In spring 324 BC Hephaestion left Susa, where he had been married, and accompanied Alexander and the rest of the army as they travelled towards Ecbatana. They arrived in the autumn, and it was there, during games and festivals, that Hephaestion fell ill with a fever. Arrian says that after the fever had run for seven days, Alexander had to be summoned from the games to Hephaestion, who was seriously ill. He did not arrive in time; by the time he got there, Hephaestion was dead. Plutarch says that, being a young man and a soldier, Hephaestion had ignored medical advice, and as soon as his doctor, Glaucias, had gone off to the theatre, he ate a large breakfast, consisting of a boiled fowl and a cooler of wine, and then fell sick and died.
Piecing the accounts together, it seems as if Hephaestion’s fever had run its course for seven days, after which time he was sufficiently recovered for his doctor, and Alexander himself, to feel it was safe to leave him, and for Hephaestion to feel hungry. His meal, however, seems to have caused a relapse that led to his rapid death. Precisely why this should have happened is not known. As Mary Renault says: “This sudden crisis in a young, convalescent man is hard to account for.” The explanation that fits most of the facts is that the fever was typhoid, and that solid food perforated the ulcerated intestine that the typhoid would have caused. This would have led to internal bleeding, though it would be unusual in that case for death to follow quite as swiftly as it seems to have done here. For that reason, it is not possible altogether to discount other possible explanations, one of them being poison.
Hephaestion’s death is dealt with at greater length by the ancient sources than any of the events of his life, because of its profound effect upon Alexander. Plutarch says “… Alexander’s grief was uncontrollable …” and adds that he ordered many signs of mourning, notably that the manes and tails of all horses should be shorn, the demolition of the battlements of the neighbouring cities, and the banning of flutes and every other kind of music. Arrian relates an account that “… he flung himself on the body of his friend and lay there nearly all day long in tears, and refused to be parted from him until he was dragged away by force by his Companions …”, another that said “… he lay stretched upon the corpse all day and the whole night too …”, and another which told how he had the doctor, Glaucias, executed for his lack of care. Arrian also mentions Alexander ordering the shrine of Asclepios in Ecbatana to be razed to the ground, and that he cut his hair short in mourning, this last a poignant reminder of Achilles’ last gift to Patroclus on his funeral pyre: “… he laid the lock of hair in the hands of his beloved companion, and the whole company was moved to tears.”