Cleopatra the Great

by Joann Fletcher

  The highest echelons of the Egyptian priesthood, including Cleopatra’s closest advisers, would have gathered within the palace. Incense-fuelled rites and prayers would have featured religious personnel wearing the mask of Bes, god of childbirth. According to the third-century BC legend of Alexander, Nectanebo II wore the mask of Zeus-Ammon when impregnating Alexander’s mother Olympias. Still there nine months later, he attended her labour with a divining dish, assorted wax figurines and all his inherent powers as a pharaoh of Egypt to achieve the most auspicious time for his son’s birth by ‘measuring the courses of the heavenly bodies; he urged her not to hurry in giving birth. At the same time he jumbled up the cosmic elements by the use of his magic powers, discovered what lay hidden in them and said to her “woman, contain yourself and struggle against the pressure of Nature”’ in order that Alexander would be born at exactly the most propitious moment.

  Although this description comes from a work of fiction, it nevertheless hints at the kind of rites which may have been employed when Cleopatra gave birth to a child regarded as Alexander’s descendant, although the kind of esoteric rites long employed in Egyptian medical practice had been refined and improved by the medical schools of Alexandria. Specialist obstetricians, some of whom were female, were available to the wealthy. Details of the obstetric treatments available from those trained in Alexandria’s enlightened schools were preserved in the second-century AD works of Soranus of Ephesus. He was the most famous gynaecologist until modern times, and during Europe’s Middle Ages his works were consulted widely. Soranus’ Gynaecology covered everything from pregnancy and labour to childhood illnesses, even listing the qualities required in a good midwife who must be literate with her wits about her . . . sound of limb, robust and according to some endowed of long slim fingers and short nails. . . . She will be unperturbed, unafraid in danger and able to state clearly the reasons for her measures, bringing reassurance to her patients and be sympathetic. . . . She must also keep her hands soft, abstaining from wool working which would make them hard, and she must acquire softness by means of ointments if it is not present naturally.’

  Trained in gynaecology and obstetrics, some midwives were clearly authorities in their own right and wrote on the subject, while the Greek doctor Galen (c. AD 129-210) dedicated his On the Anatomy of the Uterus to a midwife. Later Arabic sources claimed that Galen had even been taught by a female gynaecologist named Cleopatra, and although Galen himself certainly recommended treatments advocated by ‘Cleopatra’, this most likely referred to his use of medical knowledge obtained by those working under the patronage of the monarch to whom they dedicated their work. Nevertheless, Jewish Talmudic texts claimed that Cleopatra VII was actually involved in medical experiments to determine the stages of development of the foetus, no doubt reflecting her tremendous interest in matters concerning her own all-important fertility. Certainly Alexandrian-based Herophilus had identified the ovaries and Fallopian tubes by the early third century BC; and even though the actual process of ovulation and conception remained relatively mysterious, Soranus’ descriptions of the female anatomy were sufficiently accurate to have been based on the dissection of human corpses made possible by the Ptolemies’ patronage.

  Prior to this, the Egyptians had thought the uterus responded to external forces; after the Egyptian god Seth, murderer of Osiris, had threatened Isis and her unborn child during her pregnancy, his name was used in spells to scare the uterus into submission. Presumably influenced by his time with the priests and doctors of Heliopolis, the Greek philosopher Plato likewise believed that the uterus had its own ‘animal-like existence’; even Hippocrates, known as the father of medicine, referred to the ‘wandering womb’ which caused ‘hysteria’, a specifically female condition to be treated by internal fumigation.

  Challenging these earlier ideas, those trained at Alexandria realised that hysteria was based on some form of seizure of the senses, in most cases brought on by recurring miscarriage and premature birth which was the lot of many women in antiquity. Demonstrating a most admirable bedside manner, Soranus therefore recommended laying the patient in a warm room, gently rocking her and massaging her lower body with sweet olive oil, although therapeutic massage had been used in pregnancy in Egypt since at least 1500 BC.

