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Quintus curtius rufus the history of alexander pdf

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ADDICTION HISTORY

"Alexander The Great"?

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, 561–567

Blackwell Science, Ltd

Oxford, UK

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Miscellaneous

Alexander the Great’s relationship with alcoholJ. A. Liap-

pas et al.

Correspondence to:

John Lascaratos 164b Hippocratous Str. 11471 Athens Greece Tel:

+

30 1 6426486 Fax:

+

30 1 7796745 E-mail: giannop@power.ece.ntua.gr

Submitted 18 March 2002; initial review completed 14 May 2002;

final version accepted 18 December 2002

Alexander the Great’s relationship with alcohol

J. A. Liappas

1

, J. Lascaratos

2

, S. Fafouti

1

& G. N. Christodoulou

1

Departments of Psychiatry

1

and History of Medicine,

2

Athens National University, Athens, Greece

ABSTRACT

Aims

This study sought to clarify if Alexander the Great indulged pathologi- cally in alcohol and whether it contributed to his death.

Design

The texts of the historians Diodorus of Sicily, Plutarch, Arrian, Curtius Rufus, Athenaeus, Aelian and Justin were studied, with their information con- cerning wine consumption by Macedonians, and especially Alexander, and were evaluated. The surviving historical texts, all later than Alexander’s epoch, are based on a series of contemporary histories and especially on the ‘Royal Journals’, an official diary written in the imperial court.

Findings and conclusions

Alexander consumed large quantities of undiluted wine periodically, reaching pathological intoxication. However, the existing data do not provide convincing evidence that Alexander the Great manifested abuse of or dependence on alcohol according to DSM-IV or ICD-10 criteria and it seems unlikely that alcohol was involved in his untimely death.

KEYWORDS

Alcohol abuse, alcohol dependency, Alexander the Great,

history of medicine.

INTRODUCTION

Alexander the Great ascended to the throne of Macedonia in 336

BC

at the age of 20 after the assassination of his father, Philip. With the occupation of a large part of the then-known world, he completed an exploratory and cul- tural achievement, founding a great state containing var- ious races in which he endeavoured to implant Hellenic culture. This universal state, despite the fact that it was broken up into several parts after his death, nevertheless held together as a commonwealth with common forms of science, education, art and civilization. This later influ- enced the Roman and Byzantine empires and, through them, the European civilization that followed (Kalog- eropoulou 1973; Lucopoulou 1973).

Alexander reigned for 13 years until his death at the age of 33 years. As soon as he began his reign he neutral- ized his opponents, established his hegemony in Mace- donia and succeeded in winning recognition as sovereign of the Hellenic world. Later (in 334

BC

) he undertook a campaign against the Persians with the aims of punish- ing them for their attacks on Greek towns in the previous

century and of liberating the occupied Hellenic cities in Asia Minor.

After the decisive battle of Issos against Darius (333

BC

) he marched against Palestine and Egypt, where he established Alexandria, a town which became the prime cultural centre of the eastern Mediterranean world. After these victories, his army proclaimed him King of Asia; Alexander then redirected the aim of his campaign, his new plans being the creation of a universal empire. With such a purpose in mind, he proceeded to the occu- pation of eastern satrapies in the heart of Asia and in India. However, while preparation for his occupation of the Arabian peninsula was in progress, he died suddenly in Babylon (Kalogeropoulou 1973; Kanellopoulos 1973).

On the basis of historical information from the earliest sources, some modern historians and physicians have propounded a wide range of diseases as the possible causes of Alexander’s death. Among them are pneumo- nia, pleurisy, abscess of the lung, typhoid fever, hololithi- asis, pancreatitis, appendicitis, acute peritonitis, epilepsy, leukaemia, chirrosis, delirium tremens and so on.

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The exact cause of his death has not been identified. The ancient historical sources, which are all later than Alexander’s own era, lead to a diagnosis either of a patho- logical disease or poisoning (Lascaratos 1997).

