A late-fourth-century B.C. coroner's report might have read something like this: Name of deceased: The Great, Alexander. Age: 32. Occupation: Ruler of known world. Cause of death: Under investigation.
Alexander died on June 10, 323 B.C., in Babylon shortly after returning from his campaigns in India. Historians have speculated about the cause of his death for centuries. Poisoning, malaria, and even heavy drinking have been blamed. David Oldach, an infectious-diseases expert at the University of Maryland, and Eugene Borza, a retired historian who taught at Penn State, now offer a new diagnosis. They suggest that typhoid fever killed Alexander.
People contract typhoid fever by eating food or drinking water infected with the bacterium Salmonella typhi. The disease is still common in some developing countries where sewage contaminates drinking water. If not treated with antibiotics, typhoid fever kills 20 to 30 percent of those infected.
Historical accounts say that before dying, Alexander suffered from chills, sweat, exhaustion, extremely high fever, and severe pain. Eventually he fell into a coma and died. While many bacterial infections show some of these symptoms, Oldach says typhoid fever best accounts for the course of Alexander's last days. The severe pain was particularly telling because, if untreated, typhoid fever can perforate the bowel. "His illness is a classic description of typhoid," says Oldach. "It just makes perfect sense."
Oldach and Borza's theory also explains a curious historical anecdote: Alexander's body supposedly did not begin to decay until several days after his death. Historians have dismissed this as myth, but the legend might be explained by a rare complication of typhoid fever called ascending paralysis. The paralysis gradually seizes the entire body and depresses breathing. Alexander, says Oldach, might have appeared dead to his entourage before he actually died.