Tyrion Lannister (Peter Dinklage) enjoys the services of prostitute Ros (Esme Bianco ) in Game of Thrones.

Washington - The fourth season of Game of Thrones returns to our screens on April 18. 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 favourite 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 specialises in science, medicine and technology, about health and health care in medieval Westeros.

What was the life expectancy in the time of Game of Thrones, the 1400s, 1500s?

Life expectancy was really variable. It’s almost 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.

What was the Black Death?

The Black Death was an infectious disease, a massive pandemic 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.

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

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 deprivations 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. The burden of disease was more infectious disease.

Now our burden of disease is chronic diseases like hypertension, high cholesterol, heart disease and Type 2 diabetes. In the Middle Ages, and until really the 19th century, the burden of disease was infectious diseases like the plague or influenza.

What was the leading cause of death?

What didn’t kill you? My bet, 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.

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.

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

There were medical books that are organised 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 were plenty of remedies for all kinds of gynaecological problems.

Anything effective?

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, then significantly expanded on by Galen.

So everybody has their own complexion and a kind of natural balance in which the four humors 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 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.

So under the humoral model, I come down with strep throat, you come down with strep throat. We’re neighbours, or we live in the same house, so how would you approach making us each feel better if we had different humoral make-ups?

It would be a question of regulating what are called the six non-naturals. And the six non-naturals are the things 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.

Under this theory, men and women have different complexions intrinsically. Men are much hotter and drier. Women are cold and damp. So if we’re in the same house and you have a really sore throat and a fever, one of the things that might be done with you is to adjust certain kinds of food or certain kinds of drinks, so that there was less heat in your body and so the heat was circulating better. You would avoid baths because they would open up the pores too much.

Another way to approach it, if somebody had a fever and their head was really hot, you might try to warm up their feet so that you would draw the heat away from their brain and back down, so that the brain or the head would have a chance to cool off. – The Washington Post