Death of Alexander the Great
Encyclopedia
The death of Alexander the Great and subsequent related events have been the subjects of debates. According to Babylonian astronomical record, Alexander died between the evening of June 10 and the evening of June 11, 323 BC. This happened in the palace of Nebuchadnezzar II in Babylon
Babylon
Babylon was an Akkadian city-state of ancient Mesopotamia, the remains of which are found in present-day Al Hillah, Babil Province, Iraq, about 85 kilometers south of Baghdad...

.

Macedonians
Ancient Macedonians
The Macedonians originated from inhabitants of the northeastern part of the Greek peninsula, in the alluvial plain around the rivers Haliacmon and lower Axios...

 and local residents wept at the news of the death, while Achaemenid
Achaemenid Empire
The Achaemenid Empire , sometimes known as First Persian Empire and/or Persian Empire, was founded in the 6th century BCE by Cyrus the Great who overthrew the Median confederation...

 subjects shaved their heads. Sisygambis
Sisygambis
Sisygambis was the daughter of king Artaxerxes II Memnon, who married Arsames of Ostanes and was the mother of Darius III of Persia, whose reign was ended during the wars of Alexander the Great....

, having learned of Alexander's death, refused sustenance and died a few days later. Historians vary in their assessments of primary sources about Alexander's death, which results in different views.

Background

In February 323 BC, Alexander ordered his armies to prepare for the march to Babylon. According to Arrian
Arrian
Lucius Flavius Arrianus 'Xenophon , known in English as Arrian , and Arrian of Nicomedia, was a Roman historian, public servant, a military commander and a philosopher of the 2nd-century Roman period...

, after crossing the Tigris
Tigris
The Tigris River is the eastern member of the two great rivers that define Mesopotamia, the other being the Euphrates. The river flows south from the mountains of southeastern Turkey through Iraq.-Geography:...

 Alexander was met by Chaldea
Chaldea
Chaldea or Chaldaea , from Greek , Chaldaia; Akkadian ; Hebrew כשדים, Kaśdim; Aramaic: ܟܐܠܕܘ, Kaldo) was a marshy land located in modern-day southern Iraq which came to briefly rule Babylon...

ns, who advised him not to enter the city because their deity Bel
Bel (mythology)
Bel , signifying "lord" or "master", is a title rather than a genuine name, applied to various gods in Babylonian religion. The feminine form is Belit 'Lady, Mistress'. Bel is represented in Greek as Belos and in Latin as Belus...

 had warned them that to do so at that time would be fatal for Alexander. The Chaldeans also warned Alexander against marching westwards as he would then look to the setting sun, a symbol of decline. It was suggested that he enter Babylon via the Royal Gate, in the western wall, where he would face to the east. Alexander followed this advice, but the route turned to be unfavorable because of swampy terrain. According to Jona Lendering
Jona Lendering
Jona Lendering is a Dutch historian and the author of books on antiquity, Dutch history and modern management...

, "it seems that in May 323" the Babylonian astrologers
Astrology
Astrology consists of a number of belief systems which hold that there is a relationship between astronomical phenomena and events in the human world...

 tried to avert the misfortune by substituting Alexander with an ordinary person on the Babylonian throne, who would take the brunt of the omen. The Greeks and Macedonians, however, did not understand that ritual.

Causes

Proposed causes of Alexander's death included alcoholic liver disease and strychnine
Strychnine
Strychnine is a highly toxic , colorless crystalline alkaloid used as a pesticide, particularly for killing small vertebrates such as birds and rodents. Strychnine causes muscular convulsions and eventually death through asphyxia or sheer exhaustion...

 poisoning, but little data support either version. According to the University of Maryland School of Medicine report of 1998, Alexander probably died of typhoid fever
Typhoid fever
Typhoid fever, also known as Typhoid, is a common worldwide bacterial disease, transmitted by the ingestion of food or water contaminated with the feces of an infected person, which contain the bacterium Salmonella enterica, serovar Typhi...

 (which, along with malaria
Malaria
Malaria is a mosquito-borne infectious disease of humans and other animals caused by eukaryotic protists of the genus Plasmodium. The disease results from the multiplication of Plasmodium parasites within red blood cells, causing symptoms that typically include fever and headache, in severe cases...

