By the summer of 323 BC, Alexander the Great had achieved what no conqueror before him had managed.
In little more than a decade, he had transformed himself from the young king of Macedonia into ruler of the largest empire the ancient world had seen, stretching from Greece and Egypt across the former Persian Empire into what is now Afghanistan and Pakistan, encompassing dozens of peoples, languages and cultures.
He had defeated the Persian king Darius III in a succession of spectacular battles, crossed deserts and mountain ranges thought almost impassable, founded cities across Asia and marched farther east than any Greek army had gone before.
He was also only 32 years old, and not inclined to rest on his laurels, or contemplate an early retirement. Around him, the machinery of conquest was beginning to turn again. The surviving evidence suggests that Alexander was preparing another enormous campaign of further expansion. It never materialised.
Over roughly two weeks, Alexander developed a fever. Gradually, he weakened. Eventually, he could no longer speak or move. He died in Babylon in June 323 BC.
How did Alexander the Great die?
“The stories of Alexander the Great’s death are brilliant,” says historian Edmund Richardson, speaking on the HistoryExtra podcast. “And each one is more implausible than the last.”
Alexander spent his final weeks in Babylon. Situated on the river Euphrates, in what is now Iraq, Babylon had been a centre of power and culture for more than a thousand years. Even after the fall of the Neo-Babylonian Empire to Persia, it remained one of the richest and most impressive cities in the Near East.
For Alexander, this was an obvious imperial base. Babylon lay close to the geographical centre of his vast empire. It possessed excellent communications with both east and west, and it offered access to the Persian Gulf through the Euphrates river system.
It would also be the place he died.
Ancient accounts of Alexander’s illness differ in detail, but broadly agree on some things. After attending a banquet and drinking heavily, he developed a fever. At first, he continued issuing military orders. As the illness worsened, however, he became increasingly debilitated. He lost the ability to speak, and to move. Then, he died.
Later proposals suggested that he “possibly drank himself to death,” Richardson says. “Possibly he contracted some kind of illness – perhaps malaria or some other disease. Or possibly he was poisoned.”
This last idea proved to be a persuasive one.
“The stories about his poisoning are many and varied,” Richardson explains. “They’re often told after his death by his successors in order to damage the reputations of their rivals or attack people whose power they hoped to take.”
“There are even stories of a lead-lined vessel borne secretly from Macedon containing a poison that would destroy anything,” Richardson says.
“It’s all bunkum, I’m afraid.”
Could an ancient poison have killed him?
“The ancient world had many poisons, of course, and one of them could plausibly have been administered to Alexander,” Richardson says. “But it had no poisons that worked in the way Alexander’s final illness unfolded. A very slow-acting poison that gradually killed him over the course of two weeks simply didn’t exist.”
Instead, Richardson argues that infectious disease remains by far the most convincing explanation.
“It’s almost certain that he died of typhoid, caused by contamination in Babylon’s water supply.”
Babylon possessed one of the most sophisticated water-management systems in the ancient world. Canals irrigated surrounding farmland, controlled seasonal flooding and supplied the city. Maintaining these systems had been a central concern of Mesopotamian rulers for centuries, says Richardson, because “the Code of Hammurabi, one of Babylon’s earliest law codes, set out incredibly detailed rules about drinking water and keeping it clean.”
The Code of Hammurabi was issued by the Babylonian king Hammurabi in the 18th century BC – more than 1,400 years before Alexander arrived. Its provisions show how seriously Mesopotamian rulers regarded the maintenance of their water supplies.
So how could it be this carefully-managed water that killed Alexander?
When he came to Babylon, Alexander travelled with tens of thousands of soldiers, sailors, engineers, servants, craftsmen, merchants and camp followers, accompanied by horses, mules, camels, donkeys and even elephants acquired during his Indian campaigns.
“When Alexander arrived in Babylon for the last time, the route his army took meant that almost the entire force camped upstream from the city, close to the banks of the Euphrates,” Richardson says.
“Unfortunately, that meant tens of thousands of men were drinking, washing, urinating, and so on into the river over the course of several weeks and months. Not just men, either – donkeys, horses, elephants, everything.”
“We ran some computer modelling for the book to see what would have happened, and what was found was that the water in Babylon would have become incredibly toxic over the course of a couple of weeks – full of salmonella, full of E. coli, and particularly full of the bacteria that causes typhoid.”
