Healthcare knowledge roughly 300 years before Alexander

Alexander’s medical knowledge is based on the teaching he received from Aristotle. Sophisticated medicine did, however, exist much earlier. Hippocrates of Cos, for instance, lived only one hundred years before their time. The Hippocratic Oath, which may have appeared only after the physician’s death, has survived until today (see: A healthy mind in a healthy body – in early antiquity). This oath was, in fact, a religious document established to ensure that a doctor operated within and for community values. The oath was sworn by Apollo, Hygeia, and Panacea, promising to respect their teacher, not to administer poison or abuse their patients; quite importantly, they swore to keep the confidentiality between doctor and patient. 

[Fragment of a clay tablet from the Library of Ashurbanipal. Kouyunjik (ancient Nineveh), Neo-Assyrian, British Museum]

Three hundred years before Alexander and Aristotle, King Ashurbanipal of the Neo-Assyrian Empire kept the Nineveh Medical Encyclopaedia in his Library. These clay tablets held thousands of remedies and descriptions of the symptoms, which Alexander may have shared with the doctors traveling with the army. His men's lives were precious, and attending to their health and well-being was a priority (see: Alexander caring for the wounded and the dead). 

Plants were most certainly used in early civilizations since their medical effects were recorded around 2000 BC in Mesopotamia. The help of the gods was invoked for more complicated diseases requiring the performance of certain rituals or magic. Throughout antiquity, medicine mainly implied using plants, which were either applied to the affected body part or taken internally as potions. The ancient Egyptians also had a thorough knowledge of medicine, as documented by Herodotus. He reports that each part of the body requires specific treatments. It seems that physicians were actually specialized to treat one particular ailment of any sick patient. 

Anyway, in Mesopotamia, as the collection of medical texts grew over the centuries, the extensive Library of King Ashurbanipal was created in the 7th century BC. Scribes had gathered enough information to compose a medical dictionary, which may well be the first standardized, systematic handbook on therapeutic medicine. 

This Encyclopaedia was divided into twelve sections. The subjects moved from the head, through the torso, to the legs and feet. Each tablet constituted the equivalent of a chapter in our modern books, but some subjects are spread over more than one tablet, and there are 50 tablets in total. These tablets counted at least 250 lines. A note was added at the end of each tablet that referred to its place in the series. 

Today’s merit of this Library is to better understand how people looked at diseases and the best way to treat them in ancient times. Basically, they knew two types of specialists, one corresponding to our modern doctors and the other that could best be described as an alternative healer. 

This precious information collection has only been revealed in recent years because the tablets had been smashed to pieces in 612 BC when Nineveh fell into the hands of the Persians, Medes, and Babylonians. They divided the region between them afterward. Piecing the broken tablets back together was and is a tedious task as only a handful of people can decipher the cuneiform writing and thus reconstruct the texts. 

Once again, it is amazing, to say the least, that such precious knowledge remained hidden from us for 2,600 years! Where would our medical science be if we had continued elaborating and improving on the knowledge from the reign of King Ashurbanipal? Not only was it known to Alexander through Aristotle (and possibly to other physicians) but also to other key figures like King Philip’s doctor who operated on his eye, and Alexander’s own physician Philip of Acarnania (see: Alexander’s near-fatal dip in the Cydnus River at Tarsus)? So much information from antiquity has been sadly lost to us.

About the Death of Alexander the Great

Alexander's death is shrouded in mystery. From antiquity until today, scores of historians, admirers, archaeologists, authors, and philosophers have written about it, and each and every one has developed their own theory and their own point of view.

It is useless to retell the story – or the many versions of the story – as I certainly cannot add anything sensible to that. Like everybody else, I have, however, my own thoughts and own reflections on the matter.

Alexander's death most certainly was first recorded in his Royal Diaries, but is the account that reached us truly reflecting what was written down at that time, or has the original report been manipulated to suit his courtiers and successors? That is hard to tell, certainly 2,500 years onwards.