  Having identified the three stages in caring for pregnant women, Soranus stated that to preserve the ‘injected seed’ the woman must avoid stress, shocks, heavy lifting and falling, together with drunkenness, drug taking and malnutrition. Doing everything possible ‘to appease the soul’, he also noticed that some women developed unusual food cravings for charcoal, earth and unripe fruit, and although he advised a careful diet to build up strength for the birth, he warned that ‘one must not pay attention to the popular saying that it is necessary to provide food for two organisms’. In addition to gentle exercise and frequent relaxing baths, he recommended alleviating discomfort by using a broad linen bandage ‘if the bulk of the abdomen is hanging down under its weight’. All this is excellent advice still followed today.

  In preparation for the birth, which invariably took place in the home, the woman would ideally call on the services of a midwife, several attendants and a physician, who in the case of Cleopatra was probably her personal physician Olympus. Perhaps also assisted by her two devoted maids, Charmion and Eiras, she would have bathed, tied up her hair and fastened protective amulets around her neck, forehead or arm in the same way that Isis had prepared for the birth of Horus by ‘fastening an amulet about herself. Soranus himself had no time for such superstition. He nevertheless acknowledged the comforting placebo effect, advising fellow practitioners that ‘one should not forbid their use, for even if the amulet has no direct effect, still through hope it will possibly make the patient more cheerful’.

  Certainly amulets were still popular in Ptolemaic times, many made of haemetite or bloodstone which was believed to prevent excessive blood loss. They featured images of Isis, the knife-wielding hippopotamus goddess Taweret or the ram-headed Khnum, ‘god of the House of Birth who opens the vagina’, but the most popular of all was Bes, ‘greatest god of the womb of women’, whose mass-produced amulets manufactured at the Dendera temple were available for pilgrims to take home. If used with the spell to ‘bring down the womb or placenta to be said four times over a dwarf of clay tied to the woman’s head’, it was guaranteed that the ‘good dwarf himself would attend the birth to combat all dangers. The renowned potency of Egyptian-made birth amulets presumably explains their distribution across the ancient world. One example featured multiple images of Bes and Isis together with a uterus and a key to symbolise its unlocking; it was embellished by a Greek invocation to Seth and the triplicate writing of Jahweh, the one god of the Jews, in a potent blend of Egyptian, Greek and Semitic beliefs familiar in Cleopatra’s Alexandria — yet in this case found as far afield as a Roman villa in Hertfordshire.

  With the woman suitably protected by a host of unseen forces, the initial stage of labour took place in bed. Then, when the midwife had confirmed that the dilation was sufficiently large, the woman would be required to get out of bed and, supported by the midwife’s assistants, take her position on a birthing chair. This replaced the somewhat rudimentary birth bricks upon which Egyptian women had traditionally squatted. With handles at the sides to grip and a back against which to push, an open front gave access to the midwife crouching before the woman, though Soranus advised that she ‘should beware of fixing her gaze steadfastedly on the genitals of the labouring woman, lest being ashamed, her body becomes contracted’. After the woman had been encouraged to ‘make every effort to expel the child’, the baby eventually slid out into the midwife’s hands. Her assistants were on hand with ‘warm water in order to cleanse all parts; sea sponges for sponging off; pieces of wool in order for a woman’s parts to be covered; bandages to swaddle the new born; a pillow to place the newborn infant below the woman until the afterbirth has also been taken care of; and things to smell, such as pennyroyal, apple
and quince’.

  Certainly painkillers had long been available for the wealthy, from a decoction of henbane (Hyoscyamus), a mild narcotic of the belladonna family, to the opium juice or ‘poppy tears’ obtained from the heads of poppies (Papaver somniferum), known to the Greek botanist Dioscorides. The root of the white mandrake boiled in water was also used to make a draught to be drunk ‘before surgical operations and punctures to produce anesthesia’, and it also seems that cannabis (Cannabis sativa) was available. Recommended in ancient Egyptian medical texts in connection with treatments for ‘mothers and children’, cannabis was also used by the Assyrians, Greeks and Romans, its use in obstetrics due to its ‘remarkable power to increase the force of uterine contractions, concomitant with a significant reduction of labour pain’. Quite likely available for Cleopatra to inhale in order to alleviate her first birth, cannabis had certainly been used to ease the excruciating labour of a fourteen-year-old in fourth-century AD Jerusalem. Although her attempts to deliver a full-term foetus through her immature pelvis had ruptured her cervix and caused a fatal haemmorrage; the carbonised drug was found in her burial.

