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The death ofAlexander the Great and subsequent related events have been the subjects of debates. According to aBabylonian astronomical diary, Alexander died in the palace ofNebuchadnezzar II inBabylon between the evening of 10 June and the evening of 11 June 323 BC,[1] at the age of 32.
Macedonians and local residents wept at the news of the death, whileAchaemenid subjects were forced to shave their heads.[2] The mother ofDarius III,Sisygambis, having learned of Alexander's death, became depressed and killed herself later.[3] Historians vary in their assessments of primary sources about Alexander's death, which has resulted in different views about its cause and circumstances.

In February 323 BC, Alexander ordered his armies to prepare for the march toBabylon.[4] According toArrian, after crossing theTigris Alexander was met byChaldeans, who advised him not to enter the city because their deityBel 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 out to be unfavorable because of swampy terrain.[5] According toJona Lendering, "it seems that in May 323" the Babylonianastrologers 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, however, did not understand that ritual.[4]
Calanus was likely to be aHinduNaga sadhu, whom Greeks calledgymnosophists. He had accompanied the Greek army back fromPunjab, upon request by Alexander. He was 73 years of age at that time. However, when Persian weather and travel fatigue weakened him, he informed Alexander that he would rather die than live disabled. He decided to take his life byself-immolation. Alexander tried to dissuade him from doing so but upon the insistence of Calanus, Alexander relented and the job of building apyre was entrusted toPtolemy.[6] The place where this incident took place wasSusa in 323 BC.[7] Calanus is mentioned also by Alexander's admiral,Nearchus, andChares of Mytilene.[8] He did not flinch as he burnt to the astonishment of those who watched.[9][10] Before immolating himself alive on the pyre, his last words to Alexander were "We shall meet in Babylon".[11][12] Thus he is said to have prophesied the death of Alexander in Babylon. At the time of the death of Calanus, Alexander, however, did not have any plan to go to Babylon.[12][13]

According to historical accounts, Alexander's body began to decompose six days after his death. Proposed causes of Alexander's death include alcoholic liver disease, fever, andstrychnine poisoning, but little data support those versions.[14] According to Andrew N. Williams and Robert Arnott, in his last days Alexander was unable to speak, which was due to a previous injury to his neck during theSiege of Cyropolis.[15] Otherretrodiagnoses include noninfectious diseases as well.[16]
According to author Andrew Chugg, there is evidence Alexander died of malaria, having contracted it two weeks before the onset of illness while sailing in the marshes to inspect flood defences. Chugg based his argument[17] on theEphemerides (Journal) compiled by Alexander's secretary, Eumenes of Cardia.[18] Chugg also showed in a paper in theAncient History Bulletin[19] that theEphemerides are probably authentic. Chugg further noted that Arrian states that Alexander "no longer had any rest from the fever" halfway through his fatal illness.[20] This is evidence that the fever had initially been intermittent, which is the signature fever curve ofPlasmodium falciparum (the expected malarial parasite, given Alexander's travel history and the severity of the illness), thus enhancing the likelihood of malaria.[21] The malaria version was also supported byPaul Cartledge.[citation needed]
According to theUniversity of Maryland School of Medicine report of 1998, Alexander probably died oftyphoid fever[22] (which, along withmalaria, was common in ancient Babylon).[23] In the week before his death, historical accounts mention chills, sweats, exhaustion and high fever, typicalsymptoms of infectious diseases, including typhoid fever.[22] According to David W. Oldach from theUniversity of Maryland Medical Center, Alexander also had "severeabdominal pain, causing him to cry out in agony".[22] The associated account, however, comes from the unreliableAlexander Romance.
Epidemiologist John Marr andCharles Calisher put forward theWest Nile fever as the possible cause of Alexander's death. This version was deemed "fairly compelling" byUniversity of Rhode Island epidemiologist Thomas Mather, who nonetheless noted that the West Nile virus tends to kill the elderly or those with weakenedimmune systems.[24] The version of Marr and Calisher was also criticized by Burke A. Cunha fromWinthrop University Hospital.[25] 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.[25]
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.[26] The poisoning version is featured particularly in the politically motivatedLiber de Morte Testamentoque Alexandri (The Book On the Death and Testament of Alexander), which tries to discredit the family ofAntipater. It was argued that the book was compiled inPolyperchon's circle, not before c. 317 BC.[27] This theory was also advanced byJustin in hisHistoria Philippicae et Totius Mundi Origines et Terrae Situs where he stated that Antipater murdered Alexander by feeding him a poison so strong that it "could be conveyed [only] in the hoof of a horse.".[28]
InAlexander the Great: The Death of a God,Paul C. Doherty claimed that Alexander was poisoned witharsenic by his possibly illegitimate half-brotherPtolemy I Soter.[26] However, this was disputed byNew Zealand National Poisons Centretoxicologist Dr. Leo Schep, who discounted arsenic poisoning and instead suggested that he could have been poisoned by a wine made from the plantVeratrum album, known as white hellebore.[29] This poisonous plant can produce prolonged poisoning symptoms that match the course of events as described in theAlexander Romance, and was known to the ancient Greeks. The article was published in the peer-reviewed medical journalClinical Toxicology and suggested that if Alexander was poisoned,Veratrum album offers the most plausible cause.[29][30] This theory is supported by the writings of the ancient Greek historianDiodorus, who had recorded Alexander becoming "stricken with pain after drinking a large bowl of wine"[31] at a banquet hosted by one of his officers,Medius of Larissa. However, historianRobin Lane Fox has argued that allegations of poisoning are "technically implausible"[6] given the length of time between Alexander's first reported symptoms and his death. "The poisons of herbalists were swift and irremediable, whetherhemlocks, hellebores orbelladonnas, and except as an explanation of mysterious illness, a slow poison met no need in the poison-chests of ancient Greece. If Alexander had been poisoned, he should surely have been given a massive dose which was absolutely certain to kill him at once. And yet Diaries, pamphlets and official calendars insist that twelve days elapsed between Medius's fateful banquet and the death of the king."[6]

