Infect Dis Clin N Am 18 (2004) 5363

The death of Alexander the Great:

malaria or typhoid fever?
Burke A. Cunha, MDa,b
a

Infectious Disease Division, Winthrop-University Hospital, Mineola, NY 11501, USA

b
State University of New York School of Medicine, Stony Brook, NY, USA

Where is Great Alexander?

Great Alexander lives and reigns.
Greek proverb

Alexander the Great: the man and his times

Alexander the Great lived nearly 33 years and died in 323 BC. He was
one of the greatest gures in history, and his extraordinary exploits and
achievements resound through the ages. As a general and leader, no one has
ever moved faster or farther with so few troops than Alexander. When he
was only 22 years old, he and his Macedonian army of only 50,000 began
advancing into Persia in the spring of 334 BC. Alexander conquered the
known world from Egypt to the Indus River. He eventually controlled an
area larger than the Roman Empire at its peak. His bravery and military
prowess remain legendary. Many of his subjects became his allies, and some
subjects joined his Macedonian army. As with all great gures of history, he
had a complex personality with many inconsistencies [13].
Boldness and daring aside, Alexander was kind, understanding, compassionate, and sentimental in dealing with people he liked, but he could be
ruthless with people who opposed him. He also had a temper and was
given to bursts of anger in his later years. He would treat his adversaries with
dignity, respect, kindness, and courtesy if they did not resist his advances
or oers of conciliation. When stubbornly opposed, however, as during the
siege of Tyre, Alexander was merciless with the defenders for delaying his
advance for more than 1 year. Given the harshness of the geography he
traversed and the size of the forces that opposed him, he remains unrivaled as
one of historys great commanders. Alexander was an inspiration to his men;
they would follow him anywhere, and they did. His Macedonians marched
with him and for him to the ends of the known world and stayed with him to
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B.A. Cunha / Infect Dis Clin N Am 18 (2004) 5363

the end. He led by example and was always in the forefront of the battle,
which earned him the admiration, respect, and devotion of his men [35].

The greatness of Alexander the Great

Great generals are superb tacticians on the battleeld but lack the skills of
a statesman or are not interested in state craft. Alexanders military exploits
often have overshadowed his accomplishments as a statesman. He was and
remains unique in his global vision, which combined the best of the cultures
of the East and West. As a king, he respected the customs of the people that
he ruled. Persia was his old adversary, yet he respected Persian customs and
adopted their customs in his court [1].
Alexander appreciated the culture and achievements of the Persian
Empire. He wanted to combine the best of attributes of the West, as
represented by Greek culture, and of the East, as represented by the Persian
Empire. Alexanders vision was that of a world that combined the best of
Eastern and Western culture and that could live in harmony with mutual
respect. He began uniting the cultures through marriage. A mass wedding
ceremony was held at Susa in the Persian tradition, uniting members of his
army with woman of Persian nobility in marriage. Always leading by
example, Alexander married Roxanne, a Persian noble in the ceremony. He
integrated Persians into his army and into his elite Companions. These acts
oended his Macedonians as free-thinking Greeks [1,2].
Leaders and their armies have always conquered for glory, territory, or
material wealth. Much of Alexanders greatness was his vision of a single
global culture. His exploits were responsible for the spread of Hellinism
throughout the Middle East, Central Asia, and parts of India. No one,
before or since, has had such a global view of the world as one civilization,
and Alexander has been the only person to have tried to eect such a plan.
When he died unexpectedly in 323 BC, his dream of uniting Eastern and
Western cultures abruptly came to an end. Rivalries and squabbles ensued
and led to the disintegration of Alexanders greater Greece (Cheston B.
Cunha, unpublished article) [13,6].

