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Toilets through time, from sponges on sticks to medieval privies
What was it like to do your business in a Roman communal toilet? How did Romans really use a sponge on a stick? HistoryExtra's David Musgrove explains all
In this whistle-stop tour of how our ancestors have used the loo, HistoryExtra’s David Musgrove heads to the National Trust's Chedworth Roman Villa in Gloucestershire, to see what we can learn from the most universal of all experiences. With expertise from historians Hannah Platts, James Wright, Tracy Borman and Jerry White, he explores the ins and outs of how toilets have worked through time – from innovations in carrying away our waste to a remarkable ancient edict that demanded flatulence. View Green Video on the source website Find out more about the history of toilets in our podcast mini-series, when Musgrove revisits long-past lavatories in the company of leading historical experts to uncover what we can learn about our ancestors and their eras – from the sociable long-drops of Roman Britain and draughty medieval garderobes to the cesspits of the Victorian slums.
The ancient Greeks had six essential tips for health. How many do you do?
With conflicting advice and endless new trends, it can feel hard to keep up with the modern health and wellness space. But ideas about how to live a healthy life are nothing new. Thousands of years ago, the ancient Greeks had their own list of requirements
Wellness might feel like a modern concept, attached to health-tracker apps, screen time, and green smoothies. But the concept of actively trying to lead a healthy life while keeping the body in a good state isn’t new. In fact, systems of preventative health stretch back more than 2,000 years to the medical traditions of the ancient Mediterranean world. Speaking on the Life Lessons from History series from the HistoryExtra podcast, Sasha Handley, a professor of early modern history at the University of Manchester, says there used to be a “fantastic preventative healthcare culture” based on advice that dates back to ancient Greece. As she sets out, there was a list of six lifestyle factors and behaviours that physicians, medical practitioners, and ordinary people alike knew they had to take care of for their long-term health. These were the ‘six non-naturals’ and the ancient Greeks believed that “temperance of all of those six things was key to long-term good health, according to the wisdom of the time” says Handley. The term “non-naturals” described factors external to the body that could be managed or regulated, as opposed to “naturals,” which were the body’s innate characteristics So what were these six factors, and how much do they align with modern thinking? Fresh air The first non-natural to look after was fresh air – that is, “getting enough of it and making sure that you were not taking in fetid or corrupt air,” Handley says. The Greeks thought that ‘bad air’ could cause disease and advocated for good airflow within houses to lessen exposure to stagnant air. Read more | Meet the people the ancient Romans and Greeks desperately tried to hide Today, we know there is no singular concept of ‘bad air’. But there are pollutants in the air that can be hazardous to people, and we do know that some diseases are airborne. Food and drink It was considered important that a person was “eating and drinking the right kinds of things for [their] bodily constitution, but also at the right times of day,” Handley says. Theories about what was good to eat and when were based on the four humours: blood, phlegm, yellow bile, and black bile. Different foods being either cold or hot, or wet or dry, affected the balances of the four humours in the body, which led to different outcomes for people’s health and constitutions. For example, someone believed to have an excess of “heat” might be prescribed cooling foods such as cucumber or lettuce. Galen, a Greek physician and philosopher whom the idea of the six non-naturals is attributed to, thought that warm food led to the production of yellow bile, while cold food led to the production of phlegm. Galen practised in the second century AD and became one of the most influential medical authorities in history. Read more | If ancient Romans didn't understand calories, how was their theory of nutrition so accurate? Now, our understanding of food and diet is more scientific. But we do know that some specific nutrients have particular health benefits; protein helps to contribute to maintaining muscle mass, while vegetables can be a source of different micronutrients and vitamins. Exercise and rest Getting enough exercise and rest was also believed to be important. Exercise was seen as having a drying effect on the humours, and physicians recommended exercises to patients both to prevent and treat disease. The