  In different circumstances, the unfortunate girl might have had access to the sophisticated abdominal surgery certainly being performed by the first century BC, when Caesar himself is said to have been delivered this way during his mother Aurelia’s difficult labour. The family name of Caesar was perhaps based on the Latin word for womb, ‘caesus’.

  Such procedures were certainly possible with advances in medical equipment, ‘expertly-made precision instruments’ such as the first-century BC dioptra or bronze speculum used for internal examination. It was much smoother than its Renaissance equivalents, and Alexandria’s medical texts even gave instructions to warm and lubricate such cold metal implements as well as the hands of the practitioner.

  Yet despite every available procedure and painkiller, Cleopatra still faced a labour which may have been complicated by problems both psychological and physical. Had she developed an abnormal pulse and breathing, it was usual practice to lubricate the neck of the uterus with oil or grease; if the child had shifted position, physical manipulation would have been used to prevent a dangerous breach birth. But although Soranus told practitioners that ‘one should do everything gently and without bruising’, some truly horrific instruments were available to extract the child in cases of stillbirth or where the mother’s life was regarded as more important, even if this was not always necessarily the case.

  Traction hooks could be inserted into the foetus to pull it out whole, or hooked knives employed to decapitate and pull it out piece by piece. Soranus preferred to offset such extreme risks to the mother by amputating as the body parts appeared. Then, if the head was too large to come out naturally, a cranioclast made up of metal forceps with jagged teeth, quite similar to its modern equivalent, was used to break and remove the skull.

  Since giving birth was, unsurprisingly, the most dangerous time in a woman’s life, the fact that many married in their early teens when their bodies were simply not equipped to deal with the process expected of them caused many of them to die from ruptures, uterine haemorrhage or infection. The epitaph of one eighteen-year-old Egyptian asked, ‘Who died here? Herois. How and when? Heavy-wombed in pained labour she set down her burden — a mother she was for a moment, but the child died also. Light may the earth be on her, may Osiris bestow cool water.’ In equally moving correspondence to a father, he was told ‘on receiving my letter please be so good as to come home promptly because your poor daughter Herennia has died. And to think she had already come safely through a miscarriage. For she gave birth to a stillborn child in the 8th month, but herself survived 4 days, and only after that did she die ... so if you come and you so wish, you can see her.’ Caesar himself had received such a letter when campaigning in Kent, informing him that his only daughter Julia had died in childbirth and that her baby, his only grandchild, had died a few days later. But in the hot August of 54 BC, both had been cremated before he was able to pay his own last respects. So it must have been with enormous relief to both Caesar and indeed the whole of Egypt that Cleopatra finally gave birth to a healthy child, not only validating her claim to be the ‘Great Mother Isis’, ‘Great Mother of the Gods’, but truly the mother of Horus, for her first-born was a boy.

  Instantly she was transformed into the maternal figure par excellence — the image of Living Isis breast-feeding her new son cannot be underestimated. Yet despite the impact of such massively powerful propaganda, maternal breast-feeding was only recommended after a period of three weeks to allow the mother to regain her strength. Although babies could be bottle-fed using small pots with thistle-shaped strainers, cow’s or goat’s milk could cause fatal diarrhoea or dysentery. Women with sufficient means therefore tended to employ a wet nurse or ‘nutrix’. They were advised to seek out a woman who was healthy, between twenty and forty, with several children of her own and preferably Greek.

  After any birth, both mother and child traditionally remained secluded in the bedroom for seven days, the time when they were most vulnerable to the supernatural forces blamed for high rates of infant mortality — most children were unnamed for at least a week after birth. The incense used by Isis to drive away evil forces following the birth of Horus would also have been burned for Cleopatra, whose surroundings would have been thick with the costliest frankincense, myrrh and pistacia resins to counter all harm.

  Then, on the seventh day, the new mother was traditionally presented with cosmetics and a mirror. Once she was suitably attired, a celebration of thanksgiving would be held and the child named at a special ceremony. So, after the careful attentions of Eiras and Char-mion, a splendidly attired Cleopatra was able to issue the public announcement that a new pharaoh had been born.

