Alexander's Last Days: Chronological Source Rearrangement (without the poison narrative and the romances)

[AdamKvanta]

So why did Antipater wait that long before arranging for Alexander to be poisoned? It wouldn't have taken Cassander 12 months to get to Babylon.

We don't know but maybe it wasn't so easy to poison Alexander. After Hephaestion's death, Alexander was mourning and after that, he was campaigning against Cossaeans. So Alexander hasn't been in Babylonia until the spring of 323 BC.

BTW, I don't think Hephaestion was poisoned or died of pneumonia. He probably died of typhoid, his own recklessness and the doctor's failings.

Does typhoid fever really match the account of Hephaestion's death? There was no mention of a typhoid outbreak and fatal typhoid fever lasts a month or more not just seven days. On the other hand, Hephaestion fell ill after drinking, just like Alexander: https://penelope.uchicago.edu/Thayer/E/ ... fell%20ill

[AdamKvanta]

Going off at a tangent, why did Alexander summon the officers to assemble in the hall/courtyard? Did he want them there to issue instructions about the Arabia campaign, maybe that he would catch them up when he was recovered, or that it was postponed?

Or did he realise he was dying and want them there for some sort of prayer vigil or support group? He can't have wanted them there to ratify his appointed successor as he didn't appoint Perdiccas until the last minute.

Any thoughts?

Actually, I'm glad you asked because I didn't make the reconstruction of Alexander's last days just to promote the arsenic hypothesis. I'm happy to discuss any part of the reconstruction.

So regarding the summoning of the officers to assemble in the hall/courtyard (I assume we talk about Day 7), I don't think it was a summoning at all. I think, Alexander was planning to kill himself that night and he needed to be alone. So he ordered everybody to stay outside his bedroom, generals were ordered to "tarry" in the court, and the rest outside the gates "to spend the night outside" (Plutarch). This interpretation is also supported by the romances as you can see in my reconstruction thread: https://www.pothos.org/forum/viewtopic.php?t=7309 (Day 7)

[chris_taylor]

Thanks for the comment, hiphys. I didn't mention Alexander's pneumothorax because usually, a healed pneumothorax has no long-term effect on health. Here are two sources:

in the interest of accuracy: it is correct that a spontaneous pneumothorax does not have long term effects on health (except some have a tendency to recur), but Alexander had a haemato-pneumothorax from a penetrating chest wound. that's a very different pathology. it will have left extensive pleural and pulmonary scarring, adhesions and in those days, probably retained foreign bodies like bits of leather, which then act as a source of infection.

but I agree that pneumonia secondary due to a late complication of a chest injury is very unlikely - he didn't have a cough, he wasn't short of breath and he didn't have chest pain. his doctors were very experienced with war wounds and would have connected the two.

chris.

[chris_taylor]

Does typhoid fever really match the account of Hephaestion's death?

in a word: no.

Hephaestion went from walking, talking, eating & drinking to being dead within about hour.
there are very few pathologies that can do that and infection isn't one of them.

chris.

PS: thanks for the chronology of the sources, very useful!

[hiphys]

Let me insist on pneumonia (or better on a sum of causes, pneumonia among them). In 1901 (not 2024!) William Osler wrote: "The most widespread and fateful of all acute diseases, pneumonia is now the 'Captain of the Men of Death', to use the phrase applied by John Bunyan to consumpion" (William Osler, Principles and Practice of Medicine, IV ed., New York (Appleton and Company) 1901, p. 108. This testimony is far more suited to Alexander age than any evidence from our time. Anyway I think a sum of diseases may have caused his death, none of them perhaps fateful, but all of them together mortal, such as malaria, pneumonia, but above all an exausted, often injured body and even a cumulative stress of the past years.

[marcus]

Having checked this, Craterus seems to have left for Greece in June 324 BC (Hephaestion dying in the October), but 12 months later was no further than Cilicia. Heckel says his ill-health and trouble in Cilicia had held him up, but Antipater therefore must have known for 12 months that Alexander had summoned him to Babylon. So why did Antipater wait that long before arranging for Alexander to be poisoned? It wouldn't have taken Cassander 12 months to get to Babylon.

BTW, I don't think Hephaestion was poisoned or died of pneumonia. He probably died of typhoid, his own recklessness and the doctor's failings.

To an extent this is a moot point, as there is no evidence at all that Antipater had anything to do with Hephaestion's death (whereas there is at least evidence that some people thought he was responsible for Alexander's, whether we believe it or not). Having said that, I don't think it follows that Antipater was recalled at the same time that Craterus set out, so he hadn't necessarily had a year to plot Alexander's death. Of course we don't know exactly what happened, but it is possible that Craterus was actually sent with Antipater's recall papers, and then forwarded them on when he fell ill in Cilicia. If Craterus was intended to replace Antipater, no-one would have wanted a lengthy interregnum in Macedonia with Antipater gone and Craterus not yet arrived.