body, in humoural thought, was constantly shifting in balance; movement was one of the tools available to correct excess moisture or sluggishness. Galen thought work and exercise were equal, defining them as vigorous movements that made you out of breath. The exercises that he prescribed to his patients, though, were more moderate. He recommended exercises that involved a small ball. Watch now | Why the Ancient Egyptians WEREN'T ancient Massage and baths were also seen as having a similar effect to exercise, something that would be echoed in wellness modern wellness trends centred around saunas, sports massage, and cold plunges. Sleep and waking Sleep and dreams were important parts of ancient Greek philosophy as well as their medical knowledge. Dreams were deemed to be evidence of the state of the body, and therefore were helpful in diagnosing medical issues. But they were also important within ancient Greek religion. The ancient Greeks believed that the gods could communicate via dreams and that sleep had healing properties through its link with the gods. We might not bring up our dreams in doctors’ offices these days, but research increasingly shows the powerful health impact of sleep on physical, cognitive, and emotional health. Recent studies show that getting enough sleep can be associated with lower rates of chronic diseases such as dementia, diabetes, and heart disease. Excretion and retention The fifth non-natural “sounds fairly graphic, but it’s excretion and retention,” Handley says. “This refers to bowel habits, but also to things like sweating appropriately and keeping the body at the right temperature.” It was thought that excretion, in all its forms, helped keep the four humours balanced. If one humour accumulated excessively, it could be expelled through sweating, urination, bleeding, or purging. Bloodletting in particular became a standard treatment in later medical traditions influenced by humoural theory. Read more | Blood, guts and spectacle: 6 shocking events from the history of ancient Roman gladiators Although we don’t think about regulating our excretions in terms of bloodletting and purging like the Greeks did, the increasing awareness of gut health – and therefore its impact on the bowel – is perhaps a modern descendant of this idea. Passions of the mind “The very last one is usually called the passions of the mind, which we read today as emotions,” Handley says. “So emotional health, making sure that you were not getting too angry, too sad, and keeping your mind and body in a good balance.” Different emotions were associated with excesses of the four humours, so keeping your emotions in check contributed to your humoural balance. Too much blood might make you too happy and too much phlegm might make you too reserved, while too much black bile might make you melancholic and too much yellow bile might make you angry. Read more | Give away your worries, like an ancient Mesopotamian Clearly this idea links to our modern understanding of mental health – especially now we know that physical health and exercise are linked to mental health. How similar are the non-naturals to ‘wellness’ today? Nowadays, we think of ‘wellness’ as separate from ‘health’. Where health is the absence of disease, and wellness is a more general emotional and physical wellbeing that we can influence via lifestyle factors. The ancient Greeks thought the same. Health was seen as the responsibility of individuals to regulate their non-naturals to look after their own health, and maybe even avoid having to see a doctor. Read more | Are you healthier than a Roman? These ancient secrets for longevity are still shockingly relevant There was an element of taking personal responsibility for good health, leading to the idea that bad habits could cause certain diseases. But the six non-naturals also worked in tandem with the ‘naturals’ – or the innate factors that we have no control over that also cause disease. Today, we see things similarly: some diseases and conditions are caused by lifestyle factors, whereas others develop independently of how we live. And just like modern ‘wellness,’ ancient Greek health was about more than just the body, too. Medical knowledge was intertwined with ethics, morality, politics, and philosophy – which is why many of the most famous Greek physicians, such as Galen and Hippocrates, were also philosophers, and many philosophers also mused on issues of the body. The ancient Greeks actually thought that achieving perfect health was essentially impossible since it required a precise balance of the humours, which changed every day. Instead, a ‘neutral’ body was the goal – something that doesn’t necessarily align with modern ideas on health optimisation and biohacking. Dr David Musgrove was speaking to Sasha Handley on the HistoryExtra podcast. Listen to the full conversation.
