyn’s empty stomach; 2) the absence of pills or any evidence thereof in her digestive tract; 3) the absence of acidic corrosion in Marilyn’s stomach; 4) the absence of visible yellow dye staining in her digestive tract; and 5) the absence of injection sites since the original investigation revealed that Marilyn had been recently injected by her internist, Dr. Hyman Engelberg.

Dr. Noguchi’s memoir noted the answers that he offered: 1) Marilyn’s stomach was accustomed to the pills since she was an addict and like food one frequently eats, the pills were quickly and easily moved into her intestines; 2) with habitual abusers of barbiturates, he seldom encountered visible evidence of the ingested pills; 3) his autopsy report stated that Marilyn’s stomach, below its lining, displayed a considerable amount of pinpoint hemorrhaging; 4) a layperson (Robert Slatzer), one unfamiliar with Nembutal, had raised the questions regarding yellow dye staining and that layperson obviously did not know the manufacturer of Nembutal used a color which did not bleed from the gelatin capsules and cause staining when swallowed; and 5) since doctors inject patients with fine surgical needles, the skin punctures heal quickly and are therefore rendered invisible. Dr. Noguchi’s answers had an apparent plausibility; but the conspiracists remained unsatisfied and used the 1982 threshold investigation as additional evidence of a massive conspiracy to obscure the facts and the truth about Marilyn’s death. In fact, the conspiracists alleged that the 1982 threshold investigation was bogus, a hoax: the government was still protecting John and Robert Kennedy by concealing their involvement in Marilyn’s murder.

In 1986, Dr. Noguchi once again addressed the issue of Marilyn’s empty stomach and asserted that the absence of pill residue was not uncommon in barbiturate suicides, particularly with drugs ingested into an empty stomach. He reiterated that he had encountered empty stomachs during the autopsies of many suicides. He noted that the abuser’s stomach becomes accustomed to digesting the pills.

Dr. Cyril Wecht, a pathologist invoked by several conspiracists, offered an assessment not unlike Dr. Noguchi’s, noting that with an empty stomach, digestion and absorption of the ingested pills can occur rapidly, within an hour or even less. He also noted that habitual users of certain drugs develop a faster metabolism and a tolerance, not unlike the tolerance developed by morphine or heroin addicts. Most persons expect that the pathologist will find undigested pills in the suicide’s stomachs, Wecht asserted; but his experience indicated otherwise since most suicides live long enough to experience a loss of consciousness, stupor, semi-coma and coma. During the dying process, the gastric processes continue; the stomach continues digesting.

In his book, Tales From the Morgue, Dr. Wecht once again addressed Marilyn’s case and her autopsy, noting that he did not find the absence of undigested pills or pill residue in Marilyn’s stomach to be problematic since her stomach was empty at the time that she ingested the pills. With a stomach free of food, he stated yet again, any ingested material would be digested and absorbed more rapidly than normal.

During the 1982 threshold investigation, Dr. Boyd G. Stephens, chief medical examiner and coroner for the City and County of San Francisco, performed an independent review of the autopsy evidence. He did not take issue with Dr. Noguchi’s autopsy, his resultant report or the coroner’s conclusion that Marilyn’s death was a probable suicide. The 1982 summary report stated:

Dr. Stephens reports that the methodology and the report itself reflect a legitimate, scientifically acceptable medical examination performed in accordance with the 1962 standards for such examinations. He further concludes that even the application of more advanced [those used in 1982] state of the art procedures would not, in all reasonable probability, change the ultimate conclusions reached by Dr. Noguchi in 1962.

Dr. Stevens says that based on the physical evidence memorialized in the Autopsy Report and the associated documents he would have reached an identical conclusion, i.e., the subject died of acute barbiturate poisoning from the ingestion of an overdose. He further believes that the amount of chloral hydrate in the system would add to the toxicity and would to some extent compound the effect of the pentobarbital (Nembutal) in the system.

Dr. Stevens also believes that the relationship of the pentobarbital in the blood (4.5 mg. percent) to that in the liver (13.0 mg. percent) is medically significant.

Of course the conspiracists dismiss the conclusions asserted by the district attorney’s Summary Report as meaningless and self-serving since, the conspiracists have concluded and invariably asserted, the district attorney’s office was actively involved in the cover-up along with the coroner’s office. The investigations of both offices were hopelessly flawed and issued reports that were obviously fake and bogus; and despite Dr. Stephens’ considered and educated opinions, the conspiracists were still not pacified.

One decade after the LADA’s threshold investigation, Dr. James Fox, a neurosurgeon, materialized as a witness during KTLA’s 1992 docudrama. It was certainly odd that the producers of The Marilyn Files chose to consult a neurosurgeon and thereby empower him to comment on the work of a pathologist and a toxicologist; it was certainly odd, also, that neither Bill Bixby nor Jane Wallace, the program’s co-hosts, proffered any credentials to  confirm the neurosurgeon’s qualifications pertaining to either pathology or toxicology. Even so, the program’s narrator dramatically noted that Dr. Fox had examined the autopsy and the toxicology reports and uncovered several inconsistencies, the most significant of which was the absence of undigested pills in Marilyn’s stomach; and then Dr. Fox proceeded to criticize and rebuke Dr. Noguchi’s autopsy and Dr. Abernathy’s toxicology tests. Dr. Fox actually impugned his medical colleague’s integrity.

Dr. Abernathy actually prepared four different toxicology reports, according to the neurosurgeon, an odd accusation, the proof for which Dr. Fox offered absolutely no supporting evidence. If there were, in fact, four different toxicology reports that he examined, why did Dr. Fox fail to display them for the viewers and denote their inconsistencies? Dr. Fox also declared that one of the toxicology reports had no barbiturate in the liver, inferring that Dr. Abernathy’s toxicology tests did not actually detect any barbiturates in Marilyn’s liver, certainly a deceitful and intentionally deceptive inference. The neurosurgeon then insinuated that an absence of barbiturates in Marilyn’s liver proved that she received a hot shot. She could not have swallowed a multitude of Nembutal capsules and expired, leaving an empty stomach? Accordingly, he then asserted: […] if a rapid injection was given to her in her heart […] then that would circulate rapidly through the body but would not be picked up by the liver because the patient would be dead. Obviously, therefore, Marilyn was the victim of the injection as described by ambulance attendant, James Hall.

My research revealed that Dr. Abernathy delivered only two toxicology reports to Dr. Noguchi, an initial report dated August the 6th and a follow-up report dated August the 13th. I did not find or otherwise uncover any evidence of two additional toxicology reports.

Dr. Abernathy’s initial report involved and indicated only the chemical analysis of Marilyn’s unembalmed blood, which contained a high concentration of pentobarbital. The second toxicology report delivered by Dr. Abernathy noted the presence of Chloral hydrate in Marilyn’s blood, a high concentration, and also the presence of pentobarbital in her liver, virtually three times the amount concentrated in her blood; but the disingenuous Dr. Fox summarily ignored the follow-up report, apparently because what it reported did not fit the premise of the program, that an injection of some type caused Marilyn’s death. The reasons why the concentration in Marilyn’s liver was considerably higher than her blood will be discussed later in this section along with why her stomach was virtually empty.

John Miner also materialized on KTLA’s 1992 program to offer his opinion regarding Dr. Noguchi’s work. It was a thoroughly professional autopsy that was done by Dr. Noguchi, Miner defended the pathologist and then added: We examined the body with magnifying glasses, both of us did, for needle marks, and that was a complete examination. There were no needle marks on the body.

Mysteriously Missing Tissue Samples and Organs