Alexander The Great was no question one of the most famous people of ancient times, and for good and bad reasons, depending on who you ask. At such a young age, he accomplished so many things, conquered lots of empires, joined a lot of expeditions, and participated in tons of battles. After all, he wasn’t called great for nothing. When he died on either 10 or 11 June 323 BC in Babylon at the tender age of 32, his death was quite a mystery— some speculate it was malaria or typhoid that got him good. Other theories involved foul play like alcohol poisoning or assassination from his many rivals. What was more mysterious was that, according to historical records, his body did not rot for full six days after his death. Leading to a theory that he was in a coma prior to expiring.

Alexander’s Greatness

Before his greatness, he was Alexander III of Macedon, born in 356 BCE in the ancient kingdom of Macedonia. By age 20, he inherited the throne of his father, King Philip II, after he was assassinated at the wedding of Cleopatra of Macedon. During his youth, he was tutored by Aristotle until he reached the age of 16. He would spend most of his years conducting military campaigns throughout Western Asia and Northern Africa from the massive Empire of Persia up to Egypt and India. When he reached 30, he had already created one of the largest empires in history, from Greece to India, stretching in three continents at around 2 million square miles. That made him one of the greatest conquerors the world has ever seen.

Alexander the Great mosaic
Alexander the Great mosaic (100 BC) (The Guardian (DEA/G Nimatallah/De Agostini/Getty Images), Public Domain, via Wikimedia Commons)

Last Conscious Moments

Before he died, Alexander was said to have spent the night and next day drinking with Medius of Larissa. After that, he developed a fever and abdominal pain that gradually got worse and worse until he could not walk, move, or speak. Another claim said he got sick after chugging down a large bowl of unmixed wine to honor Heracles and that he felt weak for the next 11 days after without any fever or any signs of agony until he just died. Now, aside from the speculations mentioned above, other theories were bioweapons in the form of bacteria contaminating his water. There was also spondylitis, meningitis, acute pancreatitis, West Nile virus, or perhaps drinking too much booze. There was even one that suggested he died because of the anguish that he felt when his army general Hephaestion died. Unfortunately, a post-mortem was not a thing yet back then, so people could only depend on the symptoms based on the stories of those who were present. One interesting hypothesis was that Alexander was not really dead yet during those six days, and he was just paralyzed. The disease is called  Guillain-Barré syndrome.

Not Quite Dead Yet

The Coffin of Alexander the Great Carried in Procession (1504) (Sefer azeriCC BY-SA 4.0, via Wikimedia Commons)

If we are going to ask Dr. Katherine Hall of the Dunedin School of Medicine at the University of Otago, New Zealand, she would say that Alexander probably died from Guillain-Barre syndrome (GBS), and she has Science to back her theory. As defined by the National Institute of Neurological Disorders And Stroke,

Guillain-Barré syndrome (GBS) is a rare neurological disorder in which the body’s immune system mistakenly attacks part of its peripheral nervous system—the network of nerves located outside of the brain and spinal cord. GBS can range from a very mild case with brief weakness to nearly devastating paralysis, leaving the person unable to breathe independently. Fortunately, most people eventually recover from even the most severe cases of GBS.  After recovery, some people will continue to have some degree of weakness.

Now, according to Dr. Hall, Alexander might have got GBS from a Campylobacter pylori infection, a frequent cause of GBS and was pretty common during his time. Moreover, she thinks that he contracted an acute motor axonal neuropathy variant of GBS, a paralysis minus confusion or unconsciousness. Because of this paralysis, his oxygen level lowered and, in turn, reduced the visibility of his breathing. His body failed to autoregulate its temperature, and his pupils became fixed and dilated. And because the ancient method of assessing whether someone is already dead or still alive was through the presence of breath and not through pulse, they concluded Alexander was already dead. She said,

I wanted to stimulate new debate and discussion and possibly rewrite the history books by arguing Alexander’s real death was six days later than previously accepted. His death may be the most famous case of pseudothanatos, or false diagnosis of death, ever recorded.

Just like the other speculations, there is no way to prove whether this one is more accurate than the others. Nonetheless, it’s interesting to know how our technological and medical advancements could somehow shine a light on something as far as some 2,300 years ago.