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Atypical Tetanus: The Tragic Death of a Once Famous Western Movie Star

Robert S. Pinals, M.D.
Clinical Professor of Medicine
Rutgers Robert Wood Johnson Medical School
New Brunswick, New Jersey

ABSTRACT
Fred Thomson, a star of Hollywood westerns in the silent screen era, was also a world-class athlete in track and field and the husband of Hollywood's leading screenwriter, Frances Marion. At the peak of his career, at age 38, he was hospitalized for an acute illness, with painful muscle spasms in the flank and abdomen, later spreading to other areas. Jaw spasm (trismus) appeared only the day before his death, resulting in a delayed diagnosis of tetanus , too late to save him with antitoxin.

INTRODUCTION
Fred Thomson was best known as a Hollywood Cowboy star in the 1920s and as the husband of Frances Marion, the industry's highest paid and most respected screenwriter.Additionally, he was a world-class athlete, a Presbyterian minister and a World War I chaplain. Unfortunately, his life ended at age 38 after an acute illness, just before the introduction of sound in the movies. Thomson has been largely forgotten and almost all of his films have deteriorated or been destroyed , but details of his memorable life and tragic death deserve a recounting (1).

A HERO'S LIFE
When the US entered World War I the nation's most famous movie actress, Mary Pickford, was selected to be the honorary Colonel of the 143rd Field Artillery, stationed near San Diego. Dressed in a tailored uniform and mounted on a horse, Mary led the regiment on parade and made regular visits to inspect the camp. In early February, 1918 she invited her best friend, screenwriter Frances Marion, to accompany her.(Fig 1)

Fig1. Mary Pickford and Frances Marion working on a screenplay. (Courtesy of Cari Beauchamp)

On a previous visit to the base hospital Mary had seen a young officer who had fractured his leg in a football game and she was eager to have Frances meet him. After the introduction Mary left to complete her inspection, while Frances spent the afternoon talking to Fred Thomson, who was tall, muscular, articulate and excessively handsome. Although the phenomenon had appeared in many of her screenplays, Frances had never believed in 'love at first sight' until it happened to her (2 ). Before the regiment left for France 10 days later Frances and Fred had agreed to marry when the war was over.

Frances was born in San Francisco; her father was a wealthy advertising executive and her mother a pianist (2). She was talented and attractive, working as a model, journalist and commercial artist, and had 2 brief marriages, ending in divorce. Frances moved to Los Angeles in 1913 and found work in the movies as an illustrator and later a writer. Her scenarios for 13 Mary Pickford movies elevated her to the top rung of the new screenwriting profession, of which she was one of the early leaders.

Fred Thomson was born in Pasadena CA, the son of a prominent Presbyterian minister. At Occidental Academy and College, both Presbyterian institutions, he was an outstanding student and athlete, starring on the football team and setting records in many track and field events, in both intercollegiate and national competitions. In 1910 Fred enrolled in the Princeton Theological Seminary to prepare for a life in the ministry. He played football for Princeton University and attracted national attention as three time All-Around National Champion in track and field. However, he declined participation in the 1912 Olympic Games on religious grounds because he would have been expected to perform on Sundays. In 1913 he moved back to Pasadena, where he married and later started his ministry in a small town in Nevada. He was also appointed State Commissioner of the Boy Scouts. Fred was an advocate for clean living; he did not smoke or drink and of course was a world class athlete. Life was going according to plan until his wife died suddenly in late 1916. When the US entered World War I in 1917 Fred enlisted in the army as a Chaplain. The war ended in November, 1918 before Fred's regiment reached the front , but he won several medals in athletic competitions.

Frances was commissioned as a lieutenant in the Army Signal Corps and assigned to a unit making a documentary film about the wartime activities of American women in Europe. She spent much of her time near the battlefront and was the first American woman to cross the Rhine into Germany at the war's end.

Fred and Frances married in New York in 1919, with Mary Pickford serving asMaid of Honor. On their honeymoon in Europe the newlyweds were joined by Mary and her new husband, Hollywood star Douglas Fairbanks. Frances resumed her screenwriting career but Fred had to find a new occupation because his marriage to a double divorcee ruled out the ministry. Acting was not his first choice but he accepted a role in The Love Light, playing Mary Pickford's husband in a film written and directed by Frances. After 5 more films in which he was able to exhibit his athletic skills, Fred found a comfortable cinematic environment in Westerns, starting with The Mask of Lopez in 1924. He had trained a large white horse, Silver King, to perform tricks and stunts, which Fred always did himself, sustaining many injuries. Fred made 24 Western movies in 4 years and both he and Silver King gradually succeeded (Fig 2).

Fig 2. Fred Thomson and Silver King rampant. (Courtesy of Cari Beauchamp)

Westerns were very popular in the silent screen era, since action took precedence over dialogue. In competition with other cowboy stars, including Tom Mix, William S. Hart, Buck Jones, Hoot Gibson, Ken Maynard and others, Fred and Silver King rose quickly to the upper echelon. None could match his handsome, clean-cut image and athleticism. Silver King mastered many tricks but to expand his repertoire Fred trained 20 additional white horses, each to perform just one or two tricks. With both Fred and Frances prospering, the couple built Enchanted Hill, a luxurious 30 room hilltop home, on 24 acres in Beverly Hills. The estate also included a state-of-the-art mahogany floored stable for Silver King, who was receiving a weekly salary of $2000 from the studio. In his spare time Fred also designed and drove sports cars and speed boats, and was involved in real estate development. By 1928 Fred and Frances had 2 children and were at the peak of their careers, when disaster struck.