The overlooked history of Muslims in Europe
Tharik Hussain speaks to Danny Bird about the long but often overlooked and distorted history of Muslims in Europe – and the enduring resistance to its reappraisal
Danny Bird: You open your book by recounting a chance visit to an old mosque in Cyprus. What was so significant about that moment? Tharik Hussain: Nothing changed for me on the day itself, because I knew very little about Islam’s history in Europe at that time. On a long, cheap layover in Larnaca – a place I’d never heard of – I was simply looking for a way to pass the time with a toddler in tow. I’d found a brief reference to a nearby mosque, and decided to visit. At the time (2003), I was preparing to make hijrah – to leave Britain, because I felt that I no longer belonged. My education had led me to believe that there was no meaningful Muslim history in Europe. So when we arrived at this neglected Ottoman-era mosque at the Hala Sultan Tekke, I had no framework for understanding it. The elderly guide didn’t speak English, and neither of us knew what we were looking at. What unsettled me was a tomb inside the mosque, which clashed with the theological outlook my wife and I held at the time. We left, dismissing the place, though the guide handed us a small booklet as we went. Two years later, while working as an English language teacher in Jeddah, Saudi Arabia, I rediscovered the booklet. To my shock, it claimed that the tomb belonged to a relative of the Prophet Muhammad – his maternal aunt, Umm Harâm. That completely overturned my belief that Europe had no real Islamic history, let alone connections reaching back to the Prophet’s own family. When did Islam first come to Europe? If we look at the very beginnings of Muslim presence in Europe, it’s striking how quickly it arrived. Within 20 years of the Prophet Muhammad’s death in AD 632, Muslims were present in places such as Cyprus and, later, Sicily, establishing themselves far more quickly than Christian or Jewish communities had done in the continent. Some of these early arrivals, including members of the Prophet’s family, were then buried in Europe, their tombs becoming sites of ziyara (pilgrimage), holding great spiritual significance. Medieval sources document these tombs as being attached to a mosque, and highly revered. That period also marked the creation of the first Muslim navy. Initially, ambitions to launch a maritime expedition to Cyprus were met with caution, because Muslims had previously conquered only overland territories. After persistence and strategic negotiation, the naval expedition was allowed. Umm Harâm accompanied her husband on that mission, and she died during the campaign. This acquisition of Cyprus and establishment of a naval presence were pivotal, securing Muslim control of the eastern Mediterranean and enabling subsequent campaigns across Greek islands, Sicily, Malta, Portugal and Spain. Far from being minor raids, these early campaigns were foundational to the long-lasting Muslim presence in Europe. <img src="https://images.immediate.co.uk/production/volatile/sites/7/2026/02/CR65R8webready-ae14d6f-e1770821971435.jpg" width="1500" height="1000" alt="An 18th-century painting showing a bearded man in red and gold robes sitting atop a white horse. Under the horse are several men being trampled. The background shows a blue and white sky" title="An 18th-century painting of Saint James ‘the Moor-slayer’ turning the tide in the legendary battle of Clavijo – a myth created centuries after the supposed clash (Image by Alamy)" /> Why do you think that the history of Islam’s presence in Europe has for so long been hidden or even denied? There are several factors, as I suggest throughout the book. Put simply, in the long contest between Christendom and Islam in Europe, Muslim powers – the Umayyads in Iberia, later dynasties in the south and, latterly, the Ottomans – eventually ‘lost’. As the aphorism goes, winners write history. From the crusades onwards, anti-Muslim narratives grew in tandem with a developing exclusionary ‘European’ identity in Christendom. In the regions I discuss, these later fed into the Spanish Reconquista story and anti-Ottoman rhetoric to develop what I call an anti-Muslim DNA that runs through western European identity. National legends such as Santiago Matamoros [‘Saint James the Moor-slayer’, patron saint of Spain] or the ‘tribute of 100 virgins’ myth [the false narrative that the Christian kingdom of Asturias had to pay such a tribute annually to the Muslim emirate of Córdoba] helped cement these attitudes, as did countless local stories in areas that once had Muslim communities. This isn’t always the result of deliberate design – it’s a common human pattern – but the effect is undeniable. I also refer to the erasure and neglect of Islamic heritage – sometimes through