Was Alexander the Great poisoned?

January 7, 2014, 1:27 pm

Alexander the Great

Alexander the Great

★★★☆☆

Was the death of Alexander the Great due to poisoning? Was it Veratrum album? Schep LJ et al. Clin Toxicol 2013 Dec 26 [Epub ahead of print]

Abstract

Although accounts of the events leading up to the death of Alexander the Great (356-323 BC) vary, many versions describe a sudden onset of abdominal pain following a banquet featuring abundant amounts of wine. This was followed by weakness and trouble walking or speaking. He may or may not have developed fever. Symptoms persisted for 11 or 12 days before he died.

Since that time, historians and commentators have debated about what caused the death, and whether or not Alexander was poisoned. Proposed diagnoses have included typhoid fever, acute pancreatitis, perforated peptic ulcer, malaria, and even West Nile fever. Speculations about toxicological causes have considered aconite, strychnine, arsenic, poison hemlock, wormwood, henbane, and calicheamicin — a potent toxin that may have been produced by bacterium in the River Styx (Mavroneri).

This interesting but highly speculative paper suggests that Alexander may in fact have been poisoned, and that the agent may have been Veratrum albuma toxic plant of the lily family.  According to Auerbach’s Wilderness Medicine (6th edition):

[Veratrum] alkaloids are extremely toxic and rapidly increase permeability of voltage-sensitive sodium channels in excitable cell membranes. This results in initial depolarization and then subsequent loss of membrane potential. Stimulation of vagal fibers may result in bradycardia and hypotension.

The discussion goes on to note that:

Symptoms generally occur within 30 minutes to 4 hours and generally resolve within 24 to 48 hours, although symptoms may persist for many days. Toxicity is characterized by headache, diaphoresis, salivation, nausea, vomiting, diarrhea, abdominal pain, hypotension, bradycardia, and shock.

In making the case for poisoning, Schep et al fail to note that V. album tends to grow in the same fields, and can be confused with, Gentiana lutea (yellow gentian), which is non-toxic and used to make wine. Therefore, if Alexander did indeed die from a poison ingested at the banquet, the exposure may have been inadvertent.

Veratrum album

Veratrum album

[Photographs of Veratrum album and the bust of Alexander the Great from wikipedia.org]

ADDENDUM: [1/12/14) – A reader’s comment led me to a BBC documentary from about a decade ago titled “Alexander the Great’s Mysterious Death.” In it, Alexander’s final days are depicted, and Dr. Schep propounds on his theory of poisoning by hellebore.

 

 

 

5 Comments:

  1. John Robertson Says:

    Veratrum album was used as a treatment for diarrhoea back when it was thought that purging was a good idea.

    The early herbals say it is very powerful and should not be given to women or effeminate men. If Alexander was being treated for a stomach upset he may have persisted with the Veratrum album to avoid any suggestion that he was weak.

    Incidentally, Schep and others at Otago University have written about this before and participated in a TV programme some years ago.

    I couldn’t work out what was new about this paper.

  2. Leon Says:

    John:

    Thank you for your message. I know Schep has written before about Veratrum, but I could not find a citation where he specifically discussed the topic in relation to the death of Alexander.

    However, it appears that in 2005 psychiatrist Harold J. Bursztagn had a piece in the Harvard Medical Alumni Bulletin in which he speculated that white hellebore (i.e., Veratrum album) might have killed Alexander. So I agree the idea is certainly not new.

  3. Leonard Says:

    I found the journal article quite interesting; as you mention anything written in modern times regarding Alexander’s death will remain speculative although this article seems to have investigated the poisoning theory reasonably thoroughly. The only thing I wanted to perhaps mention regarding your post was that if Veratrum was mistaken for Gentiana lutea wouldn’t that mean that the majority of the people at the banquet would have also become sick with poisoning? I suspect that Alexander was not the only one drinking wine that night and if it was a ‘bad batch’ it perhaps would have been documented in the classical literature that the illness affected many people. I think a single person becoming unwell may point more to a malicious poisoning (if it was poison that killed him).
    I also remember the television show based around this when Schep originally put his theory forward, circa 2003, (http://www.royalsociety.org.nz/2003/10/16/alexander/)

  4. John Robertson Says:

    No XI on this list of 17 essays http://bmcr.brynmawr.edu/2009/2009-10-13.html from a 2006 conference says ‘Schep thinks the poison would likely have been hellebore’.

  5. Leon Says:

    John:

    Thank you for pointing out the reference to earlier writing by Schep proposing that if Alexander was poisoned, the agent could very well have been hellebore.

    Following a clue offered by a reader (Leonard), I have also found a BBC documentary, “The Mysterious Death of Alexander the Great’, which depicts Alexander’s death and features Dr. Schep propounding his theory. I am adding it as a link to the main post.

    Leonard:

    Good point. I agree that if the cause was inadvertently tainted wine and there was in fact no poisoning plot, others would have been affected. And thank you for the link to the article from the Royal Society of New Zealand, which led me to the television show depicting Alexander’s last days. I’m adding it to the original post.