Omens and portents on Alexanders return to Babylon

In 324 BC, Alexander returned to Babylon and ordered ships to be built in
Phonecia and transported unassembled to Thapsacus on the Euphrates River.
His intention was to colonize coastal areas of the Persian Gulf to consolidate
trade between Babylon, the Arabian Peninsula, and Western India.
Alexander was involved in altering the course of the Tigris and Euphrates
Rivers to facilitate navigation of his eet. He interrupted his activities in
Babylon to go to the funeral of his dear friend Hephaestion, who died in
Ecbatana. In Alexanders absence, one of his Companions, Apollodorus, was

B.A. Cunha / Infect Dis Clin N Am 18 (2004) 5363

55

left in charge. Apollodorus wrote to his brother Pythagoras in Babylon

regarding his future. He feared severe punishment if unfavorable reports on
his administration would be heard by Hephaestion or Alexander. Pythagoras
made an animal sacrice concerning Hephaestions future and found that the
sacricial animals liver contained no lobe. The absence of a liver lobe
apparently was an ominous sign to the ancients. Pythagoras sent a letter to his
brother and indicated that there was nothing to fear from Hephaestion,
because he soon would be dead. Pythagoras then sacriced another animal
with Alexanders future in mind and once again found no visible lobe in the
liver. He informed Alexander directly. On his return approach to Babylon,
Alexander asked Pythagoras about the nature of the animal sacrice and its
signicance. Pythagoras replied, something very serious.
In spite of this ominous portent, Alexander continued toward Babylon.
On the outskirts of Babylon, Alexander was greeted by a delegation of
Chaldaean priests who related that an oracle indicated that he should not
enter Babylon or something bad would befall him. Alexander was
suspicious, because the priests were supposed to rebuild the temple at
Marduk after Alexanders previous visit to Babylon. He suspected that they
had used the funds for their personal use. Alexander surmised that they
wanted to prevent him from discovering their misuse of funds. He was
determined to enter Babylon. The Chaldaean priests urged him to use an
eastern rather than a western approach to Babylon. Alexander agreed and
approached Babylon from the east only to nd that the eastern approach
was blocked by marshes. Alexander suspected that this advice was another
subterfuge by the Chaldaean priests and entered Babylon from the west.
After he arrived in Babylon, he left the city by way of the western gate
and went to inspect the Babylonian canal system in the area. He later
returned to the city, only to be confronted with more bad signs.
Shortly thereafter, Alexander sailed down the Euphrates River to
a swamp area near the Arabian border where the ancient Assyrian kings
were buried. The ribbon from the kings hat was blown o and got stuck on
a reed in the water. A sailor retrieved the ribbon and tied it around his head
to prevent it from falling into the water. The purple and white ribbon, the
royal colors of the king, was returned to Alexander by the well-intentioned
sailor. Some say Alexander rewarded him with a talent, whereas other
versions of the story indicate that he gave the sailor a talent and then had
him beheaded for daring to wear the royal ribbon. Other versions suggest
that the sailor was not beheaded but was only ogged after receiving a talent.
After Alexander returned to Babylon to attend to ocial duties, he left
his throne for a moment to quench his thirst. Once the King had departed
the throne room, an obscure individual, not in the royal party, passed
through crowd and sat on Alexanders throne. Members of the court
watched in disbelief at the intruders erontery. The man stated that he was
compelled to do so by the god Sarapis. Alexanders advisors recommended
that the intruder be executed for this unconscionable act, and the intruder

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B.A. Cunha / Infect Dis Clin N Am 18 (2004) 5363

was killed. After this episode, Alexander began to lose condence in himself.
He became obsessed by fears of the supernatural and interpreted any
unusual or trivial event as a bad omen. Strange things continued to happen
to him. Apparently, a docile donkey in the kings menagerie attacked and
kicked to death the most powerful of the royal lions. With so many signs of
impending misfortune and evil omens, Alexander feared for life and felt that
the gods had deserted him [3,5,68].

