Elizabeth Barrett Browning's illness deciphered after 150 years

Known for her poetry, letters, love affair and marriage to Robert Browning, Elizabeth Barrett Browning also left a legacy of unanswered questions about her lifelong chronic illness. Now, a Penn State anthropologist, with the aid of her daughter, may have unraveled the mystery.

Born in 1806, Barrett Browning suffered throughout her life from incapacitating weakness, heart palpitations, intense response to heat and cold, intense response to illnesses as mild as a cold, and general exhaustion in bouts that lasted from days to months or years. Her doctors were unable to diagnose or treat her illness, which apparently first appeared around age 13.

"Conjectures by modern biographers about Barrett Browning's condition include anorexia nervosa, neurasthenia; tuberculosis; pertussis, an encephalomyelitis; non-paralytic poliomyelitis; paralytic scoliosis, or the lifetime effects of injuries to her spine from falling from her horse in early adolescence; opium addiction; and mental illness, including anxiety and agoraphobia," Anne Buchanan, research associate in anthropology, reports in the current issue of Perspectives in Biology and Medicine.

Some even attribute her illness to defense against the inferior status and treatment of Victorian women, or simply to malingering.

Ellen Buchanan Weiss, Buchanan's daughter, noted the symptoms recorded in Barrett Browning's letters because the symptoms seemed so similar to those that she experienced. Buchanan Weiss has hypokalemic periodic paralysis (HKPP), a muscle disorder that causes blood levels of potassium to fall because potassium becomes trapped in muscle cells. The disorder was first described in 1874 in German and then in 1901 in English. Barrett Browning died in 1861, long before physicians would have any idea of HKPP.

Today, oral or intravenous potassium can prevent or stop an attack, but there is no cure for the disorder, which may be genetic, either inherited or caused by a sporadic mutation. According to Buchanan, there is slight evidence of an uncle in Barrett Browning's family who may have suffered the same symptoms. While Elizabeth and Robert did have a son, he apparently had no offspring so there are no living descendants.

A variety of triggers can initiate weakness for people with a periodic paralysis, says Buchanan. Common triggers for people with HKPP include anything that increases secretion of insulin -- alcohol, hunger or high carbohydrate foods -- table salt, excessive heat or cold, sudden temperature change, illness, sleep, exercise or some medications. Symptoms of HKPP generally first appear at puberty.

Barrett Browning's first bout occurred after a minor illness, which was followed by measles. Her health continued to decline, and although physicians were unable to diagnose her malady, one prescribed opium to which she became addicted for life. This illness lasted for more than a year and at times she was so weak she could not sit upright without support.

Barrett Browning writes in the diary that she kept during her 25th year of other triggers for her ailment. She notes becoming weak after eating a generous portion of honey, a substance that would increase insulin production. She reports an episode that followed an outing where she ran down a hill, was rained upon and thoroughly soaked.

Throughout her life, she suffered terribly during the cold damp winters in England, especially in London, and only found some relief after marrying Robert Browning and escaping to the warmer, milder climate of Italy.

Other incidents in her life that she recorded include suffering terribly after a day of religious fasting. Hunger is a strong HKPP trigger. Her letters to Browning, her 25th year diary and other letters to friends and relatives describe not only the symptoms of her disease, which mirror those of HKPP suffers and Buchanan Weiss specifically, but also a list of triggers that are now known to be specific triggers for HKPP.

After two years of declining health, Barrett Browning died on June 29, 1861, in Browning's arms.

Buchanan notes that "many others have read these same descriptions, looking for clues to her illness, but my daughter's experience with HKPP has given us a perhaps unique lens through which to view them."

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