Alexander on his deathbed, surrounded by mourners, and dictating his will to his notary, Unknown Flemish artist

The Cold Case of Alexander the Great: Have Toxicologists Finally Explained His Untimely Death?

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It might be a surprise to learn that Alexander the Great was only 32 when he died in Babylon in June 323 BC. In a short period of 12 years as ruler he managed to create an empire stretching from modern Albania to Pakistan. As much as we know of his achievements as a fearsome general, we still have no conclusive cause of his untimely and unexpected death. He did not die in battle as might be thought the appropriate and honorable end for such a conqueror. He died at home of an unknown malady after being taken sick during one of his celebratory feasts. People attempted to present diagnosis for his sickness over the 2,000 years post mortem, suggesting diseases like typhoid or malaria would fit the symptoms but they are mostly found lacking. A very different possible cause of death was examined by research undertaken by New Zealand and UK toxicologist team a few years ago, and it seems to fit the case well.

Alexander in the Alexander mosaic from the House of the Faun in Pompeii

Alexander in the Alexander mosaic from the House of the Faun in Pompeii ( Public Domain )

The Great Man

Alexander III of Macedon was born in Pella in 356 BC and was educated by Aristotle until the age of 16. Succeeding his father King Philip II, he became king of Macedon, an ancient kingdom on the northern edge of classical Greece. The small kingdom of Macedon had grown powerful under the rule of Philip II and continued to prosper under Alexander’s reign. Having created a kingdom stretching from the Ionian Sea to the Himalayas by the age of 30, Alexander is considered one of history's most successful commanders.  He conquered the whole of the Persian Empire and his ambition even drove him to invade India in 326 BC. This invasion was thwarted and he eventually abandoned it turning back west. He is credited with founding some 20 cities bearing his name, including Alexandria in ancient Egypt, and both spreading Greek culture east and bringing some Eastern culture back with him.  It was when on the verge of executing a plan to invade Arabia that he fell sick and died after a long 12 days of resistance.

The Crucial Circumstances of His Death

Historical records report that Alexander was holding a memorial feast to honor the death of a close friend.  Halfway through the revelry, he suddenly experienced intense pain and collapsed.  He was taken to his bedchamber where, after days of agony, high fever, convulsions and delirium, he fell into a coma and died. 

Alexander on his deathbed. From The Story of Greece : Told to Boys and Girls (191-?) by Mary Macgregor

Alexander on his deathbed. From The Story of Greece : Told to Boys and Girls (191-?) by Mary Macgregor ( Public Domain )

For the team led by Dr. Leo J. Schep to make their analysis, the exact symptoms observed before death were crucial. His initial systems were described as agitation, tremors, stiffness in the neck, and sharp pain in the area of the stomach.  He then collapsed and suffered acute and excruciating agony wherever he was touched.  He experienced an intense thirst, fever and delirium, and throughout the night he experienced convulsions and hallucinations, followed by periods of calm.  In the final stages of the condition he was mute, although he could still move his head and arms.  Ultimately, his breathing became difficult and he died.

Based on this circumstantial information, theories have been put forward for the cause of death for what now amounts to over two millennia.

Alexander the Great on his deathbed.

Alexander the Great on his deathbed. ( Image: Gophoto)

The Main Theories

The four most popular theories concerning his death are: Malaria, typhoid, alcohol poisoning, or being intentionally poisoned by a rival.  Three can probably be discounted. Could he really have been slain by a mosquito? Malaria is carried by mosquitoes that live in jungle and tropical locations, but not in desert regions such as central Iraq where Alexander died. Typhoid is transmitted by contamination of food or water by bacteria, causing widespread infection and even epidemics and not just single, individual cases.  No such outbreak is recorded in Babylon at the time of Alexander’s death.  The main effect of alcohol poisoning is continual vomiting, but not once do any of the historical sources mention vomiting or even nausea as one of Alexander’s symptoms.


Interesting, that Cassander, who later poisoned Roxana and Alexander IV to take over the throne, had just recently arrived in Babylon. Alexander had humiliated Cassander, after Cassander had laughed out loud at the obeisance ritual Alexander held every morning. My money for poisoning would be on him.

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