ALEXANDER’S LAST DAYS
Several ancient Greek and Roman historians described Alexander’s last days. They had access to many contemporary texts that no longer survive, including a mysterious source called the “Royal Diaries” or “Journal” [1,2]. We know that five men close to Alexander wrote accounts of his death: Alexander’s bodyguard and friend Ptolemy, his admiral Nearchus, his secretary Eumenes, his chamberlain Chares, and his military engineer Aristobulus. Unfortunately their memoirs are all lost except for fragmentary quotations preserved by later historians, including Diodorus Siculus (first century BC); Plutarch (about AD 100); Pliny and Quintus Curtius Rufus (both first century AD); Arrian, Pausanias, and Justin (second century AD); Aelian (about AD 200); and the so-called History or Romance of Alexander (dating to about AD 250; several manuscript versions exist). According to Diodorus (17.117), at the last banquet he attended in Babylon, Alexander “drank much unmixed [strong] wine… and finally gulped down a huge beaker. Instantly he shrieked aloud as if struck by a violent blow.” His attendants “conducted him to bed, and his physicians were summoned” but Alexander continued to suffer in great pain. Justin (12.13!15) adds more details: “Taking up a cup, he had drunk half of it when he suddenly uttered a groan, as if he had been pierced by a spear; he was carried half-conscious from the banquet. The torture was so excruciating that he called for a sword to put an end to it. The pain upon being touched by his attendants was if he were covered with wounds… . On the sixth day, he could no longer speak.”
The historian Arrian (7.25!26) affirmed that Alexander was unable to speak near the end: “Lying speechless as his men filed by, he struggled to raise his head, and in his eyes there was a look of recognition for each individual as he passed.” Justin (12.17) had also noted that Alexander was speechless but was able to move his hands: “Unable to speak, he took his ring from his finger, and gave it to Perdiccas [Alexander’s trusted general].”
Alexander’s biographer Plutarch (Alexander 75!77) denied the stabbing pain, describing only “a raging fever” marked by “violent thirst.” Plutarch said “he drank a lot of wine, upon which he fell into delirium.” Plutarch also described restlessness, loss of appetite, high fever, and inability to speak.
According to the third-century AD Greek Alexander Romance (3.30!31), which contains both historical facts and fantasy about Alexander’s life and death, after his cupbearer Iolaus served him a beaker of wine late in the evening, Alexander began showing signs of malaise, getting up and pacing around the room. “He again sat down [and] with his hands trembling, complained that it was as if a heavy yoke were upon his neck. When he stood again to drink… he shouted with pain as if pierced in the liver with an arrow.” The Romance continues: “[R]acked with pain,” Alexander’s condition deteriorated, and he “could not speak because his tongue was so swollen.” He suffered convulsions, delirium, hallucinations, and bouts of unconsciousness. “Throughout the night the king would writhe and shake upon his bed, then he would become still. At other times he would ramble with meaningless words, appearing to speak with spirits in the bedchamber” [3].
About 13 days after falling ill at the banquet, Alexander was pronounced dead, on the afternoon of June 11, 323 BC, just before his 33rd birthday. His body was placed in a coffin in a storeroom. The Egyptian and Chaldean embalmers who arrived on June 16 noted that Alexander’s body was strangely preserved, even in Babylon’s hot climate (Plutarch Alexander 77; Curtius 9.19). This effect has been taken by modern historical detectives to indicate that some sort of poison may have preserved the corpse or that a profound coma was mistaken for death.
Many ancient Greek and Roman writers speculated on the true cause of Alexander’s death, which remains an unsolved mystery. Several ancient historians reported that rumors of poisoning circulated soon after the untimely death of Alexander [4!6]. His closest friends suspected a legendary poison gathered from the Styx River waterfall near Nonacris in Arcadia (north central Peloponnese, Greece), a substance reputed to be so corrosive it could only be contained in the hoof of a horse. The Styx River was thought to be an entrance to the Underworld in classical antiquity and its waters were believed to be toxic.
The ancient historians were divided on whether Alexander died of natural causes or was murdered by poison. Justin (12.13-14) and Pliny (Natural History 30.53) accepted the poison conspiracy, as did PseudoPlutarch (Lives of the Ten Orators 56; Moralia 849 F). Pausanias (8.17.18), Arrian (7.27), and Curtius (10.10.14) were neutral. Plutarch (Alexander 75!77) was skeptical. Diodorus (17.117.5!118.1!2) was cautious, pointing out that after Alexander’s bitter enemies, Antipater and Cassander, took over Alexander’s empire, “many historians did not dare to write about the drug” or the plot. Moreover, he noted that Alexander’s mother Olympias sought revenge on Cassander and others because she believed that they had poisoned her son (Diodorus 19.11.8). Olympias was then murdered by Cassander. Diodorus’s intimations were more strongly expressed by Justin (12.13), who wrote, “The conspiracy… was suppressed by the power of Alexander’s successors.” In the Middle Ages and Renaissance, murder by poisoning was generally accepted as the cause of Alexander’s death; Voltaire, among others, accepted the poisoning plot.
