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DISCUSSION
A synopsis of medical history of Marilyn, including doctors who
had treated her, hospitals visited by her, drug use, circadian rhythm
sleep disorder (i.e., asynchrony of body clock or 'lateness' in common
parlance) and suicide attempts is available in the encyclopedia compiled
by Victor88). As the origin of sleep medicine, as a discipline, post-dates
Marilyn's death in 1962, it is tempting to postulate that had Marilyn sur-
vived another quarter century, she might have been saved by therapeu-
tics for circadian rhythm sleep disorders95).
Sexual promiscuity
That Marilyn had a defective gynecological system in her body
(menstrual pain, endometriosis etc.) by either design or happenstance
(such as sexual molestation) was a fact90,94). Though many Marilyn
enthusiasts among her biographers sympathize with her as being sexual-
ly exploited, one cannot ignore another fact that Marilyn self-destructed
herself via her own career improving decision steps by willfully tamper-
ing with her defective gynecological system by opting the route of sexu-
al promiscuity. Marilyn herself had acknowledged this two years before
she died in a conversation, as follows:
"When I started modeling, it (i.e. sex) was part of the job. All the
girls did. They weren't shooting all these sexy pictures just to sell peanut
butter in an ad or get a layout in some picture magazine. They wanted
to sample the merchandise, and if you didn't get along, there were 25
girls who would. It wasn't any big dramatic tragedy. Nobody ever got
cancer from sex."94)
This was stressed by Claire Booth Luce, in her 1964 Life magazine
essay: "What Marilyn's sex life was like in the days before she sought to
storm the golden gates of Hollywood can only be surmised. It cannot,
even by today's easy standards, have been 'moral'. For she had no father
or mother image to guide her as to the proper behavior of boys and girls.
Never having known the face of marital or parental or even fraternal
love, she was certainly incapable of giving what she herself had never
known."96)
Apart from her casting couch bonding ties with numerous photogra-
phers, Hollywood agents and producers, Marilyn was suspected of hav-
ing lesbian relationships Marilyn had with actress Joan Crawford
(1908?-1977)97), her drama coach Natasha Lytess (1915-1964)94),
menage-a-trois plays with Elia Kazan and Arthur Miller90), as well as
Elia Kazan and Marlon Brando98).
Though she yearned for children, Marilyn was also careless in her
personal habits of cigarette smoking94) and excessive use of alcoholic
drinks which preempted her desire to carry the pregnancy for a full
term. (Table 3)
International Medical Journal Vol. 29, No. 3, pp. 216 - 219 , June 2022
HISTORY OF MEDICINE
Medical Issues on Marilyn Monroe's Life and Death; A
Retrospective---Part 2
Sachi Sri Kantha1) and Yuri Matsui2)
ABSTRACT
Objective: Apart from film studies, Marilyn Monroe's name recognition and career profile had generated investigations and
research on diverse themes, since 1956. To mark the 60th anniversary of her death, we present a retrospective on the medical
issues Marilyn faced during her short life span and subsequently, after death.
Methods: For reliable information on Marilyn's life, a ghosted autobiography, trusted biographies as well as recognized ref-
erence sources were studied.
Results: A chronology of health-related major life events of Marilyn is presented in a table. For genetic predisposition, gyne-
cological problems and circadian rhythm sleep disorders, Marilyn consulted with at least 11 doctors in New York and
Hollywood. Though they could offer her prescriptions and some solace to relieve her from pain, Marilyn's medical caretakers
failed to prevent her premature death at the age of 36.
Conclusion: It's unfortunate that Marilyn was served with a horrible genetic disposition, being born to an invalid mother
Gladys who suffered from mental disorders, and both maternal grandparents inflicted with brain disorders. Based on current
knowledge of endogenous prostanoids and oxytocin, we propose that the fundamental cause of Marilyn's morbidity could have
been imbalances in prostaglandins and oxytocin in the brain and reproductive system that made her sick with insomnia and
gynecological symptoms such as dysmenorrhea and endometriosis.
