Eclampsia strikes Downton Abbey

Eclampsia isn’t a word that easily rolls off most people’s lips. Unless of course you saw the most recent episode of the British period drama, Downtown Abbey, in which a major, beloved character died from eclampsia shortly after giving birth. Downton Abbey’s portrayal of eclampsia was, to my knowledge, very accurate. It was also vivid and very heart-breaking, especially when this death could have(supposedly) been prevented if Sybil was taken to hospital. Although I did not cry, some friends of mine who are big fans of the program cried for several minutes straight and are still teary-eyed.

Sybil100

Lady Sybil Crawley

Since I am not a huge fan, I’ve missed a few episodes here and there. That said, Sybil was my favorite of the 3 aristocratic Crawley sisters. She was the most free-spirited and a strong supporter of women’s rights in a society that was still very sexist and patriarchal. She also wasn’t a snob, in a very classist society, in spite of her upper class English upbringing, exemplified by her marrying the family’s Irish Catholic revolutionary chauffeur(talk about a mixed marriage!). All this made her easy to identify with, except to misogynistic snobs, so her death was a huge loss for the show.

I don’t want to get too bogged down in the details, but basically, her father, Robert Crawley(Earl of Grantham) comes off looking sort of like a villain now, even though he didn’t kill anyone on purpose(some Anglophile friends of mine who are fans of the show want to run over to England to kill him). Although they already had a highly-qualified family doctor, Dr Richard Clarkson(who has made a few mistakes here and there, none resulting in any deaths to my knowledge, though some may dispute this) to deliver the baby, her father, the Earl of Grantham, decided to bring in a more aristocratic yes-man kind of doctor to take care of his daughter. This new doctor effectively overruled Dr Clarkson who believed Sybil needed to be taken to hospital due to her pre-eclampsia.

The new doctor that everyone now loathes didn’t think the symptoms were a big deal, and, sadly, convinced Sybil’s father that they weren’t a big deal. As said before, Sybil eventually died from eclampsia, a rare though often fatal complication of pregnancy. It causes terrible seizures and the complete disruption of breathing, resulting in coma and death. We still don’t know for sure what causes this terrible condition.

The merits of this turn of events on the story that is Downtown Abbey isn’t the point of this post, but the disease of eclampsia is. It seems a lot of people blame her father, Lord Grantham, for Sybil’s death, for ignoring Dr Clarkson’s concerns and not taking his daughter to hospital. Yet, that just as easily could have killed Sybil, due to the primitive state of medicine in 1920. Modern scientific medicine was in its infancy, antibiotics were not available and surgical instruments weren’t properly sterilized, at least according to today’s standards. Even today, many people die due to medical errors in hospitals, though medical care has drastically improved since the 1920s.

Could Lady Sybil have been saved? I honestly do not know, as I am not a doctor, or medical historian, but I am very much fascinated by the subject. Based on my readings, a C-section done early enough could have possibly saved her, so long as the hospital conditions and surgical instruments didn’t give her a terrible illness. As said before, this was a risky procedure back then. Another possibility is intravenous magnesium sulfate, which had just been recently introduced as a treatment for pre-eclampsia.

I am not sure if it was widely available as a treatment in England at the time, but it should have been, since magnesium sulfate is better known to the world as Epsom Salt. The town of Epsom, near Surrey, has a spring that is rich in magnesium sulfate(hence the name) and wasn’t too far from Downton Abbey(which was in northern England). Another town where magnesium sulfate occurs plentifully is Magnesia, in Greece. This common laxative sure has an interesting history. According to: A Historical Overview of Preeclampsia-Eclampsia

In addition to the diverse approaches to manage preeclampsia-eclampsia in the 20th century, the use of magnesium sulfate was introduced. Although a mainstay of current treatment, it was not until 1906 that Horn first used magnesium sulfate to manage preeclampsia-eclampsia (Chesley, 1984). During the 1920’s, the parenteral use of magnesium sulfate in the treatment of preeclampsia-eclampsia was popularized by Lazard and Dorsett (Chesley, 1984), for Dr. Lazard’s work (as cited in Gabbe, 1996) demonstrated that treatment with intravenous magnesium sulfate was both efficacious and safe.

