Solving The Mysterious Cause Of Alexander The Great's Death

On a summer's day in Babylon in the year 323 B.C., the seemingly invincible Alexander the Great was confined to his sickbed. There was no doubt that he was seriously ill, but his symptoms baffled his attendants. Then, just days after becoming weak, the military genius died at the age of 32. The cause of his untimely death has puzzled historians for over 2,000 years, but a doctor named Katherine Hall may have finally found a bizarre answer to what she called "the most famous case of pseudothanatos, or false diagnosis of death, ever recorded."

The beginning of the end

Why is there so much uncertainty around the death of such a famous figure? Well, there are various accounts of Alexander’s illness and death, but perhaps the two best-known were both penned some four centuries after their subject had died.

The two versions agree on many, but not all points. One was penned by Sicilian-born Diodorus Siculus, the other by a Greek, Plutarch. Both accounts agree that the great man’s illness started after a bout of heavy drinking.

Conflicting accounts of his final days

Diodorus has it that Alexander fell ill after drinking a large bowl of wine. After that he was seriously weakened and in great pain before he died after 11 days of illness.

However, Plutarch says that Alexander went on a 24-hour binge with two senior lieutenants. After that, he developed a fever, something not mentioned by Diodorus. He then lost the power of speech and died after 14 days.

A body that defied decomposition

But perhaps the most intriguing detail about Alexander’s death, or specifically the days after it, is mentioned only by a third chronicler. Only parts of the Roman Quintus Curtius Rufus’s history have survived.

However, he wrote that Alexander’s body did not decompose for six days after his death. And this was despite the scorching heat of a Babylonian summer. This perceptible lack of decomposition is a key clue that underpins Dr. Katherine Hall’s new theory as to what killed Alexander.

Destined for greatness

Alexander was born into a royal family in 356 B.C. in the Macedonian city of Pella, the ruins of which are in the north of modern-day Greece. His father was Macedon’s ruler, King Philip II.

His mother was Olympias, the daughter of Neoptolemus I of Epirus, another ancient Greek kingdom. She was one of several wives, perhaps as many as eight, that Philip married over the years.

Half man, half myth

As with many important Greek figures from ancient history, the facts of Alexander’s life are intertwined with myth. One tale recounted by Plutarch claimed that the day before her wedding to Philip, Olympias dreamt that she had been struck by a lightning bolt.

Plutarch speculated that this sign may have meant that Alexander’s father was actually Zeus, regarded as king of the gods by the ancient Greeks. We doubt historians today would believe this theory, though.

Tales of glory

Further legends surround the day of Alexander’s birth. For example, his father faced two enemy armies and defeated them both on the battlefield on that day. Plus the king’s horses took first prize at the Olympic Games.

Some historians believe that Alexander himself may have been behind those tales in an early example of embroidered reality designed to boost the status of a leader.

Groomed for the throne

As an infant, Alexander’s care was entrusted to a nurse, Lanike. As an older boy, he was taught by the stern Leonidas from his mother’s side of the family. By contrast, another tutor was Lysimachus of Acarnania.

Lysimachus was said to have been a man with a sense of humor. The young Alexander learned to ride, fight, read, and play the lyre: all the skills an aristocratic Macedonian would be expected to have.

A student of Aristotle

As his son entered his teenage years, Philip sought a tutor suitable for the boy who would one day inherit his throne. After considering various candidates, the king appointed Aristotle to teach his young son.

As payment, Philip agreed to rebuild Aristotle’s destroyed home city and to free those citizens who had been taken as slaves. In fact, it was Philip himself who’d destroyed the city and enslaved the population.

Crushing all resistance

Alexander was just 16 years old when his formal education came to an end and he first took on the mantle of military leader. He displayed his prowess almost right away.

He crushed a rebellion against Macedon (also known as Macedonia) by a rival tribe, the Thracian Maedi, while his father was absent on a military campaign. Alexander then joined his father in quelling other rebellious tribes.

Back-stabbed and betrayed

The father-and-son partnership enjoyed considerable military success, expanding the lands they controlled within Greece. In 336 B.C. Alexander’s time to inherit his father’s throne came. One Pausanias, the senior officer of Philip’s personal guard, killed Philip while the king was at his daughter’s wedding.

His son now acceded to the throne, still only 20 years old. Some historians have speculated that Pausanias’s regicide may have been part of a conspiracy involving Alexander and his mother Olympias.

The young king

Now anointed as Alexander III of Macedon, the young king was to have an anything-but-peaceful start to his reign, despite executing a few rivals that he saw as a threat.