[Continued, from Part 1, published in the previous issue.]
KEY WORDS
celebrity, barbiturates, endometriosis, insomnia, polypharmacy, sex symbol
Received on December 22, 2021 and accepted on January 3, 2022 Sachi Sri Kantha: 0000-0001-6693-0110
1) Toyotama Kita 2 chome, 2-8, Nerima ku, Tokyo 176-0012, Japan
2) Toushin-cho 1 chome, 226, Obu City, Aichi ken 474-0073, Japan
Correspondence to: Sachi Sri Kantha
(e-mail: sachisrikantha53@gmail.com)
216
C 2022 Japan University of Health Sciences
& Japan International Cultural Exchange Foundation
Kantha S. S. et al. 217
Dysmennorhea and Endometriosis
Dysmennorhea is thought to be caused by the release of prostaglan-
dins in the menstrual fluid, causing uterine contractions and pain99). That
endogenous prostanoids are also involved in sleep-wake balance,
according to Hayaishi hypothesis100-103), makes us postulate that Marilyn
might have suffered from prostaglandin imbalance in her brain and
reproductive system. Unfortunately for Marilyn, endogenous prostanoid
studies in clinical research blossomed only since 1970s104). Drug thera-
pies using prostaglandin inhibitors for premenstrual syndrome105), dys-
mennorhea106) and endometriosis107,108) came to be promoted since 1980s.
That Marilyn suffered from anxiety disorders has been recognized
by her peers and biographers. Her predilection to be late for appoint-
ments and shooting was attributed to her anxiety concerns by Jane
Russell (her co-star in the movie 'Gentlemen Prefer Blondes')109). It
could be that, apart from prostaglandin imbalance, Marilyn also faced a
degree of malfunction in the production of endogenous oxytocin. The
involvement and relevance of oxytocin hormone in psychiatric disorders
such as schizophrenia, mood and anxiety disorders110) as well as endo-
metriosis-related pain111) have been recognized recently. One can hypoth-
esize that Marilyn's addition to alcohol and barbiturates could have
worsened her balance of brain oxytocin and vasopressin hormones112).
An empirical evidence for this oxytocin malfunction hypothesis was
published recently by Matsumoto et al113). In a nested case-control study
sample of pregnant women (N = 162) with a medical history of anxiety
disorder and endometriosis as cases and pregnant women without such
medical history as controls adjusted for age and parity, Matsumoto et
al.113) found that the plasma oxytocin concentrations were significantly
lower in cases suffering from endometriosis in their first, second and
third trimesters of pregnancy. Current knowledge on the maternal plas-
ma levels of oxytocin during pregnancy114) may explain to an extent the
recurrent miscarriages and other related gynecological disorders in
Marilyn's life.
Bipolar Personality Disorder
Marilyn's suffering from bipolar personality disorder89) has been
observed by three recognized names in the movie industry-namely actor
Laurence Olivier, director Billy Wilder, and costume designer William
(Billy) Travilla. Laurence Olivier had recorded, "There are two entirely
unrelated sides to Marilyn. You would not be far out if you described
her as a schizoid; the two people that she was could hardly have been
more different."115)
Those of Billy Wilder's "One side of Marilyn was wonderful, and
the other side was terrible. She was two of a kind."116), and Billy
Travilla's "She was for me a dual personality. She was not well educated
but an extremely bright woman, and she had the whims of a child."89)
were also identical to that of Olivier's. The two personalities inhabiting
Marilyn's body frame could be understood as that of traumatized,
orphaned model and starlet Norma Jeane Baker (1926-1949), and the
famous movie star Marilyn Monroe (1950-1962).
Autopsy Report
The six page autopsy report of Marilyn (#81128, dated Aug 5,
1962), released by Thomas Noguchi, Deputy Medical Examiner, of Los
Angeles County's Office of Coroner was commented by Smith in a
chapter of his book.97) Vital Statistics of Marilyn, after death, assembled
from the autopsy report is presented in Table 4.
