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The Macedonians and their monarchs had a proud tradition of heavy alcohol consumption. It was not at all uncommon for a session to end with drinkers passing out. In a play performed in Athens earlier in the fourth century, Dionysus, the god of wine, sets out the stages of inebriation:

For sensible men I prepare only three craters: one for health (which they drink first), the second for love and pleasure, and the third for sleep. After the third mixing bowl is drained, sensible men go home. The fourth crater is nothing to do with me—it belongs to bad behavior; the fifth is for shouting; the sixth is for rudeness and insults; the seventh is for fights; the eighth is for breaking the furniture; the ninth is for depression; the tenth is for madness and unconsciousness.

Alexander had experience of the higher numbers of the scale and drank a toast to each of the twenty men present in the room. Then he decided to leave the party early and get some sleep. This was unusual behavior for him; he may have been feeling a little off-color. As was his habit, he took a bath before sleeping, but then a Thessalian friend of his, Medius, invited him to join a late-night party. "You'll enjoy yourself," he promised. The king agreed and continued drinking. Eventually he left and turned in.

On the following day, he felt feverish and spent much of his time in bed. He played dice with Medius and dined with him. Alcohol was on the menu again. According to one version of events, Alexander challenged a fellow guest to down a crater of wine in one go. After he had done so, the man counterchallenged the king to repeat the trick. Alexander tried, but failed. He felt a stabbing pain in his back "as if he had been pierced by a spear," gave a loud cry, and slumped back onto his cushion. He left the party, ate a little food, and took a bath. He now definitely had a fever and fell asleep on the spot in the bathhouse.

By the morning of the third day, Alexander was no better. He was carried out on a couch to conduct the usual daily sacrifice to persuade the gods to watch over him and his army. His indisposition was an annoying setback, but no more than that. He issued instructions to his officers for the imminent Arabian campaign and amused himself by listening to Nearchus reminisce about his adventures at sea.

Then the king was carried on his bed to a waiting boat and taken downstream to the palaces in Babylon. Here he was installed in the paradeisos or, in other words, the Hanging Gardens, doubtless because of their calm, quiet, and coolness. He lay in a vaulted chamber beside a large bathing pool. He discussed vacant posts in the army with his commanders and spent time chatting with Medius.

Days passed; Alexander's condition gradually worsened. There seems to have been a variety of pools and bathhouses in the vicinity, and the king was transferred to at least one of them and finally to a lodge beside the reservoir. These constant removals suggest growing panic among the king's staff.

It was increasingly obvious that he was gravely ill; his commanders and high officials were warned to stay within reach. Generals waited in the courtyard. Company and regimental officers were to gather outside the gates. On June 5 Alexander was ferried back to the Summer Palace. He stayed either there or in the royal tent in the nearby army encampment.

The fever did not abate. By the next evening it was obvious that the king was dying. He had lost the power of speech and he handed his signet ring to his senior general, Perdiccas. In this way he dramatized an at least temporary handover of power.

A rumor spread that Alexander was already dead. Soldiers crowded round the palace entrance, shouting and threatening to riot. A second doorway was knocked through the bedroom wall so that they could walk more easily past their dying leader. They were let in, wearing neither cloak nor armor. Alexander's historian Arrian writes:

I imagine some suspected that his death was being covered up by the king's intimates, the eight Bodyguards, but for most their insistent demand to see Alexander was an expression of their grief and longing for the king they were about to lose. They say that Alexander could no longer speak as the army filed past him, but he struggled to raise his head and gave each man a greeting with his eyes.

Seven of his commanders undertook a ritual of incubation. They spent the night in the temple of a Babylonian deity, hoping for an omen-bearing vision or dream. They inquired whether the king should be moved there, but were told, discouragingly, that they should leave him where he was.

On June 11, between three and six o'clock in the afternoon, Alexander died, a month or so short of his thirty-third birthday. What was to happen next? everyone wondered uneasily. Nobody knew. If the stories are correct, the king himself had been no wiser. While still able to speak, he turned his disenchanted attention to the succession. When someone asked him: "To whom do you leave the kingdom?" he replied: "To the strongest." He is said to have added: "I foresee great funeral games after my death."

Perdiccas asked when he wished divine honors paid to him. He replied: "When you yourselves are happy." It is reported that these were Alexander's last words.

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