Alexander the Great died at the age of 32 years, with acute abdominal pain that began after several days of binge drinking. Might it have been from a perforated peptic ulcer?
Founding a great empire may be an extraordinary example of life stress, but stress is currently out of fashion as a cause of ulcer.1For many years the dominant etiologic model was exquisitely psychosomatic: a vulnerable person—on grounds of personality and pepsinogen—encounters a major life stress, and a duodenal ulcer is born.2But afterHelicobacter pyloriproved to be a key and curable element in the ulcer diathesis, many concluded that the "real" cause had been found and had nothing to do with psychology. Research into stress effects on ulcer fell off precipitously, and the earlier literature was dismissed as misguided and naive, given the new, respectable status of peptic ulcer as an infectious disease. In a recent telephone survey of ordinary Americans' views of what causes an ulcer, the authors seemed to consider the widespread belief in a psychological component tantamount to a superstition deserving eradication.3