Philip’s death immediately sparked rebellions against Macedonian rule by several Greek states including Athens, Thessaly, and Thebes. But Alexander proved to be the master of his fate, defeating those who rebelled against him.

Expanding his borders

Now secure in his power over Macedon and other Greek states and tribes, Alexander could turn his attention to lands outside Greece. He started by heading east with a powerful force of foot soldiers, cavalry, and ships.

His target was the mighty Persian Empire, roughly the land we now call Iran. He made no secret of his plan to conquer and rule the Persians.

Turning back the Persian tide

In 333 B.C., Alexander defeated the Persians at the Battle of Issus and forced their ruler, Darius III, into flight. Alexander now turned south along the eastern seaboard of the Mediterranean, heading towards Egypt.

Two cities, Tyre and Gaza, resisted Alexander on this journey. Both were defeated, with all of their fighting men slain, and the remaining population subjugated and forced into slavery.

Striking down his rivals

After his Egyptian sorties, Alexander turned back to the east and met his old adversary Darius III in battle again. At the decisive Battle of Gaugamela in 331 B.C. Alexander emerged as the victor for a second time.

Darius fled and, in the end, was killed by his own disgruntled soldiers. His death was reportedly much regretted by Alexander, who had wanted to take his adversary alive.

World renown

Alexander was still only 25 years old, but by now he had thoroughly earned his title “the Great.” But it was still not enough for him and he continued to campaign and conquer new territories.

Now that he had control of the Persian Empire, he turned his attention to lands further to the east. He led his army to Afghanistan and northern India.

Ruler of the known world

During his years of campaigning and conquest, Alexander’s achievements were extraordinary by any standards. He led his men on a series of journeys that covered some 11,000 miles after he had already conquered Persia.

He founded more than 70 new settlements, many of which bore his name. His empire straddled three continents and spanned an area stretching more than two million square miles.

Cut down in his prime

The year 323 B.C. found Alexander in the city of Babylon. Details vary across different accounts of his final days, but ancient writers agreed that he fell ill after drinking a copious amount of wine.

Then after 11 or 14 days of illness, depending on which historian you choose, he died. And the end of his life has produced one of history’s most enduring mysteries.

Medical mysteries

As well as a fever, Alexander is said to have experienced severe stomach pain as well as a stabbing sensation in his back, as though he was being pierced by a weapon.

And as his illness progressed, so did a creeping paralysis. Despite that paralysis, it’s said he retained his intellectual capacity until just before his death.

Accusations of poison

There have been many theories advanced as to what exactly killed Alexander. One idea that has frequently been suggested is that he was poisoned.

During his life, Alexander had made many enemies, and in his era, poison was often used to settle scores. It seems it was an especially popular practice among the ruling class of Macedons.

Potential suspects

Certainly, some of the historians from antiquity such as Plutarch and Diodorus raised the possibility that Alexander was poisoned, although Plutarch discounted this theory.

Various accounts pointed the finger at Antipater, a senior Macedonian official. According to some, he believed that Alexander might be about to kill him. Some have even accused Alexander’s own son, Iollas, of administering the poison in wine.

A laundry list of diseases

Professor Candida Moss of England’s University of Birmingham wrote about Alexander’s death for the Daily Beast in February 2019. According to her:

“Previous explanations for his mysterious death have included typhoid fever, acute pancreatitis, West Nile virus, alcoholism, leukemia, malaria, influenza, and even poison.” So there is no shortage of theories to explain Alexander’s premature death.

A slow-acting toxin

Some have argued that the gap between Alexander falling ill and his death means that poisoning is unlikely. But in a documentary broadcast on BBC television in 2003, Leo Schep of the New Zealand National Poisons Centre suggested that a poison derived from the white hellebore plant may have been used.

He might have been on to something. This poison takes some time to kill off its victim, and so it could fit the facts of Alexander’s death.

Brought down by mosquitoes

Andrew Chugg, who has written extensively about Alexander, offered another theory in 2005. Discounting the idea that Alexander was poisoned, Chugg asserted that it was, in fact, malaria that killed him.

He points out that Alexander had been traveling through marshes near Babylon not long before his death. Even today, according to Chugg, this area is a hotspot for malarial mosquitoes.

Work hard, play hard, die hard

Then there’s the theory that Alexander might simply have died as a result of a lifetime of excessive drinking and hard fighting. He had suffered a variety of wounds during his campaigning.

In a battle with the Aspasioi tribe in India, for example, Alexander was hit in the shoulder by a projectile. Not long after he sustained a grievous ankle wound while besieging a fort. Over time, frequent wounds and habitual heavy drinking could well have compromised his health.