MODERN THEORIES OF NATURAL CAUSES
Many modern theories propose an array of natural causes for Alexander’s slow death. These retrodiagnoses include alcohol poisoning from extremely heavy drinking, septicemia from infected old wounds that Alexander received on previous campaigns, pancreatitis, malaria, typhoid, West Nile fever, porphyria, schistosomiasis, accidentally harmful treatment by the royal physicians, or a combination of causes. In 2009, John Atkinson, Elsie Truter, and Etienne Truter produced a AU:1 valuable summary and full bibliography of Alexander’s last days, with the reported symptoms, a timeline based on the ancient sources, and an appendix of proposed causes of death and their merits and drawbacks (Atkinson J, Truter E, Truter E. Alexander’s last days: malaria and mind games? Acta AU:2 Classica 2009).
Before falling ill in Babylon, Alexander had traveled across India, Pakistan, Iran, and Iraq. Hindu doctors accompanied his army in India and Pakistan; they provided Alexander with exotic natural medicinal plants, venoms, and minerals. Significantly, Alexander was known to have treated himself with unknown, powerful drugs—in one of these experiments he nearly died. One might speculate that some experimental self-treatment was the cause of his death (Mayor A. The poison king: the life and legend of Mithradates, Rome’s deadliest enemy. Princeton, NJ: Princeton University Press; 2010).
It also may be significant that in the 2 weeks before his death Alexander had been sailing for 3 days in the Great Swamp of Babylonia, the marshy Tigris!Euphrates delta (Diodorus 17.116.5!7). This raises the possibility of mosquito-borne disease; many of the symptoms fit the ancient descriptions. West Nile fever has been suggested (Marr JS, Calisher CH. Alexander the Great and West Nile virus encephalitis. Emerg Infect Dis 2003;9:1599!603), but that is a recently evolved disease; perhaps an unknown precursor existed in Alexander’s era. Malaria was first proposed by a French physician in 1878 and has been promoted by several recent historians (Engels D. A note on Alexander’s death. Class Philol 1978;73:224!8; Borza EN. Alexander’s death: a medical analysis. In: Romm J, editor. The landmark Arrian: the campaigns of Alexander. New York, NY: Pantheon; 2010. p. 404!6). Malaria is an attractive candidate, but the distinctive recurrent fever curve in malaria caused by the Plasmodium parasite was absent from the ancient reports. Typhoid has also been suggested (Oldach D, Richard RE, Borza E, Benitez RM. A mysterious death. N Engl J Med 1998;338:1764!9; Cunha B. The death of Alexander the Great: malaria or typhoid fever? Infect Dis Clin North Am 2004:53!63). A complication of typhoid is ascending paralysis, which could have caused Alexander to appear dead for several days before he died. But if any of these infectious diseases was the culprit, it seems likely that other people in Babylon would have been struck with similar symptoms. According to the detailed historical accounts, Alexander was the only one to fall ill, a fact that could point to poisoning.
MODERN THEORIES OF POISONING
Many modern arguments have been made for accidental or deliberate poisoning. In one theory, for example, Alexander’s doctors treated him with a fatal dose of medicine in an attempt to counteract poisoning. Leo Schep, a toxicologist, considered what sort of drug might have been administered if Alexander was thought to have ingested poison; in 2009, he concluded that hellebore was the likely culprit (Schep L. The death of Alexander the Great: reconsidering poison. In: Wheatley P, Hannah R, editors. Alexander & his successors. Camas, WA: Regina Books; 2009. p. 227). In 2014, Schep’s team suggested that if Alexander had been deliberately poisoned, it would have been by white hellebore (Veratum album) fermented into wine (Schep LJ, Slaughter RJ, Vale JA, Wheatley P. Was the death of Alexander the Great due to poisoning? Clin Toxicol 2014;52:72!7).
If Alexander was poisoned by his enemies, the agent may have been an easily available mineral or plant toxin. In 2004, Paul Doherty concluded that Alexander was poisoned with arsenic, which might have preserved the body from decomposition (Doherty P. The death of Alexander the Great: what—or who—really killed the young conqueror of the known world? New York, NY: Carroll and Graf; 2004). Strychnine was first suggested by R.D. Milnes (Milnes RD. Alexander the Great. New York, NY: Pegasus; 1968), citing Theophrastus (History of Plants 9.11.5!6). In 2004, Graham Phillips suggested an alkaloid plant such as belladonna (deadly nightshade), aconite (monkshood)—both easily available—or strychnine. Since Alexander did not suffer vomiting, which always accompanies alcohol, belladonna, arsenic, and aconite poisoning (as well as hellebore ingestion), Phillips concluded that the agent must have been strychnine (Nux vomica). Strychnine poisoning appears to match some of the symptoms: paroxysmal contractions of muscles followed by complete relaxation, skin very painful to touch, high fever, sweating, high blood pressure, intense thirst, and lockjaw. Nux vomica has a very bitter taste, however, making it difficult to hide in a drink. This plant would have had to come to Babylon from southern India, never reached by the Greeks. Moreover, poisoning by this and other plant toxins would have required repeated doses to cause Alexander’s slow death, and this would increase the chances of the plot being discovered. It is also notable that Alexander, who was described as pathologically paranoid at this time, apparently did not himself suspect poisoning.