omission from history books, sometimes through archaeological indifference, and at other times through misrepresentation. In places such as the Alhambra in Spain, later European romanticism or orientalist projections have distorted how that history is presented. Even today, popular historians often reinforce these old tropes. Read more | Step onto the medieval Silk Road and you'll witness its intense wonders – and its hidden horror That’s why, after I first visited Larnaca, I was shocked to realise how much had been excluded from the history I’d grown up with. Even academic works often reflected a strongly Eurocentric perspective. To counter this, I draw heavily on Muslim sources, and occasionally Jewish ones, which offer a very different picture: richer, more nuanced and far more appreciative of these moments in European history. Ultimately, whether we are comfortable admitting it or not – and I include myself as someone educated within this system – an anti-Muslim thread shapes our sense of European identity. Take the Balkans: this region is full of indigenous European Muslims, full of Islamic heritage, yet we instinctively place it outside ‘real’ Europe and label it ‘eastern’. People often blame the Iron Curtain, but the region was being othered long before communism, largely because it was the heart of Ottoman – and, therefore, Muslim – Europe until quite recently. All of this is part of the same 1,400-year story. In telling it, I use the Islamic calendar intentionally, beginning with the first Muslim presence within Europe around AD 647. How does the historical record debunk the notion that Islam, rather than being ‘foreign’, has in fact been an integral part of European history? What’s striking is that, regardless of the period, long Muslim presences in Europe – 800 years in Spain, 500 in Portugal, more than 200 in Sicily – are still described as ‘invasions’. It’s an odd way to characterise communities who, over centuries, became as Spanish or Portuguese as anyone else. We would never describe the European presence in modern America as an ongoing ‘invasion’, yet traditional historians have spoken this way about Muslims in Iberia and, later, the Balkans. Whether the initial arrival of Muslim armies is seen as invasive or not, the people who lived there afterwards, and whose descendants still live there, were not invaders. When I began examining these histories from alternative perspectives, especially Muslim and Jewish sources, a more complex picture emerged. Take the Muslim arrival in Iberia. When Tariq ibn Ziyad crossed into the Visigothic territories from north Africa in 711, one neglected factor is the role of the local Jewish population [in Iberia], who were enduring severe persecution. Some Jewish historians suggest that those people actively sought Muslim support. There is certainly evidence that Muslims and Jews cooperated: the 17th-century scholar Ahmad al-Maqqari records that, when Muslim forces captured major cities such as Córdoba, Granada and Toledo, they often left the local Jewish community in charge – a sign of both trust and local collaboration. <img src="https://images.immediate.co.uk/production/volatile/sites/7/2026/02/P9GMRXwebready-c14b821-e1770821776100.jpg" width="1500" height="1000" alt="Medieval-style illustration showing two seated figures beneath stone arches. On the left, a bearded figure in purple and red robes sits on a throne with a small dove near his shoulder; on the right, another bearded figure in tan clothing sits holding a sheathed sword across his lap, both facing slightly toward each other against a pale parchment background." title="A 14th-century miniature depicts Roderic, the usurper Visigothic king of Spain, and Tariq ibn Ziyad, who led the Muslim forces against him in 711 (Image by Alamy)" /> From Jewish and Muslim perspectives, the arrival of Muslim rule could legitimately be seen as a liberation, given the conditions the Jewish communities had endured under Christian Visigothic rule. What followed was a celebrated period of coexistence – even a Jewish ‘Golden Age’ – in what became known as al-Andalus. Yet conventional European history insists on framing this as a conquest, which later justified the narrative of the Reconquista created by northern Iberian Christian realms – a narrative made even more curious by the fact that many leading figures of the so-called reconquest were descended from people who came from outside Iberia altogether. One of the most evocative parts of your book deals with what you term the ‘Córdoban Caliphate Culture’ – a world of poetry, architecture and science. What was this civilisation really like? It’s hard to summarise briefly, but this was a period of extraordinary scientific, philosophical and cultural achievement unlike anything Europe had seen. Lost Hellenic works returned to Europe through