Did Alexander the Great die from an infection?

The sudden death of Alexander the Great has triggered many theories and speculations over the past centuries but from time to time a more realistic explanation surfaces (see my previous blog: About the death of Alexander the Great).

This time, the news comes from a pure medical study about the symptoms leading to the king's death. The cause of his death is labeled as "the neurological disorder Guillain-Barré Syndrome (GBS)" which is contracted from a Campylobacter pylori infection which was common in his days.

Digging deeper into this disease, the internet leads me to an article by the Australian Department of Health which defines it as "an infection of the digestive tract (or gut), caused by Campylobacter bacteria”. They further explain that a person can contract "Campylobacter by taking in the bacteria through your mouth” either “by:

- eating contaminated, undercooked meat, especially chicken

- drinking contaminated water or unpasteurised milk

- eating food (such as salad) that has been cross-contaminated with Campylobacter from raw meats/poultry

- handling young pets, other animals, raw meat and pet meat".

One has to be a specialist in medicine in order to evaluate this kind of theory but we have seen wilder statements and who knows, this one may well be a solid cause for Alexander’s so far unexplained death.

If we have to postpone his date of death with six days as suggested in this article, one could wonder whether during those six days Alexander was in a complete state of coma or if his mind somehow was still alert and able to hear all the commotion around his bed and the conniving of this generals fighting to claim his succession (I hope not). As always, answers lead to new questions which, maybe one day me be answered.

To be as complete as possible, I insert hereafter the full article published by The Archaeological News Network. It is up to the reader to draw his own conclusions.

New Explanation For Alexander The Great's Death

It may have happened more than 2,300 years ago, but the mystery of Alexander the Great's death could finally be solved, thanks to a University of Otago, New Zealand, academic.

Dr Katherine Hall, a Senior Lecturer at the Dunedin School of Medicine and practising clinician, believes the ancient ruler did not die from infection, alcoholism or murder, as others have claimed. Instead, she argues he met his demise thanks to the neurological disorder Guillain-Barré Syndrome (GBS).

In an article published in The Ancient History Bulletin, she says previous theories around his death in 323BC have not been satisfactory as they have not explained the entire event.

"In particular, none 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.

"The Ancient Greeks thought that this proved that Alexander was a god; this article is the first to provide a real-world answer," Dr Hall says.

Along with the reported delay in decay, the 32-year-old was said to have developed a fever; abdominal pain; a progressive, symmetrical, ascending paralysis; and remained compos mentis until just before his death.

Dr Hall believes a diagnosis of GBS, contracted from a Campylobacter pylori infection (common at the time and a frequent cause for GBS), stands the test of scholarly rigour, from both Classical and medical perspectives.

Most arguments around Alexander's cause of death focus on his fever and abdominal pain. However, Dr Hall says the description of him remaining of sound mind receives barely any attention.

She believes he contracted an acute motor axonal neuropathy variant of GBS which produced paralysis but without confusion or unconsciousness.

His passing was further complicated by the difficulties in diagnosing death in ancient times, which relied on presence of breath rather than pulse, she says.

These difficulties, along with the type of paralysis of his body (most commonly caused by GBS) and lowered oxygen demands, would reduce the visibility of his breathing. A possible failure of his body's temperature autoregulation, and his pupils becoming fixed and dilated, also point to the preservation of his body not occurring because of a miracle, but because he was not dead yet.

"I wanted to stimulate new debate and discussion and possibly rewrite the history books by arguing Alexander's real death was six days later than previously accepted. His death may be the most famous case of pseudothanatos, or false diagnosis of death, ever recorded," she says.

Dr Hall believes people are still interested in Alexander because he was a psychologically complex and complicated person who was viewed as a warrior-hero.

"While more modern analyses have attempted to be broader and more nuanced, whatever way people want to conceive of Alexander there is a desire to try and understand his life as fulsomely as possible.

"The enduring mystery of his cause of death continues to attract both public and scholastic interest.

"The elegance of the GBS diagnosis for the cause of his death is that it explains so many, otherwise diverse, elements, and renders them into a coherent whole."

PS. An update to this post has been published under the title "A Personal approach to the cause of death for Alexander the Great" in March 2021

Memorable clash at Mount Haemus

Once his succession to the throne was secured and he had taken care of his father’s funeral, all Alexander wanted was to start his Asian campaign. But having learned that the Triballi and the Thracians were on the warpath he had no other option than to change his plans.