The royal diaries description of Alexanders last days

Alexanders end began on May 29 when he dined with his soldiers and
made his customary sacrices and oerings as a prelude to the Arabian
campaign. That evening, an elaborate symposium was prepared to honor
admiral Nearchus, who would lead his eet in the campaign. The
description of Alexanders last days are based on the royal diaries [8]:
On 29 May he slept in the bathroom because he was feverish. Next day
after taking a bath he moved into the bedchamber and spent the day
playing dice with Medius. He took a bath late in the evening, oered
sacrice to the gods, dine and remained feverish throughout the night. On
the 31 May he again bathed and sacriced as usual and while he was lying
down in the bathroom he was entertained by listening to Nearchus
account of his voyage and his exploration of the great sea. On 1 June the
fever grew more intense: He had a bad night and all through the next day
his fever was very high. He had his bed moved and lay in it by the side of
the great plunge bath; there he discussed with his commanders the vacant
posts in the army and how to ll them with top calibre ocers. On the 4
June his fever was still worse and he had to be performedside to do
sacrice. He then Gave orders to his senior commanders to spend the
night outside. On June 5th he was moved to the palace on the other side
of the Euphrates, and there slept a little, but the fever did not abate.
When his commanders entered the room he was speechless and remained
so through June 6th. The Macedonians now believed he was dead and
crowded the doors of the palace; they began to shout and threaten the
Companions, who at length were forced to let them in. When the doors
had been thrown open they all slowly led past his bedside one by one,
wearing neither cloak nor armour. Nothing could keep them from seeing
him a last time and the moved in almost every heart was grief and a sort
of helplessness bewilderment at the thought of losing their king. Lying
speechless as the men led by, he yet struggled to raise his head, and in
his eye there was a look of recognition for each individual as he passed.
Python and Seleucus were sent to the temple of Serapis to ask whether
Alexander should be moved there. The god replied that they should leave
him where he was. On the Twenty-eight day of the month of Daisios (10
June 323 B.C.) toward evening he died. Alexander was not yet thirty-three.

A daily summary of the medical aspects of Alexanders nal days is

presented (Table 1) [3,68].

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57

Table 1
Last days of Alexander
Dates (Macedonian
calendar)
June 23, 323 BC
(Daisios 17th18th)
June 4, 323 BC
(Daisios 18th)

June 5, 323 BC
(Daisios 19th)
June 6, 323 BC
(Daisios 20th)

Symptoms and signs

AM:

Fever noted

Drank little wine at symposium

PM:

No comments
Summoned his generals to bedside to
plan Arabia expedition

PM:

Fever noted
Fevers continued
(in bed sick at
Royal Palace)
No comments

AM:

Felt somewhat better

PM:

Fevers continued
No comments

AM:

AM:

PM:

June 7, 323 BC
(Daisios 21st)

AM:

June 9, 323 BC
(Daisios 23rd)
June 10, 323 BC
(Daisios 24th)

No comments
Fever continued

AM:

No comments
Very ill

PM:

No comments

PM:

June 8, 323 BC
(Daisios 22nd)

Continued to
deteriorate
PM: Fevers continued
AM: Continued to get worse
AM:

No comments
Deteriorated further.
Unable to speak, but
able to recognize his
generals
PM: Fever intensied
AM: Fevers continued
to intensify
PM:

June 11, 323 BC

(Daisios 25th)

June 12, 323 BC

(Daisios 26th)

AM:

PM:

June 13, 323 BC

(Daisios 27th)

June 13, 323 BC

(Daisios 28th)

No comments

Recognized
companions, but only
able to nod his head in
response
PM: No comments
AM: Remained very ill
AM:

PM:
a

Comments

Alexander died

Marduk-Bel, Babylonian god of healing.