Muslim scholars who flourished in centres such as Córdoba, Palermo, Kairouan [in what’s now Tunisia] and, later, Cairo. Córdoba, in particular, became the intellectual heart of this vast cultural sphere. What’s remarkable is how widely these advances spread. They shaped not only Muslim societies but also Europe long after the caliphate fragmented. Yet this influence is still rarely acknowledged. Figures such as Ibn Sina [known in the west as Avicenna], al-Razi and al-Zahrawi were central to this transformation. Al-Zahrawi’s Kitab al-Tasrif (The Method of Medicine), published around the year 1000, described sophisticated surgical procedures, including draining fluid from an infant’s brain and treating migraines, at a time when England was still relying on remedies from ‘leechbooks’ and folk cures. His work covered surgery, orthopaedics, ophthalmology, dentistry, pathology and childbirth, and remained authoritative for centuries. <img src="https://images.immediate.co.uk/production/volatile/sites/7/2026/02/BAL3085389webready-fe4d4ea-e1770822370370.jpg" width="1500" height="1000" alt="An 18th-century miniature depicting three men wearing white and red turbans sitting together. On the left is a man with a long beard wearing a green robe, sitting crossed legged on a wooden bench. Behind him, another man wearing a blue robe stands, looking over the scene. To the right, another man dressed in red robe holding a horizontal stick with a basket on each end" title="An 18th-century miniature from what’s now Turkey shows treatment for smallpox based on Ibn Sina’s earlier writing (Image by Bridgeman Images)" /> Equally influential was Ibn Sina’s Canon of Medicine, which synthesised Greek knowledge with Arabic scholarship and became a foundation of European medical education. In philosophy, Ibn Rushd [Averroes] made Aristotle accessible, earning the byname ‘the Commentator’. Muslim scholars didn’t simply preserve knowledge – they expanded it and pushed it forward. Read more | Marvellous medieval medicine: why their curious cures were better than you think The cultural impact was just as striking. Ziryab (Abu al-Hasan ’Ali ibn Nafi), arriving in Córdoba from Baghdad like a rock star in 822, revolutionised etiquette, cuisine and music. Under his influence, Europeans adopted table coverings, cutlery, crystal glassware, three-course meals and refined dining customs. These innovations spread across the continent. All of this helped sow the seeds of the Renaissance, from which the Enlightenment eventually emerged. When you trace the intellectual lineage backwards, you find it leads directly to this era. Comparing medieval Córdoba to the cities of northern Europe, the 20th-century author Victor Robinson captured the contrast perfectly: “Europe was darkened at sunset, Cordova [sic] shone with public lamps; Europe was dirty, Cordova built a thousand baths; Europe was covered with vermin, Cordova changed its undergarments daily; Europe lay in mud, Cordova’s streets were paved; Europe’s palaces had smoke-holes in the ceiling, Cordova’s arabesques were exquisite; Europe’s nobility could not sign its name, Cordova’s children went to school; Europe’s monks could not read the baptismal service, Cordova’s teachers created a library of Alexandrian dimensions.” It’s a vivid reminder of just how brilliant this period truly was. When did Europe’s erasure of its Islamic past begin – and what drove it? The construction of an anti-Muslim identity in Europe began with the crusades, when papal calls urged Christians to unite against what was depicted as an infidel presence. In Spain, this sentiment gained momentum with narratives such as that of Santiago Matamoros, who was said to have miraculously appeared on a white horse to help Christians defeat Muslims at the mythical ninth-century battle of Clavijo. This legend emerged only in the late 12th century – long after the supposed battle. Another powerful myth was the aforementioned ‘tribute of 100 virgins’, in which the king of Asturias allegedly sent 50 noble and 50 common virgin girls to Umayyad rulers each year. Both narratives became central to emerging Spanish cultural identity, appearing in festivals and plays. To this day, many Spanish churches have statues depicting Saint James slaying Muslims. Through such myths, imagery and ritual, these narratives reinforced anti-Muslim sentiment and helped shape what became a modern Spanish identity. If you could sneak a few more pages into every European history textbook, which stories or people would you add first, and why? One of the most fascinating figures is Abd al-Rahman III, the first Umayyad ruler in Iberia to declare himself caliph. His story begins with the massacre of the Umayyads by the Abbasids in the Middle East in 750, in which his great ancestor Abd al-Rahman I was the sole heir to survive. Abd