Two reliable historians, Plutarch and Arrian, whose information is based on the contents of the ‘Royal Jour- nal’, a diary kept in the court of Alexander, lead us to a diagnosis of a feverish disease with fluctuating tempera- tures, which lasted from the end of May to 10 June, when Alexander died. According to their version Alexander’s activities, at least during the first days of his illness, were not affected at all. The emperor continued his collabora- tion with his closest colleagues for the preparation of future campaigns, his daily routines and his sacrifices to the gods. At the end of the period, however, a sudden dete- rioration occurred which rendered him unable to speak and, soon after, he died (Brunt 1954; Perrin 1971). Based on this information, the great Hippocraticist, Littré (1865) propounded the view that Alexander died as a result of malaria.

A second group of ancient sources, which are called of the ‘Vulgate tradition’, attribute the death of the emperor to poisoning. To this group belong the historians Diodorus of Sicily, Justin and all the versions and editions of the ‘Romance of Alexander’, written by pseudo-Callis- thenes (Bradford Welles 1963; Holton 1974; Seel 1985). All this historical material supports the view that the fatal disease of Alexander began with an acute pain of the right hypochodrium which continued until he died, without losing consciousness or contact with his environment and without any temperature. These sources maintain that Alexander fell victim to a conspiracy. Antipater, the Regent of Macedonia, after being in violent conflict with the emperor’s mother, Olympias, feared losing his posi- tion and decided to poison him. Aristotle, the philosopher and learned teacher of Alexander, prepared a strong poi- son, being dissatisfied at the fact that Alexander had exe- cuted one of his relatives, Callisthenes, a former colleague of the emperor, who fell out of favour.

Some modern historians have adopted the views of the Vulgate sources, providing historical and political argu- ments. Apart from the well-known conflict between Anti- pater and Olympias, the feelings of the army and the new Macedonian aristocracy which had been created by Alex- ander after the deaths or executions of the old members, mainly of the Attalides, were dissatisfied with Alexander’s policy of conferring titles on Persian soldiers who had been trained according to Macedonian military princi- ples. This equality of the Macedonian and Persian sol- diery had already led to an unparalleled mutiny of Alexander’s Macedonians in Ope (324

BC

). The aristoc- racy was afraid that the policy of Alexander, which regarded the Persians and Macedonians as races with equal rights in his empire, would lead to the sharing-out

of their rights with the ‘foreign’ Persian aristocracy. Already many Persians had been appointed as Satraps (Viceroys) by Alexander.

Thus, the atmosphere among both the army and Alex- ander’s entourage encouraged the possibility of a

coup d’état

, a fact which is consistent with a plot to assassinate Alexander, as the Vulgate sources indicate (Badian 1964; Bosworth 1971).

A third account of his death derives from numerous writers, ancient to modern, who have alleged that Alex- ander consumed large quantities of alcohol and that this might have been a factor in causing pathological health problems to himself, even leading to his early death (Sour- nia 1987; Maxwell O’Brien 1994; Simopulos 1995).

AIMS

The aims of this paper are to attempt to clarify: • Whether Alexander indulged pathologically in alcohol. • If, on the basis of the existing historical evidence, the

diagnosis of alcohol abuse, consumption causing harm to health with resulting dependency, or pathological intoxication, as defined by the diagnostic criteria DSM-IV (American Psychiatric Association 1992) and ICD-10 (World Health Organization 1992), can be established.

• The social and political context of alcohol use in Alex- ander’s time and during his military campaigns.

• The probable accuracy of the attribution of alcohol as Alexander’s cause of death.

SOURCES

The references to excessive consumption of wine by Alex- ander the Great can be found mainly in the surviving texts of the historians Athenaeus (1st century

AD

), Plu- tarch (1st

-

2nd century

AD

) and Aelian (2nd

-

3rd cen- tury

AD

) (Burton Gulick 1961; Cole Babbit 1969; Dilts 1974). The majority of the information is derived from now-lost texts of Alexander’s contemporary historians, such as Aristobulus, Carystius, Duris, Chares, Lygeus, Nicovuli, Ephippus, etc. and the ‘Royal Journals’, an offi- cial diary written in the court of Alexander (Lascaratos 1997).

