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Mystery of Herod's death 'solved'

BALTIMORE, Maryland (CNN) -- A physician has suggested a grisly new theory as to what killed King Herod, of biblical fame.

It was chronic kidney disease complicated by a severe infection that led to the rotting of his genitals, said Jan Hirschmann, a clinician at a Veterans' Administration hospital and professor of medicine at the University of Washington.

The condition, known as Fournier's gangrene, was announced Friday after a "historical autopsy" -- an annual event at the Clinico-Pathologic Conference (CPC) organized by the VA and University of Maryland School of Medicine.

In previous years, the conference has explored the deaths of Edgar Allan Poe, Alexander the Great, Beethoven, General George Custer, Pericles, Mozart and Claudius.

This year, the conference organizers asked participants to study different texts that describe the death of a mystery figure from history (who turned out to be King Herod), and come up with an explanation of what killed him.

Herod, King of Judea, also known as Herod the Great, was one of the classic "bad guys" of the Bible. After hearing of the birth of the baby Jesus, called the newborn King of the Jews by the Three Wise Men, Herod tried to kill him off by ordering the so-called "Slaughter of the Innocents," according to the New Testament.

As told in the Gospel of Matthew, Herod ordered the deaths of all male children two years old and younger in Bethlehem and its surrounding districts.

Scholars believe Herod died in the year 4 BC. The Jewish historian Flavius Josephus recorded details of his death, telling of symptoms that included intense itching, intestinal pain, shortness of breath, convulsions, and gangrene of the genitalia. Hirschmann used these texts to make his diagnosis.

It was the itching that tipped him off. First, he compiled a list of diseases that cause intense itching. Then, one by one, he checked to see which of the diseases on that list could cause all of the other symptoms, too. In the end, chronic kidney disease emerged as the most likely diagnosis.

"When I first looked at the general diseases that cause itching, it became clear that most of them couldn't explain a majority of the features of Herod's illness," Hirschmann said. "At first, I considered Hodgkin's disease and some diseases of the liver... . I finally concluded that the most likely explanation was that his chronic kidney disease was complicated by an unusual infection of the male genitalia called Fournier's gangrene."

The gangrene might have been caused by the kidney disease, or possibly by gonorrhea, or, given the itching symptom, he might have just scratched himself raw and gotten the infection that way.

Hirschmann said it is unclear how long Herod suffered from kidney disease, but that once the Fournier's gangrene set in, he probably died within days or weeks.

While it is impossible for anyone to ultimately prove or disprove the new theory, as there are no remains to examine, Hirschmann's study will be submitted at a later date to a medical journal for publication. Previous "historical autopsies" from the CPC have been published in the American Journal of Medicine and the New England Journal of Medicine.


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