Crossed the Euphrates River to

benet from the fresher air there
Played dice with his friend Medios
Had diculty sleeping
Nearchus reported on eet preparations.
Fleet ordered to be read to sail
in 3 days (Daisios 23rd)
No comments
Ordered troops and eet to maintain
readiness to sail
No comments
Again ordered eet to stay ready
Spoke to some of his generals about
appointments
No longer able to give orders to
the eet
No comments
Ordered his generals to assemble at the
Court Palace for next morning
No comments
Had himself returned back over the
Euphrates River to the Court Palace

No comments
No audiences with his Macedonian
troops. Rumors spread that
he was dead.
Troops led past Alexander in his sick
bed
Six friends went to Marduka
Temple to sleep and ask if Alexander
should be bought to the temple
No comments
Oracle adviced that Alexander should
not be bought to the temple and
should stay at the Court Palace

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Clinical diagnostic approach to the cause of Alexanders death

Because the information from ancient sources is incomplete and subject to
interpretational variation, the diagnostic approach must arrive at the most
likely explanation for the diagnosis being entertained. An important principle
of the dierential diagnosis of infectious diseases is to discern between
features that are characteristic of a infection and features that are compatible
or consistent with a particular infectious disease. Most infectious diseases
have cardinal ndings that are characteristic. When considering a diagnosis,
these ndings should be present because of their central importance as key
diagnostic ndings. The absent of such characteristic ndings would argue
strongly against the diagnosis. Findings that are consistent with the diagnosis
are less specic and are of less diagnostic importance [9,10].
The nding of fever is consistent with a wide variety of infectious
diseases. Fever patterns are highly characteristic of some infectious diseases
and may be used diagnostically. High spiking fevers separated by afebrile
intervals characteristic of malaria would argue strongly against diagnoses of
infectious diseases that are characterized by continuous fevers. The presence
or absence of chills also can be an important diagnostic nding (eg, chills
accompanying fevers are a key feature of the diagnosis of malaria). Chills
are rare in typhoid fever, and prominent chills in a disease description would
argue strongly against such a diagnosis. The presence or absence of a pulsetemperature decit cannot be ascertained from the written record, but the
presence of a pulse decit would not be helpful, because relative bradycardia
is a feature in both infections.
Clinical analysis must be conned to the key features of the infections in
the dierential diagnosis. Besides fever and chills, other ndings are of
potential diagnostic importance. Delirium was noted during Alexanders last
days. Any infectious disease that is considered a diagnostic possibility must
have delirium as a potential complication. The time course of infectious
events is also important in the dierential diagnosis of infectious diseases.
Alexander became ill on May 29 and died on June 10, 323 BC. His illness was
relentless, progressive, and resulted in the death of a healthy young adult in
his prime in less than 2 weeks. These facts limit the diagnostic possibilities to
infections that are acute and fatal within 2 weeks. Epidemiologically, malaria
and typhoid fever were present in ancient Babylon during Alexanders time.
These two infectious diseases are the most likely diagnostic possibilities that
best explain Alexanders death [3,11,12].

Interpretational diculties with ancient accounts of Alexanders death

There are many problems with trying to derive contemporary explanations
from ancient accounts. Early descriptions of disease are often fragmentary
and insuciently detailed for medical diagnostic purposes. Most ancient
writers were nonphysicians, and their descriptions of illnesses are given in lay,

