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 is 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, spent 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 advertised by ancient and modern historians alike.

Rare report from the Makran Desert or the Desert of Gedrosia

Alexander’s march across the Gedrosian Desert is mentioned rather casually in history, probably because it is not one of his great accomplishments. Scholars generally label it as his greatest blunder. A few even pretend that he wanted to punish his soldiers for refusing to follow him to the edge of the world, which is absolutely ridiculous for two reasons. Firstly, he needed his troops, which he loved, meaning that he would never send them off to their death. Secondly, if Alexander did indeed want revenge, which is not in his personality, he would not have led this expedition in person.

One thing is sure, the Gedrosian or Makran Desert is one of the most inhospitable places on our planet of which we know very little. The survivors of Alexander’s daring expedition only met very few people on their way, and there is no reason why the situation would be different today.

Until now, we only had a few images of that region which reveal nothing more than a bare rocky landscape. But Iran has decided to have a closer look at the Makran Sefidkuh region, which is part of the Sistan and Baluchestan province.

The first season of archaeological survey has started this year evidencing intriguing archaeological and anthropological finds. The most striking element is the circular or oval structures that closely resemble today’s dwellings.

The specific pottery that has been collected seems to date the site to the Bronze Age or the Chalcolithic era as it is known in India. This pottery is called Londo, which is typical for the region around the Persian Gulf, the Sea of Oman and the Makran Desert. In Pakistan (which was India in Alexander’s days) this Londo could belong to the 3^rd/2^nd century BC, but the dating of this Baluchistan site in Iran may be slightly different.

So far, the team has identified twelve separate settlements that are no longer inhabited but surprisingly are all known by a name: Baragdan, Kuchkodam, Koddap, Tangsam, Kopidap, Javanja, Torkeguash, Dangar, Kupchu, Sorkhkalut Patgan and Siyahdan. Based on the glass bracelets and fragments of pottery, it could be established that these communities were semi-nomadic. They played a vital role in this important trade route between the Persian Gulf and the province of Sistan and Baluchestan (see: Alexander’s outpost in the Gulf).

Many questions, however, remain unanswered and will require further long-term studies, but these first excavations sound quite promising.

It remains an interesting subject altogether, not only because Alexander crossed the Gedrosian on his way west from Pattala but also because Craterus crossed the most fertile part of the Makran diagonally. He led thousands of demobilized veterans, much of the baggage train, and Alexander’s pregnant wife, Roxane to Alexandria-Arachosia to meet up with Alexander near Harmezeia (modern Hormuz).

[Pictures: Prehistoric circular structure found in the area (top) and Dwellings of the current nomad inhabitants of the area (bottom) [Credit: Hossein Vahedi)]

An eye for beauty in spite of the daily challenges

On a lovely autumn day, I was enjoying a picnic high up the hills among the ruins of Tlos, overlooking the Xanthos Valley. My mind automatically drifted away to Alexander, who must have ridden down this very valley towards Patara, Letoon, and Xanthos. I pictured him proudly riding his faithful Bucephalus, who was happily shaking his colorful tassels and twinkling bells.

In my pleasant mental picture, I imagined a good-humored Alexander enjoying the ride and the beauty of the land with Hephaistion at his side. No history book will mention this, of course. The landscape, roads, or weather conditions are no topic unless they reach extremes.

The few such exceptions our historians picked up are, for instance, the blizzards that hit the army on the passes of the Hindu Kush, the never-ending monsoon rains in India, and the flash flood in the Gedrosian Desert. Otherwise, we can only use our imagination, and that is not easy since most of us have not traveled to those faraway lands.

I feel privileged to have trodden in the footsteps of this great conqueror on several occasions, but to truly appreciate what is involved, we would have to venture out on foot. Only a handful of braves have set out on such an adventure. Traveling by plane or car, as is common nowadays, does not allow us to experience the impact of the elements. The wind, the rain, the heat or the cold remain blocked until we step outside of our metal cocoon. We miss out on the smells of the land, the dust, the fog, the crispy frost in the air. The most common sounds of bleating sheep, mooing cows, the songs of the birds, and the laughter of children are stifled entirely.