Athenaeus, based on the ‘Royal Journals’ and the con- temporary historians Nicovuli, Aristobulus, Chares and Lygeus, supports the opinion that Alexander was fre- quently drunk, as were his companions, and after the symposia would sleep for 2 whole days. The same historian, deriving his information from the historians Carystius and Duris, states that Alexander organized processions in honour of the god Mithras in which he

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paraded, drunk, on a chariot, imitating the Persian kings. He further passes on the information of the historian Nicovuli that, at his last feast, Alexander challenged his dinner companions and led them to drink excessively. Athenaeus also states that Alexander, after heavy drink- ing at his last banquet, collapsed into unconsciousness and died after a few days from an alcohol-related disease (Burton Gulick 1961).

Plutarch writes that his own contemporary and friend, Philinus, believed that Alexander had experienced drowsiness and sleepiness the day following each ban- quet; this is again derived from the ‘Royal Journals’ (Cole Babbit 1969).

Aelian, deriving his information from the ‘Royal Jour- nals’, maintains that a few months before his death, Alex- ander was accustomed to excessive drinking at almost daily symposia which caused him to sleep during the next day. These were continued for a period of 1 month, the Macedonian Dius (October–November). The historian, however, has doubts about the reliability of the source and regards such information as a mere rumour (Dilts 1974).

Further, Antipater, the Regent of Macedonia after the death of Alexander, adhered to the accusation that Alex- ander was a drunkard (Jacoby 1962).

The information about the supposed alcoholism of Alexander, even from antiquity, was rebutted by some authors, mainly Plutarch, Arrian (1st

-

2nd century

AD

), Curtius Rufus (1st century

AD

) and Justin (3rd century

AD

) (Brunt 1954; Rolfe 1962; Perrin 1971; Seel 1985); the two former also drawing from the ‘Royal Journals’, which they interpreted differently, and basing their opin- ions on Alexander’s contemporary historians Ptolemy and Aristobulus (Lascaratos 1997).

For the purposes of this study, the two sets of diagnos- tic criteria DSM-IV and ICD-10 were used (American Psy- chiatric Association 1992; World Health Organization 1992). Their purpose is to provide clear descriptions of diagnostic categories to enable clinicians to diagnose, communicate with, study and treat persons with mental disorders.

Diagnostic criteria: general remarks

According to these criteria, the cardinal feature of alcohol abuse is a maladaptive pattern of alcohol use, which is manifested by recurrent and considerable adverse conse- quences related to its repeated use, such as failure to fulfil major role obligations, repeated use in situations in which it is physically hazardous, multiple legal problems, and recurrent social and interpersonal problems over a 1- year period. Alcohol abuse may lead to dependence, i.e. a maladaptive pattern of use, leading to clinically signifi- cant impairment or distress as manifested by several

characteristic symptoms of tolerance, withdrawal and compulsive alcohol-taking behaviour (Schuckit 2000). Moreover, both DSM-IV and ICD-10 provide a thorough set of criteria pertaining to alcohol intoxication. Thus, the essential feature of this condition is the presence of patho- logical behavioural or psychological changes that develop during, or shortly after, the ingestion of alcohol; these changes are evidenced by slurred speech, incoordination, unsteady gait, nystagmus, impairment in attention or memory or stupor or coma that are not due to another general medical condition (American Psychiatric Associ- ation 1992; World Health Organization 1992).

Special efforts have been made in preparation of DSM- IV and ICD-10 manuals to incorporate an awareness that these are used in culturally diverse populations interna- tionally. Clinicians have been called on to evaluate indi- viduals from numerous different ethnic groups and cultural backgrounds. The wide international accep- tance of DSM-IV and ICD-10 suggests that these classifi- cations are useful in describing mental disorders as they are experienced by individuals throughout the world.

Furthermore, there is historical evidence that alcohol abuse was a social problem in the ancient world. People who committed antisocial or criminal acts while drunk were punished more strictly than others. On Mytilene Island the legislators doubled the penalties in cases of lawlessness and, in Athens, Solon changed the misde- meanour of insulting behaviour to a public criminal fel- ony. In other ancient Greek cities the use of wine was strictly prohibited for minors (Schmitt Pantel 1992).