, was common in ancient Babylon). In the week before Alexander's death, historical accounts mention chills, sweats, exhaustion and high fever, typical symptom
Symptom
A symptom is a departure from normal function or feeling which is noticed by a patient, indicating the presence of disease or abnormality...

s of infectious diseases, including typhoid fever. According to David W. Oldach from the University of Maryland Medical Center
University of Maryland Medical Center
The University of Maryland Medical Center is a teaching hospital with 705 beds based in Baltimore, Maryland, that provides the full range of health care to people throughout Maryland and the Mid-Atlantic region. It gets more than 35,000 inpatient admissions and 165,000 outpatient visits each year...

, Alexander also had "severe abdominal pain
Abdominal pain
Abdominal pain can be one of the symptoms associated with transient disorders or serious disease. Making a definitive diagnosis of the cause of abdominal pain can be difficult, because many diseases can result in this symptom. Abdominal pain is a common problem...

, causing him to cry out in agony". The associated account, however, comes from unreliable Alexander romance
Alexander Romance
Alexander romance is any of several collections of legends concerning the mythical exploits of Alexander the Great. The earliest version is in Greek, dating to the 3rd century. Several late manuscripts attribute the work to Alexander's court historian Callisthenes, but the historical figure died...

.

Previous most popular theories hold that Alexander either died of malaria or was poisoned. Other retrodiagnoses
Retrospective diagnosis
A retrospective diagnosis is the practice of identifying an illness in a historical figure using modern knowledge, methods and disease classifications...

 include noninfectious diseases as well. According to author Andrew Chugg, there is evidence Alexander died of malaria, having contracted it two weeks before his death while sailing in the marshes to inspect flood defences. Chugg based his argument on Ephemerides by otherwise unknown Diodotus of Erythrae, although the authenticity of this source has been questioned. It was also noted that the absence of the signature fever curve of Plasmodium falciparum
Plasmodium falciparum
Plasmodium falciparum is a protozoan parasite, one of the species of Plasmodium that cause malaria in humans. It is transmitted by the female Anopheles mosquito. Malaria caused by this species is the most dangerous form of malaria, with the highest rates of complications and mortality...

(the expected parasite, given Alexander's travel history) diminishes the possibility of malaria. The malaria version was nonetheless supported by Paul Cartledge
Paul Cartledge
Paul Anthony Cartledge is the first A. G. Leventis Professor of Greek Culture at Cambridge University, having previously held a personal chair in Greek History at Cambridge....

. In Alexander the Great: The Death of a God, Paul C. Doherty claimed that Alexander was poisoned with arsenic
Arsenic
Arsenic is a chemical element with the symbol As, atomic number 33 and relative atomic mass 74.92. Arsenic occurs in many minerals, usually in conjunction with sulfur and metals, and also as a pure elemental crystal. It was first documented by Albertus Magnus in 1250.Arsenic is a metalloid...

 by his possibly illegitimate half-brother Ptolemy I Soter
Ptolemy I Soter
Ptolemy I Soter I , also known as Ptolemy Lagides, c. 367 BC – c. 283 BC, was a Macedonian general under Alexander the Great, who became ruler of Egypt and founder of both the Ptolemaic Kingdom and the Ptolemaic Dynasty...

. Throughout the centuries suspicions of possible poisoning have fallen on a number of alleged perpetrators, including one of Alexander's wives, his generals, his illegitimate half-brother or the royal cup-bearer. The poisoning version is featured particularly in politically motivated Liber de Morte Testamentoque Alexandri (The Book On the Death and Testament of Alexander), which tries to discredit the family of Antipater
Antipater
Antipater was a Macedonian general and a supporter of kings Philip II of Macedon and Alexander the Great. In 320 BC, he became Regent of all of Alexander's Empire. Antipater was one of the sons of a Macedonian nobleman called Iollas or Iolaus and his family were distant collateral relatives to the...

. It was argued that the book was compiled in Polyperchon
Polyperchon
Polyperchon , son of Simmias from Tymphaia in Epirus, was a Macedonian general who served under Philip II and Alexander the Great, accompanying Alexander throughout his long journeys. After the return to Babylon, Polyperchon was sent back to Macedon with Craterus, but had only reached Cilicia by...