We have a very detailed, day-by-day account of Alexander's whereabouts and health during the last days of his life. I find this rather strange, as it sounds more like a justification than an actual report of the events. Alexander's life has been in the balance before, but not so many details were reported, or at least have not survived. The first time the troops feared for the king's life was at Tarsus after he plunged into the cold waters of the Cydnus River, and the remedy of his doctor, Philip, was being questioned by Parmenion, in those days his trusted general. We have no day-to-day account of Alexander's condition at that time, although it must have been quite critical nonetheless, as it kept him pinned down for several weeks.

Another life-threatening experience was during his attack on the Malian town in India when Alexander was hit by a poisonous arrow while scaling the city wall. The soldiers had been slow to follow their king, exposing him to the full force of the enemy's attack. Alexander had to be carried away, and for three days, he fought between life and death. At the cost of enormous superhuman efforts, he eventually showed himself to his troops and even hoisted his battered body on the back of a horse to prove to them he was still alive. No day-to-day account of his eating and drinking patterns has been recorded, and none of the worries and treatments by his doctor have been documented. All we know is that he floated down the Indus in full view of his men. He needed much rest to help the healing process, but the march to the mouth of the Indus went on as planned.

So, why this detailed list of activities in Babylon? If Alexander had been straightforwardly sick, there was no need to document his eating, drinking, or sleeping patterns during the days preceding his death.

The question that arises more often than not is, was Alexander poisoned? Attempts to take his life had occurred before. The first one mentioned in our sources is Philotas' attempt to at least cover up the plot to kill Alexander in 330 BC. In Central Asia, the king survived the Pages' conspiracy, said to be planned by Callisthenes. There may have been more attempts to take his life that are not necessarily recorded, and the next occasion may have arisen here in Babylon.

If Alexander was indeed poisoned, which I doubt, then Hephaistion would have died of poisoning also. Had his dear friend still been alive, the murderer(s) would have had less chance and could expect the full wrath of Hephaistion? He was not only Alexander's most intimate and dearest friend but also the second-in-command, the only one ever to be promoted to the title Chiliarch and, as such, the obvious person to replace and take over from Alexander. Many people must have envied his privileged position.

With Hephaistion no longer in the way, the main question is, however, who would or could benefit from eliminating the king? It is not only about killing Alexander but also about providing a good and approved replacement. So, who would be eligible? Not Ptolemy, since he withdrew soon enough to his beloved Egypt and didn't interfere much in succession. Not Nearchus, who was happy to keep his admiralship of the navy. Not Peucestas, who made an effort to learn the Persian language and must have been quite happy in his role as satrap. Not Seleucos, who had married the daughter of Spitamenes – the only marriage that survived the big Susa wedding. Not Eumenes, who faithfully served King Philip and Alexander as secretary and archivist for years. Not Craterus, who was halfway to Macedonia with strict orders to replace Antipater. According to some sources, Antipater has been named as a possible beneficiary, as he sent his son Cassander to Babylon in his place, carrying a very potent poison. If so, the poison was not very potent since it took Alexander almost ten days to die. Besides, Antipater did not hold Cassander in high esteem, for he did not allow him to recline with his guests during the Symposia but had to sit like a little boy on a chair at the end of his father's couch. When Antipater died, Polyperchon was appointed as his successor and not his own flesh and blood. That tells enough. Perdiccas may be a suspect as he helped Roxane poison Alexander's Persian wives after the king's death, but that may be simply because he was still a Macedonian in heart and soul. Besides, in my honest opinion, I think he was far too loyal to Alexander to harm him in any way.

Cassander, however, may have acted on his own, seizing the opportunity of being delegated to Babylon. Not impossible. Although he had shared the early years at Mieza with Alexander and his Companions, he stayed behind when Alexander went east, probably as persona non grata. He must have resented this denial. Fueled by his father's attitude, he developed a deep grudge against Alexander and his clique. Life at the Babylonian court was totally alien to Cassander. He cannot have operated without inside help, possibly that of his younger brother Iollas, one of the king's Pages. All this is based on speculations, although eight years later, Olympias accuses Cassander of murdering her son – perhaps not entirely unfounded.

