‘Downton Abbey’ death had clues that might have spared Lady Sybil

Posted Jan. 30, 2013, at 1:09 p.m.




Eclampsia, strictly speaking, isn’t present until the woman has a seizure. By that time, the patient, the doctors (and the baby, if not yet born) are in deep trouble. The job is to diagnose what’s happening before then, when the condition is known as preeclampsia.

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In Sybil’s case, there were a lot of clues.

The hallmark of preeclampsia is elevated blood pressure. Taking the blood pressure with stethoscope and inflatable cuff was about the only test a doctor could perform on a woman delivering at home. Sybil’s pressure appears to have been up.


Long before then — when there was still time to diagnose her condition correctly — Sybil had “peripheral edema” — the fancy term for swelling of the legs.


Preeclampsia also causes a protein called albumin to spill into the urine rather than stay in the blood. Dr. Clarkson suggests testing Sybil’s urine. He may have had a chemistry set in his bag. Or he could have gotten some idea just by shaking up a jar of it. Urine full of protein foams. In any case, he reports elevated protein.



The mechanism of Sybil’s death was a little unclear.

Seizures can cause a pause in breathing. But people rarely suffocate from them. The doomed young woman may have had a massive bleed in her brain. Before she relaxed in the dusky pallor of death, she had what looked like “decerebrate posturing” — an arching of the neck that occurs as the brain is squeezed through the base of the skull.

Nobody knows what caused preeclampsia in the early 1920s or causes it now. It appears to be an out-of-control state of inflammation. There is some evidence it may be a reaction against “paternal factors.” That, in turn, has led to the idea of the “dangerous father” as the cause of the condition. Sybil’s husband and the father of their daughter is Tom Branson, the former Grantham chauffeur and Irish revolutionary who can’t go home. For purposes of drama, it was a fitting way for her to die.

There was another message, too: Beware the “VIP syndrome.” Among Sir Philip’s mistakes was his apparent desire not to discomfit the Grantham family by sending Sybil to the hospital. However, doctors who treat you differently because you are an important person can be dangerous to your health.

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