The 'Anatomical summary' presented in the autopsy report is as fol-
lows:
External Examination:
1. Lavidity of face and chest with slight ecchymosis of the left side
of the back and left hip.
2. Surgical scar, right upper quadrant of the abdomen
3. Suprapubic surgical scar.
Respiratory System:
1. Pulmonary congestion and minimal edema.
Liver and Biliary System
1. Surgical absence of gall bladder.
2. Acute passive congestion of liver.
Urogenital System
1. Congestion of kidneys
Digestive System
1. Marked congestion of stomach with petechial mucosal hemor-
rhage.
2. Absence of appendix.
3. Congestion and purplish discoloration of the colon.
The last mentioned observation of "purplish discoloration of the
colon" had been pointed out by observers as a tell-tale sign of inflam-
matory response of barbiturates overdose, possibly administered by
enema that could have resulted in Marilyn's death97). Toxicology analysis
reported 'pento-barbital level of 12.5mg% in the liver (above fatal dose)
and blood chloral hydrate level 8 mg% (above fatal dose)'.76).
The remaining components of Marilyn's autopsy report [1,084
words] also make interesting reading in composition, and is in public
record. As Marilyn was one of the leading sex symbols of 1950s with a
well-publicized figure seen in photos, magazine covers and movies, her
vital organs (such as breasts, hips, nose, scalp hair, lips, neck etc. and
even pubic hair in the genital system) were technically described for
posterity by Noguchi. For relevance, we reproduce these autopsy find-
ings verbatim.
"External Examination: The unembalmed body is that of a
36-year old well-developed, well-nourished Caucasian female weighing
117 pounds and measuring 651
/
2 inches in length. The scalp is covered
with bleached blond hair. The eyes are blue. The fixed lividity is noted
in the face, neck, chest, upper portions of arms and the right side of the
abdomen. The faint lividity which disappears upon pressure is noted in
the back and posterior aspect of the arms and legs. A slight ecchymotic
area is noted in the left hip and left side of lower back. The breast shows
Table 3: Doctors associated with the life and death of Marilyn
Monroe
Doctor Life Span Specialty and link to Marilyn Monroe
[in Life]
Hyman Engelberg 1913-2005 internist; MM's personal physician
Lee E. Siegel 1909-1990 internist; Medical director at 20th
Century Fox Studios, from 1955 to 1971.
Leon Krohn 1906-1983 gynecologist
Mortimer Rodgers 1898-1970 gynecologist
Bernard Berglas 1899-1984 treated MM for a tubal pregnancy in
Aug 1957, in New York City.
Eliot Corday 1914-1999 cardiologist
Myron Prinzmetal 1908-1987 cardiologist; MM's physician circa 1952.
Margaret Hohenberg 1898-1992 psychiatrist and psychoanalyst
Marianne Kris 1900-1980 psychiatrist and psychoanalyst
Ralph Greenson 1911-1979 psychiatrist and psychoanalyst
Michael M. Gurdin 1910-1994 plastic surgeon
[in Death]
Theodore J. Curphey 1897-1986 pathologist; Coroner of Los Angeles
County
Thomas Tsunetomi 1927 - pathologist; Coroner of Los Angeles
Noguchi County
Sources: Ref. 92, 94.
Table 4: Vital Statistics of Marilyn Monroe, after death
Parameter Weight / Length
Body Height 166.4 cm
Body Weight 53.1 Kg
Internal Organs
Heart 300 g
right lung 465 g
left lung 420 g
liver 1,890 g
spleen 190 g
kidneys (both) 350 g
brain 1,440 g
Source: autopsy report signed by Dr. Thomas Noguchi. Ref. 97
Medical Issues on Marilyn Monroe's Life and Death; A Retrospective-Part 2
218
no significant lesion. There is a horizontal 3-inch long surgical scar in
the right upper quadrant of the abdomen. A suprapubic surgical scar
measuring 5 inches in length is noted.
