Death of Alexander the Great

The death of Alexander the Great, after Karl von Piloty.

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.^[1] This happened in the palace of Nebuchadnezzar II in Babylon.

Macedonians and local residents wept at the news of the death, while Achaemenid subjects shaved their heads.^[2] Sisygambis, having learned of Alexander's death, refused sustenance and died a few days later.^[3] 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.^[4] According to Arrian, after crossing the Tigris Alexander was met by Chaldeans, who advised him not to enter the city because their deity Bel had warned them that to do so at that time would be fatal for Alexander.^[5] The Chaldeans also warned Alexander against marching westwards as he would then look to the setting sun, a symbol of decline.^[5] 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.^[5] According to Jona Lendering, "it seems that in May 323" the Babylonian astrologers tried to avert the misfortune by substituting Alexander with an ordinary person on the Babylonian throne, who would take the brunt of the omen.^[4] The Greeks and Macedonians, however, did not understand that ritual.^[4]

Causes

Proposed causes of Alexander's death included alcoholic liver disease and strychnine poisoning, but little data support either version.^[6] According to the University of Maryland School of Medicine report of 1998, Alexander probably died of typhoid fever^[7] (which, along with malaria, was common in ancient Babylon^[8]). In the week before Alexander's death, historical accounts mention chills, sweats, exhaustion and high fever, typical symptoms of infectious diseases, including typhoid fever.^[7] According to David W. Oldach from the University of Maryland Medical Center, Alexander also had "severe abdominal pain, causing him to cry out in agony".^[7] The associated account, however, comes from unreliable Alexander romance.

Previous most popular theories hold that Alexander either died of malaria or was poisoned. Other retrodiagnoses include noninfectious diseases as well.^[9] 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.^[10] Chugg based his argument on Ephemerides by otherwise unknown Diodotus of Erythrae, although the authenticity of this source has been questioned.^[10] It was also noted that the absence of the signature fever curve of Plasmodium falciparum (the expected parasite, given Alexander's travel history) diminishes the possibility of malaria.^[9] The malaria version was nonetheless supported by Paul Cartledge.^[10] In Alexander the Great: The Death of a God, Paul C. Doherty claimed that Alexander was poisoned with arsenic by his possibly illegitimate half-brother Ptolemy I Soter.^[10] 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.^[10] 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. It was argued that the book was compiled in Polyperchon's circle, not before ca. 317 BC.^[11]

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 epidemiologist Thomas Mather, who nonetheless noted that the West Nile virus tends to kill the elders or those with weakened immune systems.^[12] The version of Marr and Calisher was also criticized by Burke A. Cunha from Winthrop University Hospital.^[13] 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.^[13]

Other causes that have been put forward include acute pancreatitis provoked by "heavy alcohol consumption and a very rich meal",^[14] acute endocarditis,^[8] schistosomiasis brought on by Schistosoma haematobium,^[8] and porphyria.^[8] Fritz Schachermeyr proposed leukemia and malaria. When Alexander's symptoms were entered to the Global Infectious Disease Epidemiology Network, influenza gained the highest probability (41.2%) on the list of differential diagnoses.^[9] 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.^[13]

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.^[15] 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 suggested that the body was submerged in a vat of honey,^[16] while Plutarch reported treatment by Egyptian embalmers.^[15]

Egyptian and Chaldean embalmers who arrived on June 16 are said to have attested to Alexander's lifelike appearance.^[3] This was interpreted as a complication of typhoid fever, known as ascending paralysis, which causes a person to appear dead prior to death.^[7]

Resting place

On its way back to Macedonia, the funerary cart with Alexander's body was met in Syria by one of Alexander's generals, the future ruler Ptolemy I Soter. 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 for reburial^[15] (by Ptolemy Philadelphus in c. 280 BC, according to Pausanias). Later Ptolemy Philopator placed Alexander's body in Alexandria's communal mausoleum.^[15] Shortly after the death of Cleopatra, Alexander's resting place was visited by Augustus, who is said to have placed flowers on the tomb and a golden diadem upon Alexander's head.^[15] By the 4th century AD the resting place of Alexander was no longer known; later authors, such as Ibn 'Abd al-Hakam, Al-Masudi and Leo the African, report having seen Alexander's tomb, but do not specify its location.^[15] According to one legend, the body lies in a crypt beneath an early Christian church.^[17]