Just a thought ...

[AdamKvanta]

in the interest of accuracy: it is correct that a spontaneous pneumothorax does not have long term effects on health (except some have a tendency to recur), but Alexander had a haemato-pneumothorax from a penetrating chest wound. that's a very different pathology. it will have left extensive pleural and pulmonary scarring, adhesions and in those days, probably retained foreign bodies like bits of leather, which then act as a source of infection.

Thanks for the comments, chris. I'm not sure about the extensive pleural and pulmonary scarring, though. First, let's see the source:

Alexander himself also was wounded with an arrow under the breast through his breastplate into the chest, so that Ptolemy says air was breathed out from the wound together with the blood. But although he was faint with exhaustion, he defended himself, as long as his blood was still warm. But the blood streaming out copiously and without ceasing at every expiration of breath, he was seized with a dizziness and swooning, and bending over fell upon his shield. After he had fallen Peucestas defended him, holding over him in front the sacred shield brought from Troy; and on the other side he was defended by Leonnatus. But both these men were themselves wounded, and Alexander was now nearly fainting away from loss of blood.

...

Others carried off the king, who was lying in a faint condition, upon his shield; and they could not yet tell whether he was likely to survive. Some authors have stated that Critodemus, a physician of Cos, an Asclepiad by birth made an incision into the injured part and drew the weapon out of the wound. Other authors say that as there was no physician present at the critical moment, Perdiccas, the confidential body-guard, at Alexander's bidding, made an incision with his sword into the wounded part and removed the weapon. On its removal there was such a copious effusion of blood that Alexander swooned again; and the effect of the swoon was, that the effusion of blood was stanched.

...

Some say that Alexander, having received a blow on the head with a piece of wood, fell down in a fit of dizziness; and that having risen again he was wounded with a dart through the corselet in the chest. But Ptolemy, son of Lagus, says that he received only this wound in the chest.
https://en.wikisource.org/wiki/The_Anab ... /Chapter_X

I agree that Alexander had both hemothorax and pneumothorax but that doesn't mean that the pneumothorax was more severe. After all, he was hit by an arrow (or a dart) so only the tip of the arrow might have penetrated the lungs. We don't know the precise location of the chest wound, nor what was the angle of the arrow. Therefore, we don't have proof of extensive pleural and pulmonary scarring, IMO.

Anyway, I agree with the other things you said about pneumonia and typhoid fever.

[AdamKvanta]

Let me insist on pneumonia (or better on a sum of causes, pneumonia among them). In 1901 (not 2024!) William Osler wrote: "The most widespread and fateful of all acute diseases, pneumonia is now the 'Captain of the Men of Death', to use the phrase applied by John Bunyan to consumpion" (William Osler, Principles and Practice of Medicine, IV ed., New York (Appleton and Company) 1901, p. 108. This testimony is far more suited to Alexander age than any evidence from our time. Anyway I think a sum of diseases may have caused his death, none of them perhaps fateful, but all of them together mortal, such as malaria, pneumonia, but above all an exausted, often injured body and even a cumulative stress of the past years.

So why only Alexander and Hephaestion died within a year after Alexander decided to replace Antipater with Craterus? Wouldn't malaria and pneumonia kill injured soldiers left and right? I'm afraid no such a historical report exists. Pneumonia and malaria don't target physically injured people but infants, the elderly, and people with compromised immunity. That's why they are so widespread and deadly.

[AdamKvanta]

Having said that, I don't think it follows that Antipater was recalled at the same time that Craterus set out, so he hadn't necessarily had a year to plot Alexander's death. Of course we don't know exactly what happened, but it is possible that Craterus was actually sent with Antipater's recall papers, and then forwarded them on when he fell ill in Cilicia. If Craterus was intended to replace Antipater, no-one would have wanted a lengthy interregnum in Macedonia with Antipater gone and Craterus not yet arrived.

I agree that Antipater wasn't recalled immediately. But Antipater must have known that he would be recalled after Craterus's arrival in Macedonia. I don't think it was a secret mission. So long before the arrival, Antipater made some preparations to avoid that...

[marcus]

Having said that, I don't think it follows that Antipater was recalled at the same time that Craterus set out, so he hadn't necessarily had a year to plot Alexander's death. Of course we don't know exactly what happened, but it is possible that Craterus was actually sent with Antipater's recall papers, and then forwarded them on when he fell ill in Cilicia. If Craterus was intended to replace Antipater, no-one would have wanted a lengthy interregnum in Macedonia with Antipater gone and Craterus not yet arrived.

I agree that Antipater wasn't recalled immediately. But Antipater must have known that he would be recalled after Craterus's arrival in Macedonia. I don't think it was a secret mission. So long before the arrival, Antipater made some preparations to avoid that...