The conjunctivae are markedly congested; however, no ecchymosis
or petechiae are noted. The nose shows no evidence of fracture. The
external auditory canals are not remarkable. No evidence of trauma is
noted in the scalp, forehead, cheeks, lips or chin. The neck shows no
evidence of trauma. Examination of the hands and nails shows no
defects. The lower extremities show no evidence of trauma.
Body Cavity: The usual Y-shaped incision is made to open the tho-
racic and abdominal cavities. The pleural and abdominal cavities con-
tain no excess of fluid or blood. The mediastinum shows no shifting or
widening. The diaphragm is within normal limits. The lower edge of the
liver is within the costal margin. The organs are in normal position and
relationship.
Cardiovascular System: The heart weighs 300 grams. The pericar-
dial cavity contains no excess of fluid. The epicardium and pericardium
are smooth and glistening. The left ventricular wall measures 1.1 cm
and the right 0.2 cm. The papillary muscles are not hypertrophic. The
chordae tendineae are not thickened or shortened. The valves have the
usual number of leaflets which are thin and pliable. The tricuspid valve
measures 10 cm, the pulmonary valve 6.5 cm, mitral valve 9.5 cm, and
aortic valve 7 cm. in circumference. There is no septal defect. The fora-
men ovale is closed.
The coronary arteries arise from their usual location and are distrib-
uted in normal fashion. Multiple sections of the anterior descending
branch of the left coronary artery with a 5 cm interval demonstrate a
patent lumen throughout. The circumflex branch and the right coronary
artery also demonstrate a patent lumen. The pulmonary artery contains
no thrombus.
The aorta has a bright yellow smooth intima.
Respiratory System: The right lung weighs 465 grams and the left
420 grams. Both lungs are moderately congested with some edema. The
surface is dark red with mottling. The posterior portion of the lungs
shows severe congestion. The trachea-bronchial tree contains no aspirat-
ed material of blood. Multiple sections of the lungs show congestion
and edematous fluid exuding from the cut surface. No consolidation or
suppuration is noted. The mucosa of the larynx is grayish white.
Liver and Biliary System: The liver weighs 1890 grams. The sur-
face is dark brown and smooth. There are marked adhesions through the
omentum and abdominal wall in the lower portion of the liver as the
gallbladder has been removed. The common duct is widely patent. No
calculus or obstructive material is found. Multiple sections of the liver
show slight accentuation of the lobular pattern; however, no hemorrhage
or tumor is found.
Hemic and Lymphatic System: The spleen weighs 190 grams. The
surface is dark red and smooth. Section shows dark red homogeneous
firm cut surface. The Malpigian bodies are not clearly identified. There
is no evidence of lymphadenopathy. The bone marrow is dark red in
color.
Endocrine System: The adrenal glands have the usual architectural
cortex and medulla. The thyroid glands are of normal size, color and
consistency.
Urinary System: The kidneys together weigh 350 grams. Their
capsules can be stripped without difficulty. Dissection shows a moder-
ately congested parenchyma. The cortical surface is smooth. The pelves
and ureters are not dilated or stenosed. The urinary bladder contains
approximately 150 cc. of clear straw-colored fluid. The mucosa is not
altered.
Genital System: The external genitalia shows no gross abnormality.
Distribution of the pubic hair is of female pattern. The uterus is of the
usual size. Multiple sections of the uterus show the usual thickness of
the uterine wall without tumor nodules. The endometrium is grayish
yellow, measuring up to 0.2 mm in thickness. No polyp or tumor is
found. The cervix is clear, showing no nabothian cysts. The tubes are
intact. The openings of the fimbria are patent. The right ovary demon-
strates recent corpus luteum haemorrhagicum. The left ovary shows cor-
pora lutea and albicantia. A vaginal smear is taken.
Digestive System: The esophagus has a longitudinal folding muco-
sa. The stomach is almost completely empty. The contents is brownish
mucoid fluid. The volume is estimated to be no more than 20 cc. No res-
idue of the pills is noted. A smear made from the gastric contents and
examined under the polarized microscope shows no refractile crystals.
