It’s a summer’s day in the year 323 B.C. and the scene is the ancient city of Babylon in modern-day Iraq. One of history’s most intriguing figures, Alexander the Great, is confined to his sickbed. His symptoms baffle his attendants, but he appears to be seriously ill. In fact, days after falling sick, Alexander is dead at the age of 32. And what caused his untimely death has been an unsolved puzzle for more than 2,000 years. But thanks to research by New Zealand doctor Katherine Hall, we may finally have an answer.
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.
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.
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. But 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 apparent lack of decomposition is a key clue that underpins Dr. Katherine Hall’s new theory as to what killed Alexander. We’ll return to Dr. Hall’s hypothesis about Alexander’s cause of death shortly. But first let’s get to know this figure who bestrode the ancient world, conquering large parts of it by force of arms, a little better.
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, while his mother was Olympias and she was 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.
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 may have meant that Alexander’s father was actually Zeus, regarded as king of the gods by the ancient Greeks.
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.
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, 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.
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.
Alexander was just 16 when his formal education came to an end and he first took on the mantle of military leader. 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.
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.
Now anointed as Alexander III of Macedon, the young king was to have an anything-but-peaceful start to his reign, despite executing various rivals 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.
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.
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 resisted Alexander on this journey, Tyre and Gaza. Both were defeated, with all men able to fight slain, and the remaining population subjugated and forced into slavery.
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 the victor for a second time. Darius fled and in the end was killed by his own disgruntled soldiers. His death was apparently much regretted by Alexander, who had wanted to take his adversary alive.
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.
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.
As we’ve seen, the year 323 B.C. found Alexander in the city of Babylon. Accounts of his death vary in details but agree 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.
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.
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 Macedon.
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. He apparently believed that Alexander might be about to kill him. Some have even accused Alexander’s own son, Iollas, of administering the poison in wine.
Professor Candida Moss of England’s University of Birmingham wrote about Alexander’s death on the Daily Beast website 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.
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. This poison takes some time to kill off its victim and so could fit the facts of Alexander’s death.
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 travelling through marshes near Babylon not long before his death. Even today, according to Chugg, this area is a hotspot for malarial mosquitoes.
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.
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 journal The Ancient History Bulletin.
In the article, Dr. Hall points out that none of the various theories about how Alexander died actually 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.”
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 neurological condition.
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.
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 really 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.
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.
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.
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. And his illness may have meant that his body could no longer control its temperature, so that he was cold to the touch.
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.
There’s no doubt that Alexander was indeed dead, at least eventually. But the particular symptoms created by GBS mean that his death could well have been prematurely diagnosed. And 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.
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.
One of those sceptics 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.”
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.”
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.”