Alexander the Great died in Babylon in 323 BC. His death at age 32 followed a 2-week febrile illness. Speculated causes of death have included poisoning, assassination, and a number of infectious diseases. One incident, mentioned by Plutarch but not considered by previous investigators, may shed light on the cause of Alexander’s death. The incident, which occurred as he entered Babylon, involved a flock of ravens exhibiting unusual behavior and subsequently dying at his feet. The inexplicable behavior of ravens is reminiscent of avian illness and death weeks before the first human cases of West Nile virus infection were identified in the United States. We posit that Alexander may have died of West Nile encephalitis.
Alexander the Great died in the ancient Mesopotamian city of Babylon, on June 10, of 323 BC (Figure). His death after a 2-week febrile illness (Table) has fascinated ancient scholars and contemporary medical investigators (1), who have posited various diagnoses based on sparse clinical information—a few recorded signs and symptoms. Retrodiagnoses have included poisoning and infectious as well as noninfectious diseases (1–6). After reviewing ancient accounts and modern theories, we have concluded that Alexander may have died of West Nile encephalitis.
Previous Theories
Poisons
Few poisons induce fever, and few of these were available in Alexander’s time—except plant salicylates, which disturb temperature regulation; alkaloids, which interfere with perspiration; and ergot mycotoxins, which produce a subjective sensation of heat. Plutarch mentions that Aristotle (Alexander’s tutor) procured arsenic to poison Alexander (7). But plants, mycotoxins, and arsenic are not the likely causes of death since none would have caused the reported high, sustained fever.
Alexander the Great and West Nile Virus Encephalitis
John S. Marr and Charles H. Calisher
Emerging Infectious Diseases: Vol. 9, No. 12 (2003)
Abstract
Alexander the Great died in Babylon in 323 BC. His death at age 32 followed a 2-week febrile illness. Speculated causes of death have included poisoning, assassination, and a number of infectious diseases. One incident, mentioned by Plutarch but not considered by previous investigators, may shed light on the cause of Alexander’s death. The incident, which occurred as he entered Babylon, involved a flock of ravens exhibiting unusual behavior and subsequently dying at his feet. The inexplicable behavior of ravens is reminiscent of avian illness and death weeks before the first human cases of West Nile virus infection were identified in the United States. We posit that Alexander may have died of West Nile encephalitis.
Alexander the Great died in the ancient Mesopotamian city of Babylon, on June 10, of 323 BC (Figure). His death after a 2-week febrile illness (Table) has fascinated ancient scholars and contemporary medical investigators (1), who have posited various diagnoses based on sparse clinical information—a few recorded signs and symptoms. Retrodiagnoses have included poisoning and infectious as well as noninfectious diseases (1–6). After reviewing ancient accounts and modern theories, we have concluded that Alexander may have died of West Nile encephalitis.
Previous Theories
Poisons
Few poisons induce fever, and few of these were available in Alexander’s time—except plant salicylates, which disturb temperature regulation; alkaloids, which interfere with perspiration; and ergot mycotoxins, which produce a subjective sensation of heat. Plutarch mentions that Aristotle (Alexander’s tutor) procured arsenic to poison Alexander (7). But plants, mycotoxins, and arsenic are not the likely causes of death since none would have caused the reported high, sustained fever.
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