At the time of Alexander's death, all of Alexander's Bodyguards and other powerful men like Aristonous, Leonnatus, Lysimachos, Meleager, Pytho, Stasanor, Asander, Olcias, Philip the physician, and Peithon were present in Babylon. Still, none of them really stood out to replace Alexander. If we follow Pseudo-Callisthenes, only Ptolemy, Perdiccas, Peucestas, Lysimachos, Asander, and Olcias are beyond suspicion. Whatever the plan, either it was ill-conceived, or whoever was supposed to gain from it was facing unexpected opposition from the other contenders. After all, the Succession War lasted almost forty years, and even the rising star of Antigonus Monophthalmus only made waves many years later.

Suppose Alexander had indeed been killed with poison without involving his Bodyguards and his other faithful generals (I cannot imagine they were not). Why don't we hear anything about an investigation to find the culprit? This was certainly the case when Philotas' plot was discovered and after the Pages' conspiracy. These were, of course, led or instigated by Alexander. Still, in his absence, the army certainly expected that much from their commanders, and there was no way anyone could avoid the Macedonian legal machine.

Another possible cause of Alexander's death could be his excessive drinking, which would immediately make any investigation superfluous. The heavy drinking is at least what the Royal Diaries, in all their elaborate details, want us to believe. However, some twenty-five years after the facts, Aristobulus casually remarks that Alexander sat for hours over his wine for conversation. The drinking theory, however, has been widely developed in the Alexander Romance. On one such occasion, Alexander is spending a drinking night with twenty other guests, toasting to their health in turn with unmixed wine, creating the ideal circumstances for the poisoning theory. But as we know, the Alexander Romance must be taken with a large pinch of salt, maybe a shovel full.

Less often highlighted but genuine are the prophecies made by the Chaldean diviners who advised Alexander not to enter Babylon. Their warning was recorded on cuneiform tablets and predicted Alexander's death in these words "When in the month Ajaru, during the evening watch, the moon eclipses, the king will die. The sons of the king will vie for the throne of their father, but will not sit on it" (see: Alexander the Great and the Magi). Alexander is not mentioned by name, just as "king." We no longer believe in prophecies in our modern world, but maybe we should. After all, facts and figures do not explain everything.

Alexander dying of exhaustion and the consequences of his near-fatal wound in India is not a heroic way to end his life, which evolved between myths and reality from the beginning. But why did he not name his successors if he was suffering from his chest wound? Was he hoping and waiting for Roxane to give birth to a boy? His Persian wife, Stateira, is also said to be pregnant, meaning that it was not beyond reason for Alexander to want to live long enough to see his heir(s). Another possibility is that he was in denial and did not take his declining health seriously, which is very much unlike Alexander. His succession, I think, was a problem even for him. He was surrounded by capable men and generals, but none had the vision of his greater world. The only one who ever shared that insight with him was Hephaistion, and he was dead.

When Alexander gave his signet ring on his deathbed to "the strongest," he may have meant just that: the man who would be strong enough to keep his empire together, but they had to work it out for themselves. A poor legacy, one may say, but under the circumstances, this was the best he could do, for even had he indeed named Perdiccas, as some sources pretend, he probably lacked the capabilities and vision to pursue Alexander's goals. Well, time has given us the answer, and Alexander was right one last time.

Le Roman d’Alexandre, traduit du grec par A Tallet-Bonvalot

Just as there is not one Silk Road, there certainly is not one Alexander Romance. 

The oldest known version dates probably from the 3rd century AD, and its author is unknown, although it has been attributed to Pseudo-Callisthenes - not known otherwise. This version is generally called version α and served for all subsequent versions, which appeared on a more or less regular basis until the 16^th century and were written in Latin, Greek, Armenian, Georgian, Persian, Hebrew, Arabic, Islamic, French, English, Italian, Spanish, Hungarian, Romanian, German, Ethiopic, Mongolian and many Medieval patois. Useless to say that each version added tales of its own fantasy and embellished the legend that Alexander became over the centuries.

Le Roman d'Alexandre (ISBN 9-782080-707888), which I read is the Codex Parisinus Graecus 1711, discovered at the Bibliothèque Nationale in Paris in the 18^th century. This Greek text is entitled The Life of Alexander the Macedonian, poorly copied, with spelling mistakes and others, and composed in the 11^th century. It is labeled version A since it closely relates to the original Romance.