's circle, not before ca. 317 BC.

Epidemiologist John Marr and Charles Calisher put forward the West Nile fever as possible cause of Alexander's death. This version was deemed as "fairly compelling" by the University of Rhode Island
University of Rhode Island
The University of Rhode Island is the principal public research university in the U.S. state of Rhode Island. Its main campus is located in Kingston. Additional campuses include the Feinstein Campus in Providence, the Narragansett Bay Campus in Narragansett, and the W. Alton Jones Campus in West...

 epidemiologist Thomas Mather, who nonetheless noted that the West Nile virus tends to kill the elders or those with weakened immune systems. The version of Marr and Calisher was also criticized by Burke A. Cunha from Winthrop University Hospital. According to analysis of other authors in response to Marr and Calisher, the West Nile virus could not have infected humans before the 8th century AD.

Other causes that have been put forward include acute pancreatitis
Acute pancreatitis
Acute pancreatitis or acute pancreatic necrosis is a sudden inflammation of the pancreas. It can have severe complications and high mortality despite treatment...

 provoked by "heavy alcohol consumption and a very rich meal", acute endocarditis, schistosomiasis
Schistosomiasis
Schistosomiasis is a parasitic disease caused by several species of trematodes , a parasitic worm of the genus Schistosoma. Snails often act as an intermediary agent for the infectious diseases until a new human host is found...

 brought on by Schistosoma haematobium
Schistosoma haematobium
Schistosoma haematobium is an important digenetic trematode, and is found in the Middle East, India, Portugal and Africa. It is a major agent of schistosomiasis; more specifically, it is associated with urinary schistosomiasis....

, and porphyria
Porphyria
Porphyrias are a group of inherited or acquired disorders of certain enzymes in the heme bio-synthetic pathway . They are broadly classified as acute porphyrias and cutaneous porphyrias, based on the site of the overproduction and accumulation of the porphyrins...

. Fritz Schachermeyr
Fritz Schachermeyr
Fritz Schachermeyr was an Austrian historian, professor at the University of Vienna from 1952 until retirement.Schachermeyr was born in Linz, and studied in Graz, Berlin and Innsbruck...

 proposed leukemia
Leukemia
Leukemia or leukaemia is a type of cancer of the blood or bone marrow characterized by an abnormal increase of immature white blood cells called "blasts". Leukemia is a broad term covering a spectrum of diseases...

 and malaria. When Alexander's symptoms were entered to the Global Infectious Disease Epidemiology Network, influenza
Influenza
Influenza, commonly referred to as the flu, is an infectious disease caused by RNA viruses of the family Orthomyxoviridae , that affects birds and mammals...

 gained the highest probability (41.2%) on the list of differential diagnoses
Differential diagnosis
A differential diagnosis is a systematic diagnostic method used to identify the presence of an entity where multiple alternatives are possible , and may also refer to any of the included candidate alternatives A differential diagnosis (sometimes abbreviated DDx, ddx, DD, D/Dx, or ΔΔ) is a...

. However, according to Cunha, the symptoms and time course of Alexander's disease are inconsistent with influenza, as well as with malaria, schistosomiasis and poisoning in particular.

Body preservation

One ancient account reports that the planning and construction of an appropriate funerary cart to convey the body out from Babylon took two years from the time of Alexander's death. It is not known exactly how the body was preserved for about two years before it was moved from Babylon. In 1889 E. A. Wallis Budge
E. A. Wallis Budge
Sir Ernest Alfred Thompson Wallis Budge was an English Egyptologist, Orientalist, and philologist who worked for the British Museum and published numerous works on the ancient Near East.-Earlier life:...

 suggested that the body was submerged in a vat of honey, while Plutarch
Plutarch
Plutarch then named, on his becoming a Roman citizen, Lucius Mestrius Plutarchus , c. 46 – 120 AD, was a Greek historian, biographer, essayist, and Middle Platonist known primarily for his Parallel Lives and Moralia...

 reported treatment by Egyptian embalmers.

