How Did Alexander the Great Die: Illness or Not?

Alexander the Great’s death was, most probably, caused by an illness. There are still many questions among scholars and historians about Alexander’s death. Since the accounts from that time are not very clear, people cannot come to a conclusive diagnosis. Was it some mysterious illness that had no cure at the time? Did somebody poison him? How exactly did Alexander the Great meet his end?

How Did Alexander the Great Die?

The death of Alexender the Great in Shahnameh, painted in Tabriz around 1330 AC

By all accounts, Alexander the Great’s death was caused by some mysterious illness. He was struck down suddenly, in the prime of his life, and died an excruciating death. What was even more confusing for the ancient Greeks and what makes historians ask questions even now is the fact that Alexander’s body did not show any signs of decomposition for six whole days. So what exactly was wrong with him?

We know Alexander as one of the greatest conquerors and rulers in the ancient world. He journeyed across and conquered much of Europe, Asia, and parts of Africa at a very young age. The reign of Alexander the Great was a prominent period in the timeline of ancient Greece. It can perhaps be seen as the zenith of the ancient Greek civilization since the aftermath of Alexander’s death was a mess of confusion. Thus, it is important to find out how exactly Alexander died at such a young age.

READ MORE: Ancient Civilizations Timeline: The Complete List from Aboriginals to Incans

A Painful End

According to historical accounts, Alexander the Great fell ill suddenly and suffered immense pain for twelve days before he was declared dead. After that, his body did not decompose for almost a week, baffling his healers and followers.

The night before his illness, Alexander spent a great deal of time drinking with a naval officer called Nearchus. The drinking spree continued on to the next day, with Medius of Larissa. When he suddenly came down with a fever that day, it was accompanied by severe back pain. He is said to have described it as being stabbed by a spear. Alexander continued to drink even after that, though the wine could not quench his thirst. After some time, Alexander could neither speak nor move.

Alexander’s symptoms seem to mainly have been intense abdominal pain, fever, progressive degradation, and paralysis. It took him twelve painful days to die. Even as Alexander the Great succumbed to fever, a rumor spread around camp that he had already died. Terrified, the Macedonian soldiers stormed into his tent while he lay there severely ill. He is said to have acknowledged each of them in turn as they filed past him.

The most mysterious aspect of his death was not even the suddenness of it, but the fact that his body lay without decomposing for six days. This happened despite the fact that no special care was taken and it was left in rather wet and humid conditions. His attendants and followers took this as a sign that Alexander was a god.

Many historians have speculated on the reason for this over the years. But the most convincing explanation was given in 2018. Katherine Hall, a senior lecturer at the Dunedin School for Medicine at the University of Otago, New Zealand, has done extensive research on the mysterious death of Alexander.

She has written a book arguing Alexander’s real death only took place after those six days. He was simply lying paralyzed for the entire time and the healers and doctors on hand did not realize that. In those days, a lack of movement was a sign taken for the death of a person. Thus, Alexander might have died well after he was declared dead, only lying in a state of paralysis. She argues that this might have been the most famous case of false diagnosis of death ever recorded. This theory puts an even more horrifying spin on his death.

Alexander the Great – Mosaic detail, House of the Faun, Pompeii


There are several theories that Alexander’s death could have been the result of poisoning. It was the most convincing cause for the mysterious death that the ancient Greeks could come up with. Since one of his main complaints was abdominal pain, it is not even that far-fetched. Alexander could quite possibly have been poisoned by one of his enemies or competitors. For a young man that had risen through life so rapidly, it is hardly difficult to believe that he must have had many enemies. And the ancient Greeks certainly had a propensity to do away with their rivals.

The Greek Alexander Romance, a highly fictionalized memoir of the Macedonian king written sometime before 338 CE, states that Alexander was poisoned by his cupbearer Lolaus while he was drinking with his friends. However, there were no chemical poisons in those days. The natural toxins that did exist would have acted within a few hours and not allowed him to live for 14 days in complete agony.

