Buried Alive?

There has been a lot of speculation over the centuries concerning the death of Alexander the Great (d.323 BC), perhaps the world’s most successful lgbt emperor. In recent years the question has centred round the possibility that he may have been buried alive. The truth is much more horrific.

The manner and cause of Alexander’s death have been theorised for centuries based on the few records that have survived. One popularly believed cause of death can be dismissed immediately. Alexander did not died from intense grief after the death of his lover Hephaestion in 324BC. He showed no signs of grief in the days before his death. In fact he partied for days, as he often did before and after Hephaestion died.

The historical accounts don’t tell us very much, or at least not enough for us to name a definitive cause of death. The symptoms recorded in the decades and centuries after his death have been interpreted as being due to many different ailments. Here is a short list of those that have been suggested: liver disease caused by alcoholism, typhoid, malaria, pancreatitis, leukaemia, arsenic poisoning, and strychnine poisoning (these last two suggesting murder).

One particularly rare condition which was suggested is Guillain-Barré Syndrome, or GBS. This is a condition that affects the nervous system. It causes a gradual paralysis of muscles and very often reduces the heart rate and breathing.

I think the first suggestion that Guillain-Barré Syndrome (GBS) may have played a part in Alexander’s death came in a paper called “A Mysterious Death” presented to the Historical Clinopathological Conference 1996 at the University of Maryland. Its authors, three doctors at the university and one from Pennsylvania State University, suggested that Alexander died of typhoid “complicated by bowel perforation and ascending paralysis”. They interpreted this paralysis as a symptom of GBS. They didn’t say explicitly that GBS was responsible for Alexander’s death, but it was enough for others to latch on to and develop the suggestion further.

What later commentators have theorised is that because GBS causes paralysis Alexander the Great was still alive when he was examined by his physicians and pronounced dead.

In ancient times physicians didn’t know about the circulation of blood and didn’t check anyone’s pulse to see if they were alive. They relied on a person’s breathing, and GBS slows down the breathing rate to a point where it is virtually undetectable. Naturally, this has led to sensationalised click-baiting headlines across the media (like those shown below, and, I suppose, the title I gave above!) saying that Alexander was buried alive. This is not the case, but one implication of the GBS diagnosis means that Alexander suffered from what I think is a worse fate.

There are no surviving documents form Alexander’s time that tell us exactly how he died or what he died from. But there are fragments of the Ephemerides of Alexander, which are royal journals written at the time. These formed the basis of later biographies of Alexander by writers such as the Roman historian Quintus Curtius Rufus, and the Greek philosopher Plutarch, both of the 1st century.

Quintus Curtius Rufus describes how Alexander’s body didn’t start to putrefy for six days despite the heat of the Mesopotamian summer (Alexander died in Babylon). Plutarch writes that embalmers were brought from Egypt to preserve Alexander’s body while preparations were made for his burial in Egypt. The embalmers, who arrived six days after the emperor’s death, remarked how lifelike his body still appeared. So, if Alexander did suffer from GBS brought on by something like typhoid he may have been conscious for most of those 6 days.

I hope for his sake that he wasn’t, because I’m sure you’re aware of the methods Egyptians used to embalm bodies. The body was drained of blood, the brain was pulled out of the skull through the nose, and the lungs, stomach, liver and intestines were cut out. Then the body was placed in a salt called nitron for 40 days to remove all moisture, and then wrapped in bandages. Imagine being fully conscious and unable to move or speak as you experienced your blood being drained from your body.

Another ancient story says that Alexander’s body was preserved in honey until it could be buried. This implies that Alexander, if he had GBS and was still alive, drowned in honey.

But this is all speculation. No-one has come up with proof of the exact cause of Alexander’s death, and without examination of his bodily remains (which haven’t been found) we probably never will. All we can say after thinking about what could have happened is Rest In Peace.