Egyptian and Chaldea
Chaldea
Chaldea or Chaldaea , from Greek , Chaldaia; Akkadian ; Hebrew כשדים, Kaśdim; Aramaic: ܟܐܠܕܘ, Kaldo) was a marshy land located in modern-day southern Iraq which came to briefly rule Babylon...

n embalmers who arrived on June 16 are said to have attested to Alexander's lifelike appearance. This was interpreted as a complication of typhoid fever
Typhoid fever
Typhoid fever, also known as Typhoid, is a common worldwide bacterial disease, transmitted by the ingestion of food or water contaminated with the feces of an infected person, which contain the bacterium Salmonella enterica, serovar Typhi...

, known as ascending paralysis
Ascending paralysis
Ascending paralysis refers to a form of paralysis where the presentation appears in the lower limbs before the upper limbs.It can be associated with:* Guillain–Barré syndrome *Tick paralysis...

, which causes a person to appear dead prior to death.

Resting place

On its way back to Macedonia, the funerary cart with Alexander's body was met in Syria
Syria
Syria , officially the Syrian Arab Republic , is a country in Western Asia, bordering Lebanon and the Mediterranean Sea to the West, Turkey to the north, Iraq to the east, Jordan to the south, and Israel to the southwest....

 by one of Alexander's generals, the future ruler Ptolemy I Soter
Ptolemy I Soter
Ptolemy I Soter I , also known as Ptolemy Lagides, c. 367 BC – c. 283 BC, was a Macedonian general under Alexander the Great, who became ruler of Egypt and founder of both the Ptolemaic Kingdom and the Ptolemaic Dynasty...

. In late in 322 or early 321 BC Ptolemy diverted the body to Egypt where it was interred in Memphis. In the late 4th or early 3rd century BC Alexander's body was transferred from the Memphis tomb to Alexandria
Alexandria
Alexandria is the second-largest city of Egypt, with a population of 4.1 million, extending about along the coast of the Mediterranean Sea in the north central part of the country; it is also the largest city lying directly on the Mediterranean coast. It is Egypt's largest seaport, serving...

 for reburial (by Ptolemy Philadelphus in c. 280 BC, according to Pausanias
Pausanias (geographer)
Pausanias was a Greek traveler and geographer of the 2nd century AD, who lived in the times of Hadrian, Antoninus Pius and Marcus Aurelius. He is famous for his Description of Greece , a lengthy work that describes ancient Greece from firsthand observations, and is a crucial link between classical...

). Later Ptolemy Philopator placed Alexander's body in Alexandria's communal mausoleum. Shortly after the death of Cleopatra, Alexander's resting place was visited by Augustus
Augustus
Augustus ;23 September 63 BC – 19 August AD 14) is considered the first emperor of the Roman Empire, which he ruled alone from 27 BC until his death in 14 AD.The dates of his rule are contemporary dates; Augustus lived under two calendars, the Roman Republican until 45 BC, and the Julian...

, who is said to have placed flowers on the tomb and a golden diadem
Diadem
Diadem may refer to:*Diadem, a type of crown-Military:*HMS Diadem was a 64-gun third rate ship of the line in the Royal Navy launched in 1782 at Chatham and participated in the Battle of Cape St Vincent in 1787...

 upon Alexander's head. By the 4th century AD the resting place of Alexander was no longer known; later authors, such as Ibn 'Abd al-Hakam, Al-Masudi
Al-Masudi
Abu al-Hasan Ali ibn al-Husayn ibn Ali al-Mas'udi , was an Arab historian and geographer, known as the "Herodotus of the Arabs." Al-Masudi was one of the first to combine history and scientific geography in a large-scale work, Muruj adh-dhahab...

 and Leo the African, report having seen Alexander's tomb, but do not specify its location. According to one legend, the body lies in a crypt
Crypt
In architecture, a crypt is a stone chamber or vault beneath the floor of a burial vault possibly containing sarcophagi, coffins or relics....

 beneath an early Christian church.

According to one story, Alexander, having realized he was dying, dragged himself out of the palace to throw himself into the Euphrates
Euphrates
The Euphrates is the longest and one of the most historically important rivers of Western Asia. Together with the Tigris, it is one of the two defining rivers of Mesopotamia...

, hoping to vanish and strengthen his claim of divine origin. His wife Roxana
Roxana
Roxana sometimes Roxane, was a Bactrian noble and a wife of Alexander the Great. She was born earlier than the year 343 BC, though the precise date remains uncertain....

, however, saved him in the last moment.
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