Elephants have no knee joints, so if they fall down they cannot get up again. To avoid falling, the elephant leans against a tree while it sleeps. To capture an elephant, a hunter can cut part way through a tree; when the elephant leans against it, the tree breaks and the elephant falls. Unable to rise, the beast cries out, and a large elephant tries to lift it up, but fails. In some accounts, twelve elephants next attempt to lift it, and also fail. Finally a small elephant comes and succeeds in raising the fallen one.

The idea that elephants have no knee joints may be a misunderstanding of, or a conflation with, an account of the elk in Caesar's Commentaries on the Gallic and Civil Wars, repeated by Pliny (see Sources).

Male elephants are reluctant to mate, so when the female wants children, she and the male travel to the East, near Paradise, where the mandrake grows. The female elephant eats some mandrake, and then gives some to the male; they mate and the female immediately conceives. The female remains pregnant for two years, and can only give birth once. When it is time to give birth, the female wades into a pool up to her belly and gives birth there. If she gave birth on land, the elephant's enemy the dragon would devour the baby. To make sure the dragon cannot attack, the male elephant stands guard and tramples the dragon if it approaches the pool.

The elephant's life span is three hundred years. They travel in herds, are afraid of mice, and courteously salute men in whatever way they can. They once lived in both in Africa and India, but now only live in India.

Persian and Indian soldiers build wooden towers on the back of elephants and fight from there.

The elephant and its mate represent Adam and Eve. When they were still without sin in the Garden of Eden, they did not mate, but when the dragon seduced them and Eve ate the fruit of the tree and gave some to Adam, they were forced to leave Paradise and enter the world, which was like a turbulent lake of pleasures and passions. The elephants mated and she conceived, and "gave birth on the waters of guilt." The big elephant represents the law, which could not raise up mankind from sin, nor could the twelve elephants, which represent the prophets. Christ is the small elephant who succeeded to raising the fallen. The burning skin and bones of the elephant represent the commandments of God, which allow nothing evil to enter the pure soul.

There are several common illustrations of the elephant to show its various aspects.

• Elephant and castle: The elephant is shown carrying a "castle", which can be anything from a simple platform to an actual stone castle.
• Giving birth in water: Usually the female elephant is shown standing in water with the baby elephant below her or nearby. Often the male elephant is standing guard on shore, with a dragon menacing the mother and child.
• Fighting a dragon: The elephant is shown with a dragon wrapping its coils around it.

If the skin or bones of an elephant are burned, the smoke will drive out serpents.

Albertus Magnus says that elephant meat and manure is useful in medicine. A chronic cough can be cured by sipping a broth made from elephant meat, water, salt and fennel seeds; dried elephant bile placed in the nostrils helps prevent epileptic seizures; an infestation with lice, can be relieved by smearing the body with fresh elephant manure and leaving it on until it dries; elephant lard rubbed on the scalp will cure a headache; pulverized elephant bone mixed with mint and given in a drink will help prevent infection with leprosy; fumigation by burning dried elephant dung will cause mosquitoes to flee.

Hildegard von Bingen says, "One who ails in his lungs, so that he coughs and is congested, should heat the bone of an elephant in the sun and shave some of it into wine. He should cook it in a little dish, then strain it through a cloth, and discard the powder. He should drink that wine often, and he will be cured. The heart of an elephant and its liver, lungs, and other parts are not valuable as medicine." (Throop translation)

While elephants with actual castles on their backs is highly improbable, elephants were used to carry a platform or carriage called a howdah, which could sometimes be quite large and elaborate. The elephant and castle motif is likely an exaggeration of traveler's tale of seeing a howdah.