Friday, July 29, 2011

The death of Frank Gotch

Frank Gotch

     Frank Gotch, arguably one of the greatest professional wrestlers of all time, died at the age of 39 on December 16, 1917.  While the official cause of death was attributed to uremic poisoning (kidney failure), it has long been rumored that Gotch may have died from complication of syphilis. (1)

     Wrestling historian and biographer Mike Chapman provides what may be the most accurate account of Gotch's illness in the book Gotch: An American Hero. (2)   The first signs of any health problems  came in the summer of 1916.  Gotch began experiencing stomach problems.  This was soon followed by several other symptoms including lack of appetite, pain in the back and abdomen, and headaches.   Prior to his death, Gotch developed confusion, weight loss, fatigue, mood swings, irrational behavior, nose bleeds, puffiness around the eyes, and vomiting.

     While the health issues experienced by Gotch may seem vague and can be seen with many different medical conditions, the constellation of symptoms is certainly consistent with chronic kidney failure (see Table 1).

Table 1: symptoms of kidney failure

  • Fatigue.
  • Headache.
  • Impaired mentation. 
  • Lethargy.
  • Muscle cramps.
  • Bruising.
  • Pallor. 
  • Nausea and vomiting.
  • Gastroenteritis.
  • Peptic ulcer.
  • Easy bleeding.
  • Edema.

     During the course of his illness Gotch sought medical attention with his personal physician (Dr. Arent) in Humbolt, IA and also with physicians in Glenwood Springs, CO, Chicago, IL, and Little Rock, AR.  He was told that he could be suffering from Bright's disease.  The condition was named after Dr. Richard Bright (1789-1858), an English physician who did pioneering work on kidney diseases.  While the term may have initial been used to refer to the abnormal presence of protein in the urine,  at the turn of the last century it was often broadly used to refer to most any kidney disease.  The term has since been abandoned and is not recognized in any of the current classification systems of kidney diseases.

     A variety of different conditions are known to cause chronic kidney failure (see Table 2). 

Table 2: common causes of chronic kidney failure.

  • Diabetes.
  • Hypertension.
  • Glomerulonephritis (inflammatory condition of the kidneys).
  • Inherited.

     There is nothing is Gotch's medical history to support any one particular cause. However, it is unlikely his kidney disease was due to hypertension or diabetes as both of these disorders should have been readily diagnosed in the early 1900's.  As his father died in 1911 and his mother was alive at the time of his death, an inherited disease seems less likely, although cannot be completely excluded.  This would seem to suggest that one of the conditions giving rise to a glomerulonephritis would be the most reasonable cause.  There is a lengthy list of conditions that can cause glomerulonephritis (see Table 3).

Table 3: examples of glomerulonephritis.

  • Fibrillary glomerulonephritis
  • Focal glomerulosclerosis. 
  • IgA nephropathy.
  • Lupus.
  • Membranoproliferative glomerulonephritis.
  • Membranous nephropathy.
  • Mesangial proliferative glomerulonephritis.
  • Minimal change disease.
  • Postinfectious glomerulonephritis.
  • Rapidly progressive glomerulonephritis.
  • Thin basement membrane disease.

Frank Gotch

     Could Gotch have died from syphilis?  An argument could be made that it was possible.  However, as will be shown, it would require a number of assumptions and rare events.

     During the early 1900's syphilis was a common sexually transmitted disease that was often difficult to diagnose.  The infection, caused by the bacterium Treponema pallidum, has been referred to as "the great mimicker" because the symptoms resemble so many other diseases.  Although arsphenamine became available for treatment in 1910, the rate of infection in the United States really did not decline until the widespread use of penicillin in the late 1940's.

     Following infection with Treponema pallidum , the initial symptoms are termed primary syphilis and usually consist of a chancre (skin ulcer) at the site of inoculation.  It is possible for the lesion to go unnoticed.  Because the lesion is not painful and will spontaneously resolve, many individuals will not seek medical attention.  Weeks to a few months later, approximately 25 percent of individuals with untreated infection develop a systemic illness that represents secondary syphilis (See Table 4).  As with primary syphilis, the manifestations of secondary syphilis will usually spontaneously resolve.  An individual may then enter the latent stage where no manifestation of the disease are evident.

Table 4: symptoms of secondary syphilis. (3)
  • A rash (the most characteristic finding)
  • Fever
  • Headache
  • Malaise
  • Anorexia
  • Swollen lymph nodes.
  • Hepatitis.
  • Arthritis.
  • Glomerulonephritis.