SOCIOCULTURAL CONTEXT

It must be pointed out at the outset that it is difficult to pose an

ex post facto

diagnosis of Alexander’s pathological condition in relation to his consumption of alcohol and to define his degree of dependency based only on historical data which are presented at second-hand.

The social conditions of the epoch, with widespread consumption of alcohol, must always be taken into account in examining the particular case of Alexander. Thus, one must scrutinize the customary use of alcohol among ancient Greeks and especially in the Macedonian military barracks to determine what was considered, at that period, abnormal in relation to alcohol consumption.

It is well known that ancient Greek banquets had been considered from Homeric times an acceptable and wide- spread general social institution organized with rules and etiquette, consisting not simply of social gatherings but mainly of centres for exchanging and forming intellectual ideas. The ritual proceedings began with eating and liba- tions; hymns to the Gods followed, with incense. Then the drinking began.

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In the circles of sophists in Athens, the table compan- ions consumed wine diluted with water, as they believed that the drinking of undiluted wine was an abuse (Sicu- tres 1970; Schmitt Pantel 1992). One of the companions, elected by his fellows as leader of the symposium and called

symbosiarches

, arranged the rules of drinking (when and how much everyone would drink) which all the guests obeyed. Usually the companions elected the most hardened drinker, whose demands were consider- able; thus, the consumption was excessive. The feasts of the sophists in ancient Athens were famous, the most noteworthy being the feasts of Socrates and his pupils about which Plato’s work

The Symposium

affords us a detailed account. In earlier times at symposia it was man- datory to consume large quantities of wine. Later, this primitive system was replaced with one giving guests freedom to choose the desired quantity by making a sign to the servants when they wanted more wine. However, the usual end of these symposia, despite their good inten- tions, was that all the participants were drunk or asleep. During the drinking, the guests discussed in detail several topics of significance, gave orations, composed impromptu verses, played board games and enjoyed a rich programme performed by singers, conjurers, jug- glers, comedians, etc. (Sicutres 1970; Borza 1983; Schmitt Pantel 1992).

In the area of ancient Macedonia, unlike in Athens, guests consumed the so-called

akratos

(that is, undiluted) wine, as the historian Athenaeus confirms from informa- tion quoted in the texts of the historians Aristobulus, Nicobuli, Lygeus and Chares (Burton Gulick 1961). This custom, despised by classical Greeks, originated perhaps because, as today, the superior quality of the Macedonian wines compared to those of southern Greece did not require dilution to temper the taste of a strongly flavoured wine, high in alcohol (Borza 1983).

Some historians maintain that noble Macedonians in Alexander’s time had a strong habit of drinking, as archaeological artefacts found in the tombs of Vergina (drinking vessels, goblets, pitchers) have verified (Borza 1990; Maxwell O’Brien 1994). These give evidence of the Bacchanian revels in honour of the god Dionysus and reveal the influence of Dionysus at the highest levels of society of ancient Macedonia. The worship of Bacchus formed the nucleus of the king’s cult practices, observed closely by the ruling Argead dynasty (Sicutres 1970). Artefacts similar to these, however, have been discovered all over Greece, which indicate the pan-Hellenic worship of the god of wine (Schmitt Pantel 1992).

A number of symposia, from the great 9-day festival in Macedonia on the eve of Alexander’s departure for Asia to the emperor’s final drinking bout in Babylon, are described in varying detail. Between battles, the Bac- chanian festivities were an institution for Macedonians;

ritual toasts always accompanied them, to honour their dead heroic comrades or to anticipate new victories. In other words, those feasts were inseparable from the col- lective organization of the military way of life (Borza 1983; Maxwell O’Brien 1994). Feasts took place in the Macedonian army at every significant social event, such as the marriages of the soldiers to local girls and festivities in honour of Dionysus. The festival in Ecbatana was of magnificent extravagance, with importation of 3000 per- formers from the Dionysiac guild in Greece (Borza 1983). On some special occasions (marriages, receptions, victo- ries, the King’s recovery from serious wounds, etc.) a great tent of a hundred couches, carried with the expedi- tion, was used (Tomlinson 1970).