  The decree was set up in Egyptian demotic script at Sakkara’s Serapeum, as throughout the country, and this great-great-great-great-great-great-great-great grandson of Ptolemy I was inevitably given the same name, Ptolemaios, to continue the dynasty descended from Alexander’s half-brother. The additional titles ‘Philometor’ and ‘Philopator’, ‘Mother and Father Loving’ in honour of both his parents were also reflected in the Egyptian form of his name, ‘Ptuwlmis djed tuw en ef Kisrs’, ‘Ptolemaios named Caesar’, for Cleopatra was determined that ‘the child’s parentage was not in doubt. He combined Egypt and Rome in his lineage.’ This was something the Alexandrians fully acknowledged when they nicknamed him Caesarion, meaning ‘son of Caesar’ or ‘Little Caesar’, the name by which he is still best known.

  Cleopatra’s production of a son must have been a particularly proud achievement in Caesar’s Roman world, where male children were considered far superior to girls. Announcing the news of his fatherhood to his close associates Gaius Matius and Gaius Oppius, Caesar also began to contemplate plans for a new law which would make it legal for him to have more than one marriage for the purpose of producing an heir — clear evidence of the serious nature of his relationship with Cleopatra and his intentions for their son.

  He issued coinage featuring the head of his ancestor Venus-Aphrodite holding her distinctive sceptre, as well as a series of coins from her Cyprus mint showing Cleopatra as Aphrodite holding the same type of sceptre and nursing her tiny baby. As the coins circulated in the Mediterranean world and announced the news abroad, Cleopatra’s royal decree sent throughout Egypt was followed up by Caesarion’s name and titles being carved upon the walls of key monuments.

  Extraordinary scenes of the birth were completed at her Hermonthis Mammisi, where Cleopatra was portrayed as the goddess helped by female attendants as she gave birth to Horus ‘the Sun Child’, fulfilling the famous inscription in the temple at Sais which stated that Isis would give birth to the sun. Sustained by the potent milk of Isis, Hathor and Rattawy, the Sun Child was also portrayed as the son of Montu the war god in a subtle compliment to Caesar, Montu’s living representative, and, as stated in the accompanying hieroglyphs, in public acknowledgement t
hat he was Caesarion’s father.

  As scenes of Caesarion’s divine birth continued, Cleopatra was then shown alongside Amun-Ra, whose habit of impregnating royal women by assuming the guise of their husbands was well known; the Hermonthis clergy declared that the god had indeed impregnated their living goddess Cleopatra by assuming the form of Caesar. Yet this complex theological motif stressed an even deeper link with Amun, whose role as father of Alexander as well as Caesarion made the child Alexander’s true successor, and like him the bringer of a new golden age.

  The repeated stressing of paternity and ancestry at Hermonthis is also revealed in Cleopatra’s choice of titles. Alongside her epithets ‘Female Horus, the Great One, Lady of the Two Lands’ she was also ‘the Goddess who loves her father’ and ‘Image of her father’, the Egyptian word ‘father’ being interchangeable with ‘ancestor’.

  This connection with previous generations, be they father or great-great ad infinitum dating back millennia, was emphasised in the Mammisi’s very curious architecture, in which Cleopatra had borrowed from tomb design by commissioning a false door. It was built against the wall of the temple’s second room to allow communication with the spirit world, and its presence within her Hermonthis Mammisi suggests the same desire to communicate with the dead as revealed in rites undertaken in Alexandria in the burial chamber of the Soma.

  Although new mothers were not allowed inside any temple during a forty-day period of purification after giving birth, such rules can hardly have applied to Cleopatra as pharaoh, nominal high priest of every temple and living incarnation of the deity herself. Wishing to present lavish offerings once sufficiently recovered, she, like most Egyptian and Greek women, would have offered up clothing and jewellery. These would have ranged from the silver uterus-shaped amulets offered to Great Mother Isis to the decorated textiles presented to Hathor-Isis and Artemis-Eileithyia, honoured with various items of clothing in heartfelt thanks for ‘keeping dreadful death far away when in labour’. Similar relief was expressed by a second-century BC grandmother at the birth of a baby girl: ‘From your mother, greetings. We received the letter from you in which you announce that you have given birth to your child. I kept praying to the gods every day on your behalf. Now that you have escaped, I am spending my days in the greatest joy. I sent you a flask full of olive oil and several pounds of dried figs.’