The Wound That Nearly Killed Alexander the Great

Alexander the Great died at age 32 after falling ill with a high fever following a night of heavy drinking. Twelve days later, the legendary general succumbed, leaving behind a vast empire unlike any other before.

More than 2,300 years later, scientists and historians are still trying to determine the nature of his illness and what caused it. It was all so sudden that some historians believe he could have been poisoned.

There is an inescapable irony that a king so renowned for leading his troops in battle from the front met his demise in bed at age 32. Whether he was poisoned by conspirators or died of alcohol poisoning or some other cause will never be known.

Yet, in 2018 a group of Greek surgeons (Efstratios Apostolakis, Nikolaos A. Papakonstantinou, Nikolaos G. Baikoussis, and Georgia Apostolaki) took the task of researching the cause of death of the great stratelates and wrote a paper with the title Alexander the Great’s Life-Threatening Thoracic Trauma, published in the Korean Journal of Thoracic and Cardiovascular Surgery.

The paper details the wound that Alexander had suffered that should have killed the Macedonian king.

Drawing from the accounts of historian and Alexander‘s biographer Arrian of Nicomedia, the Greek surgeons discovered the specific wound that Alexander suffered in a battle in what is now Pakistan, along with how ancient battlefield medicine treated it. He was lucky to have regained consciousness, let alone survive, the doctors claim, concluding that it was a fatal case of tension pneumothorax.

According to the US National Library of Medicine, tension pneumothorax is a life-threatening emergency wherein a large air collection in the pleural space compromises respiration and cardiac function.

“There is no part of my body free from wounds”

In many battles, Alexander the Great fought on the front line alongside his soldiers. In his book The Anabasis of Alexander the Great, Arrian of Nicomedia describes the young Macedonian king clashing with the Persians next to his men during the Battle of Granicus.

In earlier battles, generals were forced to scold Alexander for throwing himself against the enemy as a regular soldier defying danger. In one battle, general Parmenion saved the young king from the hands of a Persian who was ready to slay him by cutting the enemy’s arm.

Alexander’s zeal to fight cost him many injuries, some of them serious. At Granicus, he was hit in the head by a sword that knocked his helmet off. In the same battle, he was hit with a missile that pierced his shield and lodged in his shoulder.

Rather than being deterred, Alexander used those wounds in a speech to inspire his soldiers to cross the Indus River:

“There is no part of my body, in front at any rate, remaining free from wounds, nor is there any kind of weapon used either for close combat or for hurling at the enemy, the traces of which I do not bear on my person.”

As if pain was a concept unknown to him, the great commander soldiered on, fighting battle after battle, thus forging one of antiquity’s greatest empires.

The wound that nearly killed Alexander the Great

While throwing himself fearlessly into battle, there was one that nearly cost the Macedonian king his life.

Before crossing the Indus River, the men of Alexander’s army were disillusioned from the many casualties, the hardships, and the harsh Asian climate. It took the inspirational speech of their great leader to convince them to continue.

After crossing Indus, the Macedonians came face to face with the Mallians of Punjab, in modern-day Pakistan. The Mallians refused to allow Alexander’s army to cross through their territory leading to a conflict that lasted almost four months.

The Mallians had an army of 50,000 men, a sizeable force that was not easy to confront. Yet the Macedonian army fought them and forced them to retreat to their citadel with a wall of a mile-long perimeter.

After the Macedonians made their way into the outer parts of the citadel and started undermining the next layer of walls, Alexander grew impatient, grabbed a ladder, and climbed it himself with only two soldiers following him. Others started climbing the ladder to protect him, but the ladder broke due to their weight.

The Mallians recognized the king and attacked him immediately. His soldiers called to him, urging him to jump down to them. Alexander did not. Instead, he leaped down to the inner area and started cutting down the Mallians with his sword, killing their leader.

The Mallians started shooting arrows at Alexander and one of them hit the king in his left breast. Alexander kept fighting even though he was bleeding profusely until he finally collapsed on his shield. Meanwhile, more Macedonians had entered the city. Upon seeing Alexander lying on his shield they thought he was dead. In a rage, they started killing every Mallian on site.

After realizing that Alexander was alive, they ran back taking the unconscious king to a tent to remove the arrow. General Perdiccas volunteered to make the incision to remove the tip of the arrow. Then they moved the king to the camp to recover.

Since the largest part of his army was still away, rumors spread that the king was dead. The soldiers became desperate and despondent. They wondered who would become their new leader to safely lead them back to Greece. Arrian wrote that upon the rumors of his death, “at first there arose a sound of lamentation from the entire army, as one man handed the rumor on to another. When they ceased their lamentation, they became spiritless, and felt perplexed as to the man who was to become the leader of the army…as if “everything was difficult, if not impossible, without Alexander.”

However, a still-living and awake Alexander the Great was put on a boat to sail on a nearby river to show his army that he was alive. When the rest of the army was informed that the king was alive, they couldn’t believe it. When they saw him, some ran near him to touch him or his clothes to confirm that he was alive indeed.

Modern-day surgeons and the thorax wound

Based on historical accounts, the modern-day Greek surgeons who wrote the article believe the arrow pierced Alexander’s thorax on his left breast, entering the thoracic wall and puncturing the lung.

In The Anabasis of Alexander the Great, Arrian describes symptoms of dizziness and swooning. From that, the surgeons inferred that Alexander’s lung collapsed, which is a life-threatening condition that would send anyone to the intensive care unit.

The surgeons called this tension pneumothorax, which would lead to a drop in blood pressure, and cause Alexander to lose consciousness, as historians reported. When he fell onto his shield, it closed the air leak, which allowed him to wake up.

The arrow was lodged in the king’s breastplate, and the point in the space between his muscle tissue and his heart. Removing it risked breaking Alexander’s ribs and causing internal bleeding. Nevertheless, it was removed. The body of the arrow was torn away and then an incision was made using a sword. The arrowhead was cut out of the king’s chest, which caused severe hemorrhaging and he fell unconscious.

The historical accounts do not mention how Alexander managed to survive the wound or how long it took him to recover since there is no medical data.

The surgeons note that the shape of the arrowhead prevented it from going further into Alexander’s body than the lung. If it had, it would have penetrated his heart and the king would have died. No record of his recovery exists, but the doctors also note that if his remains were discovered, evidence of this wound would surely be visible in his left rib cage.