Modern historians and doctors state that given the sheer amount Alexander had drunk, he might simply have died of alcohol poisoning.

Theories of Illness

Different experts have different theories about what kind of illness Alexander might have had, from malaria and typhoid fever to pneumonia. However, research shows that none of them actually line up with Alexander’s symptoms. Thomas Gerasimides, the Professor Emeritus of Medicine at the Aristotle University of Thessaloniki, Greece, has dismissed the most popular theories.

Although he did have a fever, it was not the kind of fever that is associated with malaria. Pneumonia is not accompanied by abdominal pain, which was one of his main symptoms. He also already had a fever by the time he entered the cold Euphrates River, so the cold water could not have been the cause.

The other diseases that have been theorized are the West Nile virus and typhoid fever. Gerasimides stated that it could not be typhoid fever since there was no epidermis at the time. He also ruled out the West Nile virus since it causes encephalitis rather than delirium and abdominal pain.

Katherine Hall of Dunedin School gave Alexander the Great’s cause of death as the Guillain-Barre Syndrome. The senior lecturer of Medicine said that the autoimmune disorder could have caused the paralysis and made his breathing less obvious to his doctors. This might have resulted in a false diagnosis. However, Gerasimides has ruled out GBS since the paralysis of the respiratory muscles would have led to discoloration of the skin. Nothing of the sort was noted by Alexander’s attendants. It is possible that it happened and wasn’t ever written about but this seems unlikely.

Gerasimides’ own theory is that Alexander died of necrotizing pancreatitis.

Confidence of Alexander the Great in his physician Philip during grave illness – A painting by Mitrofan Vereshchagin

How Old Was Alexander the Great When He Died?

Alexander the Great was only 32 years old at the time of his death. It seems incredible that he achieved so much so young. But since many of his victories and conquests came in his early life, it is perhaps not surprising that he had conquered half of Europe and Asia by the time of his sudden death.

Immense Rise to Power

Alexander the Great was born in Macedonia in 356 BCE and famously had the philosopher Aristotle as a tutor during his early life. He was only 20 when his father was assassinated and Alexander took over as King of Macedonia. By that time, he was already a capable military leader and had won several battles.

READ MORE: History’s Most Famous Philosophers: Socrates, Plato, Aristotle, and More!

Macedonia was different from city-states like Athens in that it clung firmly to monarchy. Alexander spent a great deal of time subjugating and collecting revolting city-states like Thessaly and Athens. Then he went on to fight a war against the Persian Empire. It was sold to the people as a war to right the wrongs from 150 years ago when the Persian Empire terrorized the Greeks. Alexander the Great’s cause was taken up by the Greeks enthusiastically. Of course, his main aim was to conquer the world.

With Greek backing, Alexander defeated Emperor Darius III and ancient Persia. Alexander got as far east as India during his conquest. One of his most famous accomplishments is the founding of Alexandria in modern Egypt. It was one of the most advanced cities in the ancient world, with its library, ports, and lighthouse.

All of his accomplishments and the advancement of Greece came to a crashing halt with the abrupt death of Alexander.

Alexander the Great, from Alexandria, Egypt, 3rd cent. BC

Where and When Did Alexander the Great Die?

Alexander the Great died in the palace of Nebuchadnezzar II in ancient Babylon, close to modern-day Baghdad. His death took place on 11th June, 323 BCE. The young king had faced a mutiny by his army in modern-day India and had been forced to turn back instead of continuing east. It was an extremely difficult march through rough terrain before Alexander’s army finally made their way back to Persia.

Journey Back to Babylon

The history books make much of the fact that Alexander faced a mutiny by his army at the thought of making further inroads into India. The journey back to Susa in Persia and the march through deserts have made their way into various biographies of the young king.

Alexander is said to have executed several satraps on his way back to Babylon, for misbehaving in his absence. He also held a mass marriage between his senior Greek officers and noblewomen from Persia at Susa. This was meant to further tie the two kingdoms together.

