What was the real cause of Alexander’s death?

Alexander the Great, also known as Alexander III, king of Macedonia, as we all know was one of the most successful military commanders in the history of Ancient Greece. He was born in the year 356 BC to King Phillip II and Queen Olympias. By the time of his death in 323 BC, he had conquered most of the world known to the ancient Greeks. However twelve years of constant military campaigning finally took a toll on his health and he succumbed to a curious “illness”, leaving behind no clear successor. But did he really die of natural causes? The purpose of this article is to examine the causes of his premature demise.

For 12 years Alexander had personally led his men from the rugged highlands of Macedonia, in the north of the Greek peninsula, first destroying the rebellious Thebes, then crossing the Hellespont—today's Dardanelles—to begin his revenge on Persia. His troops fought their way across Anatolia, subjugating the great Persian Empire, defeating even the Bactrian armored cavalry, and winning onward, undefeated, as far as the Beas River in India. Alexander had been wounded many times, but nothing, it seemed, could overcome his boundless energy, his iron constitution, and his capacity for quick recovery. And now struck this curious ‘fever’, which modern doctors believe was typhoid, "complicated by bowel perforation and ascending paralysis."

There are various theories on the actual cause of Alexander’s death. Modern historians are generally divided on this issue. On the afternoon of June 10-11, 323 BC Alexander died in the palace of Nebuchadrezzar II of Babylon. Many ancient historians, like Plutarch and Arrian, believe that it was caused by the relapse of malaria which he contracted some 12 years ago. However a startling new theory has come to light which suggests that he was poisoned. Yes poisoned.

This theory derives from the story of Justin and Curtius. The original story states that Cassander, son of Antipater, the viceroy of Greece and his brother Iollas together conspired to bring about the downfall of the young monarch. Many around Alexander, including his most trusted generals, had powerful motivations for seeing Alexander gone. The poison that finished him off is commonly believed to be strychnine, a curious poison which is mainly used for killing small vertebrates like rodents. It causes muscular convulsions and effectively paralyses the spinal cord and the brain. According to the story, it was Iollas who actually administered the poison after Cassander had mixed it in his wine. However according to R. Lane Fox, the strongest argument against the poisoning theory is the fact that twelve days had passed between the start of his illness and his death and in the ancient world, such long-acting poisons were not available. But even then the poison theory is quite a plausible one.
The Diadochi, were supposedly the rival successors of Alexander’s huge empire. It is believed that it was actually the Diadochi, and not the sons of Antipater, who had a hand in Alexander’s “natural” death. Alexander had no natural heir and many close to him wanted to take advantage of that fact. According to T. Peter Limber, Alexander, on his deathbed, assembled his closest companions, to hear his answer to the inevitable question: to whom would he leave the then Macedonian empire? His answer is still debated. Arrian quotes it as, “Hoti to kratisto” – which means “to the strongest” or “most able”. If Alexander meant “to the strongest of my generals”, then he was almost certainly predicting a series of succession wars (which actually happened). Yet he had already handed his royal ring to Perdiccas, his second-in-command, thus appointing him regent. A final ambiguity is that instead of “Hoti to Kratisto”, the dying man may simply have said “Krater’oi”, referring to arguably his greatest and most trusted general, Craterus, whom he had already appointed as the regent of Macedonia! And shortly after Alexander’s death, Craterus was assassinated. By whom it is not known. What is known is that his empire was split between the Diadochi.

However most modern historians scoff at the poison theory and call it an attempt to “further romanticize the fanciful legend of Alexander”. According to John S. Marr of the Virginia Department of Health, Richmond and Charles H. Calisher of the Colorado State University, it was a disease, which was a combination of the recently-discovered West Nile Fever and Encephalitis, which actually felled the young king. In the 3rd century BC, a disease caused by West Nile virus arrived in Mesopotamia for the first time in recorded history, killing indigenous birds and an occasional human and causing only incidental febrile illnesses in many others. Over subsequent centuries the virus may have devolved, becoming less pathogenic for indigenous birds, while retaining its potential as a dangerous human pathogen. We now know that unexplained bird die-offs can foretell human cases of disease caused by West Nile virus. In 323 BC, a similar event might have been considered an omen of Alexander the Great’s death. Greek historian C.N. Sbarounis supports the natural cause theory but says that it was actually acute pancreatitis, which is usually caused by heavy alcohol consumption that vanquished the unconquerable king.

Many historians, like Plutarch and Aristobulus, back the “Typhoid Fever” theory. Historian Niel Roffe Chamberlain as well as a medical team headed by Dr. David W. Oldach and others from the University of Maryland laid out the case of typhoid fever in the 1998 June issue of the New England Journal of Medicine. An important clue is that he suffered from severe abdominal pain. This could have been the result of a perforated bowel caused by untreated typhoid fever.
However a new theory has come to light which suggests that Alexander might actually have been done to death by his beloved wife Roxana. She was the daughter of a Bactrian named Oxyartes of Balkh in Bactria (then eastern Persia, now northern Afghanistan), and married Alexander in 327 BC after he visited the fortress of Sogdian Rock. Historian Graham Philip and jounalist Steve Connor support the theory that it was actually Rozana who murdered the young monarch out of sheer jealously after Alexander professed his love for Hephaestion, son of Amyntor and a Macedonian aristocrat (this further backs claims that Alexander might actually have been bisexual). Another theory has been put forward by University of Otago poisons expert Dr. Leo Schep, who may actually hold the key to the mystery that has baffled historians for nearly two and a half thousand years. His theory is one of the leads in a documentary, Alexander the Great's Mysterious Death offering a plausible explanation for Alexander's untimely death, based on scientific and forensic research on information that has come down through history. Dr Schep had his theory on the murder weapon taken up as the lead case scenario, after fielding a call from a researcher with UK film company Atlantic Production's researcher late last year. He supports the poison theory completely but has withheld the identity of the supposed murderer, which will be disclosed later this year at a press conference after all the evidence pointing to this theory has been thoroughly confirmed. However many historians remain skeptical and unconvinced.

The mystery of Alexander’s death, as we can see, is a multi-layered and rather complex one. No clinching evidence has been found till date to support either the “natural causes” theory or the “poisoning” theory. What we have before us is a theory which is extremely hypothetical and not very substantial. Alexander’s death till now has been one of History’s great mysteries and one which has been widely debated in academic circles. Whether there is any truth in Dr. Schep’s claims remains to be seen. Whether any evidence will be found regarding the death of the enigmatic king only time will tell. From a purely personal point of view, I feel that Alexander’s death might not have been due to natural causes and there’s certainly more to it than meets the eye.