WEDNESDAY, Dec. 17, 2003 (HealthDayNews) -- For more than 2,300 years, historians have been trying to diagnose the mystery illness that struck down Alexander the Great, one of most powerful men of all time. The long list of suspects includes poison, plague, polio and typhoid fever.
Now, armed with a computerized analysis of ancient clues, researchers are blaming a seemingly modern malady -- the West Nile virus.
Alexander's symptoms closely match those caused by West Nile, and the researchers think it's possible the disease has existed in the Middle East for millennia. The possible clincher in the case, however, has more to do with man's feathered friends than the general's medical history.
Contemporary accounts report that ravens flew into Babylon and died at Alexander's feet before his own death. West Nile disease, which became famous only after it hit New York City in 1999, also strikes birds, especially crows and jays -- and ravens. To two professors, this spells a solution to the Alexander mystery.
"What you've got is a couple of old gomers talking about things that happened 2,000 years ago, and a couple of years ago putting it all together," says self-deprecating study co-author Charles H. Calisher, an infectious diseases expert at Colorado State University.
At the time of his death at the age of 32 or 33, the Greek emperor Alexander ruled an empire stretching across Africa, Asia and Europe, making him perhaps history's greatest conqueror. "This guy went around and killed people. That's what he did for a living," Calisher says. "He captured slaves and took all their gold and belongings and women. You know what history is about. It's a mess, people not minding their own business."
However, things began going south in Alexander's life before his illness became obvious. "A lot of people thought he was becoming crazy, or at least a megalomaniac," says Rutgers University professor of ancient history Jack Cargill. "He is supposed to have killed one of his friends in a moment of drunken anger. He had begun to see plots everywhere, and seeing people plot against him. A lot of people got executed who weren't trying to kill him."
Alexander didn't exactly lead a quiet life. He drank, fooled around and got burned (his male lover had recently died), and, of course, he was always running around conquering people. "I just figured he abused his body and died young from all the stress he'd been put under, all the battles, all the wounds," Cargill says. "He was like the Hank Williams of his day."
Luckily for historians, Alexander's contemporaries kept a close eye on his physical deterioration, although ordinary citizens were spared the level of detail that accompany the bouts of modern-day American presidents.
This much is clear: Alexander became ill upon returning to ancient Babylon, near present-day Baghdad. He developed a fever and chills, became delirious and finally died after two weeks of misery.
What killed him? Calisher and co-author John S. Marr, an epidemiologist at the Virginia Department of Health, analyzed the case and report their findings in the December issue of the journal Emerging Infectious Diseases.
Alexander didn't have high approval ratings among ancient big shots, so the possibility of murder has long intrigued scholars, including Plutarch, who thought Aristotle -- yes, that Aristotle -- killed the man he tutored. But the authors reject that possibility because poisons available at the time didn't cause long periods of fever.
They also discount other diseases because Alexander didn't have their major symptoms, including intermittent fevers (malaria) and cough and diarrhea (typhoid fever).
The little-noticed death of the ravens may have solved the mystery, Calisher says. West Nile virus is carried by mosquitoes and strikes humans, horses and birds, which become "little bags of virus." Other mosquitoes feast on the birds, fill up with virus-laden blood, and go off to bite humans.
While the disease became famous after striking the New York City region, it was actually discovered in 1937 in Uganda. Calisher suspects it may have been around for much longer.
A computer analysis of Alexander's symptoms suggested that influenza was the most likely killer, but there were no reports of a flu epidemic at the time. When the computer was told that the disease was carried by birds, it pointed to West Nile.
Once Alexander was infected, the virus apparently made its way to his brain, causing swelling and weakness that left him unable to move. Doctors were just as helpless as they are now. "All you do is treat the symptoms and hope for the best," Calisher says. "Either they recover or they don't."
Alexander didn't. Would-be emperors fought over the spoils. Within about 20 years, his empire fell apart. "A lot of people think he wouldn't have been able to hold it together, even with his own charisma, but he didn't live long enough to show that one way or another," Cargill says.
And what of the disease that vanquished the conqueror? If it was indeed the West Nile virus, it survived to threaten us today.
More information
Learn more about West Nile virus from the U.S. Centers for Disease Control and Prevention. And catch up on the story of Alexander the Great here.
