{"id":474,"date":"2019-02-03T01:25:00","date_gmt":"2012-12-30T12:29:15","guid":{"rendered":"https:\/\/drmirkin.com\/2019\/02\/03\/what-killed-alexander-the-great\/"},"modified":"2019-10-09T21:33:14","modified_gmt":"2019-10-09T21:33:14","slug":"what-killed-alexander-the-great","status":"publish","type":"post","link":"http:\/\/drmirkin.com\/?p=474","title":{"rendered":"What Killed Alexander the Great?"},"content":{"rendered":"<div id=\"cke_pastebin\">\n<img decoding=\"async\" style=\"width: 141px; height: 175px; float: left;\" src=\"\/wp-content\/uploads\/FamousDeaths\/Alexander2.jpg\" alt=\"alexander the great\" \/>In 323 BCE, Alexander the Great died suddenly at the very young age of 32.\u00a0 This month, more than 2,300 years later, Dr Katherine Hall of the University of Otaga in New Zealand gives a very strong argument that he died of nerve damage from Guillain-Barr\u00e9 Syndrome (<em>The Ancient History Bulletin<\/em>, 2018;32(3):106-128).<\/div>\n<div id=\"cke_pastebin\"><\/div>\n<div id=\"cke_pastebin\">Alexander never lost a battle and was one of the most successful military commanders of all time. He was born in 356 BCE and was tutored by Aristotle until he was 16. By age 18, he led large armies in battle. At 20, he became king of Macedon, a state in ancient northern Greece, after the assassination of his father, Phillip II. At 22, Alexander&#8217;s forces crossed into Asia. By age 30, he had reached the edge of the known world (modern India), to form an empire that stretched from today&#8217;s Albania to eastern Pakistan, the largest empire of the ancient world. He founded Alexandria in ancient Egypt and more than 20 other cities that were named after him, bringing successful commerce to the entire region.<\/div>\n<div id=\"cke_pastebin\"><\/div>\n<div id=\"cke_pastebin\"><strong>How Did He Die?<\/strong><\/div>\n<div id=\"cke_pastebin\">Alexander had been quite healthy up to age 32, when he hosted a feast in memoriam for the death of a close personal friend.\u00a0 That evening, after a day of drinking 12 pints of wine, his muscles started to hurt, his stomach started to cramp and he felt exhausted. Over the next few days, his belly felt better but hurt when it was touched.\u00a0 Then he developed severe chills, sweating and high fever, and was exhausted, lost his appetite and developed diarrhea. On the eighth day of illness, he had an extremely high fever, was unable to speak, was paralyzed and could move only his eyes and hands. His doctors noted that he was sweating heavily and responded to questions only with slight movements of his eyes and hands. On the 11th day of his illness, he started to breathe shallowly, passed out and died.<\/div>\n<div id=\"cke_pastebin\"><\/div>\n<div id=\"cke_pastebin\">\n<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/FyjAyIyXOeM\" width=\"420\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<div id=\"cke_pastebin\"><strong>Ruling Out Causes of Death<\/strong><\/div>\n<div id=\"cke_pastebin\">Alexander&#8217;s contemporaries thought he might have been poisoned, and many other theories on his death have been offered over the years.\u00a0 I have reviewed the descriptions of his symptoms from the multiple reports on his death written by his contemporaries.\u00a0 Based on our modern medical knowledge, he did not die from:<\/div>\n<div><\/div>\n<div id=\"cke_pastebin\"><em>Alcohol Poisoning or Alcoholic Liver Failure:<\/em> Alcohol poisoning almost always causes continuous vomiting, but I could find no mention anywhere of nausea or vomiting. His illness started after drinking a huge amount of alcohol, but he did not die of liver failure caused by alcohol because that would not explain his fever, belly pain or diarrhea, which point to an infection in his intestines.<\/div>\n<div><\/div>\n<div id=\"cke_pastebin\"><em>Pancreatitis:<\/em> One medical article suggested that he died of pancreatitis because of his many years of heavy drinking (<em>J Clin Gastroenterol<\/em>, 2007;24 (4): 294-296), but that would not explain the acute onset of paralysis.