Jan. 25 -- He was a ruthless man who died a miserable death.
More than 2,000 years after Herod the Great succumbed at age 69, doctors have now settled on exactly what killed the king of ancient Judea: chronic kidney disease complicated by a very uncomfortable case of maggot-infested gangrene of the genitals.
The clues to Herod's diagnosis were listed in ancient history books and, according to Jan Hirschmann, the lead diagnosing doctor in the case, included "intense itching, painful intestinal problems, breathlessness, convulsions in every limb and gangrene of the genitals."
Hirschmann, who is a physician at the Veterans Affairs Puget Sounds Health Care System in Washington state, said chronic kidney disease could explain nearly all of Herod's symptoms. However, he said the king's case of gangrene (now a rare condition known as Fournier's gangrene) could not be explained by kidney disease and was "unusual."
Hirschmann suspects one of three conditions likely introduced Fournier's gangrene to the leader's "privy parts." An infection in Herod's abdomen could have spread to his groin and rectal areas (Herod is said to have complained of abdominal pain).
He may have sexually contracted gonorrhea, which could have led to an infection of the urethra — the tube connecting the bladder to the outside world. This infection could have cause urine to leak inside the king's body, spreading bacteria.
Finally, since reports indicate the king "had a terrible desire to scratch himself," this scratching could have introduced gangrene directly into the area.
Records also indicate the swelling at the leader's groin was further wracked by an infestation of worms. Hirschmann says what may have looked like "worms" could have actually been shredded pieces of skin, although, he says there is a possibility they were real.
"There could have been maggots feeding on the tissue," said Philip Mackowiak, chief of the Medical Care Clinical Center at the Veterans Affairs Maryland Healthcare System, who oversees an annual conference at the center to diagnose historical figures. "It's tough to know how long he was suffering but it was probably months, possibly a couple years."