Alexander the Great Caught a Lucky Break After Suffering the Worst Wound of His Campaign

When Alexander the Great died at age 32, it came as the result of an illness brought on after a night of drinking. For 12 days, the ancient general struggled with a fever before he finally succumbed. His illness was so sudden and dire that some historians believe he could have been poisoned. 

Whether it was poison or the world's worst hangover that finally killed Alexander the Great can't really be known. But in 2018, a group of surgeons wrote  a paper for the National Institute of Health (NIH) detailing some of the wounds that should have killed the Macedonian. 

Drawing from historical accounts, they detailed one wound in particular that came in what is today Pakistan, along with how ancient battlefield medicine treated it. He was lucky to have regained consciousness, let alone survive. 

Alexander was known to fight at the head of his armies, often on the very front line. Greek historian Arrian of Nicomedia detailed the campaigns of the general in his work, "The Anabasis of Alexander the Great." In it, he describes the young king fighting the Persians at the Battle of the Granicus in modern-day Turkey alongside his soldiers. 

It was during these early battles that the young leader nearly met his death at the hand of a Persian soldier, saved only by the general Parmenion, who cut off the enemy soldier's arm. Alexander was so drawn to battle his generals eventually had to chide him for enduring so much front line combat. 

The Macedonian generals had every cause for concern. At Granicus, Alexander was hit in the head by scimitar-wielding cavalry, causing his helmet to fly off his head. The Persians later struck the king with a missile, which went through his shield and lodged in his shoulder. Alexander even used those wounds in a speech meant to inspire his troops 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."

But Alexander's most grievous wound nearly killed the king, and it couldn't have come at a worse time for the Macedonian Army. Shortly after crossing the Indus River, they encountered the army of the Mallians in modern-day Pakistan. 

After forcing the Mallians to retreat into their city's acropolis, its final defensive citadel, Alexander climbed the wall of the fort, alone at first, but then accompanied by a handful of men. 

As they jumped down inside the fort, the Macedonians were met by a hailstorm of enemy arrows and a rush of attackers. The ladder they used to scale the wall was broken, and the small band of men was alone in the citadel with the enemy. 

The Mallians recognized Alexander and focused their fire on him. His soldiers tried to shield Alexander from the incoming projectiles, but one of them hit the king in his left breast. All continued fighting the oncoming Mallians, including Alexander, who was bleeding profusely. 

Alexander fought his way to the Mallian leader and killed him, but soon fainted onto his shield. The Macedonians secured his limp body on the shield and fought until the rest of the army could join them. The Macedonians went into a rage, thinking the king had died, and vowed to kill all of the Mallians in the citadel. 

Based on the historical accounts, modern-day surgeons in the NIH journal 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, which leads the surgeons to believe Alexander's lung collapsed, a life-threatening condition that would send anyone to an 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, but Alexander ordered the men to do it anyway. 

It's not known whether a medical man or a soldier performed the procedure, but 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. The king fell unconscious.

The histories don't mention how Alexander managed to survive the wound or how long it took him to recover. When he scaled the wall of the citadel, his main force was still four days away. By the time they arrived, rumors spread the king was dead, but a still-living and awake Alexander was put on a boat on a nearby river to show them he was alive.

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 surely 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. 

-- Blake Stilwell can be reached at blake.stilwell@military.com. He can also be found on Twitter @blakestilwell or on Facebook.

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