The topic of the weather fully hit me when I drove south along the Zagros Mountains in a relentless dust storm. The sands from Mesopotamia were carried through the air in sweeping gusts. As long as I sat inside the comforts of my vehicle, I only noticed a hazy landscape, but as soon as I left my protective shell, the grains hit me in the face, stinging me with thousands of needles. The wind was tearing at my clothes, the sand was crushing between my teeth, and breathing became difficult. Alexander must have known such days. 

The role of the landscape and the climate during Alexander’s campaign became even more apparent to me after reading “The Road to Oxiana” by Robert Byron. This book is a true eye-opener when it comes to envisioning the full scale of his daily challenges.

In 1933, Byron traveled from Damascus to Baghdad and crossed Persia to finally reach Afghanistan one year later.  It is quite exciting to discover that long stretches of his route match the itinerary taken by Alexander more than 2,000 years earlier. The landscape is a commanding factor common in both cases. Then and now, roads run along the same rivers, pass the same oases and towns, skirt the same deserts and mountains, and use the same passes and goat tracks. I enjoy his descriptions of the many valleys in full spring bloom in Central Asia, where the fiery red poppies rule the fields as they still do in Alexander’s homeland. They are a welcome breather after witnessing the barren deserts with their frequent dust devils whirling around.

Byron hitchhiked on board lorries but also traveled by car or on horseback. Despite modern means of transportation, he did not move much faster than a traveler on foot would. Roads were often impassable because of flooding or flash floods that washed away entire portions, including bridges or other rudimentary crossings.

He used old caravanserais when there was no local governor or friendly Brit around to offer him a room for the night. Lodging was, more often than not, uncomfortable and dirty. He generously recounts the folklore details of such encounters, and it seems to me that life has not really changed much since the days of Alexander.

As I read on, I search for those landscapes and cities that most likely have seen the Macedonian army marching through. Places like Ecbatana, Persepolis, Pasargadae, Balkh, Kabul, and Peshawar, the crossing of the Elbruz Mountains towards the Caspian Sea, and the perilous trek over the Hindu Kush.

Byron describes a poignant moment as he descends to the Caspian Coast. In a few minutes, the world of stone, sand, and mud he had endured since Damascus turned into one of green-leafed trees and bushes. The everlasting drought made way for moisture as even his body somehow returned to its natural buoyancy. I imagine Alexander and his dust-covered Macedonians must have experienced the same kind of refreshing relief.

Insofar as possible, Alexander used the well-maintained Persian Royal Road. Once beyond that network, it came down to finding tracks and trails. It appears that Byron had a rather similar experience, and his worst progress was made after he left Persia to enter Afghanistan.

The sudden changes in the weather pattern are widespread in that part of the world, and Byron truly undergoes these extremes. He tells how it rained all night, how the river had subsided but rose again fast, four feet deep at times. Of rain falling like bath-waste turning the road into a river for miles in a row, flooding the desert, and turning every mountain into a cataract. He describes the dark skies as cloud-wracked set against inky jagged hills.

At one time, after passing the Paropamisus, he labors for an hour and a half, ankle-deep in freezing slush, to lever away the rocks blocking the road. Landslides were common, and he mentions how not one but a dozen such landslides prevented him from reaching Kabul overnight. A mile beyond the Shibar Pass across the Hindu Kush, which Alexander also used, Byron hits more landslides, heaps of liquid mud and pebbles concealing large rocks. The crops below the road, already half destroyed by a river of mud, are then menaced by a new spate.

Another exciting feature that is not mentioned in our history books, either, is the qanats. A very recognizable and ingenious water management system from antiquity that still exists today and is still functioning in some parts of the world. The quality of the river water could not always be trusted, but the qanats carried the precious fluid from the snow level high up the mountains or from clean underground water tables (see: The qanats, one of the greatest inventions of mankind).