According to one story, Alexander, having realized he was dying, dragged himself out of the palace to throw himself into the Euphrates, hoping to vanish and strengthen his claim of divine origin.^[2] His wife Roxana, however, saved him in the last moment.^[2]

Notes

1. ^ "A contemporary account of the death of Alexander". Livius.org. http://www.livius.org/aj-al/alexander/alexander_t41.html. Retrieved Aug 21, 2011. 
2. ^ ^{a b c} Freeman, Philip (2011). Alexander the Great. Simon and Schuster. p. 320. ISBN 1416592806. 
3. ^ ^{a b} Chugg, Andrew (2007). The Quest for the Tomb of Alexander the Great. Lulu.com. p. 25. ISBN 0955679001. 
4. ^ ^{a b c} Jona Lendering. "Death in Babylon". Livius.org. http://www.livius.org/aj-al/alexander/alexander16.html. Retrieved Aug 22, 2011. 
5. ^ ^{a b c} "Alexander and the Chaldaeans". Livius.org. http://www.livius.org/aj-al/alexander/alexander_t63.html#2. Retrieved Aug 22, 2011. 
6. ^ Cunha BA. The death of Alexander the Great: malaria or typhoid fever?. Infectious Disease Clinics of North America 2004 Mar;18(1):53-63. PMID 15081504. 
7. ^ ^{a b c d} "INTESTINAL BUG LIKELY KILLED ALEXANDER THE GREAT". University of Maryland Medical Center. http://www.umm.edu/news/releases/bug.htm. Retrieved Aug 21, 2011. 
8. ^ ^{a b c d} Carlos G. Musso. "MEGAS ALEXANDROS (Alexander The Great ): His Death Remains a Medical Mystery". Humane Medicine Health Care. http://www.humanehealthcare.com/Article.asp?art_id=662. Retrieved Aug 21, 2011. 
9. ^ ^{a b c} John S. Marr, Charles H. Calisher. "Alexander the Great and West Nile Virus Encephalitis". CDC. http://www.cdc.gov/ncidod/eid/vol9no12/03-0288.htm#1. Retrieved Aug 21, 2011. 
10. ^ ^{a b c d e} "Disease, not conflict, ended the reign of Alexander the Great". The Independent on Sunday. http://www.alexanderstomb.com/main/deathofalexander/IoS6on7Aug05b.JPG. Retrieved Aug 21, 2011. 
11. ^ John Atkinson, Elsie Truter, Etienne Truter (Jan 1, 2009). "Alexander's last days: malaria and mind games?". Acta Classica. http://www.thefreelibrary.com/Alexander%27s+last+days%3A+malaria+and+mind+games%3F-a0221920136. Retrieved Aug 21, 2011. 
12. ^ "Nature-Alexander the Great". GIDEON. http://www.gideononline.com/reviews/nature2003/. Retrieved Aug 21, 2011. 
13. ^ ^{a b c} "Alexander the Great and West Nile Virus Encephalitis". CDC. http://www.cdc.gov/ncidod/eid/vol10no7/04-0039_104_396_320.htm. Retrieved Aug 21, 2011. 
14. ^ Sbarounis CN. Did Alexander the Great die of acute pancreatitis?. Journal of Clinical Gastroenterology 1997 Jun;24(4):294-6. PMID 9252868. 
15. ^ ^{a b c d e f} Robert S. Bianchi. "Hunting Alexander's Tomb". Archaeology.org. http://www.archaeology.org/online/features/alexander/tomb.html. Retrieved Aug 21, 2011. 
16. ^ Aufderheide, Arthur (2003). The scientific study of mummies. Cambridge University Press. pp. 261–262. ISBN 0521818265. 
17. ^ "Alexander's death riddle is 'solved'". BBC. June 11, 1998. http://news.bbc.co.uk/2/hi/health/110852.stm. Retrieved Aug 21, 2011.