I don't disagree regarding Antipater's pre-warning (although I don't buy the poisoning theory, and definitely not that Antipater killed Hephaestion). My comment was merely about whether Antipater had a full 12 months to plan, because I don't think he knew that far in advance (ref to Alexias' earlier post).

M

[hiphys]

We can't compare diseases in the age of Alexander with the ones of our times; for this reason I quoted William Osler, a doctor of early XX cent., who knew nothing of antibiotics, X-rays, ultrasounds and blood transfusions. Besides , it is universally known that in ancient times there were more deaths of illnesses than of war. If we know nothing of people dying from epidemic or even flu it is because death was so normal that no one took the trouble to record it.

[AdamKvanta]

We can't compare diseases in the age of Alexander with the ones of our times; for this reason I quoted William Osler, a doctor of early XX cent., who knew nothing of antibiotics, X-rays, ultrasounds and blood transfusions. Besides , it is universally known that in ancient times there were more deaths of illnesses than of war. If we know nothing of people dying from epidemic or even flu it is because death was so normal that no one took the trouble to record it.

I think it's the other way around. We can compare the age of Alexander with the primitive regions of our age because not every region in our age has antibiotics, X-rays, ultrasounds, and blood transfusions.

But we shouldn't compare the age of Alexander with Osler's [Western world] report from the early XX. century because in the early XX. century there was a huge air pollution from intensified coal usage. And I think nobody denies the connection between air pollution and pneumonia:

In contrast, mortality due to respiratory diseases [e.g. pneumonia], the category most closely associated with industrial pollution, was rising over most of the study period. This increase was particularly pronounced in the period before 1880, a period that also saw the greatest increases in coal use intensity (see Appendix A.1.2). By the 1891-1900 decade, respiratory mortality was accounting for as many deaths as all of the major infectious diseases combined.
https://www.nber.org/system/files/worki ... pdf#page=9

[hiphys]

It doesn't matter why there were such diseases and illnesses, but if and how it was possible to heal, without antibiotics and other modern medicines.

[AdamKvanta]

It doesn't matter why there were such diseases and illnesses, but if and how it was possible to heal, without antibiotics and other modern medicines.

This is what Osler wrote about pneumonia and age/health:

As Sturges remarks, the old are likely to die, the young to recover. Under one year it is more fatal than between two and five. Of 50 cases under 10 years of age, 4 died; of 119 cases under 20, 16 died (Chatard). Above sixthy the death rate is very high, amounting to 60 or 80 per cent.; 33 of 44 cases in our series. From the reports of its fatality in some places, one may say that to die of pneumonia is almost the natural end of old people.

Previous habits of life and the condition of bodily health at the time of the attack are most important factors. In analyzing a series of fatal cases one is very much impressed with the number of cases in which the organs show signs of degeneration. In 25 of the 100 autopsies at the Montreal General Hospital the kidneys showed extensive interstitial changes. Individuals debilitated from sickness or poor food, hard drinkers, and that large class of hospital patients, composed of robust-looking laborers between the ages of forty-five and sixty, whose organs show signs of wear and tear, and who have by excesses in alcohol weakened the reserve power, fall an easy prey to the disease. Very few fatal cases occur in robust, healthy adults. Some of the statistics given by army surgeons show the low mortality from pneumonia in healthy picked men. The death rate in the German army in over 40,000 cases was only 3.6 per cent.
https://archive.org/details/principlesa ... 8/mode/2up

Alexander was young (32) and healthy (he was able to cross the Gedrosian desert).

[hiphys]

Doctor Mario Bertolotti (La critica medica nella storia. Alessandro Magno, Torino, Fratelli Bocca editori, 1930, p. 356 s.) wrote: "Come potremo noi valutare, a distanza di secoli, le condizioni fisiologiche di quell'uomo in quell'istante [scil. Alexander before his last illness]? Supponiamo che un medico, fiduciario di una grande Società di previdenza sociale del nostro tempo, avesse dovuto proporre per un premio di assicurazione sulla vita il giovane Monarca, che da poco più di due anni aveva varcato la trentina: quale giudizio avrebbe egli potuto emettere? Sicuramente i dati anamnestici e l'etiologia non avrebbero concesso la possibilità di stabilire una valutazione molto favorevole, dacché il medico fiscale avrebbe dovuto registrare le malattie pregresse, gli accidenti traumatici ripetuti, ed i diuturni disagi della vita d'ogni giorno. Questo professionista del Novecento avrebbe quindi dovuto calcolare le invalidità temporanee pregresse e quelle permanenti consecutive alle molteplici ferite e i segni, forse ancora non completamente scomparsi, del paludismo e dell'ameba dissenterica. Tirate le somme, era fatalmente riconoscibile la precarietà di vita del grande conquistatore: pochi giorni contati rimanevano, prima che le parche ne tagliassero il filo."