Pat Wheatley

Was the death of Alexander the Great due to poisoning? Was it Veratrum album?

Objective. To investigate the death of Alexander the Great to determine if he died from natural causes or was poisoned and, if the latter, what was the most likely poison. Methods. OVID MEDLINE (January 1950–May 2013) and ISI Web of Science (1900–May 2013) databases were searched and bibliographies of identified articles were screened for additional relevant studies. These searches identified 53 relevant citations. Classical literature associated with Alexanders death. There are two divergent accounts of Alexanders death. The first has its origins in the Royal Diary, allegedly kept in Alexanders court. The second account survives in various versions of the Alexander Romance. Nature of the terminal illness. The Royal Diary describes a gradual onset of fever, with a progressive inability to walk, leading to Alexanders death, without offering a cause of his demise. In contrast, the Romance implies that members of Alexanders inner circle conspired to poison him. The various medical hypotheses include cumulative debilitation from his previous wounds, the complications of alcohol imbibing (resulting in alcohol hepatitis, acute pancreatitis, or perforated peptic ulcer), grief, a congenital abnormality, and an unhealthy environment in Babylon possibly exacerbated by malaria, typhoid fever, or some other parasitic or viral illness. Was it poisoning? Of all the chemical and botanical poisons reviewed, we believe the alkaloids present in the various Veratrum species, notably Veratrum album, were capable of killing Alexander with comparable symptoms to those Alexander reportedly experienced over the 12 days of his illness. Veratrum poisoning is heralded by the sudden onset of epigastric and substernal pain, which may also be accompanied by nausea and vomiting, followed by bradycardia and hypotension with severe muscular weakness. Alexander suffered similar features for the duration of his illness. Conclusion. If Alexander the Great was poisoned, Veratrum album offers a more plausible cause than arsenic, strychnine, and other botanical poisons.

Response to letter to the Editor regarding “A note on Conium maculatum L., the plant that defeated Alexander the Great” in Clinical Toxicology 2014: (doi: 10.3109/15563650.2013.870341)

We thank Wiart for his interest in our paper in which we put forward our hypothesis for the cause of Alexander the Great ’ s death. 1 Wiart challenges our conclusion, “If Alexander the Great was poisoned, Veratrum album offers a more plausible cause than arsenic, strychnine, and other botanical poisons ” . In our manuscript we investigated the toxicological properties of a number of botanical poisons known to the ancients and concluded that, based on one account of his death, poisoning by V. album offers the most plausible explanation. Wiart suggests that Conium maculatum is a better match for Alexander ’ s fi nal illness. Typically, as we described in our paper, C. maculatum , produces features rapidly. It is unlikely that poison hemlock would cause a prolonged illness leading to death 11 to 12 days post-ingestion. C. maculatum can cause death within hours in severe poisoning, 2 with rapid loss of consciousness and respiratory arrest, 2,3 sometimes after an initial stimulatory phase. 3 Veratrum , on the other hand, has been shown to cause an illness extending up to 15 days post-exposure. 4 While Alexander was described as weak throughout his fi nal illness, he remained conscious until just before death. V eratrum poisoning causes hypotension and bradycardia which leaves the victim weak and immobile yet fully conscious. We believe the symptoms of Veratrum poisoning closely match Alexander ’ s illness based on the account described in the Alexander Romance, while C. maculatum does not. Wiart comments on Androcydes ’ advice to Alexander and suggests that Alexander was advised to drink wine as an antidote to C. maculatum. We do not believe that this interpretation is correct. What Alexander ’ s physician essentially said, using a parallel with deadly hemlock, was “ Ease up on the drink, its poisonous ” . Advice that is as pertinent today as it was in Alexander ’ s time! Wiart also suggested that V. album could not have been the cause of Alexander ’ s death as it does not grow near the Euphrates River. V. album is, as described in our paper, found across alpine regions of Europe and Western Asia and its emetic properties were well recognized and exploited by the ancient Greeks. Even if this plant was not distributed around the Euphrates or Babylon in Alexander’s time it cannot be discounted as a possible cause of his death as it could easily have been kept as a fermented liquid or powder. As it was regarded as a medicinal product, 5 the military doctors of the day would most likely have stocks of powder or liquid to treat soldiers. It would not be diffi cult for those implicated in the poison plot, particularly his cup bearer Iollas, to obtain these formulations of V. album in order to spike Alexander ’ s wine. They would not need to rely on local fl ora. The cause of Alexander ’ s death will always remain a mystery. However, based on the account described in the Alexander Romance , we believe V. album still offers the most plausible explanation.