King Herod painting Courtesy ArtToday

Historians remember King Herod as brutal, unpredictable and paranoid. With his many sons and wives involved in a bitter rivalry for his throne, he ordered the executions of one wife, three sons and a brother-in-law. In a vain effort to destroy the infant Jesus, he is reputed to have ordered the slaughter of all boys in and around Bethlehem under age two.

It is no wonder that Jews celebrated when this demon of discord died at age 69.

And a particularly nasty death it was. The ancient Jewish historian Josephus described the symptoms of the illness that killed Herod, intense itching, painful intestinal problems, breathlessness, convulsions in every limb, and gangrene of the genitalia.

Past notions speculated that Herod died from complications of the sexually transmitted disease gonorrhea. But University of Washington medical professor Jan Hirschmann says the symptoms argue for a different diagnosis. "A handful of different diseases emerged and the one that seemed most convincing in explaining the other features of this disease was chronic kidney disease," he says.

Dr. Hirschmann says the answer is not obvious. Several diseases that cause itching did not include most of the other symptoms. When he found that chronic kidney disease did, he was still baffled because it could not immediately explain the genital gangrene.

But deeper research showed that the kidney ailment could relate to a genital infection in several ways. Dr. Hirschmann offers one example. "Since one of the major features of Herod's disease was itching, it's conceivable that vigorous scratching could have caused an infection in that area and that would have led to gangrene," he says.

Dr. Hirschmann undertook the diagnosis of King Herod at the invitation of University of Maryland medical professor Philip Mackowiak, who for the past eight years has held an annual clinical conference in Baltimore examining why famous historical figures died. "I'm prejudiced," he says. "I love history and I think it's important."

Past conferences diagnosed the deaths of such notables as the composers Mozart from rheumatic fever and Beethoven from syphilis, the Roman Emperor Claudius from mushroom poisoning at the hands of his wife, and the American writer Edgar Allen Poe from rabies, not alcoholism as previously thought. "They immerse our doctors and our student doctors in the social milieu in a different way than most other things we do in our training programs," he says.

The event is an outgrowth of a standard exercise in medical institutions where physicians and medical students sharpen their diagnostic skills by analyzing symptoms and coming up with a diagnosis.

Dr. Mackowiak combines the standard presentation of symptoms and diagnosis to the medical professionals with something out of the ordinary. Actors portray the historical figures. And, in the case of Mozart and Beethoven, musicians perform their music. This month, the doctors watched a leading Herod scholar, Peter Richardson, play the king in front of an elaborate set depicting the temple Herod built in Jerusalem. "It teaches them the relevance of art and music and literature and history to life in general and medicine in particular," says Dr. Mackowiak. "In addition to that, it teaches them the history of medicine. If we understand where we come from, we should have a better appreciation not only of where we are today, but where we might be tomorrow."

Dr. Jan Hirschmann, the physician who conducted this year's diagnosis of King Herod, says the historical perspective the conference offers is interesting for another, more scientific reason. "The thing is to try to see the ways in which diseases that we currently recognize were present in the past and whether they resemble what we see nowadays or whether they are quite different," he says.