B.A. Cunha / Infect Dis Clin N Am 18 (2004) 5363

59

not medical, terms. Even when ancient writers describe diseases in medical
terms, they use the terminology of the time. The medical meaning of words is
subject to great variations in interpretation and meaning. The description of
fever is critical in describing the cause of Alexanders death, yet the word for
fever in Greek is applied dierently by Hippocrates, Arrian, and Plutarch and
varies from feverish to fever to high fever. Each of these descriptions has
dierent diagnostic implications. Investigators are left with incomplete
accounts that are written by nonphysicians in lay terms for maladies and are
subject to interpretational variation by translators (eg, classic scholars who
are not physicians). It is worthwhile to investigate the probable cause of
Alexanders death, because he is so important in the history of Western
civilization [2,13,14].
Noninfectious explanations of Alexanders death
Alexander was a heavy drinker, and it has been suggested that he died of
advanced alcoholic cirrhosis terminally complicated by delirium tremens.
The description of Alexanders demise does not resemble delirium tremens.
The characteristic high fever and the tremulousness or hypermetabolic state
of delirium tremens are not included in the descriptions of Alexanders death.
Much has been made about Alexanders prodigious consumption of
wine. Although Alexander was a heavy drinker, he was healthy and able to
remain mentally clear and in control. During his last few days, he frequently
was thirsty and resorted to quenching his thirst by drinking wine. From the
descriptions of Arrian and Plutarch, it seems that Alexander drank wine to
quench his thirst. The consumption of wine, even if excessive, does not t
the description of his death.
Other researchers have suggested that Alexander was poisoned by someone for a variety of reasons. Strychnine poisoning has been mentioned as the
most likely possibility in the category. Strychnine was available in the ancient
world, and its lethal eects recognized. Its peculiar taste could be hidden
by wine, which would be a perfect vehicle to use to poison the wine-loving
Alexander. Strychnine poisoning, however, is characterized by a rigidity of the
muscles and convulsions, characteristics that are incompatible with the descriptions of his nal days. Fever, delirium, and semicomatose state were not
the cardinal features noted in accounts that survived. It is unlikely that
Alexanders nal exodus was caused by a ruptured amebic liver abscess,
chronic alcoholism with superimposed delirium tremens, or strychnine
poisoning [2,5,7,13].
Infectious diseases in ancient Babylon
In the time of Alexander the Great, a variety of infectious diseases
periodically ravaged the ancient world. Endemic infectious diseases were
responsible for much of the mortality and morbidity that controlled
population growth in ancient populations. Infectious diarrhea and dysentery

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B.A. Cunha / Infect Dis Clin N Am 18 (2004) 5363

were a major group of infectious diseases that aicted ancient people,

according to many sources. These diseases include diarrhea caused by the
common enteric pathogens, such as Salmonella typhi enteric fever. Malaria
was an unremitting scourge of ancient people. Malaria was believed to
emanate from the bad air associated with swamps or marshes (hence the term
mal aria, which was condensed into malaria in recognition of something bad
in the swampy air that caused malaria). The most plausible infectious
diseases responsible for Alexanders death include amebic liver abscess,
typhoid fever, and malaria [11,15,16].
Amebic dysentery was common at the time, and amebic abscesses often
complicated amebic dysentery. Preceding his demise, Alexander was described
as having a sudden pain that some scholars have suggested may have
represented a rupture of an amebic abscess that led to his demise. The time
relationships and clinical features between rupture of the abscess, presumably
into the peritoneal cavity, and Alexanders subsequent signs and symptoms
argue against a ruptured amebic abscess as the cause of his death [11,12].
Malaria versus typhoid fever
From the febrile description of the illness, there seems to be little doubt
that Alexander died from typhoid fever or malaria. Both infections were
present in the marshy swamplands that Alexander inspected just before his
death. He could have acquired typhoid fever from the water or malaria or
from being bitten by malaria-carrying mosquitoes. He began to feel feverish
on May 29, but the fever really took hold on June 2. His fevers were
described as continuous and gradually increased until Alexander became
very ill on June 8. The fever described does not seem to be hectic, septic, or
remittent. Importantly, paroxysms of fever are not described. From the
record, it can only be inferred that the fever was continuous and gradually
increased over the course of the illness. Shaking chills and sweats are
conspicuous by their absence. Alexanders inability to speak was noted on
June 11, suggesting central nervous system (CNS) involvement independent
of the fever. Alexanders face was described as expressionless; although
bedridden, he was responsive enough for nal farewells from his troops. The
apathetic facies and delirium (ie, typhoid state) that can accompany
typhoid fever ts this description. Malaria is characterized by headache, but
not apathetic facies or delirium. If delirium occurs with malaria, it is only
with severe Plasmodium falciparum infections involving the CNS. The
cardinal ndings and time course of malaria and typhoid fever are presented
(Tables 2 and 3) [1720].
Diagnostic signicance of fever patterns
Classic malarial paroxysms are absent from the descriptions of Arrian or
Plutarch. Patients dying of malaria have a dramatic clinical presentation.

