April 7, 2014

Shouldn’t all those guys in ‘Game of Thrones’ have STDs?

HBO’s ‘Game of Thrones’ opens window onto life in Europe in 15th century. It’s amazing civilization survived the wars, malnutrition and disease.

As anyone with a cable connection or a sword of Valyrian steel can tell you, the new season of HBO’s “Game of Thrones” (9 p.m. Sundays) means lots of dragons, lots of heads lopped off and lots and lots of visits to brothels. And another 13 weeks of wondering how everyone in the 1400s stayed so healthy and strong.

I asked Elly Truitt, a medieval historian at Bryn Mawr College who specializes in science, medicine and technology, about health and health care in medieval Westeros.

Q: What is the life expectancy in the time of “Game of Thrones” – the 1400s, 1500s?

A: Life expectancy was really variable. It’s almost like the same way it is now. As it is now, in a lot of developing countries or poorer populations, a lot of it has to do with if a person can live to their first birthday or their fifth birthday. Then, in aggregate, their chances of living to adulthood are much greater.

Life expectancy depended wildly on what kind of person you were. And it also depended on when and where you were living. Because ... the 14th century ... saw the pandemic of the black death, which significantly changed the demographic of Europe. The black death was an infectious disease a widespread epidemic that started to hit Europe in 1348 and just kept coming in successive waves for the rest of the 14th century, and then for centuries after that.

Q: You mentioned that ... life expectancy depended on who you were and where you were living. Can you elaborate?

A: One of the things that’s important to remember is that most people during the 14th century in Europe were quite poor and undernourished. So if your life was one in which you were ... essentially living at a subsistence level, with poor nutrition and improper housing or inadequate housing, you would be more prone to illnesses and depredations that come with that. Whereas if you were fortunate enough to have proper shelter and plenty of food and access to some kind of medical care, then you might have a better chance. ...

The other thing is that people had fewer what we would consider now to be chronic illnesses, and the burden of disease was more infectious disease. So now our burden of disease is chronic diseases, like hypertension, high cholesterol, heart disease, Type 2 diabetes – at least in the United States. In the Middle Ages and, until the 19th century, the burden of disease was infectious diseases like the plague, or an influenza.

Q: What was the leading cause of death?

A: My educated guess is that it would be anything related to being really poor – starvation, exposure, chronic malnutrition. ... There were high maternal mortality rates, in childbirth and also near childbirth. And then ... you could die of any kind of trauma, like having a lance shoved in your neck.

Q: There are lots and lots and lots of visits to brothels in this show. Were STDs rampant?

A: In the 15th century there is a lot of discussion of the “French disease,” which is syphilis. Some people called it the French disease. The French didn’t call it the French disease. I think they called it the Italian disease.

Q: But they didn’t have any ways of attempting to address anything like that.

A: They did, actually. Even going back to the period of antiquity, you do find pharmacologic treatises as well as medical treatises on gynecological and reproductive health and disease.

They didn’t have a model of disease based on a germ theory. Instead, the therapeutic framework, or at least the learned therapeutic theory, was based on “humoral theory,” going back to Hippocrates and then significantly expanded on by Galen.

So everybody has their own complexion, and kind of natural balance in which the four humors (black bile, blood, phlegm and yellow bile) are in the proper portions to one another. And disease is caused, according to humoral theory, when the humors get out of balance, and that causes essentially corruption of some kind. Some kind of noxious-like toxicity in the body.

Q: Under the humoral model, I come down with strep throat, you come down with strep throat. We’re neighbors, or we live in the same house ... how would you approach making us each feel better if we had different humoral makeups?

A: So it would be a question of regulating what are called the “six non-naturals.” And the six non-naturals are the things that you can essentially control. And they are: the sleep and waking cycle, your food and drink, environment, all evacuation and elimination (and that includes orgasm and ejaculation), your mental state or emotional state, and physical activity. So the idea is these non-naturals would influence a person’s health. So you would have a regimen in place to try to redress the balance of the humors.

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