The mucosa shows marked congestion and submucosal petechial hem-
orrhage diffusely. The duodenum shows no ulcer. The contents of the
duodenum is also examined under polarized microscope and shows no
refractile crystals. The remainder of the small intestine shows no grass
abnormality. The appendix is absent. The colon shows marked conges-
tion and purplish discoloration. The fecal contents is light brown and
formed. The mucosa shows no discoloration.
The pancreas has a ten lobular architecture. Multiple sections shows
a patent duct.
Skeletomuscular System: The clavicle, ribs, vertebrae and pelvic
bones show no fracture lines. All bones of the extremities are examined
by palpation showing no evidence of fracture.
Head and Central Nervous System: The brain weighs 1440
grams. Upon reflection of the scalp there is no evidence of contusion or
hemorrhage. The temporal muscles are intact. Upon removal of the dura
mater the cerebrospinal fluid is clear. The superficial vessels are slightly
congested. The convolutions of the brain are not flattened. The contour
of the brain is not distorted. No blood is found in the epidural, subdural
or subarachnoid spaces. Multiple sections of the brain show the usual
symmetrical ventricles and basal ganglia. Examination of the cerebel-
lum and brain stem shows no gross abnormality. Following removal of
the dura mater from the base of the skull and calvarium no skull fracture
is demonstrated.
Liver temperature taken at 10:30 am registered 89℉.
Specimen: Unembalmed blood is taken for alcohol and barbiturate
examination. Liver, kidney, stomach and contents, urine and intestine
are saved for further toxicological study. A vaginal smear is made."97)
It could be vaguely inferred that the superficial details provided
about Marilyn's genital system ["The external genitalia shows no gross
abnormality. Distribution of the pubic hair is of female pattern. The
uterus is of the usual size."] in the autopsy report were meant to titillate
the print and visual media audience of 1962, and can be evaluated as
showing shades of indignity. However the finding about the non-appear-
ance of nabothian cyst indicated that Marilyn failed to complete a term
pregnancy117-119).
Varied Speculations on Death
Marilyn's death is open to conjecture89). Though Los Angeles
County's then deputy medical examiner Noguchi delivered a verdict of
'probable suicide', it has been challenged by quite a number of Marilyn's
acquaintances in the movie world, biographers and other investigators.
John Miner (The Los Angeles County deputy district attorney) who
attended the autopsy as an observer had believed that Marilyn was mur-
dered89,120). Miner's 1995 story of a 40 min. 'secret tape' of Marilyn about
her private thoughts to her psychiatrist Greenson, (after Greenson's death
in 1979)) is not trusted by Marilyn's biographer Summers, because of
Miner's assertion that 'Greenson subsequently destroyed the record-
ing'.121). But in 1994, Marlon Brando (who had dated Marilyn) wrote in
his autobiography, "The last time we spoke was two or three days before
she died....with Marilyn I didn't sense any depression or clue of impend-
ing self-destruction during her call. That's why I'm sure she didn't com-
mit suicide I believe I would have sensed something was wrong if
thoughts of suicide were anywhere near the surface of Marilyn's mind. I
would have known it. Maybe she died because of an accidental drug
overdose, but I have always believed that she was murdered"122).
As opposed to this view of murder, director John Huston (who had
directed Marilyn's last completed movie 'The Misfits'in 1960 and The
Asphalt Jungle, a pivotal 1950 movie for Marilyn's career) viewed
Marilyn's death as an accident. "Too many sleeping pills --- a bottle of
them at hand and no one there to save her. She'd made this mistake sev-
eral times before had had received emergency treatment. I'm sure she
never meant to take her life."123). One biographer Donald Spotto also
proposed the death as an accident, due to an adverse reaction to an
enema given by her house keeper Eunice Murray prescribed by psychia-
trist Greenson, containing fatal dose of Nembutal and chloral hydrate124).
