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ARTICLE VIII.

THE DEATHS OF ANTIOCHUS IV., HEROD THE GREAT, AND HEROD AGRIPPA I.

BY EDWARD M. MERRINS, M.D.

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BOTH in sacred and profane literature it is recorded that, during the last illness of various eminent persons, the fatal issue was accelerated, and the circumstances of death made extremely repulsive, by parasites infesting the body to such an extent as to give the impression to the beholders, that the unfortunate patient was being literally devoured up with worms. A familiar instance is the death of Herod Agrippa as narrated in the Acts of the Apostles, and the closing scenes in the lives of Antiochus Epiphanes and Herod the Great were even more distressing from the same cause. As all three kings were guilty of blasphemous impiety, it has been assumed by some commentators, that "he was eaten of worms is simply a picturesque phrase, without any foundation of actual fact beneath it, which has been added to the narrative to intensify the description of the horror and pain of the death, considered to have fallen upon the offenders as the just punishment for their particular sin. There is nothing intrinsically improbable, however, in a single detail of these narratives; on the contrary, the clinical observations, as far as they go, are so accurate as to enable us practically to identify the

1 Acts xii. 20-23.

21 Macc. vi. 4, 8; 2 Macc. ix.; Josephus, Antiquities of the Jews, xii. 9; but see Polybius, xxxi. II.

8 Josephus, Antiq. xvii. 6; Jewish Wars, i. 33.

particular disease and its complications, from which each of these royal patients suffered, and it is quite certain that parasites of various kinds, either directly or indirectly, have been the cause of many deaths. The only doubt and difficulty lie in determining precisely the creature that is meant by "worm," a term which is as indefinite in Hebrew and Greek as it is in English. Three words are translated worm" in the Old Testament:

1. Hebr., Sâs; Gk., oýs.

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This denotes the larvæ of moths, found in clothes, tapestries, and carpets: "For the moth shall eat them up like a garment, and the worm shall eat them like wool" (Isa. li. 8: see, also, Job iv. 19; xxvii. 18; Isa. i. 9).

2. Hebr., Rimmah; Gk., σαπρία, σῆψις.

3. Hebr., Tôle'ah; Gk., σкóλNĘ.

These two words appear to be synonymous, and denote:(1) A species of caterpillar probably, as in Jonah iv. 7: "God prepared a worm when the morning rose next day, and it smote the gourd."

(2) The larvæ of moths and weevils which devour vegetation; e.g., grapes 1 (Deut. xxviii. 39); manna (Ex. xvi. 24).

(3) The crimson dye-stuff consisting of the dried bodies. of cochineal insects (Isa. i. 18).

(4) The creeping things that burrow in the earth: hence applied to man in a depreciatory sense (Job xxv. 6; Ps. xxii. 6; Isa. xli. 14).

1The vine-weevil; the convolvulus of Pliny (Nat. Hist. xvii. 47) and Cato (De Re Rustica, chap. xcv.), who prescribe elaborate precautions against its ravages. Plautus (Cistell. iv. 2) calls it involvulus. Bochart (Hieroz. Part ii. lib. iv. chap. 27) identifies this worm with that called or by the Greeks. [Note in Speaker's Commentary.] But the enemies of the vine, consisting of insects and parasitic fungi, are very numerous. Of the former there are at least thirty two species.

(5) Parasitic creatures which infest living beings, as in Job vii. 5; "My flesh is clothed in worms and clods of dust; my skin is broken and become loathsome." It is most reasonable to suppose that reference is here made to the small worms or maggots, the larvæ of various insects, often found on ulcers and sores, where there is a lack of proper care and cleanliness. The writer well remembers a patient coming to a hospital in Jersey City with a large ulcer of the leg, the dressing of which had not been changed for several days. On removing the soiled bandages, the leg was seen to be swarming with maggots to such a degree as to arouse the amazement and disgust of all who were present. In Eastern countries, where the dogs come and lick the neglected sores of every Lazarus, this condition must always have been very common. A high authority on this subject writes: "In the heat of summer and in hot climates, the larvæ easily get into badly managed, putrid, and open wounds. Nay, even the short time occupied in dressing the wound is sufficient to enable the fly to deposit her brood in it, if particular care be not taken.” 1 Herodotus, in speaking of the mother of Arcesilaus being destroyed by worms, uses the word evλn which certainly denotes the worms or maggots bred in decaying flesh, whatever else it may mean.