Pre-exclampsia is also called toxemia, due to toxic levels of certain proteins found in the urine of sufferers. Although the exact cause of this is still not known, genetics likely play a role, along with “toxins”. In fact, vegetarians and vegans appear to have significantly lower rates of eclampsia, possibly due to not getting overloaded with the toxins that accumulate in animal fat: Preeclampsia and reproductive performance in a community of vegans

Studies at “the Farm,” a community of spiritually gathered young people in Summertown, Tenn, have shown that it is possible to sustain a normal pregnancy on a vegan diet. The source of dietary protein (ie, animal or vegetable) does not seem to affect birth weight, as long as vegans are health conscious, receive continuous prenatal care, supplement their diets with prenatal vitamins, calcium, and iron, and apply protein-complementing nutritional principles. Preeclampsia may be caused by a relative prostacyclin deficiency in the face of excessive production of thromboxane A2. A vegan diet (one low in arachidonic acid) might provide protection against this condition, especially if the conversion of linoleic acid to arachidonic acid is inhibited by decreased activity of the enzyme delta-6-desaturase. We examined the maternity care records of 775 vegan mothers for symptoms of preeclampsia, and only one case met the clinical criteria. Since preeclampsia in our culture is frequently associated with unrestrained consumption of “fast foods” (foods having high levels of saturated fat) and rapid weight gain, it is possible that a vegan diet could alleviate most, if not all, of the signs and symptoms of preeclampsia.

People who eat a plant-based diet or try to eat healthy use the word “toxins” as an umbrella term to refer to what they are trying to avoid: pesticides and industrial chemicals that find their way into the food supply, which have a tendency to accumulate in animal fat. Sometimes this use of the word “toxins” has merit, sometimes it doesn’t. Though we have ways of removing or detoxifying many of these potentially harmful chemicals from our bodies, there is some evidence that they play a role in cancer, Parkinsons disease and other conditions. Through the process of biomagnification, these toxins can accumulate to high levels in animal fat, which may be one of the reasons vegetarians tend to have lower rates of heart disease and some other diseases. The higher up an animal is on the food chain, the more concentrated the toxins become – this is why big fish tend to be much more toxic than small fish.

Yorkshire, England

Yorkshire, England. Source: Wikipedia

As ridiculous as it sounds, if Sybil had been a vegetarian, it could have prevented the eclampsia, and it would have easily fit with her free-spirited personality and progressive politics. Some British progressives of the era were vegetarians, like George Bernard Shaw, and Henry Stephens Salt. Interestingly enough, the founder of the modern veganism movement, Donald Watson(1910 – 2005), was born in Yorkshire, the county in northern England where the fictional Downton Abbey is located(though the Highclere Castle itself is actually located in southern England).

Eclampsia, unfortunately, is still with us, and kills many pregnant women, especially in poor countries. Now I fully realize this is fiction, but let’s imagine Lady Sybil had been a real, breathing person: my non-medical opinion is that Lady Sybil would have been better off being taken to hospital since even though whatever treatment they may have used would have been very risky, not treating her very serious medical condition was even riskier.

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12 responses to “Eclampsia strikes Downton Abbey

  1. Interesting post. That episode was a tear jerker for me, as Sybil was definitely my favorite (and probably most people’s). It also inspired me to research eclampsia and it is sad that it’s still a risk today. Interesting connection about toxins and vegetarians. Makes sense though, but do you think pesticides and other chemical toxin exposure to animals were as high then as they are now? I have no idea if they were, I know people were less aware about the dangers back then.

    • England was the first country in the world to industrialize, so they’ve had problems with industrial pollution longer than anyone. By 1920s England, so much damage had already been done.

      While the modern class of organo-phosphate pesticides currently in use were not widely used until the 1940s, prior to this, all sorts of “natural” though toxic chemicals were used as pesticides on crops. Lead, mercury, pyrethrum(derived from flowers but still toxic), arsenic and even nicotine were all used as pesticides. Arsenic and derivatives were among the most commonly used in the early 20th century.

