title: Lord Byron's death: a case of late malarial relapse?
abstract: The study examines the pathological circumstances related to Byron's death, the primary issue being malaria. Lord Byron died during the Greek War of Independence against the Ottoman Empire, in Messolonghi on 19 April 1824. Byron's medical profile consists of recurrent onsets of fever, which gave rise to the issue of malaria relapses. According to Byron's letters he reported crises of fever in Greece (1810), Malta (1811), Italy (1817-1819) and England. Evidence from Byron's autopsy, specifically the absence of hepatosplenomegaly, does not support a hypothetical diagnosis of malaria. Nonetheless, the relapsing fevers cannot be ignored and the same applies to the possibility of malaria relapse or re-infection in line with the endemic nature of the Messolonghi area. Our research on the chronologies of Byron's reported fevers found that new attacks occurred at intervals of 540 days on average. Moreover, the most outstanding feature of Plasmodium vivax and Plasmodium ovale is their ability to form dormant forms of hypnozoites in the liver which, when reactivated (110-777 days), cause true relapses of clinical disease. Of course, an ex post facto diagnosis is under debate, because the diagnosis is not clinical but microscopic. Byron's example raises alarm over a current medical problem, i.e. the diagnosis of unexplained fevers, and the need for a detailed travel or immigration history, which will include malaria in the differential diagnosis.
authors.affiliation: Department of Microbiology, Medical School, University of Athens, Greece.
authors.forename: Costas
authors.initials: C
authors.lastname: Tsiamis
authors.affiliation: Department of Microbiology, Medical School, University of Athens, Greece.
authors.forename: Evangelia Theophano
authors.initials: ET
authors.lastname: Piperaki
authors.affiliation: Ophthalmology Department, Leeds Teaching Hospitals, NHS Trust, Leeds, UK.
authors.forename: George
authors.initials: G
authors.lastname: Kalantzis
authors.affiliation: Department of History of Medicine, Medical School, University of Athens, Greece.
authors.forename: Effie
authors.initials: E
authors.lastname: Poulakou Rebelakou
authors.affiliation: Department of Political History, Hellenic Army Academy, Athens, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Tompros
authors.affiliation: Department of Hygiene, Epidemiology and Medical Statistics, Athens Medical School, University of Athens, Greece.
authors.forename: Eleni
authors.initials: E
authors.lastname: Thalassinou
authors.affiliation: Department of Forensic Medicine and Toxicology, Athens Medical School, University of Athens, Greece.
authors.forename: Chara
authors.initials: C
authors.lastname: Spilipoulou
authors.affiliation: Department of Microbiology, Medical School, University of Athens, Greece.
authors.forename: Athanassios
authors.initials: A
authors.lastname: Tsakris
mesh_terms: D004739:England; D005197:Famous Persons; D006115:Greece; D049671:History, 18th Century; D049672:History, 19th Century; D006801:Humans; D008288:Malaria / Q000175:diagnosis / Q000266:history*; D008297:Male; D011037:Poetry as Topic / Q000266:history*; D011057:Politics; D012008:Recurrence; D014195:Travel / Q000266:history; D014857:Warfare