In spring 335 BC, he marched to Mount Orbelus, crossed the Nestos River to reach Mount Haemus, apparently ten days after he had left from Philippi.

Mount Haemus is the modern Balkan Mountain Range which is a 700 km-long spine running east-west through Bulgaria. It is here that the Thracians awaited the Macedonians, holding the major thoroughfare from Philippopolis to the north. This pass is better known by its modern appellation, the Shipka Pass situated at an elevation of 1150 meters. Few people in Bulgaria are aware of Alexander’s daring confrontation but rather remember the pass for the more recent battle they fought with the help of the Russians against the Ottoman Empire in 1877-78. In the 20^th century, an ugly monument was erected on this spot to commemorate the liberation of Bulgaria. The Bulgarian-Orthodox Church with its gold-covered onion shaped steeples is a far nicer marker to remember the soldiers who died for their country. 

Alexander’s encounter with the determined Thracians was one of his masterminded confrontations. A large enemy force was awaiting him at the top of the narrows. The Thracians had hauled wagons up the pass with the intention to let them thunder down on the advancing Macedonians as soon as they were within reach. Alexander assessed the situation immediately and issued orders to the phalanx to open up their ranks to let the wagons run through. In places where there was not enough space for the soldiers to step aside, they were instructed to lie down on the ground and lock their shields above their head. As a result, the Thracian wagons hardly caused any damage as they bolted downhill. 

Imagine how that went down with the troops this early in Alexander’s generalship! It is notable that the army obeyed his orders to the letter, showing that they trusted their new king and commander – a matter of detail, but a very important one! In the end, 1,500 Thracians were killed; the women and children were sent to Macedonia to be sold as slaves.

This episode is so characteristic for Alexander and even more telling when you consider what happens a few years later when he is confronting the Persian King Darius at the Battlefield of Gaugamela. Facing the Scythian chariots with the one meter long blades extending on each side able to mow away the enemy, he gave his troops the exact same order to let the carts run through the ranks with optimal result. Just remember that the very idea was born only one year into his kingship here in these Balkan forests. 

How Roman roads led to the prosperity of Europe

The Romans were master builders and that included the roads, many of which have survived as such or simply by their itinerary.

The very first road the Romans built was the well-known Appian Way that connected Rome to Capua as early as 312 BC. Realizing the importance of moving troops quickly over all-weather roads through the Italic peninsula, the Via Appia was constructed that same year in order to link Rome to Brundisium, modern Brindisi. It was named after Appius Claudius, who was Consul of Rome at that time.

The success of the Via Appia was such that the road immediately became the model for all those built afterward not only in Italy but all over the Roman Empire, i.e. from Hadrian’s Wall on the modern Scottish border all the way to Northern Africa and the Near East.

A team of Danish researchers took a very close look at the Roman network when it was at its greatest geographical extent in 117 AD and compared it with satellite images of modern Europe at night with astonishing results. As expected, the night view revealed that the most brightly illuminated spots corresponded to major cities, towns, and motorways. Overlaying the Roman network, it appeared, however, that modern road density went hand in hand with the Roman road density, meaning greater economic activity. This similarity is particularly striking for today’s capitals like London, Paris, and Rome, as well as for the densely populated Po Valley in Northern Italy.

[Picture from Archaeology News Network]

Let us not forget that Roman cities and military outposts all over Europe needed to be reached quickly by the legions and only well-maintained and paved roads could ensure such fast moves of troops. At the same time, these roads were used for trade purposes which in turn led to a serious economic development that lasted even after the fall of the Roman Empire, and it is still strong two thousand years later.

It is not really surprising to notice that North Africa and the Middle East did not follow this trend because after the Romans left the area the roads were no longer maintained. The local tribes, abandoning horses and carts switched to camel caravans who moved outside the paved routes. As a consequence, no significant link between the old and modern infrastructure is left for us to see.

In Europe alone, the Roman network extended over 80,000 kilometers. Speed and travel comfort were important for the Romans in order to reach their base or battlefield and to connect with their colonies at the edge of the empire.  It is worth mentioning that roads also implied the construction of bridges, tunnels, and adequate drainage systems – logistics that have nothing to envy our modern communication system. An amazing facet of Roman history.

