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King Herod's Swan Song

Symptoms in final days suggest gonorrhea didn't kill him

FRIDAY, Jan. 25, 2002 (HealthDayNews) -- In the days before his death, a 69-year-old man went to healers with low-grade fever, fluid buildup, abdominal pain, hunger pangs, bad breath (and shortness of it), inability to stand, convulsions, itching, and, according to one source, "gangrene of his privy parts, engendering worms."

The patient: Herod the Great. The diagnosis: In a dose of armchair medical history, a University of Washington doctor says Herod succumbed not to gonorrhea, as has commonly thought, but to chronic kidney failure and a wicked genital infection.

Herod, king of Judea during the first century B.C., was a third-generation Jew with Arab bloodlines appointed by the Romans (Judea was a "client state" of the Empire) and hated by his own people. The gospel of Matthew claims Herod ordered the slaying of all first-born males to prevent the birth of Jesus, a charge that has never been verified and is now considered by many to be self-serving and historically inaccurate. However, the king did have two of his sons executed shortly before he died in 4 B.C., which highlighted his penchant for brutality.

Historians have asserted that Herod, born in 73 B.C., died of a sexual infection (he married 11 times to 10 wives, and most probably had a hearty carnal appetite). However, for Dr. Jan Hirschmann, that diagnosis was unsatisfactory.

"It's seems like every major figure who has died of unexplained causes died of gonorrhea," says Hirschmann, who was to present his analysis today at an annual medical history meeting in Baltimore.

True, the bacterial infection (or even syphilis) is a reasonable guess, considering it appears to have earned mention in the Old Testament book of Leviticus and was known to the ancients. Yet, after reviewing Herod's symptoms, Hirschmann reached a different conclusion.

The historian Josephus, writing well after Herod's death, offered the portrait of the king's ailments above. Hirschmann says those symptoms more closely match chronic kidney disease complicated by a condition called Fournier's gangrene -- a genital infection in which bacteria from elsewhere in the body manage to enter the penis.

For Hirschmann, the royal's insatiable groin itching, described so vividly by Josephus, was the likely source of those germs.

"He could have scratched it enough to let bacteria get into" the genital bloodstream, Hirschmann says.

Herod biographer Peter Richardson, a University of Toronto religion expert, says he used to believe his subject died of raging syphilis. However, Richardson, author of Herod: King of the Jews and Friend of the Romans, says Hirschmann's new diagnosis makes sense.

"This seems to me to be a much more interesting diagnosis, and likely to be correct. I hope I may be able to change it in the next edition of my book," he says.

In the meantime, Richardson and a fellow classicist will share the dais today to discuss the life of King Herod at the Clinical Pathologic Conference after Hirschmann's lecture.

Begun in 1995, the meeting has revisited the deaths of several noted figures, including General Custer, Alexander the Great, Mozart, Beethoven and Edgar Allan Poe.

Dr. Philip A. Mackowiak, director of the medical care clinical center at the VA Maryland Health Care System in Baltimore, hosts the annual conference with the University of Maryland. He says the popular meeting packs a 300-seat auditorium with doctors, historians, medical students and other listeners.

The format is as follows: Physician attendees are issued an anonymous case history, chosen by Mackowiak, before the event, and come in blindly about who the patient is or when he lived. The presenter, in this case Hirschmann, then makes his diagnosis. Finally, historians help flesh out the patient's life.

While this routine sounds a few steps removed from conventional medical conferences and deals mostly in arcana, Mackowiak says it serves a purpose: "It teaches [participants] about the history of medicine. If one has an appreciation for where we've been, one will have a better appreciation for where we are and where we might be in the future." It can also add important artistic and social dimensions to the practice of medicine.

So, as the organizer of the conference does Mackowiak always endorse his presenters' conclusions? The short answer is no. One scientist recently proposed that Mozart died of acute rheumatic fever rather than the kidney failure biographers have blamed for the composer's death.

"I didn't agree," says Mackowiak, who is putting together a book on the lectures. "I thought that an acute renal disease as opposed to a cardiac illness was much more likely."

What To Do

Try this site for more on the life of King Herod.

To learn more about kidney failure, check out the National Library of Medicine's MEDLINEplus or the National Kidney Foundation.

SOURCES: Interviews with Jan Hirschmann, M.D., staff physician, VA Puget Sound Health Care System, and professor, medicine, University of Washington School of Medicine, Seattle; Peter Richardson, professor emeritus, department for the study of religion, University of Toronto, Canada; Philip A. Mackowiak, M.D., director, medical care clinical center, VA Maryland Health Care System, Baltimore
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