(6) The larvæ, or maggots, which appear in the dead bodies of animals and men,-those "laborers of death," as they have been strikingly called,—that perform the beneficent work of ridding the earth of all decaying and dead organic substances. "When a man is dead," says the son of Sirach, "he shall inherit creeping things, beasts and worms." 3 Το the same effect, and with the implication that the laborers 1 Kuchenmeister, Manual of Parasites, ii. 98. Hist. iv. 205.

Ecclus. x. II.

find pleasure in their work, Job affirms that "the worm shall sweetly feed on him." In another passage in the Old Testament it is said of those who transgress against the Lord: "Their worm shall not die, neither shall their fire be quenched; and they shall be an abhorring unto all flesh." Here the slowly devouring worm becomes a symbol of eternal punishment, and is so used in the New Testament, where the Hebrew word is translated into the Greek, skoler. This in turn, translated into Latin, becomes lumbricus, which is also the translation of the Greek, xvs.

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But the question as to what kind of creature is meant by worm," cannot be satisfactorily settled in every instance by etymological or other scholastic considerations. The identification must be made by working backward from our knowledge of the parasites which we positively know infest the human body at the present time, and by assuming, as we safely may of nearly all our diseases and infirmities, that matters in this respect were very much the same thousands of years ago as they are to-day.

The most common of these parasites are the following:1. Ascaris lumbricoides, or round worm.-These worms resemble the common earthworm in appearance, their length varying from one to nine inches. They are found in the inhabitants of every land, and are so common in hot countries that scarcely a single individual is free from them. Sometimes they are present to an incredible degree, not simply by tens and hundreds, but by thousands. Their usual habitat is the small intestine, but they may wander to almost any part

1 Job xxiv. 20; see also, xvii. 14; xxi. 26; Isa. xiv. 11. 2 Isa. Ixvi. 24.

Mark ix. 48.

Allbutt's System of Medicine, ii. 1033, and see account in Memphis Medical Monthly, March, 1904, of a baby in this country passing 1,992 in two weeks.

of the human body, and occasion very serious ailments. They have been known to set up fatal peritonitis by perforating the walls of the intestines, and multitudes have died from common complaints, who would certainly have recovered, if it had not been for these parasites.1

2. Tapeworms.-Of these there are several species which take up their abode in man. They are long, flat, ribbon-like worms, several feet in length. The "scolex," comprising the head and neck, is very small. Springing from it are the innumerable segments of the body, each of which may be regarded as possessing independent life. On reaching maturity, these segments break off in ones or twos, or in strings, and leave the body of the host. They are easily recognized as white, oblong bodies, capable of active movements.

These parasites, especially the beef tapeworm, are extremely common in Egypt, a writer recently stating that a cadaver is seldom opened in that country without finding specimens of one or more of them. Many of those who entertain these ugly visitors suffer no inconvenience, but generally there are symptoms of impaired digestion and irritability of the nervous system. The segments of these worms may appear in abdominal wounds. To illustrate the broad view that must be taken of maladies described by the Oriental events of antiquity, an Arab writer relates of one of his patients, that "God tried him with a disagreeable disorder called Chabb al-kar, which consists in a worm fixing itself at an issue of the body, which gnawed the intes

1In an article published in the Indian Medical Gazette, April, 1904, on intestinal parasites as factors in the mortality of prisoners confined in the gaols of Hindustan, the author tells how he has saved hundreds of lives, reducing the death-rate per mille from 76.65 to 12.49 solely by the use of anthelmintics directed especially against the ascaris lumbricoides; and he urges that "the sickness and mortality produced by this parasite ought to be impressed on the people at large."

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