     When patients are untreated during the earlier stages of syphilis, they are at risk for the major complications of the infection.  About one third of untreated individuals will develop late complications (see Table 5).  These may occur at any time from 1 to 30 years after the primary infection and are referred to as tertiary syphilis.

Table 5: tertiary syphilis. (4)
  • Central nervous system involvement (neurosyphilis).
  • Cardiovascular syphilis (especially aortitis).
  • Gummatous syphilis (nodular lesions which can occur in a variety of organs).

     There are limited data on the natural history of untreated syphilis, and the incidence of syphilis related kidney failure is unknown but historically was thought to be rare. (5-8)  If the kidneys are involved it typically occurs during the secondary stage of the illness and will usually spontaneously resolve.  Syphilis has been associated with diffuse proliferative glomerulonephritis (classic postinfectious) and membranous nephropathy.  There is a case report describing  a patient with syphilis who developed rapidly progressive glomerulonephritis. (9)  There are also several reports describing the development of the nephrotic syndrome due to syphilis. (10-16)  This however, is thought to be very rare, with an estimated incidence of less than 1%. (17,18)

Frank Gotch
     Assuming Gotch had contracted syphilis during his lifetime that went untreated, it is possible he could have developed a kidney disease during the secondary or latent stages.  In the era before antibiotics and supportive care including measures such as dialysis, some cases, such as rapidly progressive glomerulonephritis and severe forms of nephrotic syndrome were likely fatal.  The greatest mortality from syphilis however occurs during the tertiary stage.  Twenty percent of untreated patients with tertiary syphilis die of the disease.  Prognosis for advanced symptomatic disease in cardiovascular syphilis is poor.  There is nothing in Gotch's available medical history to suggest he had symptoms of tertiary syphilis.


     In the final analysis, it would seem more probable that Gotch succumbed to one of the more common causes of kidney failure as opposed to a very rare complication of syphilis.  Nevertheless,  Frank Gotch's death will forever remain one of wrestling greatest mysteries.

  1. Meltzer, D.  (July 18, 2011).  Wrestling Observer Newsletter. 
  2. Chapman, M.  (1999). Gotch: An American Hero. Culture House Books.
  3. Gorbach SL, Bartlett, JG, Blacklow, NR. (1992).  Infectious Diseases.  W.B. Saunders.
  4. J Chronic Dis 1955;2:311.
  5.  J Chronic Dis 1955;1:127.
  6. Arch Intern Med 1964;114:792.
  7.  J Vener Dis Inform 1947;28(suppl 21): 1.
  8. Goffe, JR (Ed).  (1897).   Medical News. 253. 
  9. Am J Med1984;76(6): 1106.
  10. Am J Kidney Dis 1987;9(2):176.  
  11. Am J Med. 1970;48(5):643. 
  12. Clin Nephrol. 1974;2(4):164. 
  13. Br Med J. 1971;4(5784):404. 
  14. East Afr Med J. 1975;52(4):172. 
  15. Postgrad Med J. 1989;65(759):14. 
  16. West J Med. 1992; 156(6): 654.
  17. Arch Intern Med.  1946;78:679.
  18. Amer J Syph Gonorrhea Vener Dis.  1946;30:463.

The medical resource www.uptodate was used in the preparation of this blog.

Photographs are for illustrative purposes only.  Wrestling with Death does not claim ownership.

    Friday, July 22, 2011

    Savage autopsy

    Randy Savage
         Randy Poffo (Randy Savage) died May 20, 2011 from natural causes due to heart disease according to the Pinellas County Medical Examiner's office.  Savage crashed his 2009 Jeep Wrangler after becoming  unresponsive due to what is being called a "cardiac event" while driving in Seminole, Florida. 

         The autopsy revealed the presence of an enlarged heart and severe atherosclerosis of the coronary arteries. Savage sustained only minor injuries from the crash. (1)  The toxicology report listed the presence of acetaminophen, caffeine, doxylamine, doxylamine metabolites, hydocodone, dihydrocodeine, and a blood alcohol concentration of 0.03 g/dL in Savage's system, although none were thought to play a role in his death. (2)

         The findings of an enlarged heart and coronary artery disease are suspicious for anabolic androgenic steroid (AAS) use.  Savage was known to have used AAS during his wrestling career.  For related blogs see Randy Savage (November 15, 1952-May 20, 2011) and Anabolic androgenic steroids and heart disease

         It is difficult to interpret the findings of the toxicology report without knowledge of what over the counter and prescription medications Savage was taking.  Several of the drugs are found in common pain medications.  Acetaminophen is an analgesic best known by the brand name Tylenol.  Acetaminophen can also be combined with other drugs such as hydrocodone (brand names Vicodin, Lortab, Lorcet)  and caffeine/dihydrocodeine  (brand names Panlor SS,Trezix, ZerLor). 

