More than 2,000 years after his death, medical detective work has revealed what most likely killed Herod the Great. According to the Bible, the tyrannical ruler of ancient Judea ordered numerous executions during his reignincluding those of countless newborn males during the infamous Slaughter of the Innocentsbut the cause of his own demise has long eluded scholars. The new findings, presented last Friday at the historical Clinical Pathological Conference in Baltimore, suggest that he succumbed to a combination of chronic kidney disease and an unusual genital infection.

Written accounts of Herod's last days indicate that the king suffered from respiratory and intestinal problems, severe itching, widespread convulsions and gangrene of the genitalia. Earlier diagnoses had pointed to gonorrhea, but when Jan Hirschmann of the University of Washington considered the symptoms, he found them to be most compatible with chronic kidney disease. Only one symptomgangrene of the genitaliadid not fit with that assessment. Taking that into account, Hirschmann says he "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 King Herod diagnosis is the latest in a series of case studies of prominent historical figures discussed at the annual conference. Previous subjects include Edgar Allan Poe, Alexander the Great and Wolfgang Amadeus Mozart.