By Manny Frishberg, JTNews Correspondent
Herod the Great, who ruled as King of Judea beginning about a century after Judah the Maccabee made his treaty with Rome, was almost certainly an unhappy man. Not only did he order the deaths of his first wife and a number of his own children, but, at least for the last few of his 69 years, he was consumed by a terrible itching all over his body, a low-grade fever, abdominal pain, convulsions in his limbs and gangrene in his privates. Some accounts say that Herod also became even more murderous at the end, but it is hard to say, based on the history of his rule, whether that was a symptom of his illness or not.
To Dr. Jan Hirschmann the array of symptoms was like a puzzle to be solved. This January he presented his conclusion at an annual conference in Baltimore, Maryland’s VA Hospital that the tyrant king who built the fortress at Massada and raised the Temple Mount in Jerusalem to its present size probably died of chronic kidney disease.
Hirschmann, an infectious disease specialist at the Seattle Veterans Administration Hospital and a professor at the University of Washington Medical School, said he based his conclusions on the only existing account of Herod’s death, written by the Jewish historian Flavius Josephus about 70 years later.
“The discussant is given a case with just the information about the medical history and is asked to figure out, based on the information given, what the diagnosis is,” Hirschmann explained. “We do this at the VA as a routine in current cases and this person at the Baltimore VA [Dr. Phillip Mackowiak] decided it would be interesting to do it with historical figures, rather than current patients.” Over the past several years, the VA has explored the diseases and deaths of Mozart and Beethoven, Claudius and Alexander the Great, among others.
“When I started reading about him,” Hirschmann said of the king, “I didn’t have much interest in him and when I was reading Flavius Josephus, it was primarily for the medical information rather than for the historical information.” For that matter, he said he had not really started out with a great interest in historical medical mysteries at all.
Yet this talk, the eighth one given at the Baltimore VA facility, was Hirschmann’s second foray into diagnosing the cause-of-death of a notable person from the past. He was first drawn into it by a friend who, he said, is both a musician and a doctor, who was puzzled by the predominant theories about what had killed Wolfgang Amadeus Mozart.
“Having read a great deal about Mozart and his life and death,” Hirschmann said, “he found [the existing theories] unconvincing, but couldn’t figure out an alternative diagnosis. He asked me if I would give a talk on this. I didn’t have any particular interest in Mozart or his music, either.” That talk, two years ago, led to Mackowiak inviting him to look into Herod’s medical history, with only a case history to go on.
“When I was given the information about Herod’s death I wasn’t given the fact that it was Herod. I was just given the case history of a 69-year-old man that had so-and-so problems. I had two tasks — one was to figure out who it was and the second was to figure out, given the information available, what the most likely cause of his illness and death were. After I figured out who the person was — and it was pretty clear after reading a little bit about the case history that it was some biblical character — it was pretty easy to figure out that it was Herod the Great,” Hirschmann said.
“The way I approached this problem is what we do in medicine when we’re faced with a difficult diagnosis — that is, to list the features of the illness,” he said. “Then, if it’s not obvious from just the list of things — and sometimes it is, but in this case it wasn’t — the next best step is to pick one of those features, preferably one that has just a few causes, and look through the different causes that are responsible for that feature of the illness” for one that can explain the rest of the symptoms.
In Herod’s case, he said, the defining feature was the itching, which was quite severe and all over his body. Not many diseases are associated with that sort of systemic itch and none other than kidney disease was associated with so many of the other symptoms Josephus had described.
The only one that did not fall right into place was “the gangrene of his privvy parts.” Even that had possible explanations related to the kidney disease, including a possible perforation of his intestines, an infection moving down from the kidneys themselves, or even a wound caused by intense scratching. Hirschmann said that with only Flavius Josephus’s accounts to go on, he could not reach a definite conclusion about which of the alternatives may have been responsible.
At the conference, the 57-year-old doctor gained a new appreciation of the man thanks to Peter Richardson, a biographer of Herod I from the University of Toronto who portrayed him in a question-and-answer session at the conference.
“I came away with a much greater appreciation of Herod than I had before,” Hirschmann said. “For most of his regime, he seemed to be a very astute, generous, vigorous leader, who did a lot of good things including not only the building program but help during periods of economic downturns.”
Having now taken on the role of historical medical detective in two cases, Hirschmann said he has found the process interesting enough to consider doing more in the future. And as for Mozart, Hirschmann thinks he probably died from trichinosis, possibly after eating some infected pork chops that he referred to in a letter to his wife.