Typhoid fever, caused by Salmonella Typhi, spreads through food and water contaminated by excrement. Its symptoms include prolonged fever, exhaustion, abdominal pain and, in severe untreated cases, delirium, intestinal complications and death. Whatever the exact diagnosis, Alexander’s death was sudden in political terms. He left no clear adult heir, no agreed succession plan and no institution capable of replacing his personal authority.
He did, however, leave signs of another extraordinary campaign.
What was Alexander planning before he died?
Alexander’s future plans survive only in fragments preserved by later ancient writers. Some are almost certainly exaggerated. Others may reflect genuine projects interrupted by his death. Disentangling the two requires careful, cautious discernment, but as Richardson says, “some are more plausible than others, but many, I think, contain a grain of truth.”
The strongest evidence points towards a major maritime expedition, with his first target being Arabia. “We know a whole new fleet was being built to take the army around the Arabian Peninsula and then north up the Arabian coast to the Red Sea ports of Egypt,” Richardson says.
Although Alexander had conquered the Persian Empire, the Arabian Peninsula remained largely outside his control. Arabian merchants controlled valuable trade routes carrying incense, frankincense, myrrh and other luxury goods between southern Arabia, Mesopotamia, Egypt and the wider Mediterranean. Control of the peninsula would also strengthen communications between Egypt and the eastern provinces of Alexander’s empire.
This would have been an immense logistical undertaking.
Alexander had already demonstrated remarkable skill in combined land and naval operations, especially during the siege of Tyre and his campaigns along the eastern Mediterranean coast. Circumnavigating Arabia, however, would have required fleets capable of operating for months while coordinating with armies moving through difficult terrain.
Once the expedition reached Egypt, the next stage seemed to be further Mediterranean expansion.
“One of his generals, one of his most trusted commanders, Craterus, had been sent west towards Macedon,” he says. “Along the way, though, his instructions were to build a series of dockyards and giant ships on the Mediterranean coast.”
This suggests preparation for another major naval operation.
“Carthage was one possible target,” Richardson says. “Southern Italy is another.”
Was Alexander preparing to attack Carthage?
Few states could rival Carthage in wealth or maritime power. Founded by Phoenician settlers from Tyre, Carthage dominated much of the western Mediterranean through a commercial empire stretching across North Africa, Sardinia, Sicily and southern Spain.
Alexander had already destroyed Tyre after one of antiquity’s most remarkable sieges in 332 BC. An invasion of Carthage might therefore have seemed logical as an extension of his campaigns against Phoenician power.
Such a war would have been very different from his earlier victories over Persia.
Carthage fought primarily through naval strength, overseas commerce and hired armies. Alexander would have needed a major fleet to challenge it successfully. The dockyards and ships apparently under construction therefore fit strikingly well with such an ambition.
Could Alexander have invaded Italy?
Another possibility is southern Italy.
The region known as Magna Graecia contained numerous wealthy Greek colonies founded centuries before Alexander’s birth. These cities shared language, religion and many cultural traditions with mainland Greece. They also lay increasingly close to the expanding power of Rome.
In 323 BC, Rome was still primarily an Italian state. Its great Mediterranean empire lay centuries in the future. Even so, it was growing rapidly through conquest and alliances across the peninsula.
A western campaign might therefore have brought Alexander into contact – and perhaps conflict – with the future masters of the Mediterranean.
Could Alexander have defeated Rome?
“The possibilities of what might have happened if that expedition had gone ahead have fascinated historians for centuries,” Richardson says.
“Roman historians, in particular, spent a great deal of time wondering what would have happened if Alexander had reached southern Italy with his new armies and all the resources of his empire, and what a war between Alexander and Rome might have looked like.”
“But none of those plans came to fruition,” Richardson says, “because Alexander died very suddenly in Babylon at the age of 32.”
Alexander left no recognised adult successor. Within months, Alexander’s generals began dividing territories among themselves.
The resulting Wars of the Successors lasted for decades. Instead of one empire, the ancient world acquired several powerful Hellenistic kingdoms, each growing from the influence of Alexander the Great.
Edmund Richardson was speaking to Rob Attar on the HistoryExtra podcast. Listen to the full conversation.