<\/div>\n<div><\/div>\n<div id=\"cke_pastebin\"><em>Typhoid fever:<\/em> A likely diagnosis was that he was infected with a bacteria that causes diarrhea. The one diarrhea germ that classically causes very high fever and a slow pulse rate is typhoid fever. Typhoid bacteria can punch holes in the intestines to allow fluid to pour from inside the intestines outside into his belly, which would cause severe belly pain, particularly when the abdomen is touched and released. Doctors call this \u201crebound tenderness\u201d. Typhoid fever also can cause paralysis of the arms and legs (Guillain Barre syndrome), but typhoid fever usually occurs in epidemics, not in isolated cases, because it is usually transmitted by contaminated water. There is no evidence anywhere to suggest an epidemic of\u00a0 typhoid fever in the region where he died.<\/div>\n<div><\/div>\n<div id=\"cke_pastebin\"><em>West Nile Encephalitis:<\/em>\u00a0 When Alexander entered Babylon, ravens fell dead from the sky, and historians said that was an omen to predict that Alexander himself would die. More recently, researchers reported that the ravens could have died from West Nile encephalitis (<em>Emerg Infect Dis,\u00a0<\/em>Jul, 2004;10(7):1328\u20131333), a virus that is spread by mosquitoes and could also have infected Alexander.\u00a0 However, he was rational right up to the time he died, so it is extremely unlikely that he died from a virus infecting his brain.<\/div>\n<div><\/div>\n<div id=\"cke_pastebin\"><em>Malaria:<\/em> This disease is caused by a parasite that is transmitted by mosquitoes, but it spreads in tropical jungle areas, not in desert regions such as Babylon (modern central Iraq) where Alexander died.<\/div>\n<div><\/div>\n<div id=\"cke_pastebin\"><em>Poisoning by a rival:<\/em>\u00a0A known poison such as strychnine could have killed him, but there was no evidence of any conspiracy to overthrow him in his very successful army.<\/div>\n<div id=\"cke_pastebin\"><\/div>\n<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/IugIkf1anLE\" width=\"420\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<div id=\"cke_pastebin\"><strong>Clues for a Correct Diagnosis<\/strong><\/div>\n<div id=\"cke_pastebin\"><em>Infection in his belly:<\/em> He had terrible belly pain, so severe that he would not let anyone touch his belly, and very high fever and diarrhea. He was thirsty, had all of the symptoms of a high fever, and became delirious.\u00a0 The fluid inside his intestines was probably loaded with bacteria that spread with the intestinal contents into his entire abdomen, then into his bloodstream, causing his blood pressure to drop to zero, shock and death.<\/div>\n<div id=\"cke_pastebin\"><\/div>\n<div id=\"cke_pastebin\"><em>Guillain-Barr\u00e9 Syndrome:<\/em> He developed a progressive, equal-on-both-sides, ascending paralysis, with no signs of brain damage such as confusion or unconsciousness.\u00a0 Although he could still move his head and arms, he could not talk, and eventually he became very short of breath. The diffuse nerve damage of Guillain-Barr\u00e9 syndrome is an auto-immune disease that is neither contagious nor inherited.\u00a0 His immune system would produce huge amounts of cells and chemicals to kill the germ that invaded his intestines.\u00a0 As the infection progressed, his immunity would lose its ability to tell the difference between his own nerves and the germ, so these same cells and chemicals attacked and destroyed the nerves located outside his brain and spinal cord. Usually the patient recovers, but in Alexander&#8217;s case, his immune system probably destroyed the nerves that control breathing and he smothered to death.<\/div>\n<div id=\"cke_pastebin\"><\/div>\n<div id=\"cke_pastebin\">The recent article on Alexander&#8217;s death proposes that Campylobacter pylori was the germ most likely to have caused him to suffer from\u00a0 Guillain-Barre syndrome (<em>The Ancient History Bulletin<\/em>, 2018;32(3):106-128).\u00a0 Since he was rational and coherent right up to the time of his death, this infectious agent was not likely to have affected his brain.\u00a0 Infection with Campylobacter pylori is an intestinal germ, spread by eating contaminated food, that would explain his symptoms of belly pain and diarrhea.