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What Disease Killed King Herod?

Bijal P. Trivedi
National Geographic Today
January 28, 2002
 
The life of Herod the Great—king of ancient Judea—was the
stuff of legend, but the cause of his grisly death more than 2,000
years ago has been a mystery.

Now, after studying ancient
accounts of Herod's death, Jan Hirschmann, a physician at the
University of Washington School of Medicine in Seattle, thinks the king
probably died of chronic kidney disease, complicated by a particularly
nasty case of gangrene.


Hirschmann revealed his findings last week at the Historical Clinical Pathology Conference, held at a University of Maryland medical center in Baltimore.

Herod (B.C. 73–B.C. 4) was a friend of the Emperor Augustus and knew Julius Caesar and Mark Anthony. Among his considerable achievements, he built the largest artificial harbor in the Mediterranean area.

Some of his actions were much less glorious: He executed one of his 10 wives and three of his 14 children, and might have ordered the infamous Slaughter of the Innocents in his quest to kill the baby Jesus.

Hirschmann's diagnosis was based on accounts written by biographer Flavius Josephus, who lived 75 to 100 years after Herod. Josephus had consulted the writings of Herod's court historian, Nicholas of Damascus.

Josephus wrote: "He had a fever, though not a raging fever, an intolerable itching of the whole skin, continuous pains in the intestines, tumors of the feet as in dropsy, inflamation of the abdomen, and gangrene of the privy parts."

According to Josephus, Herod also suffered from asthma, limb convulsions, and foul breath.

Other people have proposed that Herod had died of gonorrhea. Hirschman disagreed. He concluded that the string of symptoms, with the exception of genital gangrene, were more consistent with chronic kidney disease.

Faced with "no diagnostic epiphanies," Hirschmann said he decided to focus on the symptom of itching. "There are very few diseases that cause itching," he explained, adding that he narrowed the list of likely causes to fewer than ten. Among the possible causes were hypo- and hyper-thyroidism and Hodgkin's disease.

The confounding factor that muddied the investigation was Josephus' report of genital gangrene as one of Herod's symptoms. Hirschmann concluded that this was caused by a rare infection of the male genitalia, called Fournier's gangrene.

Now in its eighth year, the Historical Clinical Pathologic Conference reexamines the death of a famous person from the past who died from causes that have not been fully explained. Every year an anonymous clinical and personal history is released to the medical community and assigned to a specific discussant whose job is to figure out who the person was and the cause of death.

Previous subjects have been Edgar Allen Poe, Alexander the Great, Beethoven, Mozart, Pericles, Claudius, and General George Custer.

According to historical records, Herod sought many remedies for his excruciating ailment, from soaking in warm baths at Callirrhoe to sitting in a tub of hot oil.

"If we take some time to understand the history of medicine, we learn humility," said Philip Mackowiak of the University of Maryland School of Medicine and the U.S. Veterans Administration's Maryland Health Care System. "We think the medicine we are practicing today is the [best] medicine and that future generations will marvel at our intelligence. History teaches you that this just isn't so. What we recommend to patients today might be viewed as preposterous" by future generations.

At the conference, Herod the Great was "interviewed" in the persona of Herod scholar Peter Richardson of the University of Toronto, who donned a gold and emerald green gown and a jeweled crown for the occasion.

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