Earthquakes were another frequent occurrence at every stage of Alexander’s route. Surprisingly, the sudden shaking that rocked tents, as well as men and beasts, is never mentioned either. They probably were prevailing events not worth talking about.

No, this way of traveling is definitely not for the faint-hearted. Yet Alexander and his brave Macedonians constantly faced the elements. However, I like to believe that many, and especially Alexander, had an eye for beauty as well. Byron tells us, for instance, that he reached the most beautiful part of his entire journey at the foot of the Hindu Kush. Of all places! After leaving the river, the road constantly climbed not in twists but followed a succession of steeply sloping saddles leading from ridge to ridge. I have seen pictures of this road in a presentation at the exhibition “Afghanistan, hidden treasures from the National Museum, Kabul,” and they entirely match Byron’s description.

On the other hand, flowers must have been plentiful in antiquity, creating landscapes that were familiar to Alexander. Nowadays, they have mainly disappeared from our cities and our concrete roads. I fondly recall the Macedonian fields covered with an array of spring flowers ranging from the white chamomile and pink hollyhock to the deep-red poppies and purple wild onions. The explosion of colors over the rolling hills felt like a homecoming. The land was pleasantly green, crossed by refreshing, clear streams tumbling down from higher elevations under the blue sky filled with fleets of puffy clouds. Yet, I came across the same picture in many other places, further east to Turkey and beyond.

Truly, so much, so very much remains to be discovered and disclosed on Alexander’s whereabouts!

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.

Alexander the Great and the Logistics of the Macedonian Army by Donald W. Engels

Strangely enough, this is the only book ever (at least to my knowledge) presenting a serious study of the logistics related to such an extensive campaign as Alexander’s conquests of Asia. We take his expeditions for granted as he moves from one battlefield to the next and from one city or fortress to the next one, but there is so much more involved! In his Alexander the Great and the Logistics of the Macedonian Army (ISBN 0520042727), Donald Engels underlines a considerable amount of facts and figures to make you look at it from a very different angle.

As he takes his reader treading in Alexander’s footsteps, Engels makes me discover what accurate preparations for such campaigns meant – and I’m certainly not the only one!

I had no idea, for instance, that Alexander would plan to cross to Asia at the right time of the year to reap the upcoming harvest to get enough food for his men and fodder for his horses and pack animals. Engels calculated the daily quantity of food and water each man needed based on a thorough analysis made by the American Army. He did the same for the pack animals and the horses. If you multiply those quantities by the number of men and beasts multiplied by the number of days such provisions should last, you obtain unbelievable figures!

I had no idea horses needed a full day's rest after trudging on for four, a maximum of five days! Unlike us human beings, they cannot go on day after day.

I had no idea that when Alexander split up his forces during the winter months, the main thought behind this decision was to ensure enough forage for man and beast. This was the case between Gordion and Lycia in 334-333 BC or between Bactra, Maracanda, and Nautaca in 328-327 BC.

I had no idea that timing was so basically tributary of the terrain. One example is when Alexander has to retrace his steps across the Pillars of Jonah Pass because the Persian King Darius showed up on his back near Issus. Engels has figured out that at its narrowest part, the pass would allow only two cavalry horses or four infantrymen to march through simultaneously. Setting a pace of one such entity per second, multiplied by the number of troops, he manages to produce an irrefutable timetable. An amazing conclusion when you read that Alexander fanned his troops out almost immediately to be in place to face the Persian army!

And finally, I had no idea how accurate Alexander’s bematists were. They are rarely mentioned in any history book. Still, it is beyond belief to read how precise their step counts were, even over long distances, matching almost exactly today’s equivalent in English miles.

Donald Engels consulted ancient authors like Arrian, Plutarch, Diodorus, Curtius, and many modern writers. Interestingly, he also consulted the notes and topographic maps made by the English when they crisscrossed the regions of Afghanistan and India, for instance. The location and usage of the old Royal Persian Roads and the ancient Silk Road are other precious assets.

