The Death of Alexander
After a bout of hard drinking in Babylon a sudden fever came upon Alexander (323 BC), and he sickened and died. He was still only thirty-three years of age. Forthwith the world empire he had snatched at and held in his hands, as a child might snatch at and hold a precious vase, fell to the ground and was shattered to pieces. Whatever appearance of a worldwide order may have gleamed upon men's imaginations, vanished at his death. The story becomes the story of a barbaric autocracy in confusion. Everywhere the provincial rulers set up for themselves.
There are two divergent accounts of Alexander's death. The first has its origins in the Royal Diary, allegedly kept in Alexander's court. The second account survives in various versions of the Alexander Romance. The Royal Diary describes a gradual onset of fever, with a progressive inability to walk, leading to Alexander's death, without offering a cause of his demise. In contrast, the Romance implies that members of Alexander's inner circle conspired to poison him. The various medical hypotheses include cumulative debilitation from his previous wounds, the complications of alcohol imbibing (resulting in alcohol hepatitis, acute pancreatitis, or perforated peptic ulcer), grief, a congenital abnormality, and an unhealthy environment in Babylon possibly exacerbated by malaria, typhoid fever, or some other parasitic or viral illness. A team of researchers led by Dr. Thomas Gerasimidis of Aristotle University of Thessaloniki completed nearly a quarter of a century of painstaking studies on the last days of Alexander the Great’s life, concluding in 2019 that the conqueror died of pancreatic necrosis, and not malaria, typhoid fever or pneumonia, as previously thought.
Dr. Gerasimidis, a veteran professor of medicine, began studying Alexander’s final days in 1995, carefully analysing the symptoms experienced by the Macedonian king, as described by ancient historians including Arrian, considered one of the best sources on Alexander’s campaigns, and others ranging from Ptolemy and Plutarch to Quintus Curtius. He called this approach "evidence-based medicine."
After careful analysis, the professor concluded that severe sepsis, brought on by acute pancreatic necrosis, took the life of the undefeated commander, with the disease believed to have been brought on by gallstone disease, and the commander’s love for rich foods and alcohol.
“The onset of the symptoms was [characterised by] severe abdominal pain after a rich meal and wine, followed by fever, and a daily progressive, fatal degradation over fourteen days,” Gerasimidis explained. According to the researchers’ sources, on the first day of his illness, which struck him in Babylon (in present-day Iraq) while he was planning the conquest of Rome and Carthage, Alexander felt severe abdominal pain and had a fever, prompting doctors to induce vomiting, and follow that up with cold baths. But the commander’s fever, sweating and chills continued, eventually compounding into difficulty breathing, exhaustion, jaundice and delirium.
After fourteen days, on June 13, 323 BC, Alexander the Great died. Along with the pancreatic necrosis diagnosis, the professor also rejected other hypotheses regarding Alexander’s death. He noted, for example, that malaria does not usually cause death so quickly, or with the symptoms seen in Alexander’s case. Pneumonia, meanwhile, is rarely known to cause abdominal pain. Typhoid fever and West Nile Virus were also ruled out by researchers due to the lack of appropriate symptoms.
The professor also rejected the recently proposed theory that Alexander was suffering from Guillain-Barre Syndrome (GBS), a rare autoimmune disorder in which the body’s immune system attacks it, causing symptoms ranging from weakness of the limbs and organ failure and ending with complete paralysis. The scholar maintained that high fever and abdominal pain were the main symptoms exhibited by the commander, according to the records, thus making the GBS theory moot. Furthermore, the view that Alexander experienced the onset of paralysis while maintaining his cognitive functions cannot be true, since all available sources pointed to a progressive loss of consciousness.
Finally, Gerasimidis challenged the theory that Alexander may have been poisoned, saying that given the comparitively primitive nature of the poisons available at the time, the king would have been dead within several hours if he consumed one, rather than going on to live and suffer another 14 days.
If Alexander the Great was poisoned, Veratrum album offers a more plausible cause than arsenic, strychnine, and other botanical poisons. The alkaloids present in the various Veratrum species, notably Veratrum album, were capable of killing Alexander with comparable symptoms to those Alexander reportedly experienced over the 12 days of his illness. Veratrum poisoning is heralded by the sudden onset of epigastric and substernal pain, which may also be accompanied by nausea and vomiting, followed by bradycardia and hypotension with severe muscular weakness. Alexander suffered similar features for the duration of his illness.
The liliaceous false-hellebore (Veratrum) genus is very ancient. Greek physicians used the rootstocks of "hellebore" (helUboros) for various purposes, but primarily as a remedy for insanity, and the Greek verb helleboriáo (literally, "to need hellebore") was applied to a person who was losing his mind. White hellebore (Veratrum album) contains many poisonous alkaloids. Its ingestion causes burns in the mouth and lips, vomiting, diarrhea, shivering, cramp, dizziness, headache and cold sweats. These alkaloids are cardiac depressors which cause sinus bradycardia leading to collapse and possibly brain or coronary ischemia. Disorders induced by myocardial excitability have also been reported Glomerular filtration is often impaired. Finally, subnormal breathing capacity combined with bronchoconstriction is sometimes observed.
The untimely deaths of sovereigns at particular junctures have His work often exercised an appreciable influence on the course of events; but a"d no such accident has diverted the paths of history so manifestly and ^ ^one utterly as the death of Alexander. Twelve years had sufficed him to conquer western Asia, and to leave an impress upon it which centuries would not obliterate. And yet his work had only been begun. Many plans for the political transformation of his Asiatic empire had been initiated, — plans which reveal his originality of conception, his breadth of grasp, his firm hold of facts, his faculty for organisation, his wonderful brain-power, — but all these schemes and lines of policy needed still many years of development under the master's shaping and guiding hand.
The unity of the realm, which was an essential part of Alexander's conception, disappeared upon his death. The empire was broken up among a number of hard-headed Macedonians, capable and practical rulers, but without the higher qualities of the founder's genius. They maintained the tolerant Hellenism which he had initiated,—his lessons had not been lost upon them; and thus his work was not futile; the toils of even those twelve marvellous years smoothed the path for Roman sway in the East, and prepared the ground for the spread of an universal religion.
Some saw his sudden death as no freak of fate or fortune; but rather a natural consequence of his character and his deeds. Into thirteen years he had compressed the energies of many lifetimes. If he had been content with the duties of a general and a statesman, laborious and wearing though those duties would have been both to body and to brain, his singularly strong constitution would probably have lasted him for many a long year. Rut the very qualities of his brilliant temper which most endeared him to his fellows, a warrior's valor and a love of good fellowship, were ruinous to his health. He was covered with scars; and he had probably never recovered from that terrible wound which had been the price of his escapade at Multan. Sparing of himself neither in battle nor at the symposion, possibly he was doomed to die young.
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