Dr. Noguchi's review of autopsy findings after 24 years
For the November 1986 issue of Omni magazine, Noguchi was
interviewed by Stein125) and his responses to five questions on Marilyn's
death were as follows:
"Question: With Monroe, wasn't it a question of suicide versus mur-
der: whether the fatal drugs were swallowed or injected?
Noguchi: The autopsy found a large amount of Nembutal and chlo-
ral hydrate, but the case wasn't typical because the stomach was empty. I
did not see any residue, although the stomach and gastric lining were
much reddened. But this is standard for barbiturate abuse. And this was
not the first time we'd seen an empty stomach. Like the liver, it gets
used to handling the drug and passes it quickly into the small intestine.
Because I couldn't find needle marks, I still believe the drugs were swal-
lowed.
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.
Question: Even so, doesn't that show that someone, may be her
Kantha S. S. et al. 219
therapist or nurse, for instance, injected her with these drugs?
Noguchi: This challenge has been made --- and even today I don't
think we can tell. Some speculate that she may have been injected in a
difficult-to-detect area like the scalp.
Question: What about that bruise on her hip that you find so myste-
rious? Could that have been a cover for a needle track?
Noguchi: What does that bruise mean? I don't know! Your idea is
interesting. With an injection you have only minute skin breakage, and
of course, after some hours it starts healing. When death occurs shortly
after the injection, as with John Belushi, the breakage of the skin is still
visible, and by squeezing the skin you can see the blood come out. But
in Monroe's case I could not find a needle mark on the bruised area.
Question: You note that her therapist used to inject her. He saw her
the day before. Would that give the track time to heal?
Noguchi: I would think so. I think she received an injection from
him twenty-four hours prior to her death. There are many mysteries. I
recommended that an agency such as a grand jury or D.A.'s office
reopen the case.
Question: Why are we so obsessed with how Monroe died?
Noguchi: Perhaps this case keeps returning because she was one of
the last superstars and in many ways an American dream. But I think
most of our concern and inquiry is really about her relation to the
Kennedy brothers. It's this amazing double involvement with those fig-
ures, who were as charismatic as she both of whom were assassinated.
It should also be noted that in his 1983 memoir examining the tragic
deaths of quite a number of Hollywood celebrities, including Marilyn,
Noguchi126) had asserted that the lab technicians had failed to test all the
specimens of Marilyn (excluding blood and the liver), which he had
submitted for testing because 'the head toxicologist Raymond J.
Abernathy, apparently felt there was no need to test any further.'
Noguchi also acknowledged, "I didn't follow through as I should have.
As a junior member of the staff, I didn't feel I could challenge the
department heads on procedures." In the subsequent paragraph, Noguchi
had further recorded, "Few weeks later, I asked Abernathy if he had
stored the other organs of Monroe's body that I had forwarded to him. If
so, we could still test them. I was disappointed when he said, 'I'm sorry,
but I disposed of them because we had closed the case,' for I knew the
media would charge a cover up. I was right. A variety of murder theo-
ries would spring up almost instantly and persist even today."
Thus, in her death Marilyn joins the pantheon of other illustrious
historical personalities such as composer Wolfgang Mozart (1756-
1791)127-132) and Emperor Napoleon Bonaparte (1769-1821)132-135), whose
modes of death are still being debated in medical journals.
CONCLUSION
It's unfortunate that Marilyn was served with a horrible genetic dis-
position, being born to an invalid mother Gladys who suffered from
mental disorders, and both maternal grandparents inflicted with brain
disorders. Our inference is that Marilyn self-destructed herself by her
rash polypharmacy behavior and willfully tampering with her defective
gynecological system. Based on current knowledge of endogenous pros-
tanoids, and oxytocin we propose that the fundamental cause of
Marilyn's morbidity could have been imbalances in prostaglandin and
oxytocin in the brain and reproductive system that made her sick with
insomnia and gynecological symptoms such as dysmenorrhea and endo-
metriosis.
CONFLICT OF INTEREST AND FUNDING
None
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