As anyone with a cable connection or a sword of Valyrian steel can tell you, the next season of "Game of Thrones" returns April 6. Which means lots of dragons, lots of heads lopped off and lots and lots of visits to brothels. And another 13 weeks of me wondering how everyone in the 1400s stayed so healthy and strong.
I'll be the first to admit that "Yes, it burns when I pee, Jon Snow" isn't compelling television dialogue. But jeez, isn't anyone in my favorite show going to face disease, besides that poor little girl with "greyscale," a leprosy-like condition that seems to be the reason she spends a lot of time in dungeons?
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.
What is the life expectancy in the time of "Game of Thrones," the 1400s, 1500s?
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.
You mentioned that ... life expectancy depended on who you were and where you were living. Can you elaborate on that a little bit?
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 right now. In the Middle Ages and, until really the 19th century, the burden of disease was infectious diseases like the plague, or an influenza.
There are lots and lots and lots of visits to brothels in this show. Were STDs rampant?
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.
Were STDs rampant? I don't know. [Medieval people] were pretty familiar with ... a lot of ways male and female ... sex organs could have problems.
But they didn't have any medicines or cures or ways of attempting to address anything like that.
No, they did, actually. Even going back to the period of antiquity, you do find pharmacologic treatises [as well as medical treatises on gynocological and reproductive health and disease.].
[There were] medical books that are organized in a head-to-toe fashion, so illnesses of the head, eyes . . . neck and then going down to the feet. Or you also have [books] in which different plant substances, or parts of the plant or plant extracts . . . would be [listed along with] what they could be used for. . . . So there are plenty of remedies for all kinds of gynecological problems.
What do you mean by effective? . . . They continued using them so they must have been effective.
It might be helpful if I explained a little bit of how they did think about 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.
We think about disease, at least infectious disease — I get strep throat, you get strep throat, it's the same pathogen that's causing our two diseases. Whereas under the humoral theory, each person has their own unique complexion, so all disease is caused by the same thing. There's corruption in the body, the humors get out of whack, but ... it kind of gets worked out in each person.