‘Game of Thrones’: The science behind all that spitting




    Kent Sepkowitz, MD, is an infectious disease specialist at Memorial Sloan Kettering Cancer Center. Here, Dr. Sepkowitz weighs in on this week’s episode of “Game of Thrones,” that risky handshake and all those spitting scenes.

    The Queen’s Justice” continued the breakneck storytelling pace of season 7 of HBO’s TWX, +0.17%   “Game of Thrones.” Chronic lumbering plot lines suddenly have awoken and sped forward, threatening the lives of countless old favorites.

    With the mounting cliffhanger-ish story lines, though, bedrock attention continues to be paid to simple issues of hygiene. In last night’s episode, for example, we saw lots of unhygienic spitting and one extra-anxiety-provoking greyscale handshake. Both activities provoke a substantial cringe for those who worry about germs.

    Spitting and spittoons

    First, spitting, a favorite of the rabble at several points throughout the series. Last night, the spit was aimed at the three women captured by this season’s smirk champion, Euron Greyjoy. In their march to face the Iron Throne where Cersei sits so comfortably, each is spit upon by the delighted crowd – the same crowd that only a season or two back was spitting left and right at their current queen, Cersei.

    Though spitting is not a major sport anymore, not so long ago, spitting and the spittoon (sometimes referred to by its suave European-sounding name, the cuspidor) were standard props of any successful man.

    In the 19th century U.S. Senate, for example, spittoons were scattered in the august chambers, the better to allow the male-only senators to chew and chaw and move government forward. A pinch of chewing tobacco might have encouraged a certain brightness of the mind but required a place to squirt the muck. The spittoon and sport around demonstrating true aim were perhaps the key to the solidarity of the place – nothing better for bringing people across the aisle together than expertly arching some saliva into a brass receptacle.

    But as happened recently with the ashtray, the spittoon disappeared a century ago in the face of public health concerns. Unlike the hard science of secondhand smoke, however, the end of the Golden Age of American Spitting went by the wayside out of a modern disgust, not science. Our aversion to spitting is more about the gross-out factor, not the potential microbial threat.

    The beginning of the end started with killjoy tuberculosis experts who knew TB was spread by coughing. They wanted people to keep their phlegm to themselves and off the sidewalks and spittoons of the world. They even developed a small, handsome envelope that the concerned consumptive could hack into, then fold back into a pocket to maintain appropriate cleanliness.

    The TB people though conflated two different types of hacking: Expectorating purulent phlegm and spitting simple saliva are two acts that look and sound approximately the same, but are completely different from the perspective of a microbe. The sputum from a person with untreated tuberculosis is teeming with a billion living, contagious bacteria but the saliva of a senator or a barber of a guy visiting the local bar has the same microbes as your drooling dog. Yuck, yes. Danger, no.

    The real death knell for public spitting and spittoons was the deadly Spanish flu pandemic of 1918. Here, a faintly plausible case could be made between spread of human disease and spitting onto a sidewalk. Flu is spread by “droplet” exposure, not inhalation. For me to give it to you, it is not enough that you inhale the air I just coughed or sneezed into, but rather that you touch a surface I have coughed or sneezed onto and then, for no clear reason, rub your eyes or scratch your nose or lips, thereby inoculating yourself with my germs. So perhaps there was risk of flu spreading this way, assuming people were in direct contact with the spit – but more likely this was a low cost, low reward decision made at a time of justifiable panic.

    A gentlemanly handshake

    Enough about spitting – the more disturbing non-hygienic moment in this week’s episode of “Game of Thrones” was the gentlemanly handshake between the apparently cured Jorah Mormont, once riddled with greyscale, and Samwell Tarly, who did the curative clipping and trimming to remove all that infectious skin. In a brief scene toward the end, we watch the holier-than-thou Archmaester Marwyn pronounce Jorah cured – indeed his skin does seems to have shuffled off its scaly coil. Jorah and Samwell, surprise new best friends, then pause a long moment in silence as we head into a heart-stopping moment: Will they or won’t they…shake hands?

    Of course they will – Samwell reaches enthusiastically to press the flesh of the possibly-still-infectious-with-a-fatal-disease Jorah. We gasp a little as we see a real (fake) infectious disease become transmitted (maybe) while our two quiet heroes vow to continue to fight the good fight.

    Talk about a cliffhanger with legs, an enemy cell planted and ticking. Now we must worry about the health and welfare of heroic Samwell and his very modern blended family. What if he notes a telltale scale on his hand? What if his wildling wife does? What if he is has to go into quarantine and can’t save the world?

    So many maybes, so little time. Only one thing is for certain – in a Seven Kingdoms featuring dragons and reanimations and all the rest, only one person stands for truth, science, and the rational world: The former punching bag of the North, Samwell Tarly.

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