al-Rahman I fled first to north Africa, where he gathered support, crossing into southern Iberia a few years later. Drawing on the legacy of his family, in 755 he defeated the governor of al-Andalus and then established himself as emir Abd al-Rahman I, with Córdoba as his capital. Over subsequent generations, his descendants gradually extended Umayyad control over most of the Iberian peninsula. By 929, his great-great-great-great-grandson Abd al-Rahman III felt powerful enough to declare himself caliph – a bold move in a period when the Abbasids in Baghdad and the Shia Fatimids in Tunisia also claimed that title. He built the magnificent city-palace of Madinat al-Zahra – sometimes called the ‘Versailles of Muslim Spain’ – as a statement of his caliphate. He was of European descent, with white skin, blue eyes and reddish-blonde hair – so much so that he reportedly dyed it black to appear more ‘Arab’. His personality and appearance add another layer to his intriguing character. Read more | Divided they fell: how war, revolution and sectarianism led to the end of the Ottoman empire Are you optimistic that both Muslim and non-Muslim readers in Europe can embrace this shared heritage together and foster a fuller understanding of its past? I’m tentatively hopeful because more people today are willing to revisit accepted historical narratives. The challenge is undoing 1,400 years of anti-Muslim European storytelling and recognising the Muslim contribution to European culture often mislabelled as ‘Judaeo-Christian’. That term itself is misleading, given the repeated persecution of Jewish communities by historical European Christians while many found safety in parts of Muslim Europe. Acknowledging these shared histories could slowly shift perceptions, but it will take immense effort, courage and time. Many are uncomfortable with the idea that Europe is as Muslim as it is Christian or Jewish, reflecting the deep-rooted othering of Islam in European identity. Historians who challenge widely held narratives, such as David Olusoga or Sathnam Sanghera, often face significant hostility. Speaking openly about these histories requires resilience because it challenges beliefs central to people’s sense of identity. It’s urgent, though, because leaving Muslim contributions out of mainstream European history has allowed Islamophobic sentiment to flourish, giving contemporary far-right rhetoric room to portray Islam and Muslims as a ‘foreign’, invasive presence rather than a long-standing part of European culture – a myth repeated even in recent public demonstrations. Tharik Hussain is an author, historian and travel writer. His latest book is Muslim Europe: A Journey in Search of a Fourteen Hundred Year History (Viking, 2025) This article was first published in the January 2026 issue of HistoryExtra magazine
How did people understand pregnancy BEFORE modern medicine?
HistoryExtra’s Ellie Cawthorne took a brief look back at the wonderfully strange, surprisingly clever and occasionally downright bizarre history of pregnancy
What did people in the past do to not only diagnose pregnancy, but to ensure the health of mothers and babies in the nine months before birth? To find out, HistoryExtra’s Ellie Cawthorne took a brief look back at the wonderfully strange, surprisingly clever and occasionally downright bizarre history of pregnancy – it's a far from comprehensive but fascinating snapshot into this subject. View Green Video on the source website
Health and medicine | Alice Loxton on the world of the Georgians
In episode four of the World of the Georgians, Alice Loxton investigates Georgian healthcare, where cutting-edge science sat uneasily alongside quack cures and medical scams
Medicine in Georgian Britain was as ripe for ridicule as it was for reform. In this episode, Alice Loxton explores how satirical artists such as James Gillray mocked the confusion of 18th-century healthcare, where miracle cures, medical quacks and genuine scientific breakthroughs existed side by side. From dubious treatments to the controversy surrounding early vaccination, this episode reveals how caricature captured public anxieties about illness, science and the body. View Green Video on the source website Want more from Alice? Find more episodes of the World of the Georgians. Alice Loxton is a historian, presenter and Sunday Times bestselling author with over three million followers on social media.
Dr Lucy Shipley shares a life lesson that we can take from the approach to life of the ancient Etruscans
Be yourself and don’t be afraid to make mistakes. That’s one of the lessons that archaeologist Dr Lucy Shipley says we can take from the approach to life of the ancient Etruscans. These historical inhabitants of the Italian peninsula seem to have had a very self-confident attitude – one which we could learn from today.