The book has little to do with the historical Alexander, and the chronology of his conquests is entirely inconsistent and/or invented. To give it a credible resonance, we find familiar names in a utopian setting, for instance, Craterus of Olynthus as an architect in Alexandria or Parmenion lending his name to the Serapeum, while Roxane is presented as the daughter of the king of Persia. Interestingly, Parmenion is accused of planning the murder of Alexander by bribing the king's doctor Philip, at Tarsus. At the same time, he historically sent a letter to Alexander to warn him of Philip.

Alexander marches with a vast army to face enormous enemies without giving any details on the battles or hardly a location, but encountering one mythical or fabulous being after another. The book contains an amazing number of letters exchanged with the Athenians, Darius, Olympias, Aristotle, Porus, Kandaké, king of Meroe, and even with the Amazons and the gymnosophists. This is not a heroic Alexander but a wise man who always does the right thing, much to the awe and admiration of his audience. 

Le Roman d'Alexandre concludes with Alexander's will, which is made to fit the book's tale but can in no way be connected to historical reality. 

Alexander’s near fatal dip in the Cydnus River at Tarsus

Tarsus, in antiquity, was a large and prosperous city, but its remains are sadly disappointing since all that is left is a short stretch of Roman road of black basalt with white edges, without a beginning or end. This is not surprising, as sixteen consecutive layers of habitation have been found on top of the Roman layer. Tarsus today looks like a rather sleepy town with typical Ottoman houses recently renovated and repainted.

Consequently, all my hopes are focused on the River Cydnus. This is a typical mountain river, tumbling down from the Taurus Mountains over rocks and outcrops and meandering between trees and bushes that cling to their footholds along its very banks. It is said to be 200 ft wide. Still, I wonder about the spot where these measurements were taken for the water, at times cascades happily over the many rocks through narrow passages, while at other times, the river is slowly flowing between wide manmade banks. After some effort, I found a spot to dip my hand in the fast-flowing water. It is early May, about the same time of year Alexander was here. The water is clear and cold, chilly but not exactly ice-cold, and certainly not to the extent of causing a convulsive reaction.

What illness struck Alexander remains vague. Arrian speaks of “a bout of sickness,” adding that Aristobulus mentions exhaustion. Alexander was seized by a convulsion, followed by a high fever and sleepless nights. Curtius, as usual, is more elaborate, describing how Alexander’s limbs stiffened and how he lost his color and body warmth, making him look more dead than alive. This spread commotion and concern throughout the camp, where many started mourning their king, wailing with great anxiety. Alexander’s physicians were at a loss, but one of them, Philip of Acarnia, who knew Alexander from boyhood, promised to treat him with a strong purgative. Alexander agreed to take it when he received a letter from Parmenion, who had been sent ahead, cautioning him against the doctor. “Beware of Philip,” he wrote, adding that he was informed that King Darius had bribed Philip with a thousand talents to poison him. As Philip handed his cup of medicine to his patient, Alexander drank the concoction with the letter in his hand and gave the document to his physician. Philip showed no alarm and simply advised Alexander to continue the treatment. There obviously was nothing wrong with the medicine or with Philip, who continued to serve Alexander all through his further campaigns. Curtius says Alexander appeared before his soldiers after the third day of treatment – much to everybody’s relief.

It is nearly impossible to imagine Alexander’s camp on the banks of the Cydnus. There are simply too many modern houses and streets closing in around the river. This “illness” had pinned down the Macedonian army for a while and delayed Alexander’s advance. At that time, Darius was waiting to confront Alexander on the plains of Sochi, but as soon as he heard the bad news, he set his army in motion to safeguard Cilicia. Yet he would not take Alexander off guard, for the Macedonian king had dispatched Parmenion to hold the Syrian Gates, modern Beilan Pass, in the Amanus Mountains, southeast of Iskenderun. 

As soon as he was strong enough, Alexander set the remaining part of his army in motion too and marched to Issus.