Decoding Alexander the Great’s gastrointestinal cause of death using artificial wisdom: An artificial intelligence-human inquiry into a medical mystery

Table 2 Evaluation of sources cited by ChatGPT: Accuracy, contextual fit, and misapplication[7,10,18,19,38,50,59-73]

No.	Source	Ref.	Source type	ChatGPT’s summary of source	Average score1	Remarks
1	Did Alexander the Great die from Guillain-Barré syndrome? In: Howe T, Anson E, Balmaceda C, Fronda M, Hollander D, McAuley A, Muller S, Vanderspoel J, Wheatley P, Dunn C, editors. Ancient History Bulletin, 2018: 106-128	Hall[18]	Book	Alexander the Great and the Guillain-Barré syndrome hypothesis	11	This source actually argues that Campylobacter jejuni is the cause of the GBS rather than typhoid while ChatGPT uses it to argue for typhoid. It is a source that was taken out of context to support the argument that typhoid caused GBS, when the paper argued the opposite
2	Typhoid fever. Lancet 2015; 385: 1136-1145	Wain et al[19]	Journal	Clinical progression and symptoms of typhoid fever	8.5	No mention of typhoid causing GBS. It is also wrongly cited as the paper was in the journal lancet not nature
3	Infectious causes of Guillain-Barré syndrome. Curr Opin Neurol 2016; 29: 419-425	Willke A, Ergonul O (fictitious reference)	Journal	Supported the possibility of Guillain-Barré syndrome as a complication of infections like typhoid	7.5	Unable to locate source article. Citation likely to be erroneous
4	Alexander the Great: Murder in Babylon. London: Virgin Digital, 2012	Phillips[59]	Book	Introduced strychnine poisoning theory involving Roxanne	4.5
5	Historical principles and perspectives in toxicology. Toxicol Pathol 1999; 27: 129-138	Wax PM (fictitious reference)	Journal	General toxicological background relevant to ancient poisoning theories	0	Unable to locate source article. Citation likely to be erroneous
6	Calicheamicin gamma 1I: An antitumor antibiotic that cleaves double-stranded DNA site specifically. Science 1988; 240: 1198-1201	Zein et al[60]	Journal	Describes the chemical properties of calicheamicin, related to the Styx river poisoning theory	5
7	Was the death of Alexander the Great due to poisoning? Was it Veratrum album? Clin Toxicol (Phila) 2014; 52: 72-77	Schep et al[50]	Journal	Evaluates the white hellebore poisoning theory	9
8	Alexander of Macedon, 356–323 B.C.: A Historical Biography. University of California Press, 2013	Green[38]	Book	Provided background and narrative of Alexander’s final days	4.5
9	Acute pancreatitis. N Engl J Med 2016; 375: 1972-1981	Forsmark et al[61]	Journal	Supported acute pancreatitis hypothesis from excessive alcohol use	9.5	Authors’ names wrongly cited
10	Malaria. [cited October 17, 2025]. Available from: https://www.who.int/news-room/fact-sheets/detail/malaria	World Health Organization[62]	Website	Described malaria symptoms and prevalence	8	Unlikely, but still a possibility as malaria is always an infectious consideration
11	Pathogenesis, clinical features, and neurological outcome of cerebral malaria. Lancet Neurol 2005; 4: 827–840	Idro et al[63]	Journal	Provided evidence supporting cerebral malaria as a cause of neurological symptoms	3.5
12	Conquest and Empire: The Reign of Alexander the Great. Cambridge University Press, 1993	Bosworth[64]	Book	Historical reference for Alexander’s campaigns and death context	6
13	Alexander the Great and West Nile virus encephalitis. Emerg Infect Dis 2003; 9: 1599-1603	Marr and Calisher[7]	Journal	Proposed West Nile virus encephalitis theory	5
14	West Nile virus: A primer for the clinician. Ann Intern Med 2002; 137: 173-179	Petersen and Marfin[65]	Journal	Clinical background on WNV symptoms	5.5
15	Lives, Volume VII: Demosthenes and Cicero. Alexander and Caesar. Loeb Classical Library 99. Cambridge, MA: Harvard University Press, 1919	Plutarch[10]	Book (translated pri source)	Primary historical source detailing events of Alexander’s death	8
16	The Campaigns of Alexander. London: Penguin Classics, 1976	Arrian[66]	Book (translated pri source)	Primary source documenting Alexander’s military and health history	7.5
17	Ancient Medicine. 2nd ed. London: Routledge; 2012	Nutton[67]	Book	Context for medical practices and understandings in antiquity	6
18	Greek Fire, Poison Arrows & Scorpion Bombs: Biological and Chemical Warfare in the Ancient World. New York: Overlook Press; 2003	Mayor[68]	Book	Insight into ancient biochemical warfare and poison use	4.5
19	Alexander the Great: The Hunt for a New Past. London: Overlook Press, 2004	Cartledge[69]	Book	Reinterprets Alexander’s life and legacy, including his final illness	6.5
20	Alexander the Great: Man and God. 1st ed. London: Longman, 2004	Worthington[70]	Book	Provides historical analysis including character traits possibly relevant to health behavior	3.5
21	Fiction as History: Nero to Julian. 1st ed. Berkeley: University of California Press, 1995	Bowersock[71]	Book	Used to contextualize propaganda and myth in ancient historical narratives	5
22	Who’s Who in the Age of Alexander the Great: Prosopography of Alexander’s Empire. 1st ed. Oxford: Wiley-Blackwell, 2006	Heckel[72]	Book	Provides biographical insights into Antipater and others possibly involved in poisoning	3.5
23	Guillain-Barré Syndrome. Nat Rev Neurol 2020; 16: 10-20	Engel N (fictitious reference)	Journal	Contemporary clinical reference for GBS symptoms and progression	0	Unable to locate source article. Citation likely to be erroneous
24	The Death of Alexander the Great: Rumour and Propaganda. Classical Quarterly 1971; 21: 112-136	Bosworth[73]	Book	Explores the use of rumor and misinformation surrounding Alexander’s death	5.5	Author wrong

¹Average score: Average total score given by two reviewers for clinical plausibility (0-3), source reliability (0-3), cultural context fit (0-3), relevance (0-3). Maximum score of 12, with full details in Supplementary Table 2.

GBS: Guillain-Barré syndrome; WNV: West Nile virus.