Note: Viewers of "Downton Abbey": SPOILER ALERT!
It is not often that a very popular television dramatic program contains a valuable message for a significant portion of the viewing audience; it is certainly a rare and remarkable occurrence.
Yet Sunday's episode of "Downton Abbey" depicted an unexpected and very sad development in the intriguing ongoing drama of the Crawley family in post-WW1 England. It also sent a message to young men and woman regarding the importance of preventive medical care and the possibility of rare but tragic medical complications of normal life functions such as pregnancy.
Lady Sybil Crawley Branson is the fictional youngest daughter in the aristocratic Crawley family. Her obstetrical confinement occurs in 1920 and initially appears to be normal.
However, her longtime general practitioner Doctor Clarkson is concerned about her "muddled" mental status, small baby, ankle swelling, and urine protein, all classical signs of an ominous obstetrical complication called pre-eclampsia, eclampsia, or "toxemia."
Her London obstetrical consultant hired by her father sees only an anxious woman having a baby. Although this medical and social "conflict" is somewhat over-dramatized, normal labor delivers a healthy baby. Tragically, her suspected diagnosis is confirmed when she suffers postpartum seizures and dies.
As I watched the episode, I suspected a dire outcome, but the medical aspects of the program were reasonably accurate for the medical knowledge of the time; although the condition was known, there was no specific remedy available. Only in the late 1930s was the associated increase in blood pressure recognized, and even then, no treatment was known.
It is remarkable that in just two years, two PBS series have included deaths from eclampsia, a condition which affects about one in 10 pregnancies mildly and causes serious problems in one in a 100 cases. (The other program was "Call the Midwife," an autobiographical series relating the experiences of a young midwife in London in the 1950s.)
Pre-eclampsia is much less commonly seen today, likely due to changes in patient care beginning in the 1930s, including improvements in nutrition, preventive prenatal care, patient education, social services, aggressive control of precipitating factors, and recognition of early signs due to increased awareness aided by technology. Remarkably, no specific causation of the syndrome has been found. I have been aware of about 10 cases in my medical career, but I was not actively involved in obstetrical care for most of that time.
Television and other media have tremendous medical educational value and importance. Unfortunately, with the exception of the Public Television Networks, I often feel that television may still be the "vast wasteland" as described by Federal Communications Commissioner Newton Minow in his speech describing the state of television in 1961.
His critical opinion and well chosen words still accurately evaluate today's programming in many respects.