         Doxylamine is a first generation antihistamine that has sedating properties.  It is the present in over the counter sleep aids such as Unisom. It is also the sedating ingredient in Nyquil.

          The blood alcohol level of 0.03 g/dL is well below the level that would cause impairment. 




    Photographs are for illustrative purposes only.  Wrestling with death does not claim ownership.

      Friday, July 15, 2011

      Airplane related deaths & American professional wrestling

           Flying in an airplane is convenient, fast, economic, and relatively safe.  Worldwide millions of people fly daily. (1)  American professional wrestlers are required to perform in different cities throughout the world.  Over the years a number of wrestlers have been involved in fatal airplane crashes.

      Bobby Shane
           On February 20, 1975 an airplane went down near Tampa, Florida killing wrestler Robert  Schoenberger (Bobby Shane).  Following a card held at the Miami Beach Auditorium on February 19, Schoenberger got on a plane piloted by fellow wrestler Ronald Reed (Buddy Colt).  Also on the plane were Gary Williams (Gary Hart) and Mike McCord (Austin Idol).  The plane was destined for Tampa, Florida, but was diverted to Davis Island in Hillsboro Bay due to bad weather.  During the descent the plane landed in the waters of Hillsboro Bay at approximately 1:30 am.  All survived except Schoenberger.  (2)

           A plane carrying promoter David Crockett and wrestlers Richard Fliehr (Ric Flair), John Wisniski (Johnny Valentine), George Woodin (Tim Woods/Mr. Wrestling), and Bob Bruggers left Charlotte headed for Wilmington, North Carolina on October 4, 1975.  The plane ran out of gas and crashed before reaching the Wilmington airport.  All were hospitalized with serious injuries.  Pilot Michael Farkas would eventually die from the injuries.  While the rest survived, Valentine and Bruggers never wrestled again. (3)  

           Six professional wrestlers died while doing a United Services Organization tour for Allied troops when the plan they were traveling in went down in France on March 3, 1945.  The deceased were Benny Reuben, Harold Sabath, George Mack, Gaius Young, Lester Chapman, and George Ross. (4) 

           Joseph Lyman, a professional wrestler who achieved success in the Pacific Northwest, died on September 25, 1948 when the plane he was piloting crashed.  Lyman left Boise, Idaho and his plane went down near Bend, Oregon.  He was booked to wrestle in Eugene. (5)  




      Photographs are for illustrative purposes only.  Wrestling with Death does not claim ownership.

      Friday, July 8, 2011

      Bruno Sammartino has heart surgery

      On June 28th, 2011 Sal Corrente issued the following statement:

      "We want to address any rumors regarding Bruno Sammartino and his current health situation. If you have read Bruno's Auto Biography you are aware that he had Rheumatic Fever as a child that caused damage to the valves in his heart. He was very sick for three plus years and came very close to dying as a child.. It clearly didn't affect him for many years he grew strong and had great stamina in the ring. It was recently discovered that the valves had detriorated and had to be replaced immediately. He has had the surgery and began a rehabilitation process that should last around three months. I have been told that Bruno's doctor's expect a full recovery and he should have the heart of a forty year old man when the rehab is complete."

      Bruno Sammartino

           Acute rheumatic fever is a delayed complication of a Group A Streptococcal infection involving the tonsils/pharynx.  Features of the initial bacterial infection include the sudden onset of sore throat, pus on the tonsils, tender lymph nodes in the neck, and fever.  Cough and significant nasal drainage are usually absent.  The infection is commonly referred to as "strep throat".  Prompt recognition of the infection and treatment with appropriate antibiotics are important.  Timely therapy has been shown to reduce the duration of the illness, prevent transmission to others, and decrease the likelihood of developing delayed complications including rheumatic fever.  (1, 2)  Some of the potential complications of Group A Streptococcal infection are listed in Table 1.