Dr. Hall's theory

Since we’re talking about a man who has been dead for 2,300 years, the continued uncertainty about the circumstances of Alexander’s death is hardly a surprise. And that’s especially so since his grave has never been found.

But Dr. Katherine Hall, a lecturer at New Zealand’s Dunedin School of Medicine as well as a practicing medic, published an intriguing new theory in a January 2019 paper published in the journal The Ancient History Bulletin.

Connecting all of the dots

In the article, Dr. Hall points out that none of the various theories about how Alexander died manage to cover all the circumstances of his demise. She wrote:

“In particular, none have provided an all-encompassing answer which gives a plausible and feasible explanation for a fact recorded by one source – Alexander’s body failed to show any signs of decomposition for six days after his death.”

Supposed proof of godhood

Dr. Hall continued, “The Ancient Greeks thought that this [lack of decomposition] proved that Alexander was a god; this article is the first to provide a real-world answer.”

And the conclusion that Hall has reached is startling. She believes Alexander was killed by the disease Guillain-Barré Syndrome (GBS), a rare neurological condition.

The critical symptom

She based her conclusion on a close analysis of what we know of Alexander’s symptoms. In particular, she concentrates on two aspects of his illness.

One is the fact that accounts speak of a creeping paralysis. The second is that this paralysis was not accompanied by any apparent lack of intellectual capacity on Alexander’s part.

Losing his voice

As Dr. Hall pointed out, her emphasis on the paralysis aspect of Alexander’s illness is in contrast to most theories about his death, which tend to focus on the man’s abdominal pain and fever.

And she believes that the telling factor is the fact that Alexander seems to have remained of sound mind. This was despite him being physically disabled to the extent that he could no longer speak.

A paralyzing infection

This combination of symptoms, Dr. Hall believes, points towards a case of GBS probably caused by an infection that Alexander had picked up. And the academic has come up with an even more jaw-dropping conclusion about Alexander’s death.

She theorized that he may not have been dead at all when his family and friends believed that he had passed away. It's a morbid explanation, but also a highly compelling one.

Declared dead too early?

Dr. Hall claimed that the fact that Alexander was not dead when those around him believed he was explained why his body did not start to decompose until six days after the assumed time of his death.

She describes how the paralysis caused by GBS could have meant that although he appeared not to be breathing, his body might still have been absorbing just enough oxygen to keep him alive.

The appearance of a corpse

Alexander’s paralysis would have meant that he needed much less oxygen to stay alive. What’s more, his condition would also have offered other indicators that he was actually dead when in fact there was still a spark of life.

His illness may have meant that his body could no longer control its temperature, and as a result, he was cold to the touch.

Trapped in his frozen body

Furthermore, Alexander’s pupils may well have been dilated and his gaze fixed so that it very much looked as though he was dead.

And since the main way of determining death at the time Alexander lived was by observing whether someone was breathing or not, his lack of active respiration would have been taken as a sure sign that he was dead.

The bigger they come, the harder they fall

There’s no doubt that Alexander was indeed dead, at least eventually. However, the particular symptoms created by GBS mean that his death could well have been prematurely diagnosed.

His other symptoms of creeping paralysis combined with no loss of intellectual capacity make Hall’s diagnosis of GBS at the very least highly plausible.

A solution at last?

As Dr. Hall wrote in her paper, “The elegance of this diagnosis for the cause of his death is that it explains so many... otherwise diverse elements and renders them into a coherent whole.”

So it may be that 2,300 years after Alexander the Great’s death we finally know what killed him. Yet there are some academics who have voiced doubts about Hall’s diagnosis.

Other experts push back

One of those skeptics is Professor Hugh Willison of Scotland’s University of Glasgow College of Medical, Veterinary, and Life Sciences. He told the Live Science website that Dr. Hall’s theory was “an interesting idea.”

He cautioned, however, “From the historical evidence available, it is not possible to establish this [theory] with any degree of certainty.”

The possibility of being buried alive

In her Daily Beast article mentioned earlier, Professor Moss also expressed her doubts. She wrote, “The bigger issue is that Hall’s explanation relies exclusively on Plutarch, whose version of the death of Alexander was written at least 400 years after Alexander’s death.”

And, gruesomely, she adds that if Hall’s theory is right “then Alexander was buried alive.” That would be quite the nightmare ending to Alexander's story — though maybe the people he conquered would've seen it as karmic.

No definitive answers

However, whether we can ever really be truly sure of Alexander’s cause of death is a moot point. Dr. Hall herself was quoted in a press statement from the University of Otago:

“I wanted to stimulate new debate and discussion and possibly rewrite the history books by arguing Alexander’s real death was six days later than previously accepted… The enduring mystery of his cause of death continues to attract both public and scholastic interest.”