It was early 323 BCE when Alexander the Great finally entered Babylon. Legends and stories narrate how he was presented with a bad omen in the form of a deformed child as soon as he entered the city. The superstitious people of ancient Greece and Persia took this as a sign of Alexander’s imminent death. And so it was to be.

Alexander the Great enters Babylon by Charles Le Brun

What Were His Last Words?

It is difficult to know what Alexander’s last words were since the ancient Greeks have not left any exact records of the moment. There is a story that Alexander spoke to and acknowledged his generals and soldiers as he lay dying. Several artists have painted this moment, of the dying monarch surrounded by his men. 

It is also said that he was asked who his designated successor was and he replied the kingdom would go to the strongest one and that there would be funeral games after his death. This lack of foresight by King Alexander would come back to haunt Greece in the years after his death.

Poetic Words About the Moment of Death

The Persian poet Firdawsi immortalized the moment of Alexander’s death in the Shahnameh. It talks of the moment the king speaks to his men before his soul rises from his chest. This was the king who had shattered numerous armies and he was now at rest.

The Alexander Romance, on the other hand, went for a much more dramatic retelling. It spoke of how a great star was seen descending from the heavens, accompanied by an eagle. Then the statue of Zeus in Babylon trembled and the star ascended again. Once it disappeared with the eagle, Alexander drew his last breath and fell into eternal sleep.

Last Rites and Funeral

Alexander’s body was embalmed and placed in a gold anthropoid sarcophagus, filled with honey. This was, in turn, placed in a gold casket. Popular Persian legends from the time stated that Alexander had left instructions that one of his arms should be left hanging outside the coffin. This was meant to be symbolic. Despite the fact that he was Alexander the Great with an empire stretching from the Mediterranean to India, he was leaving the world empty-handed.

After his death, arguments broke out about where he would be buried. This is because burying the prior king was seen as a royal prerogative and those who buried him would have more legitimacy. The Persians argued that he should be buried in Iran, in the land of the kings. The Greeks argued that he should be sent to Greece, to his homeland.

How Did Alexander the Great Die: Illness or Not? 2
The coffin of Alexander the Great carried in procession by Sefer Azeri

Final Resting Place

The end product of all of these arguments was to send Alexander home to Macedonia. An elaborate funeral carriage was made to carry the coffin, with a golden roof, colonnades with golden screens, statues, and iron wheels. It was pulled by 64 mules and accompanied by a large procession.

Alexander’s funeral procession was on the way to Macedon when his casket was seized by Ptolemy. He took it to Memphis and his successor Ptolemy II transferred it to Alexandria. It remained there for many years, till late antiquity. Ptolemy IX replaced the gold sarcophagus with a glass one and used the gold to make coins. Pompey, Julius Caesar, and Augustus Caesar are all said to have visited the coffin of Alexander.

The whereabouts of Alexander’s tomb are no longer known. Napoleon’s expedition to Egypt in the 19th century is said to have unearthed a stone sarcophagus that local people thought belonged to Alexander. It now lies in the British Museum but has been disproved to have held Alexander’s body.

A new theory by researcher Andrew Chugg is that the remains in the stone sarcophagus were deliberately disguised as the remains of St Mark when Christianity became Alexandria’s official religion. Thus, when Italian merchants stole the saint’s body in the 9th century CE, they were actually stealing the body of Alexander the Great. According to this theory, Alexander’s tomb is then St. Mark’s Basilica in Venice.

There is no knowing if this is indeed true. The search for Alexander’s tomb, coffin, and body has continued in the 21st century. Perhaps, the remains will one day be discovered in some forgotten corner of Alexandria.

How to Cite this Article

There are three different ways you can cite this article.

1. To cite this article in an academic-style article or paper, use:

Rittika Dhar, "How Did Alexander the Great Die: Illness or Not?", History Cooperative, May 29, 2023, Accessed June 12, 2024

2. To link to this article in the text of an online publication, please use this URL:

3. If your web page requires an HTML link, please insert this code:

<a href="">How Did Alexander the Great Die: Illness or Not?</a>

Leave a Comment