Macedonian symposia were lengthy, commencing early in the evening and often lasting until the following morning. The formal Macedonian symposium com- menced with a flourish of trumpets, a signal to the crowd outside that ritual functions were being properly observed, thus perhaps enabling the army to share in the opening sacrifices and libations. Following this, the din- ner was served, with the commencement of drinking, the symposium’s central activity and entertainment.

Akratos

wine abuse seems to have been usual (Borza 1983). The historian Athenaeus maintains, using an earlier source, Ephippus, that Macedonians had a marked tendency to imbibing alcohol and drunkenness, to such an extent that they collapsed before completing all the dishes due to be served. He refers particularly to the example of a well-built Macedonian named Proteas, who drank repeatedly to the health of Alexander. The author, using the history written by Chares, maintains that Alexander approved of the Macedonian tendency to drinking and, when in India, he organized drinking contests because the local inhabitants loved wine. In one such contest, in honour of the dead Indian sophist Calanus, 35 competi- tors dropped dead while six expired a little later. The champion, named Promachus, who won the consider- able sum of one talent, died after 4 days (Burton Gulick 1961).

The close family circle of Alexander had, furthermore, been accused of alcohol abuse. His father, King Philip, was accused by the historian Theopompus of being a

philopotes

(a lover of drink), getting drunk on a daily basis and being accustomed to drinking excessively with other companions at the feasts. The historian Carystius adds that Philip encouraged his drinking companions to imbibe even more (Burton Gulick 1961). The famous Athenian orator, Demosthenes, who was, however, always hostile to Macedonians, likened Philip to a sponge (Perrin 1971). However, there is no historical source sug- gesting that alcohol consumption prevented Philip in any way from performing perfectly his role as sovereign and military leader during his whole reign.

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Alexander’s mother, Olympias, had been initiated into the worship of Dionysus and she was possibly an official priestess of the god; she took part in the Bacchic mysteries during which wine was freely imbibed (Perrin 1971).

Hephaesteon, the bosom friend of Alexander, died of excess alcohol consumption, according to Diodorus of Sicily (1st century

BC

), Plutarch and Arrian. His death must have taken place at a banquet in a series of feasts in the presence of Alexander in Ecbatana during the Mace- donian month of Dius (Brunt 1954; Bradford Welles 1963; Perrin 1971).

From the above information it appears that consider- able consumption of undiluted wine was the rule at the feasts between battles and at the court. Normally this had no pathological after-effects on their daily life, with few exceptions. This excess alcohol consumption did not result in a persistent and recurrent maladaptive pattern of alcohol use leading to clinically significant impairment or distress in fulfilling major role obligations at work, social life or interpersonal problems.

ANALYSIS

Harmful use

The instances of intoxications and undesirable social con- sequences, referred to during the last year of Alexander’s life, do not constitute sufficient evidence to pose the diag- nosis of harmful use, because such instances were not accompanied by evidence that the alcohol use ‘was responsible for (or substantially contributed to) physical or psychological harm including impaired judgement or dysfunctional behaviour which may lead to disability or have adverse consequences for interpersonal relation- ships’. According to ICD-10 criteria, ‘pattern of alcohol use has to persist for at least 1 month or has to occur repeatedly within a 12-month period’.

Alcohol abuse

On the basis of information derived from the above- mentioned historians Athenaeus, Aelian and Plutarch (in the view of Philinus), there appears to be no evidence to support the idea that Alexander, in the last period of his life, had a maladaptive pattern of alcohol abuse leading to clinically significant impairment or distress as manifested by one (or more) of the criteria referred to above. Espe- cially, recurrent substance use did not result in a failure to fulfil major role obligations at his work (e.g. repeated absences or poor performance of duties as king and mili- tary leader, related to substance use).

On the contrary, there are references which contradict the theory of alcohol abuse; these state categorically that Alexander was capable of carrying out his heavy daily

duties which he performed until the last days of his life. Furthermore, reference is made to the fact that, in the last period of his life, the feasts took place on days of rest and holiday after tiring activities such as hunting, military parades, trials and other activities which demanded full mental and physical endeavour (Perrin 1971; Brunt 1954).

