BALTIMORE, Jan. 25 (UPI) -- Medical researchers believe they have solved the 2,000-year-old mystery of what killed biblical king Herod the Great, whose bloody reign over ancient Judea, the Bible says, included an infamous massacre of infant boys in an attempt to destroy the baby Jesus.
"Herod the Great most likely died from chronic kidney disease, complicated by an unusual infection of the genitals," said medical investigator Jan Hirschmann of the Department of Veterans Affairs in Puget Sound Health Care System in Washington state.
Hirschmann announced his findings Friday at the annual Clinical Pathological Conference in Baltimore. Every year the conference selects a new historical figure for medical scientists to examine, including such notables as Alexander the Great and Ludwig van Beethoven.
"In training physicians, we emphasize the science of medicine so much that we tend to ignore the relationship of medicine to society in general," noted medical professor Philip Mackowiak of the University of Maryland in Baltimore. Such medical detective work "links medicine to art, music, literature and history in a special way that gives the liberal arts greater relevance to clinicians," he said.
Herod was an unpredictable, ruthless leader who ordered the executions of one wife and three sons as well as the anecdotal Slaughter of the Innocents.
"Herod is fascinating because of the complexity of his life and involvement with almost everyone who was anyone at that time -- from Pompey and Julius Caesar through Augustus and Marcus Agrippa -- all the great figures of late first century B.C. history," said religion scholar Peter Richardson of the University of Toronto, who played Herod in full costume onstage at the conference. "He was a very savvy politician and highly influential throughout the Eastern Mediterranean. Even after his death, his influence continued to be felt for hundreds of years."
The Romans named Herod king of Judea in 40 B.C., and from that point on he was the lynchpin of Rome's policy in the east, Richardson explained. He died at age 69 in 4 B.C., with ancient texts indicating the king's last days were plagued by intense itching, painful intestinal problems, convulsions in every limb and gangrene of the genitals.
Scholars in the past speculated Herod died from complications of gonorrhea. Hirschmann said the sexually transmitted disease could not be the sole cause of Herod's death, however, nor could a host of other ailments that cause itching.
"Most of them couldn't explain a majority of the features of Herod's illness," Hirschmann explained.
The investigator found the disorder that accounted for nearly all the features of Herod's illness was chronic kidney disease, when waste products normally excreted in the urine are no longer eliminated in adequate levels.
"Some of the mental changes were clues there -- when he attempted suicide by trying to cut himself with his knife," Hirschmann said in an interview with United Press International. "He was also sort of paranoid and ordered several executions, including that of one of his sons, but then again, he was sort of paranoid before his death, too."
Still, one feature of Herod's illness -- gangrene of the genitalia -- was not explained by that diagnosis. Hirschmann concluded Herod's kidney ailment was complicated by Fournier's gangrene, a rare, massive bacterial infection of the scrotum and penis that rapidly progresses from redness to tissue death, sometimes within hours, due to perforations in the intestines, genitals or urethra.
The tears through which the bacteria entered may have resulted due either to the chronic kidney disease or to Herod scratching himself in an effort to relieve his itching.
"It is a horrible way to go," Hirschmann said. "It certainly makes the men in the audience uncomfortable when I talk about it."
(Reported by Charles Choi in New York.)