Who or what killed Alexander the Great?

In June 323 BC, Alexander the Great died in Babylon aged 32, having conquered an empire stretching from modern Albania to eastern Pakistan. The question of what, or who, killed the Macedonian king has never been answered successfully. However, new research may have finally solved the 2,000-year-old mystery.

Alexander III of Macedon, also known as Alexander the Great, was born in Pella in 356 BC and was mentored by Aristotle until the age of 16. He became king of Macedon, a state in northern ancient Greece, and by the age of 30 had created one of the largest empires of the ancient world, stretching from the Ionian Sea to the Himalayas. Alexander is considered one of history's most successful commanders.  He conquered the whole of the Persian Empire but being an ambitious warrior, seeking to reach the 'ends of the world,' he invaded India in 326 BC but later turned back. He is credited with founding some 20 cities that bore his name, including Alexandria in ancient Egypt, and spread Greece's culture east.  However, before completing his plans to invade Arabia, Alexander the Great died of a mysterious death, following 12 days of suffering.

What is known from historical records is that Alexander was holding a memorial feast to honour the death of a close personal friend.  But around mid-evening, he was seized with 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. 

His initial systems were 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 could not talk, although he could still move his head and arms.  Ultimately, his breathing became difficult and he died.

Alexander the Great on his deathbed. Image source.

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. 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 food or water contaminated by bacteria which causes epidemics and not just single, individual cases.  There is nothing in any of the historical accounts to suggest such outbreak in Babylon at the time Alexander died.  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.

So what did kill Alexander? According to the historical accounts, Alexander’s body failed to show any signs of decay for six days after death, even though it was kept in a hot, sultry place.  One explanation is a lethal dose of a toxic substance that pervaded the corpse and slowed the rate of decomposition. This suggests that Alexander the Great was poisoned, but by what? 

Recent research conducted by Dr Leo Schep from the National Poisons Centre in New Zealand suggests that Alexander died from drinking poisonous wine from an innocuous-looking plant that, when fermented, is incredibly deadly.

Dr Schep, who has been researching the toxicological evidence for a decade, said some of the other poisoning theories - including arsenic and strychnine - were not plausible as death would have come far too fast, not over 12 days as the records suggest. The same applies to other poisons such as hemlock, aconite, wormwood, henbane and autumn crocus.

However, Dr Schep’s research, co-authored by Otago University classics expert Dr Pat Wheatley and published in the medical journal Clinical Toxicology, found the most plausible culprit was Veratrum album, known as white hellebore.  The white-flowered plant, which can be fermented into a poisonous wine, was well-known to the Greeks as a herbal treatment.

Dr Schep's theory was that Veratrum album could have been fermented as a wine that was given to the leader.  It would have tasted 'very bitter' but it could have been sweetened - and Alexander was likely to have been very drunk at the banquet.  The symptoms caused by consuming the plant also fit with the description of what Alexander experienced over the 12 days before he died.

However, even if Alexander were poisoned, there's no proof that he was murdered by conspiring generals. There have been documented cases of people accidentally poisoning themselves with Veratum album.  In 2010, Clinical Toxicology published a paper about four people in Central Europe who thought they were eating wild garlic. In about 30 minutes they were throwing up, in pain, partially blind, and confused. Unlike, perhaps, Alexander, they all survived.

By April Holloway