As far as heroes and mighty leaders go, Alexander the Great is sure to be in anyone’s top three. He succeeded his father Philip II of Macedonia at the tender age of 20 and from there had blisteringly-fast success as he aimed to expand his empire to the “ends of the world and the Great Outer Sea” (they had a different sense of global geography back then). He was enormously successful, advancing as far east as India before he was forced to turn back on account of homesick disgruntled troops. But his military campaigns were truly cut short by his early death, at the age of 32. Now, a new theory claims not only that it can explain the untimely death of (arguably) history’s greatest military genius, but also that he was buried alive.
In a recent article for The Ancient History Bulletin, Dr Katherine Hall, a senior lecturer at New Zealand's Dunedin School of Medicine and practicing clinician, argues the ancient hero met his end thanks to the neurological disorder Guillain-Barré Syndrome (GBS). Previous explanations for his mysterious death have included typhoid fever, acute pancreatitis, West Nile virus, alcoholism, leukemia, malaria, influenza, and even poison.
There are actually two main accounts of the death of Alexander the Great, which differ from one another. The earliest is that of the first century B.C. historian Diodorus Siculus. Diodorus records that Alexander was struck with pain “instantly” after drinking a bowl of unmixed wine. He had to retire to his quarters and went directly to bed. After 11 days of worsening health and extreme agony he died in great pain. Diodorus does not mention the fever.
A second version derives from the work of the second century A.D. biographer and moralist Plutarch’s Life of Alexander. According to this version, around two weeks before his death Alexander engaged in some heavy drinking, spending an evening entertaining Nearchus, one of his naval officers, and the next day day-drinking with another military buddy Medius of Larissa. After this “he began to have a fever” and had a sudden pain in his back “as though struck with a spear.” The fever got worse, he needed to carried into order to perform religious duties and eventually he was unable to speak. Plutarch cites another source, Aristobulus, who agrees that Alexander had a “raging fever” and got very thirsty when he drank wine.
A similar story, found in Arrian’s Anabasis, uses the same source as Plutarch but adds a few additional details about the ascending paralysis. For example, Arrian notes that when Alexander could no longer speak and his soldiers filed past him (as a gesture of respect) he looked each in the eye with a look of recognition but “struggled to raise his head.”
According to Plutarch, after his death Alexander’s body did not decompose for six days: “His body, although it lay without special care in places that were moist and stifling, showed no sign of such destructive influence, but remained pure and fresh.” The first century A.D. Roman author Quintus Curtius Rufus agrees that there was no “discoloration” or “decay.”
Hall’s theory argues that Alexander had the contracted an acute motor axonal neuropathy variant of GBS and that this is why, in addition to developing a fever, he suffered from paralysis and an inability to speak. Earlier theories have focused exclusively on the drinking, abdominal pain, and fever and have failed to pay attention to the paralysis. In addition she argues that only her theory can explain why Alexander’s body did not decompose: he wasn’t dead, she argues, he was alive and paralyzed. Somewhat horrifyingly, he ended up being buried alive. “The Ancient Greeks,” Hall has said in an interview, “thought that this proved that Alexander was a god; this article is the first to provide a real-world answer.”
Hall’s thesis is making waves in the media, but has she solved the puzzle of Alexander’s death? There are several reasons, both medical and historical, to think we have further to go.
Hall has claimed that “none [of the previous theories for the death of Alexander] 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.” And she offers some compelling evidence about symptoms not present in the descriptions of Alexander’s death and detailed analysis of various medical conditions. But a 1998 article she mentions that was published in the New England Journal of Medicine (non-paywalled summary here) argued that typhoid fever could explain the ascending paralysis and the lack of decomposition in Alexander’s body (Hall’s view is that typhoid fever only rarely causes GBS). This article also raises and discuss the possibility that Alexander was experiencing GBS. If either sets of authors are correct then Alexander was buried alive.
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. This is not to say that Diodorus’s version is accurate, but it is earlier and historians tend to use earlier sources. Now, Plutarch does tell us that he relied upon a source known as the “Royal Diaries” to compose his version of the Life of Alexander so, arguably, he preserves the earliest tradition. Interestingly, Arrian’s use of the same source does not mention the detail about Alexander’s body failing to decompose.
The larger difficulty is whether or not it is appropriate or even possible to diagnose ancient figures from the vague reports of their death provided by ancient sources. Modern medical doctors do not diagnose third-hand without seeing a patient. It’s remarkable to think that anyone can accurately examine Alexander the Great, who died 2,300 years ago. To assume that modern knowledge is so all-encompassing and superior that we can diagnose everyone else’s ills is a very particular form of hubris that critical disability theorist Lennard Davis has described as “nowism.” It’s not that these theories are bad, necessarily, but they are highly speculative and inherently limited.
Hall’s own perspective is revealed by her statement that the Ancient Greeks thought the lack of decomposition proved that Alexander the Great was a god. That’s not an entirely accurate representation of what Plutarch says about the matter. Plutarch includes this detail because, in his opinion, it offers proof that Alexander the Great wasn’t poisoned. He doesn’t say anything at all about this offering proof that he was a god (even if it does say something remarkable about Alexander). Curtius Rufus mentions that the Egyptians and Chaldeans (who had been brought to embalm him) did think that Alexander was a god, but none of them were Greek and these accounts were written long after the events. It’s likely that Curtius Rufus is peddling a trope about the superstitions of foreigners.
The reason Alexander wasn’t buried immediately seems to have been because of preparations surrounding his tomb and competing claims to his body. Some believed, on an account of a prophecy, that the presence of Alexander’s remains in their city would convey power and invulnerability to that place.
The long and short of it is that none of us know why Alexander the Great died. The details that come down to us from ancient texts are the elements of Alexander’s death that ancient authors thought were interesting, interesting, and revelatory. When Hall says that symptoms were “missing” from the descriptions of Alexander’s texts we have to recognize that these authors are not providing a comprehensive list of symptoms. They are describing what they think is relevant. We could use ancient medical texts to try and figure out why ancient people thought Alexander died, but we will never be able to use modern diagnostic tools to speak definitively about what killed him.