The unique marble from Thasos

The site of Alyki is to be found at the southern end of the island of Thasos and obviously, its marble quarries are better known as Thasos marble.

Originally, Thasos was settled by the Phoenicians who exploited the island’s rich gold mines. Yet by the 7^th century BC the Greeks from Paros coveted the gold and also were interested in the white marble that was largely available. This soft snow-white material was exported throughout antiquity and has been found in places like the nearby island of Samothrace, in Pergamon, Sardes, and Ephesos in Asia Minor, in southern Greece, and in Ostia in Italy. The Romans of the 1^st century BC developed a particular fondness for this pure white marble that lasted until the 3^rd century AD. The precious material has been retrieved as far away as Germania as it was shipped over the Black Sea to the mouth of the Danube where it was transferred on flat-bottom vessels that sailed upstream all the way to the Rhine.

In Alyki, the marble was roughly quarried and the semi-finished columns, bases, capitals, or blocks for statues and the like were loaded onto the ships anchored in the nearby harbor. It served for the construction of temples, early Christian churches, and important official buildings.

Floor tiles of Alyki marble were held in high esteem from the fifth century onward and are still highly appreciated today because they possess the unique quality to reflect the sun. Recently the Grand Mosque of Mecca has been repaved with these heat-resistant slabs of 100 x 40 x 5 cm. This floor maintains the same temperature by day and by night meaning that the pilgrims can move bare-footed without being bothered by the heat.

Even today, Thasos yields three types of marble: Extra White, Snow White, and Pure White as it is remarkably pure in color with no dark veins or shades. It is famous for its translucent quality and is praised worldwide, being exported to countries like Syria, Egypt, and even Iran.

Whoever sets out to visit these quarries will automatically pass through a number of shrines dating back to the 7^th-5^th century BC dedicated to the twins Castor and Pollux and to Apollo who were worshiped by sailors anchoring in the idyllic harbor. The stones from these buildings were largely reused by the early Christians who built two basilicas on top of the ancient temples. There also is a fragmented pillar with a Greek inscription and a large Roman sarcophagus left in situ. Two more quarries from the Roman and Proto-Byzantine era can be spotted close to the waterfront.

Anamur, ancient Anemurium in Cilicia

Anemurium, modern Anamur is situated on a promontory along the ancient coastal road of Rough Cilicia (Cilicia Tracheia) in southern Turkey. The city was founded by the Phoenicians and successively occupied by the Assyrians, the Hittites and again by the Phoenicians till Alexander the Great conquered Cilicia in 333 BC. After his death, it was ruled by the Seleucids followed by the Romans as we know that Marc Anthony generously gave Cilicia to Cleopatra.

Anemurium was a thriving city in Roman times and its impressive remains date from circa 100 BC to 600 AD occupying a 1500 meters wide bay and the entire width of about 400 meters between the beach and the mountain slope. The city walls are pretty well preserved together with two theaters and several – obviously Roman – bathhouses and aqueducts. The steep mountain slope in turn is riddled with hundreds of tombs of which a few still contain their original funerary paintings and mosaics.

The largest of the theaters still counts 26 rows, totaling 2700 seats and faces the sea. Nearby is a small Odeon and a large three-aisled basilica. The most impressive bathhouse has two storys with a vaulted roof and stands close to the mountain and connecting aqueduct. It is easy to recognize the appropriate role of the each room with a caldarium (the hot bath), a tepidarium (the warm bath) and the frigidarium (cold bath), beside the changing room and an extra hall with a pool. The guests were welcomed to these Thermae with an inscription above the gate saying “Welcome to the baths. Have a good bath”.

Most striking are the remains of Mamure Castle situated some seven kilometers east of modern Anamur. This castle dates from medieval times but is resting on Roman foundations from the 3^rd-4^th century AD. It has been enlarged and modified by the Byzantines and the Crusaders and finally by the Seljuks in 1221 - this is what we can see today.

This Mamure Kale is a quite impressive construction surrounded by a moat. It is built around several courtyards, one of which holds a mosque with a minaret from the early 1300s and all courtyards together are enhanced with thirty-nine towers. The high ramparts offer a sweeping view over the Mediterranean as well as the hinterland – a strategic point, of course.

Alexander in the snow

When we think of Greece, we automatically have mental pictures of sun-drenched beaches and blue skies but winter can be harsh especially in the north.

