The Rise and Fall of Alexander the Great – The Need for Medical Analysis: Reply to Commentaries

Alexander the Great died in 323 B.C. from an unknown cause. By elucidating the nature of his death, we can better interpret various aspects of Alexandrian history. Alexander’s death may have ensued from the sequelae of a congenital scoliotic syndrome. It would therefore be of significance to note that one of the greatest leaders in history who conquered much of the then known world may have been suffering from a physical disability.     

Antemortem pathological changes suggestive of reactive and degenerative arthritic disorders

The present case displays severe antemortem skeletal malformations suggestive of antemortem reactive arthritis (ReA), spondyloarthropathies and diffuse idiopathic skeletal hyperostosis (DISH). The ossified anterior longitudinal ligament on the right side of the thoracic vertebral bodies, with the presence of extraspinal enthesophytes, together indicates DISH. Fused lumbar vertebrae with costovertebral and sacroiliac joint fusion, combined with numerous large enthesophytes collectively suggest ankylosing spondylosis and ReA. Finally, some vertebrae showed evidence of age related osteoarthritis. However, the anatomical evidence for these conditions displays some inconsistencies with the known pathogenesis; therefore, a definitive account of this individual's antemortem condition remains uncertain. As no biological or medical information is known about the individual, skeletal morphology, irregular skeletal fusion and the presence of enthesophytes have been collectively used to propose the antemortem disorders that appear to have affected this individual's skeleton. Copyright © 2010 John Wiley & Sons, Ltd.     

Severe vertebral collapse in a juvenile from the graveyard (13th/14th–19th centuries) of the São Miguel church (Castelo Branco,Portugal): differential palaeopathological diagnosis

Diseases that culminate into vertebral collapse are of intricate diagnosis both in palaeopathology and modern clinical practice. When analysing human skeletal remains from the archaeological record this difficulty is amplified due to the absence of complementary medical diagnostic information. This is especially evident when the distinction between tuberculous and pyogenic spondylitis is intended. Taking into consideration this challenging task and based on the macroscopic and radiological study of the skeleton number 8, a specimen exhumed from the East necropolis (13th/14th to 19th centuries) of the São Miguel church, at the Portuguese city of Castelo Branco, the aims of the work here presented are to discuss the range of possible aetiological factors, especially infectious ones, ascribable to the striking pathological changes noticed on this 12‐year‐old individual. These included alterations on the axial skeleton, namely extensive vertebral destruction, presenting as a gibbus deformity, and correlated thoracic deformities. Consubstantiated on palaeopathological and clinical research, tuberculous spondylitis seems to be the most probable cause for the reported lesions. However, the scrutiny between this condition and other pyogenic spinal infections is of extreme complexity when analysing ancient human remains and deserves in‐depth future investigations. Within the framework of the Portuguese archaeological record, the specimen here presented is of major relevance since the pattern and severity of the spinal osseous changes observed were not previously reported. Further, if tuberculous spondylitis is assumed as the most probable diagnosis, the case here presented represents one of the earliest skeletal evidence of this condition in Portugal. Copyright © 2009 John Wiley & Sons, Ltd.     

The Death of Alexander the Great – A Spinal Twist of Fate

Alexander the Great died in 323 B.C. from an unknown cause. Physical depictions of this historical figure reveal the likelihood of a cervical scoliotic deformity. This is substantiated with the medical history and is correlated with his untimely death. For the first time, it is concluded that Alexander’s death may have ensued from the sequelae of a congenital scoliotic syndrome.