In 323 BC, Alexander the Great fell ill following a banquet held in Babylon (modern day Iraq) at his conquered palace. Ten days later, he was dead just a month short of his thirty-third birthday. His death has been suspicious for over two thousand years and even the sources of the time differ greatly. What actually happened to the great king?
Alexander‘s body has not been identified, so it is impossible to know for certain what caused his early death, but here is what we know: in the ten days before he succumbed to death’s embrace, he suffered from agonizing stomach pains, chills, sweats, exhaustion, and a high fever. According to an ancient source called the Macedonian Royal Diaries, the ailment started as a fever, which he apparently already had ten days before his death. Although Alexander was still drinking wine and eating at this time, he was in a weakened state and as the days went by he grew even weaker and ate less. When it became clear that he king was dying, his generals gathered at his bedside and prayed, but it was no use. He breathed his last on the 10th of June.
In 1998, David W. Oldach, an infectious disease expert at the University of Maryland Medical Center, was stated in an article published in the New England Journal of Medicine stated the most likely cause of death to be typhoid fever, which is brought on when someone drinks or comes into contact with contaminated water. Exploring this possibility, there are similarities to the disease that match Alexander’s symptoms well, however, the problem I see with this is that typhoid fever is highly contagious, so why was no one else affected? There are no records of anyone else in Alexander’s close circle or his army falling ill, which begs the question of why only the king was affected.
Malaria has also been put forward as a likely cause of death and this is most commonly accepted by historians. Malaria is an infection caused by a bite from an infected mosquito bite. The disease was rampant at the time, and has even been stated as having brought down King Tut a thousand years earlier (this is even said to have been the real Curse of the Pharaohs). It can remain dormant in the body for several weeks after a person is bitten, so if this is the case, Alexander could have already been sick for a long time before he died. The symptoms fit, but there are holes in the diagnosis. Does it account for the stomach pains that had him all-but screaming in distress? Perhaps not. Severe cases of malaria also include convulsions and gas buildup in the lungs, often leading to cardiac arrest, and these are not mentioned in the Diaries. And again, why was Alexander the only one affected? It may not be a contagious disease, but surely there would have been other fatalities among the Macedonian army at the time, and none were reported.
Now comes the drama that everyone seems to jump to in a case like this: murder. In this case, poison.
The Macedonians were a people prone to violence, much like Alexander himself, so poison seems a bit unlikely to be used as a weapon to kill someone, even a king. In fact, thirteen years before, Alexander’s father Philip II was assassinated in broad daylight while attending a wedding. Despite his title of Megas Alexandros (literally The Great Alexander in ancient Greek) the king was not well liked. Particularly towards the last few years of his reign, he seems to have become increasingly paranoid, executing those he believed to have been plotting against him, including the nephew of his old tutor Aristotle. After the death of his best friend and lover Hephaestion, his paranoia grew worse and he slipped into a depression.
My belief is that Alexander died due to poisoning, whether accidental or intentional. If he was poisoned, it certainly was not by use of anything common such as arsenic or cyanide. The most common suggestion put forward is Hellebore, specifically white hellebore. Though the root of this plant is highly toxic, it was sometimes used in ancient medicine, often to treat ailments such as depression, gout, epilepsy, tremors, and even demonic possession. Perhaps Alexander was prescribed white hellebore as a treatment for his own depression following Hephaistion’s death. What bothers me, however, is that when taking the plant medicinally, patients where strongly cautioned not to drink wine for at least three days leading up to treatment. As stated earlier, Alexander was drinking in excess just before collapsing with stomach pains. This leads me to believe that if hellebore was used, it was slipped into his wine at the banquet where he fell ill. It would not have taken much to affect him. Maybe he was given even more hellebore in order to cure him and his doctors unknowingly overdosed him. This is the theory I used for a short story I wrote in college for a historical project called Killing Alexander.
Whatever the case may be, Alexander the Great died in Babylon on 10 June 323 BC and his lengthy empire, which stretched thousands of miles from Europe deep into Asia, was split into pieces. The king had left no heirs, only his pregnant wife Roxana and an unstable half brother named Philip Arrhidaeus. When at last Roxana gave birth to a son, Alexander was already cold in his tomb in Alexandria, Egypt, where his general Ptolemy has buried him and established a dynasty in Egypt that would later end with Cleopatra. Philip Arrhidaeus was murdered on orders of Alexander’s power-hungry mother Olympias, who was later executed, and before he could exercise full power over the empire, Alexander’s son was murdered by another of his father’s generals, Cassander, along with Roxana. This time period is called the War of the Successors, which resulted in the vast territory being cut into pieces as the generals fought each other for full control over a former empire that would later be overtaken by Rome. Alexander’s tomb became a popular destination for pilgrims who sought to kneel at his coffin and pray, including Octavian Augustus, the first Emperor of Rome. Later, the tomb was lost and part of the city of Alexandra was lost to the sea, leaving no trace of the last resting place of the man once known as the greatest conqueror in the ancient world.