[Picture from All Things Greek, Author Thanasi Papoulias]

The province of Macedonia, Alexander’s homeland, has started this New Year under serious snow storms, which offered unusual and eerie pictures.

Thessaloniki made headlines with houses, boulevards and monuments covered with snow and I found it very rewarding to find both Alexander and Philip contemplating nature as they must have done 2,500 years ago. They have seen worse, of course: Philip during his repeated Balkan campaigns and Alexander in the Hindu Kush Mountains.

[Picture from Zoom News]

This is something we should keep in mind when standing in front of the statues of these two great men.

The edge of the world was not reached

After the Battle of the Hydaspes, Alexander proceeded deeper into Punjab, literally meaning The Land of Five Rivers. He had already made it across the Indus and the Hydaspes. However, there were still the Acesines River (modern Chenab), the Hydraotes River (modern Ravi), and the Hyphasis River (modern Beas) to tackle.

We know he had excellent scouting parties and always relied on local people's knowledge. Still, I can't help wondering if the messages were interpreted or understood correctly here in India.

The idea first occurred when Alexander was confronted with the monsoon rains, which he had underestimated as transpires from historical sources. Rain was, of course, not going to stop him, but these rains were far heavier and more disruptive than anything he knew or expected. The fact that the monsoons were seasonal recurrences escaped the attention of Alexander – or, to say the least, he did not take the matter as seriously as he should. We know that Nearchus was marooned in Pattala for several weeks before having the favorable winds to set sail and meet up with Alexander along the coast of the Gedrosian Desert is one such surprising timing mistake. This is very much unlike Alexander, and the question should be asked whether he really knew or understood the phenomena.

Crossing Punjab, a succession of five mighty rivers swollen by the melting snows from the Himalayas may have been tuned down by the interpreters, the locals, or both. Alexander did not give it the attention required, which cannot be ascribed to negligence. It could be explained that after witnessing countless rivers, among which the Nile, the Euphrates, and Tigris, and the Oxus and the Jaxartes – all major fast-flowing rivers in their own right – it was hard to imagine anything more threatening. Indeed, what could be worse? For instance, in Punjab, he had to deal with a succession of five such mighty and extremely wide rivers. For example, it can be noted that at the points where the army crossed these wild waters, the Indus was about 500 meters wide and the Acesines nearly 3,000 meters!

The Macedonians, by now, were seasoned troops functioning according to a well-oiled discipline whether they were on the march, fighting off some enemy, setting up camp, or crossing a river. They just did it, inspired and encouraged by their king. But eight years of constant warfare had scarred the souls of even the most faithful troops.

The Hyphasis River was one river too many, and the Macedonians stopped in their tracks, bluntly refusing to continue. As usual, Alexander fell back on his excellent oratory skills and tried to rekindle his men's enthusiasm by reminding them of the past glories since the day they had left Greece and all the riches they had accumulated since. They were now so close to the world's edge, and soon all of Asia would be theirs. To Alexander's amazement, his words fell on barren ground and were blown away by the wind. A painful and deadly silence followed his fiery speech.

[Picture from Alexander movie by Oliver Stone]

Coenus, who lately had led the significant cavalry charge at the Hydaspes, was pushed forward by the troops to formulate their resentment. He appropriately reminded his king that many soldiers who had come across the Hellespont eight years ago had been sent home as invalids. Others no longer fit for service had been left behind in newly founded cities. Others still had died in combat or from disease, and the survivors were often in shattered health as they all were marked by years of battle wounds and scars.

In fact, I think that the Macedonian spirit died on the killing ground along the Hydaspes. It had been such an outrageous carnage for so little profit as there were no grand cities to be plundered like previously in Persia. Besides, Alexander had given Porus his empire back, depriving his men of the incentive to face the next challenge or engage in another battle. The continuous downpour of the monsoon rains and the fanatical resistance of the Indians cannot have improved their mood. The army squarely refused to march on and demanded to return home. Coenus' words were received with loud applause, a sign of their far-reaching power.

Deeply offended, Alexander withdrew to his tent, licking his wound, no doubt. The non-negotiable decision of his army seriously hurt his ego and pride. When he emerged from his quarters three days later, he gave the orders to retreat, much to his dismay. This happened in September 326 BC.

It makes me wonder how much, in the end, the Battle of the Hydaspes was a victory for Alexander. His men had given their all, and they had nothing more to offer except love for their king.