Downton Abbey’s flirtation with medical facts
Surely no one thinks of Downton Abbey as anything but an elegantly lavish soap opera, one that we Colin Firth fans aren’t ashamed to admit watching. I hope no one is taking the show’s medical content seriously. While the plot lines flirt with accuracy, they shy away from commitment.
Shall we begin with the miracle of Matthew’s recovery from his wartime spinal cord injury? My sympathies were with Dr. Clarkson on this one. Matthew returned home from the WWI battlefront with complete absence of sensation and movement in his legs. I think we can all agree that his arrival home must have taken days to weeks–initial stabilization at a field hospital, transport to the coast, sailing across the Channel, and then the trip by rail or ambulance to Downton Abbey. Dr. Clarkson was entirely within his rights to assume that Matthew had suffered complete disruption of his spinal cord, causing permanent paraplegia, since he had not recovered any nerve function whatsoever since the blast.
Months later, though, Matthew starts to feel “tingling” in his nether regions, and is motivated to spring from his wheelchair when Lavinia nearly falls carrying a heavy tea tray. A medical miracle, indeed–which is attributed to Dr. Clarkson’s misdiagnosis of permanent injury when Matthew had a clear case of “spinal shock”. Without boring my gentle readers with a full treatise on spinal shock, I will simply note that trauma with bruising, swelling, or a brief decrease in blood flow to the spinal cord can lead to temporary symptoms of sensory and motor loss, but these resolve in a matter of days. Matthew’s delayed recovery can only be attributed to divine screenwriter intervention.
The influenza pandemic of 1918 certainly was not fictional and caused an estimated 50 million deaths worldwide. I guarantee you, though, that none of those people looked as pretty as Lavinia on their deathbeds. Patients either recovered within a few days or died of pneumonia and respiratory failure, meaning that their lungs filled with congestion and they suffocated. You are neither rosy pink nor delicately pale if this happens to you and you don’t have the modern advantages of oxygen and a ventilator. This is why we have the term “code blue” for impending death. The makeup artists did a more creditable job with the footman William’s demise from a blast injury to his chest in a previous episode. Poor William looked genuinely cyanotic, but I supposed we can’t have that ghastly a look for our heroines.
Downton Abbey is in good company in fudging medical details for the sake of a good story. No screen version of Little Women shows Beth looking anything but adorable as she succumbs to tuberculosis, and in Moulin Rouge the heroine played by Nicole Kidman dances on stage literally until the day she dies, with only an occasional delicate cough.
The one that bothered me most was Million Dollar Baby. It was a great movie through the first half. But when we next met Hillary Swank’s character in the hospital after the cataclysmic fight, she had suffered a high spinal cord injury in her neck. She was completely paralyzed and could not breathe on her own. (For the record, the nerves in the neck power the diaphragm.) A tracheostomy tube in her throat was connected to a ventilator keeping her alive. For a millisecond, I wondered how the movie could continue with a completely silent heroine, since the tracheostomy tube prevents air from passing through the vocal cords and generating sound. Certainly she wouldn’t be able to pick up a pencil and write notes. But in true movie tradition, the filmmakers ignored this petty detail, and Hillary Swank spoke perfectly well for the rest of the movie as the ventilator bellows hissed in the background.
Sometimes writers get it right. Jeffrey Eugenides, the author of Middlesex, did his homework and the medical detail about his hero/heroine is impeccable. In the case of Downton Abbey‘s scripts, however, I am going to take a holiday from further medical critiques no matter how wildly inaccurate the plots become (though I may change my mind if they spend much time on the subject of arsenic poisoning). This show is just too much fun to watch, and suspension of disbelief must be the order of the day.
The BBC production of Downton Abbey appears on PBS Masterpiece Theatre
8 COMMENTS
Thanks for this excellent and detailed analysis of the “period” medicine of the show. I just started watching the first season and my first thought was about the accuracy of medical procedures, etc. Depicted wrong or not, hopefully it gives a good glimpse of how far we’ve come in medical research.
[Reply]Since the dawn of movies (amd probably theatre before that) medical scenes have been depicted in an incorrect and often unbelievable way.
Just enjoy the show
What did you think of last night’s episode (10 Feb. 2013), in which Lady Mary suffered from a fertility-limiting condition that was diagnosable and treatable in the 1920’s by means of an operation so minor that her husband was unaware that she had had one?
[Reply]Dear Teresa,
I’m confused about this one too! Not being an obstetrician or infertility guru, I really can’t guess what this easily-corrected problem might have been, or if the premise is historically accurate in any way. If I find out any additional information, I’ll certainly let you know. For the record, the presentation of Sybil’s eclampsia was believable; but it wasn’t nearly so believable that a physician of the day–and a prominent one at that–would have failed to appreciate the gravity of her illness.
All the best–
Karen Sibert
[Reply]Thanks for answering! Here’s a suggestion from a historian friend: “this was the pioneer age of the endoscope, which was being put to all manner of urological uses once doctors discovered how to put a light and a lens into the body. My guess is that it was left deliberately vague but if pushed for an answer, the writers would say that it was some kind of cyst removal from the urinary tract. That would seem to fit the known facts of the case.” But I think you’re right that we just need to suspend disbelief.
[Reply]Hahahah this is wonderful. I’m an M2 taking a neuro test on Monday and will now be able to think of nothing else if I’m asked about spinal shock…
[Reply]So I just got to watch Season 2 of Downton, and thus see poor old William’s demise-I admit, you knew he was going to die when he went to war! Anyway, how could his lungs have been “damaged” so that he’d linger for weeks before he died? I would think that either he would die within hours or be ok. I mean what damages lungs so that you die that slowly? Collapsed lungs so he died of a heart attack? You can live for a long time with one lung.
[Reply]Dear Ms. Simpson,
I think the implication is that William died of “shock lung”–injury to the lungs caused by the explosion. Today, we would support a patient like William on a ventilator to allow the lungs time to recover, though survival is still uncertain if the lungs are too badly damaged. You’re correct–really, you would anticipate that a patient would either die quickly or recover. However, if a patient developed pneumonia or other complications, the condition could gradually decline over a longer period of time. I think we have to allow Downton Abbey a bit of poetic license over the medical details and facts.
All the best–
Karen Sibert
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