B.A. Cunha / Infect Dis Clin N Am 18 (2004) 5363

61

Table 2
Time course of malaria
Time course

Symptoms and signs

Incubation period
First week

Sensation of impending chill

Malaise
Headache
Fevers begin (no periodicity)
Remittent or intermittent fevers (periodicity develops)
Malarial paroxysm (chills!fever!sweats)
Complete exhaustion (following malarial paroxysm)
Afebrile (feels normal again between attacks of paroxysm)
Gradual decrease in frequency and intensity of malarial paroxysm
Remittent or intermittent fevers decrease
Gradual clinical improvement as immunity developsa

Second week

Third week

a
Except for Plasmodium falciparum-related malaria, individuals with malaria caused by
P ovale, P vivax, or P malariae resolves without treatment unless there are complications (eg,
splenic rupture). P falciparum may be complicated by cerebral malaria, ARDS, hypoglycemia,
or kidney failure.

Survivors of malaria remain febrile into the third week and gradually recover.
Except for fever, per se, there is little in the descriptions of Alexanders illness
to support malaria. Typhoid fever is the best possibility, even though some
features of typhoid fever are not described. The cardinal features of typhoid
fever are present, particularly the gradual step-wise increase in fever without
signicant rigors or sweating. The continuous fever of typhoid fever ts well
with Arrians and Plutarchs descriptions. Patients with typhoid fever initially
present with constipation and later may develop diarrhea, but these details
have been left out of the existing records. The demise of patients with typhoid
Table 3
Time course of typhoid fever
Time course

Symptoms and signs

Incubation period
First week

None
Initial chill
Fever begins
Malaise
Anorexia
Headache
Dry cough
Constipation
Gradual stepwise increase in fever
Continuous fever (temperature gradually increasing)
Apathetic aect
Skin dry or hot

Sweating but no drenching sweats
Continuous fevers peak
Delirium or stupor
Intestinal hemorrhage
Intestinal perforation or peritonitis

Second week

Third week

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B.A. Cunha / Infect Dis Clin N Am 18 (2004) 5363

fever is usually caused by intestinal hemorrhage or perforation leading to

peritonitis and death. The sharp abdominal pain that immediately preceded
Alexanders illness could have been intestinal perforation. It is unlikely that
someone in his robust physical condition could have maintained his wellness
and intensity of the activity while suering from typhoid fever before
perforation or hemorrhage occurred weeks later. The episode of sharp pain
preceding his illness is dicult to explain and is an unexplained event that is
not consistent with perforation or perforation secondary to amebic abscess or
typhoid fever. Abdominal pain is not mentioned in the description of the nal
phases of Alexanders illness. It would seem that the detailed accounts of the
royal diaries would have mentioned abdominal pain if such a symptom was
present during his nal days [2,10,17,18,21].
Summary
In Arrians and Plutarchs descriptions, some key features of typhoid
fever are present, and only the absence of gastrointestinal symptoms in the
extant description weighs against the diagnosis of typhoid fever. Except for
Table 4
Comparative aspects of typhoid fever and malaria
Comparative aspects
Epidemiology
Pathogen
Endemic in ancient Babylon
Incubation period
Onset
Symptoms
Malaise
Anorexia
Headache
Dry cough
Apathetic aect
Signs
Single chill (initial)
Multiple chills (before fever)
Apathetic aect
High fever at onset
Gradual (stepwise) increase in fever
Continuous fever
Remittent or intermittent fever
Malarial paroxysm (chills!fever!sweats)
Drenching sweats (after fever)
Complications
Delirium or stupor
Intestinal bleeding
Intestinal perforation or peritonitis

Typhoid fever

Malaria

Salmonella typhi
+
714 d
Insidious

Plasmodia species
+
714 d
Acute

+
+
+


+

+

+



+

+

+
+





+

+


+
+
+

+
+
+

a



+, usually present;
may be present; , usually not present.

