Alexander the Great's Death - a possible explanation

[Imperial Dave]

Try this theory for size!

https://phys.org/news/2019-01-zealand-academic-explanation-alexander-great.amp?__twitter_impression=true

[Chuck the Grey]

You beat me to it Dave. 

I found a story about the article from one of my online professional journals in my email this morning. The full article is available at https://ancienthistorybulletin.org/purchase-articles-from-volume-30 for $1.00. I'm not sure that I'll purchase the complete article since I'm skeptical about attempts to make medical diagnosis after a long passage of time and without a body. it's difficult enough at times in the modern age with a recently deceased person and a competent medical examiner.

[Patrick Waterson]

From the Wikipedia Guillan–Barré syndrome article:

"The first symptoms of Guillain–Barré syndrome are numbness, tingling, and pain, alone or in combination. This is followed by weakness of the legs and arms that affects both sides equally and worsens over time. The weakness can take half a day to over two weeks to reach maximum severity, and then becomes steady."

The article continues:

"In one in five people, the weakness continues to progress for as long as four weeks. The muscles of the neck may also be affected, and about half experience involvement of the cranial nerves which supply the head and face; this may lead to weakness of the muscles of the face, swallowing difficulties and sometimes weakness of the eye muscles. In 8%, the weakness affects only the legs (paraplegia or paraparesis). Involvement of the muscles that control the bladder and anus is unusual. In total, about a third of people with Guillain–Barré syndrome continue to be able to walk. Once the weakness has stopped progressing, it persists at a stable level ("plateau phase") before improvement occurs. The plateau phase can take between two days and six months, but the most common duration is a week. Pain-related symptoms affect more than half, and include back pain, painful tingling, muscle pain and pain in the head and neck relating to irritation of the lining of the brain.

Many people with Guillain–Barré syndrome have experienced the signs and symptoms of an infection in the 3–6 weeks prior to the onset of the neurological symptoms. This may consist of upper respiratory tract infection (rhinitis, sore throat) or diarrhea."

Arrian VII.25-26 notes (from the records of Ptolemy, Aristobulus and the 'Royal Diaries') that Alexander developed a fever which was accompanied by progressive weakness and eventually the inability to speak.  The passage is rather extensive to quote here, but anyone in possession of a copy of Arrian's Anabasis of Alexander can look it up.  For all others, there is Wikisource.

So what do we think?

[Erpingham]

The NHS website has a useful summary of the disease, causes and treatment.  Note that, as it is an auto-immune disease, nothing the ancients had would have treated it and many of the necessary prophylaxis treatments (like ventillators) wouldn't be available either.  Certainly not a slam dunk but worth consideration.

[Patrick Waterson]

Certainly not a slam dunk ...

Definitely agreed.  My reservations spring from:

"The diagnosis of Guillain–Barré syndrome depends on findings such as rapid development of muscle paralysis, absent reflexes, absence of fever, and a likely cause." - Wikipedia article on Guillan–Barré syndrome (it has much the same information as the NHS entry, but fuller).

If there is one thing the period accounts of Alexander's final illness emphasise, it is that he had a very evident fever.

[Erpingham]

Though we should note that GBS is frequently caused by "trigger" illnesses, such as food poisoning, flu and gladular fever, which are associated with high temperatures.  An interesting conjecture but, as usual in these diagnoses, the symptoms never seem quite fit the modern manifestation of the disease.

[Patrick Waterson]

True.  On a related note, I am currently looking through (should be reviewing) a book which purports to have identified Julius Caesar's malady as not epilepsy but trans-ischaemic attacks (minor strokes).  I think the authors are actually right about it not being epilepsy, as it never bothered him before 49 BC but became increasingly evident after 45 BC.  I very much doubt it was TIAs, because these are usually invisible in effect whereas Caesar's symptoms were very evident to his contemporaries.

I did a bit of looking around the subject, and Caesar's attacks apparently began at Corduba in 49 BC and continued intermittently through to 44 BC (they became rather irrelevant after the Ides of March).  Put another way, they coincided with the time when by special permission of the senate he was wearing a laurel wreath to hide his developing baldness.

Laurel in the classical world was not laurel as we know it: the leaf pattern of depicted wreaths suggests oleander, and oleander is poisonous.  More interestingly, if the fumes of burnt oleander are inhaled (as apparently was the practice at Delphi to help the oracular staff get into the mood for prophecies) the inhaler can exhibit symptoms just like those of an epileptic attack.  This interpretation would rely on Caesar burning his old wreath when he put on a new one, but it is interesting to note how his recorded attacks seem to coincide with important public appearances and the start of the battle of Thapsus (Aaron's Thapsus scenario for Lost Battles rmeinded me of that one), i.e. occasions when he might have been expected to get rid of an old wreath and don a fresh new one.

It would of course be necessary for him to burn the old wreath and to inhale the fumes.  I can think of reasons why he might do this: if he threw the wreath away and someone else picked it up, or if he chucked it on a rubbish pile and was seen lying there, it would be An Omen fraught with dire significance.  Burning would be the only good way of getting rid of it, and burning it himself the most reliable way because then there is no omen involved in his passing the wreath symbolising his glory and special status to someone else.  Besides, as pontifex maximus and a descendant of Venus he could dedicate the wreath to his tutelary deity and earn extra heavenly favour.  I think it could work an explanation; whether he was affected by the fumes on any particular occasion would depend on which way the wind was blowing at that point in time.

Getting back to the actual thread subject, I had the impression, right or wrong, that while GBS can indeed be induced by a trigger illness, the fever aspect of any such illness needs to fade out fairly promptly otherwise absence of fever can hardly be a criterion for diagnosis.  Our sources suggest one could practically boil an egg on Alexander up to the day of his demise.

An interesting conjecture but, as usual in these diagnoses, the symptoms never seem quite fit the modern manifestation of the disease.

A conclusion with which I am happy to concur.