This all means that in the end, Engels can retell Alexander’s conquests based on all the facts he collected from these different sources, which he analyzed and translated into realistic figures leading to a practical day-by-day progress of the king’s troops! A titanic job, but a very rewarding one!

He shares his theories and mathematics with the reader in many additional comparative tables, including an analysis of Alexander’s troops at different times of his conquests. Detailed local maps further clarify the king’s march through fertile valleys, skirting deserts, and crossing mountain ranges toward newly founded Alexandrias. A few Appendixes provide extra information about food rations, the battlefield of Issus, the horrible march through the Gedrosian desert, etc.

For those who really want to take a closer look at the genius of Alexander, this is a must-read!

The Persian Boy by Mary Renault

After Fire from Heaven, one would automatically expect Mary Renault to write a sequel to the years of young Alexander, and she did, yet in a most unexpected way. Instead of picking up the story of Alexander when he leaves for Asia, she skips over right to the heart of Persia from where his conquests are followed from afar by a eunuch called Bagoas, The Persian Boy (ISBN 0394751019). In fact she starts the book telling Bagoas’ life from the very beginning, making it an interesting reading on castration and the general role of eunuchs in that part of the world.

I know many people read this book for that purpose only or for what we call nowadays a homosexual relation. In ancient Greece neither the word nor the concept were known. Sex was simply sex without the fringes and the constraints that Christianity and other religions brought forward. It may be useful to point out here that in antiquity eunuchs were not only slaves serving the pleasure of their master, but that they also could occupy high placed positions often that of a valuable “contact person”. As a simple example, I’m thinking of another eunuch Bagoas (often mentioned more elegantly as Vizier) who assassinated King Artaxerxes III to rule himself through puppet kings – a proof, if needed, of the power some eunuchs could acquire. If we believe Andrew Chugg in his book Alexander’s Lovers (and there is no reason not to believe him) our Persian Boy may well have acted as special envoy or master of ceremony at Alexander’s Persian Court since he was familiar with all the finesses of the Persian protocol.

Whatever the reader’s opinion on this matter, to me Mary Renault’s book is about Alexander the Great. Bagoas is brought to him as a gift by Nabarzanes who in exchange is hoping to be looked upon mildly by this new ruler since he was closely involved in the murder of King Darius in Parthia in the year 330 BC.

I marvel at Mary’s dexterity in comparing and differentiating Persian customs from the Macedonian ones, as Bagoas discovers this new world around him. In his eyes, the Macedonians are perceived as Barbarians with their lack of respect for the person of the king as initial focal point and their overall lack of social graces. For us Westerners, as we have been raised with the concept that our civilization started in Greece, it comes as a surprise to learn that there is an other version to the story – in this case to history, for here we are looking towards the West from the East. It is quite interesting to witness Alexander’s eagerness to learn, which I think is a very honest and true trait of his character, but also the subtle and styled way in which Bagoas is introducing his master to Persia – a land that must have looked to the new conquerors like the New World to our Pilgrim Fathers setting sail for the Americas.

Unlike in Fire from Heaven, this book is no longer focusing exclusively on Alexander’s relationship with Hephaistion, which by the way takes another dimension as both men become more mature, but as can be expected on his relationship with Bagoas. Yet Mary Renault manages to keep up with Alexander’s campaigns as he marches on over the Hindu Kush to Bactria, crossing India’s wide streams and ultimately the death march through the Gedrosian Desert back to Babylon. The daily events become all very personal and make the reader very much part of life in and around the royal tent. It is fascinating to look on to the battles and the internal conflicts from the sideline where Bagoas keeps himself without losing the context of all the historic events as they occur. Their description is so vivid that you can almost taste the dust and feel the cold!

A true masterpiece, worthy of Mary Renault. I would even add worthy of Alexander the Great.

Also available as e-Book