Did mosquito bite defeat Alexander?

Virus: An epidemiologist believes dying ravens are a sign that West Nile killed the Greek emperor.

December 13, 2003|By Heather Dewar | Heather Dewar,SUN STAFF

When Alexander the Great stood at the gates of Babylon in 323 B.C., the story goes, a flight of ravens fell dead at his feet.

It was a bad omen, according to the soothsayers. Within two weeks the conqueror of an empire that stretched from Greece to India was dead, at age 32, of a mysterious illness.

Doctors and historians have speculated for centuries about the cause of this battle-hardened warrior's death. In 1998 two University of Maryland Medical Center physicians said he probably died of typhoid, which can cause the chills, fever, abdominal pain and delirium that Alexander suffered.

But today, across the Potomac, the Virginia Health Department's chief epidemiologist says those dying ravens weren't omens, but clues. Alexander may have been history's most famous victim of West Nile virus, John Marr claims.

The typhoid diagnosis was "brilliant," Marr said, "but I have the advantage of hindsight. ... In 1998, they didn't realize that looking for dead crows was a good early-warning system for West Nile."

Marr and a colleague, Colorado epidemiologist Charles Callisher, outlined the West Nile theory in this month's issue of the journal Emerging Infectious Diseases. Their analysis drew lavish praise from one author of the typhoid hypothesis.

"I thought it was wonderful. I loved it," said the University of Maryland's David Oldach. However, he doesn't buy it.

"I don't really believe he died of West Nile virus," Oldach said. "On the other hand, the beauty of these historical investigations is that no one can ever prove you wrong."

Diagnosing the famous dead has become a half-playful pastime among medical experts and historians. The University of Maryland holds a public post-mortem on a historical figure each year.

In these sessions, scholars have concluded that Beethoven had syphilis, Edgar Allan Poe died of rabies, Florence Nightingale had bipolar disorder, and the Roman emperor Claudius was poisoned by a mushroom.

The exercises are "a lot of fun and a useful teaching tool," Oldach said, but since they are based on incomplete or distorted historical accounts, the diagnoses are not definitive.

Medical problems

Alexander, one of history's greatest generals, was a complex man who left medical sleuths with plenty of trails to follow.

Born to the throne of Macedonia and tutored by Aristotle, Alexander was a scholar who absorbed Eastern ideas from the countries he conquered - to the dismay of his mentor, who plotted to poison him. The conqueror was also a compulsive bather who splashed in rivers throughout the known world and supplemented his otherwise healthful regimen with immense quantities of wine.

By the time Alexander conquered Babylon, near the site of modern Baghdad, he'd had a tough year - including a spear wound in his chest.

"He also had been knocked on the head," Marr noted. "His significant other had died of a fever. He was severely depressed. ... I think he was chugging about a half-gallon of wine."

Mosquitoes suspected

According to Marr's article, Alexander's counselors told him to enter Babylon from the east. That required him to pass through a swamp - where mosquitoes might breed. The insects carry West Nile virus, which they pass to birds - especially crows - and to humans, spreading the disease.

Mosquitoes must have been common, Marr said, because ancient writers described many cases of malaria, another mosquito-borne illness. The epidemiologist also concluded that ancient Babylon was hot enough for mosquitoes to spread the virus in late May instead of in late summer, when the disease most often occurs here.

As Alexander reached the walls of Babylon, Greek biographer Plutarch wrote two centuries later, "he saw a large number of ravens flying about and pecking one another, and some of them fell dead in front of him."

Other analysts ignored or dismissed that detail, assuming that Plutarch made it up. Either that, Marr said - or the crows had the deadly virus.

At a banquet in Babylon, the conqueror drank 11 pints of wine, then grabbed his chest, stricken. In the ensuing days he suffered chills, constant fever and horrible abdominal pain. Many diseases exhibit those symptoms, but one unique factor existed: a strange paralysis that began in Alexander's feet and slowly moved up the body.

That clinched the diagnosis for Marr, whose curiosity had been piqued by Oldach's original article in the New England Journal of Medicine.

Online diagnosis

Last year, he got a call from a researcher at the federal Centers for Disease Control and Prevention who was studying nine cases of "a rare complication of West Nile, that produced a flaccid paralysis of the lower limbs." Marr thought of Alexander.

To check the diagnosis, Marr and his colleague entered Alexander's symptoms and the clue about the ravens into an online diagnostic program and got an answer: West Nile.

Oldach disagrees with the diagnosis. Although West Nile virus didn't reach America until the 1990s, it has probably been in the Middle East for millennia, so Alexander could have been exposed to it, Oldach said. But West Nile virus doesn't cause abdominal pain, while typhoid does.

Marr's theory "is tongue in cheek, of course, but it's great fun," Oldach said.

Marr insists his idea is a serious one - but he doesn't deny having fun with it. "It was a wonderful puzzle to play with," he said. "As a hobby, I think it's better than golf."

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