The most popular
theory for the cause of death has been malaria. Alexander had traveled
to part of
India
where malaria was common, and some of his
symptoms do indeed match the disease. With malaria, the patient
experiences chills which cause shaking, as Alexander is said to have done,
and they develop a high fever, which comes and goes every few days for a week
or so. Alexander is described as initially having a fever which abated
until he relapsed a few days later. Malaria can also induce delirium
and periods of unconsciousness, which it also seems Alexander suffered.
And in cases where malaria is fatal, the cause of death is usually a ruptured
spleen: an agonizing condition that would result in excruciating pain in the
area of the stomach, such as described in Alexander’s case. For years,
malaria was widely accepted by historians as the cause of death, until a
tropical disease specialist, Dr James Maynard of
London
University
, examined the accounts of Alexander’s fatal
illness in the 1970s. He concluded that if the ancient reports were
reliable, then Alexander could not have died from malaria.
Dr Maynard seriously
doubted that Alexander had suffered a ruptured spleen. If his spleen
had ruptured when he was struck down with pain at the banquet, as the malaria
theory supposed, then the pain would not have subsided overnight and abated
for some days, as the sources report. Alexander would have been in
persistent agony until he died from internal hemorrhaging. Moreover,
the pain would have been on the left side of the stomach and not beneath it,
as described. The other way that malaria victims can die is when diseased
blood cells clog the brain tissue of the patient. Dr Maynard found no
evidence that Alexander had died in this way either, as the condition would
have been accompanied by severe headaches which are not mentioned once by any
of the sources. In fact, Dr Maynard was certain that Alexander not have
contracted malaria at all.
Malaria is a disease
carried by certain mosquitoes that can infect a person with a bite. These
mosquitoes live in jungle and tropical locations, but not in desert regions
such as central
Iraq
where Alexander died. However, two
years earlier Alexander had been in an area of India where malaria was
common. Nevertheless, Dr Maynard seriously doubted that Alexander could
have contracted the illness there. The disease can remain dormant in
the bloodstream for anything up to ten months from the time of the initial
exposure. Someone who fails to exhibit symptoms after that time is
probably not infected: certainly not after two years. Bouts of malaria,
lasting some days, can and do recur, so it is possible that Alexander had
previously suffered from the illness since he left
India
. However, Alexander’s life from the
time he was in
India
is well documented but there is no report
whatsoever of a previous illness of this kind.
With the malaria
diagnosis in question, in 1998 a team from the
University
of
Maryland
in the
USA
suggested that Alexander had died of
typhoid. Typhoid causes chills, high fever and delirium, from which
Alexander appears to have suffered. However, so do many other
illnesses. What convinced the team that he had specifically died of
typhoid was the description Plutarch gives of the state of preservation of
Alexander’s body after his apparent death. One symptom sometimes
associated with typhoid is a condition known as ascending paralysis: muscle
paralysis which starts at the feet and moves slowly up the body.
Patients with this condition can eventually appear dead and, in the days
before modern medicine, some unfortunate victims of typhoid were even buried
before they had actually died. As Plutarch reported that Alexander’s
body failed to show any signs of decomposition for days, the team proposed
that the king had been suffering from paralysis caused by typhoid and was
actually still alive.
However, the typhoid
theory failed to address many of the symptoms and circumstances associated
with Alexander’s death. To begin with, typhoid is caused by salmonella
typhi bacteria which is transmitted by food or water contaminated by an
infected person, or by sewage containing the germs. As such, there
would almost certainly have been an epidemic of the disease when Alexander
fell sick. However, there is nothing in any of the historical accounts
to suggest such outbreak in
Babylon
at the time. Secondly, salmonella typhi is
an intestinal bug which causes severe diarrhea and abdominal pain.
Beside the fact that diarrhea is not mentioned in the historical accounts,
Alexander’s pain is reported to have been in the area of his stomach and not
his bowl which would have been the area of discomfort if he had
typhoid. In fact, the
University
of
Maryland
team proposed that Alexander’s stabbing pain
suggested that he had died of a perforated bowel, which is often the cause of
death in cases of typhoid fatality. Even if the sources are wrong about
the location of Alexander’s pain, a perforated bowel would have left him in
constant agony until he died, rather than recovering for days as the accounts
all describe.
Perhaps the most
obvious possible cause of Alexander’s death to consider is alcohol
poisoning. Not only is he reported as having been a heavy drinker, on
the day he was taken ill Alexander had been consuming large quantities of
strong wine. Intense pain in the area of the stomach is a symptom of
alcohol poisoning and unconsciousness is inevitable. Alexander did suffer
stabbing pains in his stomach and was unconscious shortly after. If
Alexander had suffered from the toxic effects of alcohol to the point where
he was in excruciating agony, as is reported, then the lining of his stomach
would have been so inflamed that he would also be vomiting violently and
would not be able to hold down food or liquid for many hours or even
days. If Alexander was a chronic alcoholic, as has been suggested, then
this condition would be extremely serious. Unable to hold down any
alcohol, Alexander would soon suffer from dangerous withdrawal symptoms.
Serious alcoholics
suffer severe withdrawal symptoms known as delirium tremens, or DTs for
short. Unless the alcohol intake is lessened gradually, or
substituted by modern drugs, the person experiences fevered agitation,
extreme anxiety, delirium, hallucinations and severe trembling.
Moreover, delirium tremens also include grand mal seizures that sometimes
lead to death. All of these, or similar symptoms, seem to have been
suffered by Alexander. However, as DTs occur because the body has been
denied the alcohol it has become dependent upon, they do not begin until
enough alcohol has left the system – usually not for twenty-four hours or
more. Even with an extremely high metabolism, DTs would not occur until
at least six hours after the last drink; and even then they would be the less
severe effects, such as anxiety, agitation and some shaking. The more
extreme conditions - delirium, hallucinations and seizures - would not occur
until many hours later. However, Alexander was suffering from all these
symptoms the night he was taken from the banquet. In fact, the
trembling and agitation are recorded while he was still drinking.
A new theory proposed
in 2003 by two
U.S.
scientists, John Marr, an epidemiologist at
the
Virginia
department of health, and Charles Calisher of
Colorado
State
University
, proposed that Alexander had died of West
Nile Virus. One of the main features
of the
West Nile
virus is that it begins with weakness of the
muscles which Alexander does not appear to have suffered from. In fact, most damming to the theory is
that, as Massimo Galli of the
University
of
Milan
pointed out, "West Nile Virus is a
relatively young virus and reduces the probability of incidental infections
of humans before 1,000 years ago.”
Whatever Alexander was suffering from on the night of the banquet it was not
DTs, and alcohol poisoning itself would not cause such symptoms.
Alcohol poisoning either results in complete unconsciousness or a state of
stupor in which the nervous system is dangerously sedated for hours: the
victim is in precisely the opposite condition to one which would produce the
writhing seizures and delirium which Alexander is said to have suffered. In
fact, the major effect of alcohol poisoning is continual vomiting.
Death often results from the victim choking on their own vomit or, in the days
before intravenous drips, from dehydration. Even though Plutarch does
say that Alexander suffered a violent thirst on the night he was taken ill,
not once does he or any of the other historical sources once mention vomiting
or even nausea as one of Alexander’s symptoms.