Did Alexander the Great Die from West Nile Virus?

Teams of medical investigators are questioning whether Alexander the Great died from poison, as long suspected, or from a disease. According to a WaPo story this morning medical investigators at U of MD and UVA have examined historical accounts of Alex’s final illness. The prevailing theory was that he did of typhoid fever, However, it seems that a flock of ravens fell close to him before he took ill. Were these ravens sick? Did Plutarch see the ravens as an omen after the fact?

I always respect people who are willing to challenge the convetional wisdom. Read more.

Alexander and the Rustle of Black Wings

By Rick Weiss
Washington Post Staff Writer
Monday, July 19, 2004; Page A06

Medical investigators in Virginia and Maryland are engaged in an unusual public tussle over the death of a celebrity patient whose presumed death-by-poisoning has come under growing scrutiny.

It's not often that doctors and medical researchers argue in public over a possible misdiagnosis. But when the patient has been dead for 2,327 years -- and when that patient just happened to have conquered the entire known world by the time he was 25 -- well, the usual courtesies of patient confidentiality can hardly be expected to apply.

So it is that ancient descriptions of Alexander the Great's final days are being scrutinized anew for clues to the Macedonian king's death. Amid a growing consensus that an infectious disease, not poison, was the likely killer, experts have narrowed their focus to typhoid or a brain inflammation caused by West Nile virus -- two competing diagnoses proposed by medical sleuths in Baltimore and Richmond, respectively.

It's a duel of opinions unlikely to be fully resolved. Although historical documents indicate that Ptolemy, the Egyptian general, had Alexander's body preserved in honey and his sarcophagus displayed for many years, the corpse was eventually lost to history. So scientists have no tissues to test for microbial DNA or other clues.

But getting a final answer is not really the point, said John Marr, state epidemiologist for Virginia's Department of Health.

"It's intellectual candy," Marr said of his post-postmortem. "And it's a reminder of how to look at signs and symptoms, which is something that's being lost as the art of medicine is being usurped by electronic messiahs" such as laboratory tests, echocardiograms, scans of various kinds and other modern tools of diagnosis.

The debate began in earnest six years ago when David Oldach and colleagues at the University of Maryland School of Medicine published a report concluding that Alexander had died of typhoid.

The university has a proud history of diagnosing illnesses of the long-dead. A special program there devoted to the practice takes on a new celebrity each year -- concluding in recent years that Beethoven died of cirrhosis and syphilis, and Edgar Allen Poe of rabies.

Oldach's team relied largely on remarkably detailed descriptions of Alexander's death recorded by Plutarch a few centuries after the event. Alexander's medical chart, Oldach determined, would have read something like this: A 32-year-old soldier, widely traveled, with many wives and one son and a history of excessive alcohol consumption, experienced escalating fever, great thirst, profuse sweating and acute abdominal pain soon after returning to Babylon. For two weeks the patient suffered from delirium, loss of voice and increased weakness, gradually progressing to paralysis and death.

In the December 1998 issue of Emerging Infectious Diseases, a journal of the federal Centers for Disease Control and Prevention, Oldach and his colleagues concluded that Alexander's symptoms pointed to typhoid, a life-threatening bacterial disease, transmitted by contaminated food and water, that causes sustained high fevers, can be accompanied by stomach pains and sometimes affects nerves -- possibly accounting for Alexander's paralysis.

Then, in 2002, a group preparing a documentary about Alexander asked Marr to reconsider the evidence for typhoid. Marr read Oldach's paper and was at first inclined to agree with it. "But then I said, 'What the heck. Let's re-look at this thing from a larger scale,' " he recalled.

That meant going beyond the descriptions of Alexander's symptoms to include questions of what was going on at the time around Babylon (near today's Baghdad), including the kinds of plants and animals there and what the landscape and climate were like.

While Marr was doing so, he got a call from a colleague studying West Nile encephalitis, an unusual complication of West Nile virus infection that can cause a polio-like syndrome called flaccid paralysis.

"That made a light flicker in my head," Marr said. "I remembered that Alexander was awake but had to be carried."

Then Marr and fellow epidemiologist Charles Calisher of Colorado State University found a passage in Plutarch's writing that other diagnosticians had not noted.