King Herod the Great, the Roman-appointed ruler of Judea, died after a prolonged and gruesome illness that ancient sources describe as producing worms from his genitals. The first-century historian Flavius Josephus recorded the symptoms in vivid detail, and modern physicians have spent decades trying to match those descriptions to a real diagnosis. The best current explanation points to a combination of chronic kidney disease and a flesh-eating infection of the groin, with the “worms” most likely being fly larvae feeding on dying tissue.
What Josephus Actually Described
Nearly everything we know about Herod’s death comes from Josephus, a Jewish-Roman historian writing a few decades after the event. His account reads like a medical case report: Herod suffered a moderate but persistent fever, unbearable itching across his entire body, continuous intestinal pain, swollen feet resembling dropsy (fluid retention), inflammation of the abdomen, and gangrene of his genitals “that engendered worms.” He also had terrible breath, difficulty breathing when sitting upright, and convulsions throughout his body.
The phrase “engendered worms” is the detail that has captured imaginations for two thousand years. In the ancient world, this was sometimes interpreted as divine punishment. But the description is consistent with a real and recognizable medical phenomenon.
What the “Worms” Likely Were
In modern medicine, the infestation of living tissue by fly larvae is called myiasis, a term derived from the ancient Greek word for fly. When tissue dies and begins to rot while still attached to a living person, flies are attracted to the wound and lay eggs. The larvae that hatch feed on the dead tissue, and to an ancient observer, they would look exactly like worms emerging from the body.
This fits Herod’s case precisely. Josephus describes gangrenous, rotting tissue in the genital area. In a warm climate like Judea’s, open necrotic wounds would attract flies within hours. The “worms” were almost certainly maggots.
There is an alternative theory. A condition known in ancient texts as “the lousy disease” (phthiriasis) described intensely itching skin lesions that released swarms of insects, sometimes after being cut open. Researchers have argued this condition was real and potentially lethal, likely caused by a species of mite rather than lice. But the genital gangrene Josephus describes points more strongly toward myiasis in decaying flesh than a parasitic skin disease.
The Medical Diagnosis Behind the Symptoms
Jan Hirschmann, an infectious disease specialist, published the most widely cited modern analysis of Herod’s death. After systematically working through every symptom Josephus recorded, he concluded that chronic kidney disease explained nearly all of them: the fluid retention in Herod’s legs and abdomen, the difficulty breathing, the itching (a hallmark of kidney failure, caused by waste products building up in the blood), the bad breath, and the intestinal pain.
The one symptom kidney disease couldn’t explain was the genital gangrene. For that, Hirschmann pointed to Fournier’s gangrene, an uncommon but life-threatening infection in which bacteria destroy the skin and tissue of the groin and genitals. It progresses rapidly, it’s polymicrobial (meaning multiple types of bacteria work together to destroy tissue), and it overwhelmingly strikes elderly men whose immune systems are compromised. Herod, elderly and already debilitated by organ failure, would have been a textbook candidate. Even today, Fournier’s gangrene carries a mortality rate between 15 and 50 percent depending on how advanced it is at the time of treatment.
A separate theory proposed that a parasitic infection caused by a blood fluke could explain both the kidney failure and the genital symptoms. This parasite can cause chronic damage to the urinary system, eventually leading to fistulas (abnormal openings) in the genital and urinary tract. But Hirschmann’s combination of kidney disease plus Fournier’s gangrene remains the most widely accepted explanation.
Herod’s Desperate Final Treatment
As his condition worsened, Herod traveled across the Jordan River to the hot springs at Callirrhoe, a site known in the ancient world for its healing waters. The trip itself would have been an ordeal for a man struggling to breathe and wracked with pain. His physicians had him bathe in the mineral springs for several days, but nothing improved.
They then tried something more dramatic: lowering his entire body into a large vessel filled with warm oil. The treatment went badly. Herod’s eyes rolled back, and his attendants believed he was dying. The commotion of their panicked cries revived him, but the experience convinced Herod that recovery was no longer possible. He abandoned the springs and returned to his palace in Jericho, where he spent his final days.
When Herod Died
The traditional scholarly consensus places Herod’s death in early 4 BCE, a date established in the 19th century based on Roman consular records and calculations about Jewish sabbatical years. More recent scholarship has challenged this, arguing that multiple lines of evidence point instead to early 1 BCE. The debate remains active, but either date puts Herod’s death within a few years of the period the Gospels associate with the birth of Jesus.
A Death That Repeated in the Family
Herod the Great was not the only Herod described as dying from worms. His grandson, Herod Agrippa I, who ruled Judea roughly four decades later, is described in the Book of Acts as being “eaten by worms and died” after accepting divine honors from a crowd. Josephus recorded a similar account of Agrippa’s death, describing sudden abdominal pain followed by a rapid decline over five days.
Whether the grandson suffered the same medical condition is impossible to know. The “eaten by worms” language carried heavy symbolic weight in the ancient world. It was a standard way of describing the death of a tyrant or blasphemer, a sign that the body was already rotting before the person had finished dying. Ancient writers may have been reporting genuine symptoms, applying a literary convention, or both. In Herod the Great’s case, the sheer clinical detail Josephus provides suggests something real and terrible was happening to his body, whatever theological meaning later readers attached to it.