      Table 1
      • Acute rheumatic fever
      • Scarlet fever
      • Streptococcal toxic shock syndrome
      • Acute glomerulonephritis
      • PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder associated with group A Streptococci)

           Acute rheumatic fever typically occurs 2 to 4 weeks after the Group A Streptococcal infection.  It most commonly develops in children ages 5 to 15 years old.  It is rare to see in younger children and adults.  A major manifestation of acute rheumatic fever is a severe inflammation of the heart.  This can involve all components of the heart including the muscle, valves, and sac that surrounds the heart (pericardium).  The major and minor manifestations of rheumatic fever are listed in Table 2.  (3)

      Table 2

      Major manifestations:
      • Migratory arthritis (predominantly involving the large joints)
      • Carditis and valvulitis (eg, pancarditis)
      • Central nervous system involvement (eg, Sydenham chorea)
      • Erythema marginatum
      • Subcutaneous nodules
      Minor manifestations:
      • Arthralgia
      • Fever
      • Elevated acute phase reactants [erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)]
      • Prolonged PR interval on the EKG

           Rheumatic heart disease is the most severe complication of acute rheumatic fever.  It usually occurs 10 to 20 years after the original illness. The mitral valve is more commonly involved than the aortic valve. Mitral stenosis, caused by severe calcification of the mitral valve, is the classic finding in rheumatic heart disease.  As the valve disease progresses a person can experience a wide variety of problems including shortness of breath, exercise intolerance, and even congestive heart failure.  Once the valve disease is moderate to severe surgery is usually required.

      Specific details about Sammartino's health have not been released.  It is unknown how long he was having symptoms, and what valve was involved.

      1. J Pediatr. 1985;106(6):870.
      2. J Pediatr. 1978;92(2):325.
      3. JAMA. 1992;268(15):2069.  

      The medical resource was used in the preparation  of this blog.  Photographs are for illustrative purposes only.  Wrestling with Death does not claim ownership.

        Friday, July 1, 2011

        Wrestlers' sore eyes.

             Trachoma is an eye infection caused by Chlamydia trachomatis.  The organism can be transmitted by social contact through eye, nose, and throat secretions and remains the leading cause of infectious blindness worldwide.  It is estimated that over 80 million people worldwide have trachoma, and approximately 1 million are blind as a result. (1)

             The initial infection is often mild, causing a self-limited conjunctivitis (inflammation of the membrane surrounding the white of the eye).  Many cases do not produce any symptoms.  The duration and severity of the infection predict the likelihood of progression to blindness later in life. (2)  

             Trachoma used to be epidemic among early professional wrestlers.  It used to be referred to as "wrestlers sore eyes".  There are numerous references in the medical literature that attest to this.  For example, in the November 20, 1930 College of Physicians of Philadelphia Ophthalmology Society transactions there is a discussion about trachoma in wrestlers.  One physician shared his experience treating "a case of trachoma in one eye of a wrestler who at that time was champion of the world". (3)

             That trachoma was  common among professional wrestlers is also well illustrated in a presentation given on April 3, 1935 by A.F. MacCullan, President of the International Organization against Trachoma.  At the annual meeting of the Organization held in London, England he stated that "It is not generally know that nearly all professional wrestlers have trachoma". (4)  Phillips Thygeson in 1963 made similar observations in his work Epidemiologic observations on trachoma in the United States.  He concluded that the only clear cut occupation that was related to trachoma in the United States was wrestling, having personally treated several infected professional wrestlers. (5)

              Such a concern was the infection that it prompted the National Wrestling Association to state in the official 1939 rulebook that "No wrestler having trachoma (eye disease) shall be permitted, under any circumstances, to engage in any wrestling contest. The National Wrestling Association recommends that all wrestlers be given a rigid examination for evidence of trachoma before being allowed to enter the ring, and particular attention shall be given to the provisions of this rule". (6)

             The most famous professional wrestler to suffer from trachoma was Robert Freidrich, known worldwide as Ed "Strangler" Lewis (June 30, 1891-August 8, 1966).

        Ed "Strangler" Lewis

             Trachoma no longer is a common infection.  An increased awareness of the modes of transmission and antibiotics such as oral azithromycin and topical tetracycline have significantly reduced the prevalence in developed countries.  Modern era American professional wrestlers no longer have to worry about the dreaded "wrestlers' sore eyes".


        1. Bull World Health Organ. 2004;82(11):844.
        2. Ophthalmic Epidemiol. 2001;8(2-3):137.

         The medical resource was used in the preparation of this blog.

         Photographs are for illustrative purposes only.  Wrestling with Death does not claim ownership.