Other causes that have been put forward includeacute pancreatitis provoked by "heavy alcohol consumption and a very rich meal",[32]acute endocarditis,[23]schistosomiasis brought on bySchistosoma haematobium,[23]porphyria,[23] andGuillain-Barré syndrome.[33]Fritz Schachermeyr proposedleukemia and malaria. When Alexander's symptoms were entered into databases of theGlobal Infectious Disease Epidemiology Network,influenza gained the highest probability (41.2%) on the list ofdifferential diagnoses.[16] However, according to Cunha, the symptoms and course of Alexander's disease are inconsistent with influenza, as well as with malaria, schistosomiasis, and poisoning in particular.[14]
Another theory moves away from disease and hypothesizes that Alexander's death was related to a congenitalscoliotic syndrome.[34] It has been discussed that Alexander had structural neck deformities and oculomotor deficits,[35] which could be associated withKlippel–Feil syndrome, a rare congenital scoliotic disorder.[36] His physical deformities and symptoms leading up to his death are what lead experts to believe this. Some believe that as Alexander fell ill in his final days, he suffered from progressive epidural spinal cord compression, which left himquadriplegic.[37] However, this hypothesis cannot be proven without a full analysis of Alexander's body.[36]
Some have speculated that he suffered fromGuillain-Barré syndrome, which typhoid fever can lead to when complicated with other maladies. He may have contracted this disease from aHelicobacter pylori infection after his lung wound during the siege ofMultan, where it was common at the time.[38][39] Proponents say this would explain why Alexander's body reportedly did not decompose for 6 days following his presumed death, as he may well have been still alive but in a deepcoma.[40]

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.[41] 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,[42] whilePlutarch reported treatment byEgyptian embalmers.[41]
Egyptian andChaldean embalmers who arrived on 16 June are said to have attested to Alexander's lifelike appearance.[3] This was interpreted as a complication oftyphoid fever, known asascending paralysis, which causes a person to appear dead prior to death.[22]
On its way back toMacedonia, the funerary cart with Alexander's body was met inSyria by one of Alexander's generals, the future rulerPtolemy I Soter. In late 322 or early 321 BC Ptolemy diverted the body to Egypt where it was interred inMemphis. In the late 4th or early 3rd century BC Alexander's body was transferred from the Memphis tomb toAlexandria for reburial[41] (byPtolemy Philadelphus inc. 280 BC, according toPausanias). LaterPtolemy Philopator placed Alexander's body in Alexandria's communal mausoleum.[41] Shortly after thedeath of Cleopatra, Alexander's tomb was visited byAugustus, who is said to have placed flowers on the tomb and a goldendiadem upon Alexander's head.[41] By the 4th century AD, the location of Alexander's body was no longer known; later authors, such asIbn Abd al-Hakam,Al-Masudi andLeo Africanus, report having seen Alexander's tomb.[41] Leo Africanus in 1491 andGeorge Sandys in 1611 reportedly saw the tomb inAlexandria.[43] According to one legend, the body lies in acrypt beneath an early Christian church.[44]