Alcohol dependence

It would be useful to discuss the possible alcohol depen- dence of Alexander, due to the fact that more recent authors mention that Alexander manifested delirium tre- mens which was implicated, among other factors, as a cause of death (Maxwell O’Brien 1994; Simopoulos 1995). Evidence for alcohol dependence is provided by historical sources which refer to the use of alcohol by Alexander. However, there is no source which maintains that, during his last year, he developed a maladaptive pat- tern of alcohol use leading to clinically significant impair- ment as manifested by three (or more) of the criteria referred to above, occurring at any time in the same 12- month period.

The above signs are thought to be essential for the diagnosis of alcohol dependence according to the diag- nostic criteria DSM-IV and ICD-10.

On the contrary, there are historical references against such a diagnosis, supporting the fact that Alex- ander was generally moderate and usually drank during the feasts without reaching excesses of consumption. Plutarch in particular writes that Alexander drank mod- erately, conversing for long hours with his friends and only when his busy routine permitted it, because he never abandoned his duties either for wine or sleep or spectacles and ceremonies (Cole Babbit 1969; Perrin 1971). Arrian agrees that Alexander made moderate use of wine, considering it to be social drinking, due to his courtesy towards his companions (Brunt 1954). Curtius Rufus also considers him generally moderate and restrained in his consumption of wine while Justin writes that Alexander, like his father, simply loved wine (Rolfe 1962; Seel 1985). Among modern writers, Hammond (1994) maintains that the number of symposia was small for a king (three or four a month). Maxwell O’Brien (1994) believes that, during Alexander’s reign, symposia were social events providing relaxation from the pres- sures of war, as they took place between campaigns with ritual drinking of wine; they expressed the collective function of the army and the common struggle: the king was thus able to investigate both himself and his com- panions because the wine held a glass to one’s soul. The same writer maintains that Alexander’s drinking ‘proba- bly elicited almost as much admiration from his men as his heroics on the battlefield’ and ‘refusing to participate

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in the festivities might cast doubt on one’s manliness, amiability, or even allegiance’.

Pathological intoxication

There are numerous historical references which could support the view that Alexander became drunk during the feasts he organized. There are references to incidents of maladaptive, aggressive or violent behaviour, psychological changes, instability of mood, impairment of judgement and social functioning, slurred speech and uncoordinated gait (Burton Gulick 1961; Maxwell O’Brien 1994). These instances always occurred under the influence of alcohol and were not permanent symptoms.

Supporting the diagnosis of Alexander’s pathological intoxication are the following references: • very frequent consumption of alcohol during the last

period of his life (Aelian); • consumption of alcohol at symposia followed by a 2-

day period of sleep (Athenaeus); • in a drunken state Alexander paraded on a donkey, in

honour of the god Mithras (Athenaeus); • the burning-down of the palace of Persepolis and the

murder of Cleitus while intoxicated. Plutarch, Arrian, Curtius Rufus and Justin stress that Alexander regret- ted these acts when he was sober again (Brunt 1954; Rolfe 1962; Perrin 1971; Seel 1985). The contradictory behaviour of Alexander when

drunk and sober is possibly explained to a great extent by the fact that the emperor, drinking even relatively small quantities of alcohol, very soon reached a condition of pathological intoxication.

With regard to the possible cause of Alexander’s death from alcohol, this view was propounded in the 19th cen- tury by Bosc, who stressed the inherited nature of Alex- ander’s drinking and came to the conclusion that he died during an epileptic attack and a crisis of delirium tremens.

Modern historians have suggested the possibility of alcoholic cirrhosis, acute intoxication or alcohol with- drawal state with delirium tremens. The attribution of cir- rhosis was met with arguments to the contrary by many historians, the first being Littré (1865), because in no source is Alexander presented as suffering from chronic symptoms of or complications from cirrhosis. Acute intoxication must be excluded, as it would result in death some hours after consuming great quantities of alcohol without previous feverish disease. Maxwell O’Brien (1994) maintained recently that the evidence of Aristob- ulus that Alexander, when presenting with fever, drank wine to bring his temperature down, represents a laconic description of acute alcoholic deprivation syndrome. This opinion does not seem to be supported by the clinical pic-

ture of Alexander’s fatal disease, as described by both groups of historical sources. Neither of them confirms confusional state, transient visual or auditory hallucina- tions or illusions and severe tremor (Lascaratos 1997).