ILLNESS AND DEATH
In early December, 1928 Frances noticed that Fred was limping and asked him if it was because of an old injury. Fred replied 'No, I have a pain in my side, probably a pulled muscle' (2). He awoke during the night with more severe pain and a high temperature . He was taken by ambulance to Queen of Angels Hospital. An X-Ray showed a very small kidney stone and this was believed to be the cause of the pain. Over the next few days Fred's temperature fluctuated from high to subnormal. Consultants were called in and after a week in the hospital, surgery for kidney stones was performed on December 20. However, he failed to recover and had more widespread muscle spasms. Blood transfusions were of no benefit. On Christmas Eve he was barely able to sign a new will and early on Christmas day he developed jaw spasm (trismus) and a diagnosis of tetanus was made. Fred then recalled having stepped on a rusty nail before the onset of his illness. However, no puncture wound was apparent on admission. Tetanus antitoxin was administered, including some into the spinal canal, but physicians told Frances' brother that the antiserum had probably been given too late to be effective(2 ). Fred was conscious and attempting to speak despite the jaw spasm but he died in his wife's arms just before midnight on Christmas Day. His last words were : 'Frances, I love you so” (1). There was no autopsy but the death certificate gave tetanus as the cause of death with kidney stone as a secondary cause.

AFTERMATH
Many celebrities attended Fred's funeral services. After several months of bereavement Frances sold their Beverly Hills estate, including Silver King and the other horses, and moved back to Hollywood to resume her career (2). Silver King continued to appear in Western movies through 1934. Enchanted Hill had a few changes in ownership and was used as a setting for several movies before its demolition in 2000. Frances wrote screenplays for over 200 movies, including 2 for which she won the Academy Award. She also directed numerous films and wrote novels, some of which were made into movies. Frances wrote a textbook on screenwriting and , even today, she remains a role model for women who seek creative roles in the motion picture industry other than acting. She died in 1973 at age 84 (2). All of Fred Thomson's Western movies have deteriorated and are unavailable except Thundering Hoofs(1924).

DISCUSSION
Although many details of Fred Thomson's illness are lacking, the final diagnosis of tetanus is most likely correct. He presented with painful spasm of the abdominal muscles and fever. An X-ray suggesting a kidney stone led to surgery after a week in the hospital, but his painful spasms spread and later extended to his jaw muscles. This physical finding (trismus or “lockjaw”), provided convincing evidence for a diagnosis of tetanus. Unfortunately, the history of a rusty nail puncture wound was not obtained before trismus was noted. Trismus is the presenting feature in more than half of tetanus cases (3 ). However, in one report 3 of 22 patients presented with abdominal wall muscle spasm, leading to delay in diagnosis (4).

In California in the 1920s before the availability of immunization with tetanus toxoid the mortality rate was 82% (5 ). Tetanus has been a reportable disease in the US since 1947 and its prevalence has declined more than 95% since that time, largely due to immunization with tetanus toxoid in childhood and booster injections in adults. Clostridium tetani spores are found in soil and in the feces of humans and animals. They enter the body through a wound or even a minor puncture in the skin, such as might be produced by a nail. Fred Thomson spent much of his time in stables and his stunts resulted in many major and minor injuries. In an anaerobic environment the spores germinate and a toxin is conveyed by intraaxonal transport to the spinal cord, resulting in uninhibited muscle contraction (6). Symptoms usually start 4 to 14 days after injury. Autonomic dysfunction may result in tachycardia, sweating, and labile blood pressure and temperature (3). Of course fever may also be caused by infection and augmented by severe , widespread muscle spasm . In Fred Thomson's case we have no information about laboratory results but one would suppose that blood cultures were performed in the presence of high fever.

Tetanus antitoxin was discovered in 1890 by Emil von Behring (6). Paul Ehrlich and others developed antiserum for use in humans in the early 1900s by injecting horses with inactivated toxin. Immunization using inactivated toxin was developed during World War I but an effective vaccine was not produced until 1926. Availability was limited and the vaccine was not used on large populations until the 1940s. It is unlikely that Fred Thomson was immunized despite his high risk status. Currently, tetanus is rare in the US and occurs mainly in unimmunized or inadequately immunized individuals; most physicians have never seen a case and this represents a challenge to early diagnosis, which remains a key factor in successful treatment. The risk of delay may be compounded if the clinical picture is atypical as was true in 1928 for one of Hollywood's top Western stars. Even today, there is no laboratory test for tetanus and the key to diagnosis is considering the possibility when an acute systemic illness is accompanied by painful muscle spasm . In a few atypical cases the almost pathognomonic sign, trismus may have a late arrival.

ACKNOWLEDGMENT
The author thanks Cari Beauchamp, Frances Marion's biographer (2), for reviewing the paper, offering helpful advice and photographs from her collection.

Funding: None.
Conflict of Interest: None.
Authorship: Author is entirely responsible for the content of this manuscript.
Requests for reprint should be addressed to Robert S. Pinals MD, 18 Pickman Dr., Bedford MA 01730, Email: bob@ pinals.com

REFERENCES:
1. Wyatt EM. More than a Cowboy: the Life and Films of Fred Thomson and Silver King: Raleigh NC ;Wyatt Classics Inc.,1988.

2. Beauchamp C: Without Lying Down: Frances Marion and the powerful women of Early Hollywood.: New York; Scribners/ a Lisa Drew book, 1997.

3. Weinstein L.Tetanus.N Engl J Med 1973;289;1293-6.

4. Fountain EM. The early symptoms of tetanus with a review of 22 cases. Canad Med Assn J 1951;64: 58-60.

5. Condit PK. Tetanus in California: Epidemiology and Review of 232 cases. Calif Med 1959; 90: 318-21.

6. Guilfoile P: Tetanus. New York; Infobase Publishing, 2008.