THE STYX RIVER POISON PLOT
Rumors of poisoning began to circulate among some of Alexander’s companions soon after his death (Justin 12.14; Plutarch Alexander 77.1!3; Diodorus 17.118). Many people both in Babylon and in Macedon had the motives and the means. Suspicion fell on his enemy Antipater, the viceroy in Macedonia, and on Antipater’s son Cassander, who had recently arrived in Babylon from Greece. Plutarch (Alexander 75!77) gives a detailed account of the alleged conspiracy and the special poison from the Styx, mentioned above. Some (such as Arrian 7.24!27; Plutarch Alexander 77; Pliny 30.53) claimed that it was Aristotle, Alexander’s old friend and tutor, who had provided the Styx poison because he now feared his student. Aristotle was in Athens at the time of Alexander’s death. He was said to resent the murder of his nephew by Alexander in 327 BC. Was Aristotle also suspected because he had written about Styx poison in a lost book of natural history? We know that Aristotle’s fellow natural philosopher Theophrastus did write about Styx poison.
According to Arrian (7.24!27), “Antipater sent Alexander medicine which had been tampered with and he took it, with fatal results. Aristotle is supposed to have prepared this drug… . Antipater’s son Cassander is said to have brought it [to Babylon]. Some accounts declare that he brought it in a mule’s hoof, and that it was given to Alexander by Cassander’s younger brother Iolaus, who was his cup-bearer… . [O]thers state that Medius, Iolaus’ lover, had a hand in it… . [I]t was Medius who invited Alexander to the drinking-party [where Alexander] felt a sharp pain after draining the cup.” The Greek Alexander Romance [3] maintained that the banquet was a conspiracy involving Antipater, Cassander, Iolaus, and others. Ingemar Düring [20] gathered and commented on the ancient evidence for Aristotle’s involvement, and he suggested that the case was a common topos in public debates by later peripatetic philosophers. Plutarch (Alexander 75!77) identifies the authority for implicating Aristotle as Hagnothemis, who heard it from Antigonus, a trusted contemporary of Alexander. The Styx poison said to have been prepared by Aristotle was “deadly cold water from the rock cliff near Nonacris, gathered [or distilled] like a delicate dew [or exudation] and stored in an ass’s hoof, for all other vessels were corrupted by its icy, penetrating corrosiveness.”
According to the Greek Alexander Romance, Alexander was killed with a poison that destroyed bronze, glass, and clay, and had to be sealed in a lead jar inside an iron jar. When Alexander tried to induce vomiting to rid himself of the poison, Iolaus gave him a poisoned feather. A fourteenth-century illustrated manuscript of the Greek Alexander Romance contains miniature paintings depicting the poison being transported in a lead pyxis (lidded box) from Greece to Babylon, the poison passed to Iolaus the cupbearer, and Alexander drinking from a glass goblet. (The motif of a feather coated with poison brings to mind the account of the poisoning of the Roman emperor Claudius, in Tacitus (Annals 12.56!58): when poisoned mushrooms prepared by the notorious poisoner Locusta failed to kill Claudius, the emperor called for a feather to induce vomiting but his doctor poisoned the feather). Some of Alexander’s symptoms and the course of his illness seem to match ancient Greek myths about water from the Styx—for example, he lost his voice, like the Olympian gods who fell into a comalike state after drinking from the Styx. This similarity of symptoms may have led his companions and others to assume (or to claim for propaganda purposes) that Styx poison was responsible. Such a sacred pharmakon or drug would cast an aura of divinity on Alexander. The notion that their great hero had succumbed to the fabled poison taken from the gods’ sacred oath river would have carried symbolic resonance. Combined with ancient traditions associating the Styx with immortality, Alexander’s friends could blame a mythic drug worthy of their “semidivine” leader
Conclusion: We don’t know and we will never know.
A quick survey yields a list of suggested causes of Alexander’s death
Typhoid fever
Malaria
West Nile Virus
Acute pancreatitis
Acute endocarditis
Leukemia
Schistosomiasis
Porphyria
Klippel-Feil Syndrome
Alcohol hepatitis
Perforated peptic ulcer
Poisoning with arsenic
Poisoning with strichnine
Poisoning with white hellebore
Cumulative debilitation from wounds
Grief
https://www.academia.edu/34415664/Was_the_Death_of_Alexander_the_Great_due_to_poisoning_Was_it_Veratrum_album_Clinical_Toxicology_52_1_2014_72_77_co_authored_with_L_Schep_R_J_Slaughter_and_A_Vale_
To investigate the death of Alexander the Great to determine if he died from natural causes or was poisoned and, if the latter, what was the most likely poison. Conclusion. If Alexander the Great was poisoned, Veratrum album offers a more plausible cause than arsenic, strychnine, and other botanical poisons.
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