\u00a0 This infection is still very common today. Alexander the Great could not have been saved then, but could be saved today with an antibiotic (<em>NEJM<\/em>, June 1998;338 (24):1764-1769).<\/div>\n<div id=\"cke_pastebin\"><\/div>\n<div id=\"cke_pastebin\"><strong>Why Didn&#8217;t Alexander&#8217;s Body Decay?<\/strong><\/div>\n<div id=\"cke_pastebin\">His body was reported not to have decayed for six days after he died, and the ancient Greeks thought that this proved that Alexander was a god.\u00a0 A more likely explanation is that his doctors thought he died up to a week before he actually died.\u00a0 At that time doctors did not understand how the heart circulates blood through the body.\u00a0 Furthermore, they had no machines to help them take a person&#8217;s pulse to measure heart rate, so they checked whether a person was still alive by counting the rate that a person breathes and diagnosed death when a person stops breathing.\u00a0 Guillain Barre syndrome can reduce a person&#8217;s need for oxygen to slow breathing considerably.\u00a0 It also can damage the nerves that stimulate the breathing muscles including the diaphragm to help you breathe.\u00a0 Most likely he would breathe at a very low rate or periodically not breathe at all.\u00a0 The doctors at that time interpret his irregular breathing as a sign that he was dead.\u00a0 They did not check his pulse to show that he was still alive.\u00a0 They also did not know that he was not yet dead because his pupils were not fixed and dilated.<\/div>\n<div id=\"cke_pastebin\"><\/div>\n<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/mdE-07GHnnc\" width=\"420\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<div id=\"cke_pastebin\"><strong>Then and Now<\/strong><\/div>\n<div id=\"cke_pastebin\">If Alexander the Great suffered from a Campylobacter infection today, he could probably have been cured by taking the appropriate antibiotic.\u00a0 However, today we still have no effective treatment for Guillain-Barre syndrome.<\/div>\n<div id=\"cke_pastebin\"><\/div>\n<div id=\"cke_pastebin\"><a href=\"https:\/\/en.wikipedia.org\/wiki\/Alexander_the_Great\">Alexander III of Macedon<\/a><\/div>\n<div id=\"cke_pastebin\">July 21, 356 BCE &#8211; June 11, 323 BCE<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>In 323 BCE, Alexander the Great died suddenly at the very young age of 32.  This month, more than 2,300 years later, Dr Katherine Hall of the University of Otaga in New Zealand gives a very strong argument that he died of nerve damage from Guillain-Barr\u00e9 Syndrome.   Alexander never lost a battle and was one of the most successful military commanders of all time. By age 30, he had reached the edge of the known world (modern India), to form an empire that stretched from today&#8217;s Albania to eastern Pakistan, the largest empire of the ancient world.<\/p>\n","protected":false},"author":1,"featured_media":7602,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"categories":[18],"tags":[],"class_list":["post-474","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-histories-and-mysteries"],"_links":{"self":[{"href":"http:\/\/drmirkin.com\/index.php?rest_route=\/wp\/v2\/posts\/474","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/drmirkin.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/drmirkin.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/drmirkin.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/drmirkin.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=474"}],"version-history":[{"count":0,"href":"http:\/\/drmirkin.com\/index.php?rest_route=\/wp\/v2\/posts\/474\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/drmirkin.com\/index.php?rest_route=\/wp\/v2\/media\/7602"}],"wp:attachment":[{"href":"http:\/\/drmirkin.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=474"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/drmirkin.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=474"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/drmirkin.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=474"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}