Alexander the Great never lost a battle and was one of the most successful military commanders of all time. He was born 356 B.C.E., 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. At 22, he crossed from Europe to Asia. At 30, he reached the Indian frontier, the edge of the known world, to create one of the largest empires of the ancient world. What killed this man at the relatively young age of 32?
THE BEGINNING OF THE END: He had been quite healthy until, after a night of drinking 12 pints of wine, his muscles started to hurt, his stomach started to cramp and he felt exhausted. On the next few days, his belly felt better, but hurt when it was touched.
SYMPTOMS: Then he developed severe chills, sweating, and high fever, and he felt worse and lost his appetite and developed diarrhea. He was healthy until he developed belly pain, fatigue and diarrhea.
PARALYSIS: 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. So now we have belly cramps, fever and diarrhea, followed by paralysis.
SHORTNESS OF BREATH AND THEN DEATH: On the 11th day of his illness, he started to breathe shallowly, passed out and died. Do you know what killed him?
The illness started after drinking a huge amount of alcohol, but he did not die of liver failure caused by alcohol because his fever, belly pain, diarrhea, and lack of jaundice point to an infection in his intestines. A medical article suggests that he died of pancreatitis because of his many years of heavy drinking, and that his fatal illness started after drinking 12 pints of wine (J Clin Gastroenterol, 2007;24 (4): 294-296).
The most likely diagnosis is that he was infected with a bacteria that causes diarrhea. We have to explain his severe belly pain, extraordinarily high fever, and paralysis. The one diarrhea germ that classically causes very high fever and a slow pulse rate is typhoid fever. Typhoid fever also can cause a horrible paralysis of the arms and legs called Guillain Barre syndrome. The bacteria can punch holes in the intestines to allow fluid to pour from inside the intestines outside into his belly. This would cause severe belly pain, particularly when the abdomen is touched and released. Doctors call this “rebound tenderness”.
The fluid inside the intestines is loaded with bacteria that spread with the intestinal contents into his entire abdomen. Then it spread into his bloodstream, causing his blood pressure to drop to zero. He was in shock and died. The conqueror of the entire known world at the time died, at age 32, from typhoid fever. Alexander the Great could not have been saved then, but could be saved today with an antibiotic to kill salmonella typhosa, the bacteria that causes typhoid fever (NEJM, June 1998;338 (24):1764-1769).
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