      As if this wasn’t enough, large factories in England and other industrialized areas spewed mercury and lead into the air, soil, and drinking water, along with sulfur compounds and carbon monoxide. The sulfur/heavy metal rich smog that engulfed many British cities during industrialization definitely caused many respiratory diseases, as well as cancers and other diseases, though it is difficult to get statistics from then. Even the Great Smog that hit London in 1952 killed thousands of people.

      Thanks to catalytic-converters, declining use of coal, better technology, and pollution controls, most first world nations aren’t as polluted as they used to be. Unfortunately, many Chinese cities are similar to industrial English cities of the 19th century. Many 3rd world cities have hellish levels of pollution due to corrupt governments, older technology, and no pollution controls.

      Although many of these industrial pollutants can cause cancer, people were a lot more concerned about dying from an infectious agent 100 years ago than pollution. Bacteria and virus were the main killers back then, not cancer or heart disease.

  2. very interesting post. To be honest I never knew about Eclampsia before.

  3. To be ultra-fair, poor old Lord Grantham didn’t have 100% faith in the local quack because Clarkson had seriously misdiagnosed the Downton heir’s paralysis…
    interestingly, you say that toxins accumulate as you go up the food chain – but cattle and sheep are pretty low on the chain, as they are grass-eaters. If we ate dogs or lions, or other humans, there’d be a revolting heap of toxins in every mouthful. But I agree, veggies and vegans have a generally healthier diet, as long as they aren’t ingesting a load of synthetic chemicals – fertilisers and pesticides – with their agro-industrial food.

    • You may be right, but Clarkson was their family doctor since the Crawley sisters were little. And in that day and age, just about all doctors were quacks, since scientific medicine was in its infancy. Also, his misdiagnosis of Matthew’s condition wasn’t a fatal error, he just thought his condition was a lot worse than it was.

      Clarkson also demonstrated his competence much earlier in the series when he saved that farmer by doing that new, life-saving operation. Lord Grantham’s snobbery also played a part in why he preferred the aristocratic doctor over Clarkson. Thanks for visiting and for your comments!

  4. Excellent, interesting post! Lady Sybil’s death was meant to be s tear jerker of course. Downton Abby is a well dressed soap opera and a guilty pleasure for me. However the last episode of season three was a let down. Not just yet another good character’s apparent death but two hours without much happening. Still I look forward to season four!

    • Thank you for reading and for your thoughtful comments. The last episode of season 3 felt more like the first episode of season 4; they could have ended season 3 with the cricket match and how everything felt resolved. I think having 2 major characters die in the same season is “overkill”, should have left it for season 4.

  5. Very interesting post! I love how you took a TV show, (and by the way, I am a fan and a season ahead of this) and used it as a way to discuss the topics of past and present knowledge and understanding of this sad condition, alternative diets, and famous people and their dietary history. This post is a great example of using a current and popular topic to go deeper into the issues surrounding it. And ….I cried too. Just wait until next season!!!!!!!

    • Thank you so much for your comments, it’s very flattering to get such praise from a writer like you. I’m glad you liked my post. I almost didn’t write it and I think it was a long-winded and meandered a bit, but I thought it would interest some people. You have neat site too BTW!

  6. Sweet blog! I found it while surfing around on Yahoo
    News. Do you have any tips on how to get listed in Yahoo News?
    I’ve been trying for a while but I never seem to get there! Cheers

  7. Heart disease yes I can see that on average vegetarians would have lower rates than meat eaters. That average is easily influenced by heavy meat eaters who don’t exercise much. But cancer? Vegans and vegetarians to my knowledge have no edge there. Toxins in my opinion have always been in the human diet, which was since before we actually became human very meat-centered. I think of myself, eating meat only on occasion (but heavily when I get in the mood) and exercising quite a lot, as having a diet fairly typical of someone from the past. Maybe there are more pesticides and other carcinogens now. After all, there must be some reason other than sedentary lifestyles to explain the epidemic of caner. But I’m active and hope that my body is cleaning itself of the toxins. I have confidence in that, but if I turn out to have been wrong then I will die young. I simply will not live my life in fear of all sorts of things. My roommate, a vegan, seems to believe the whole world is full of things that will damage your health. She does “healing” techniques on people who don’t seem at all ill to me. I just can’t go along with that sort of paranoia.

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