Only with cerebral P falciparum-related malaria.

B.A. Cunha / Infect Dis Clin N Am 18 (2004) 5363

63

fever, no key clinical characteristics of malaria are present, and the

description argues strongly against malaria as the cause of Alexanders
demise. (Table 4).
Although the cause of Alexanders death may never be known, the extant
descriptions suggest that Alexander died from typhoid fever [9,10,18,20,21].
The life of Alexander the Great demonstrates that individuals rather than
events change the course of history. People remain in awe of the exploits of this
extraordinary man, statesman, general, and king. The cause of Alexanders
death remains a mystery. The few detailed extant accounts based on his royal
diaries suggest that typhoid fever caused his demise. What killed Alexander in
his youth and at the height of his powers is of enduring interest. Alexander
forever changed the course of history. Had he lived longer, history would have
been very dierent.

References
[1] Fox RL. Alexander the Great. London: Penguin Books; 1973. p. 3569.
[2] Plutarch. Plutarchs lives of noble Grecians and Romans, vol II. New York: Modern
Library; 1992. p. 13999.
[3] Savill A. Alexander the Great and his time. New York: Barnes & Nobles Books; 1993.
p. 13854.
[4] Arrian. Anabasis of Alexander, vol II. Boston: Harvard University Press; 1983.
[5] Green P. How many miles to Babylon? In: Alexander of Macedon. Berkeley (CA):
University of California Press; 1991. p. 4718.
[6] Wilcken U. Return and end. In: Alexander the Great. New York: W. W. Norton &
Company; 1967. p. 22938.
[7] OBrien JM. Death in Babylon. In: Alexander the Great: the invisible enemy. London:
Routeledge Taylor & Francis Group; 1992. p. 21728, 3189.
[8] Wood M. Well say our goodbyes in Babylon. In: In the footsteps of Alexander the Great.
Berkeley (CA): University of California Press; 1997. p. 22332.
[9] Osler W. The diagnosis of malarial fever. Med News 1897;70:28992.
[10] Rubin RH, Weinstein L. Salmonellosis: microbiologic, pathologic, and clinical features.
New York: Stratton Intercontinental Medical Book Corporation; 1977. p. 4658.
[11] Jones WHS. The prevalence of malaria in Ancient Greece. In: Brothwell D, Sandison AT.
Diseases in antiquity. Springeld (IL): Charles C. Thomas; 1967. p. 1706.
[12] Patrick A. Diseases in antiquity: Ancient Greece and Rome. Springeld (IL): Charles C
Thomas; 1967. p. 23846.
[13] Engels DW. A note on Alexanders death. Classical Philosophy 1978;73:2248.
[14] Samuel AE. Alexanders royal journals. Historia (Argentina) 1965;14:112.
[15] Borza EN. Malaria in Alexanders army. Ancient History Bulletin 1987;1:368.
[16] Willis T. Typhoid fever. In: Major RH, editor. Classic descriptions of disease. Springeld
(IL): Charles C Thomas; 1967. p. 17986.
[17] Osler W. Malarial fever. In: The principles and practices of medicine. New York: Appleton
and Company; 1892. p. 14056.
[18] Osler W. Typhoid fever. In: The principles and practices of medicine. New York: Appleton
and Company; 1892. p. 239.
[19] Verghese A. The typhoid state revisited. Am J Med 1985;79:3702.
[20] Wernsdorfer WH, McGregor SI. Malaria: principles and practice of malariology.
Edinburgh: Churchill Livingstone; 1988.
[21] Hak R. The complications of typhoid fever. J Trop Med Hyg 1961;64:14352.