A personal approach to the cause of death for Alexander the Great

About two years ago, I posted a blog about the death of Alexander based on the analysis made by Dr Katherine Hall, a Senior Lecturer at the Dunedin School of Medicine and an academic of the University of Otago, New Zealand. Her conclusion was that the king did not die from excessive drinking, poisoning or any other disease, but from the neurological disorder called Guillain-Barré Syndrome, in short GBS (see: Did Alexander the Great die from an infection?) 

It so happened that a few days ago, I saw another article mentioning this diagnosis of Guillain-Barré Syndrome. It was published by the New York Post in early 2019, just like the one I commented on above. The title of their article Alexander the Great was ‘buried alive’ after disease paralyzed him was true propaganda to trigger the attention of the readers. 

This Guillain-Barré Syndrome rang a bell with me and I returned to my own blog to look at the many theories about Alexander’s death. In my previous research, I found that gastroenteritis was presented as the main cause for GBS and I had stopped there. This time, however, I started a new search. As a result, I found that Healthline as well as The National Institute of Neurological Disorders and Strokes include a lung infection as a possible cause of GBS although the gastroenteritis is more widely quoted and admitted. This is very distracting because we are led to overlook this lung infection that is mentioned so casually.

At this point, I recalled how Alexander had been fatally wounded during the Malian attack and how he hovered for many days between life and death. An arrow, three feet long, had hit him piercing through his corselet deep into his chest above his breast. It has not been established whether the barbed arrow had been readily removed by Perdiccas who cut it out with this sword upon the king’s order or if it was skillfully operated by his physician. Alexander was hemorrhaging and lost a lot of blood. Because the arrow punctured the wall of his lung, the king was breathing air and blood through the cut, meaning that he suffered excruciating pain at each and every draw of breath. In time, his skin stuck to his lung and according to some sources the wound kept oozing a mixture of fluid and blood. History, afterwards, remained silent about the health conditions of the king.

It is clear, however, that Alexander never entirely recovered from this injury. His extensive march through the Gedrosian Desert will not have done him any good and the unhealthy conditions of the marshes surrounding Babylon were a fertile ground for infection. This is precisely what I was thinking of when I read that GBS may have been caused by a lung infection. His immune system had attacked his nervous system, which led to gradually paralyzing his body, including the eyes but not his brain! Hence the title of the article that Alexander was buried alive.

The death of Alexander remains shrouded in many mysteries because so much has been hushed and covered up. After the king was pronounced dead, we are flooded with stories of the many conflicts among his generals about his succession but it appears nobody showed any concern for Alexander’s body. None of the ancient authors like Arrian, Diodorus or Plutarch spend any ink on what happened next; they all remained silent about it. 

Only Curtius tells us what happened afterwards:“when at last his friends had leisure to care for Alexander’s lifeless body, those who had entered the room saw it corrupted by no decay, nor even by the slightest discoloration. The vigor too which comes from the breath of life had not yet left his face. And so the Egyptians and Chaldeans who were ordered to care for the body after their manner, at first, as if he were still breathing, did not dare to lay their hands upon him; then after praying that it might be right and lawful for mortals to handle a god, they emptied the body of entrails, the golden coffin was filled with perfumes, and the emblem of his rank was placed upon the king’s head”. 

This could mean that Alexander was in a coma during those days of neglect or that he was in a state of near-death. The medical knowledge of that time had no way to diagnose this as we would today. However, it is comforting to hear that the priests prayed that it might be right and lawful for mortals to handle a god before they started the embalmment. I like to believe that their prayers were answered.

Among modern historians and as far as I know; only Robin Lane Fox has put his worries about Alexander’s health in writing. He stated that the wound would hamper the king for the rest of his life and that walking would be “an act of extreme courage” – nothing less! Whenever possible, Alexander travelled by horse, chariot or boat. So much for the faithful reports of our historians!

In the end, it is my personal opinion that this Guillain-Barré Syndrome is a very plausible cause for Alexander’s death and not his presumed drinking bouts as advertized by ancient and modern historians alike.