The interesting article by Hirschmann et al, titled “Death of an Arabian Jew,”1 brought back fond memories of a sabbatical spent in Israel in 1974. While working as a volunteer at several archeological digs, I had the opportunity to read Josephus, and came upon the description of Herod’s life and death. As a nephrologist, I found it easy to be persuaded at that time that he died of chronic renal failure and was surprised to find that no book in the medical library indicated this. Given the fact that Herod was a very wealthy man and a leader in the Roman Empire, I came up with a possible cause that was not mentioned in the article by Hirschmann et al.1 There had been substantial speculation over the years that exposure to lead contributed to the downfall of the Roman Empire.2- 7 Apparently, only the wealthy could afford the wines that contained lead as a preservative, and the exposure to lead could be substantial.1- 6 The problem of environmental lead exposure and progression of chronic renal disease exists to this day.8 Not only could lead exposure account for the chronic renal failure, it could also have contributed to the central nervous system and gastrointestinal expression of Herod’s illness.
Hollenberg NK. Lead Exposure and Chronic Renal Failure. Arch Intern Med. 2004;164(22):2500–2509. doi:10.1001/archinte.164.22.2507-a