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.
 

References
  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.

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