CONCLUSIONS

The references in existing sources concerning Alex- ander’s relationship with alcohol are based mainly on the ‘Royal Journals’ and on the interpretations later given from time to time to the events described in these journals (Bosworth 1971, 1988; Lascaratos 1997). However, the opinion has been expressed by current historians that the journals promoted the view intentionally that Alex- ander’s death was the result of a disease in which con- sumption of alcohol was a factor, creating a locus minoris resistentiae, as the journals wanted to divert attention from the then widespread rumours of poisoning (Bos- worth 1971, 1988).

Another element which puts in doubt the reliability of some historians contemporary to Alexander is the fact that the writers of these histories seem to have had a per- sonal grudge against Alexander, such as Ephippus, Nico- vuli and Antipater (Pearson 1960; Lascaratos 1997). Furthermore, many accusations made against Alexander were due to the hostile feelings of many Greek cities towards the Macedonians in the period of the Lamian War. These cities claimed their independence and thus anti-Macedonian sentiments would be expected (Pearson 1960; Badian 1987).

Finally, other evidence which one could use against the hypothesis of Alexander’s alcohol dependence and abuse is found in the opinions of Plutarch, Arrian and Curtius Rufus. These authors, interpreting the evidence presented in the ‘Royal Journals’ differently from other historians and based on reliable authors contemporary to Alexander (Aristobulus, Ptolemy), attribute the emperor’s relationship with alcohol to defects of his char- acter, maintaining that he was a lover of wine, stressing that Alexander never exceeded the accepted limits (Brunt 1954; Rolfe 1962; Perrin 1971). Athenaeus ascribes the drinking competitions in India to the social habits of the epoch and attributes Alexander’s awarding of a prize to reasons of diplomacy, that is to give satisfaction to the occupied Indians, who loved wine (Burton Gulick 1961). Furthermore, Alexander’s Symposia in Persia did not come into conflict with the mentality of the local people, because the Persian kings were accustomed to hold sym- posia for a large circle of personalities and even ordinary citizens at which events all participants ended up drunk. Consequently, perhaps Alexander’s symposia served, among others, a political purpose—the image of a new sovereign as heir to the behaviour of that of the previous

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ruler. The successors of Alexander the Great followed the same policy in the Hellenistic kingdoms, holding lavish and luxurious banquets at every opportunity that was offered. The symposia of Ptolemy VIII have remained leg- endary, mainly those held for the priests of Apollo on occasions such as when Ptolemy himself was elected as a priest. The tradition is earlier in Macedonia, where King Amyndas offered, in honour of the Persian ambassadors, a banquet welcoming them in order to show respect to Persian laws and customs. In the same way, his father Philip used his great capacity for heavy drinking as an instrument of diplomacy, causing the admiration of occu- pied Thessalians who recognized in his appetite for wine a person similar to themselves (Schmitt Pantel 1992; Max- well O’Brien 1994).

In conclusion, it appears that Alexander was indeed involved with alcohol. However, bearing in mind the existing historical evidence, the national, social and cul- tural conditions of the historical period during which Alexander lived, it appears likely that Alexander periodi- cally consumed large amounts of alcohol which resulted in instances of alcoholic or pathological intoxication. The diagnostic criteria of ICD-10 and DCM-IV seem to prove useful in our endeavour to evaluate the involvement of Alexander the Great in the use of alcohol.On the basis of the currently existing phychiatric classification systems, the existing evidence does not support convincingly the idea that Alexander would be ‘diagnosed’ a posteriori as suffering from either dependence on or abuse of alcohol.

Acute intoxication due to use of alcohol, delirium tre- mens or cirrhosis do not seem to be implicated in Alex- ander’s death, as deduced from historical evidence.

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