If you find yourself in a state of worry, Selena Wisnom argues that you could take a leaf out of the book of the ancient Assyrians and Babylonians
Do you wake up in the middle of the night worrying? If so, you’re definitely not alone. But if you want to manage the anxieties of modern life, Selena Wisnom argues that you could take a leaf out of the book of the ancient Assyrians and Babylonians.
Get personal with your poo, like a samurai
Chris Harding’s Life Lesson from History is that we should think more carefully about how we deal with our waste products
Are we too quick to flush? In Edo Japan, people were much more mindful of how they dealt with sewage and rubbish than we are today. Chris Harding’s Life Lesson from History is that we should think more carefully about how we deal with our waste products, in the spirit of the samurai.
Forty years ago, the UK found itself in the grip of a virus that killed thousands of people and sparked fear, confusion and prejudice – HIV. Janet Weston explores the Aids crisis as it unfolded throughout the 1980s, and how it transformed attitudes about everything from sexuality to healthcare
In the early 1980s, reports of a strange new disease began emerging from the United States. It was picked up in the British gay press – Gay News ran a story in November 1981 under the headline “Gay cancer or mass media scare?” – but relatively few people noticed. Even among those who did, confusion and doubt reigned: weren’t these tales of a “gay cancer” just fear-mongering, a backlash against the gains of the fight for gay liberation in the 1970s? How could a disease target gay men, anyway? Such suspicions were not without good reason. The medical profession had a difficult history with people who didn’t conform to heterosexual norms: less than 10 years earlier, homosexuality had still been categorised by the internationally influential American Psychiatric Association as a mental disorder. And when it came to Aids, the lack of knowledge about its cause or mode of transmission led to wild speculation. One theory linked Aids to the use of “poppers”, a recreational drug popular on the gay scene; another proposed that Aids was the end point of too many sexually transmitted infections. The picture grew still more complex as the symptoms associated with this new illness were also identified both among injecting drug users and people with the blood-clotting disorder haemophilia, including women and children. By July 1983, there had been 14 reported cases of Aids in Britain, all among men. Most were gay, including one man who also injected drugs, but the group included another who had been receiving treatment for haemophilia in the form of blood products. Just two months later, the number had risen to 24, and included a woman and a second man with haemophilia. As numbers of diagnoses in the United Kingdom started to rise sharply, the deaths began. Many people died very soon after diagnosis, as an array of opportunistic infections took advantage of their weakened immune systems. Terrence Higgins died in July 1982, one of the first deaths in the UK attributed to Aids. His partner, Rupert Whitaker, recalled asking the doctors whether Higgins’ death could have been caused by the strange “American disease”, but was dismissed out of hand: he was not family, so they couldn’t tell him anything. It wasn’t until a few years later that he found out they expected him to die soon, too. In the aftermath of Higgins’ death, his friends joined with Whitaker to set up a trust in his name to provide information and education in this information vacuum – and to provide support and services for people affected by Aids. In those frightening early years, charities such as the Terrence Higgins Trust led the charge. Men and women who had begun to see the impact of this disease first-hand devoted themselves to taking action. As well as fundraising, they gathered and shared the latest information, often looking abroad for insights from countries with more advanced epidemics. Volunteers and activists also campaigned for accurate media coverage and government attention, and ran phone lines and community centres to provide counselling and advice. Dread of infection Given the uncertain and rapidly changing state of knowledge about Aids, it was often difficult to know what advice to offer. If this really was a sexually transmitted disease, then perhaps abstinence was the answer – but with a newly self-confident gay community and a flourishing scene in many of Britain’s cities, this hardly seemed realistic. There was an idea that condoms might reduce the risks, but it was far from certain, and there were fears that condoms might give a false sense of security. Campaigners and volunteers struggled to decide on the best line to take. Even so, given the paucity of medical knowledge, many of these volunteers were better informed than the average doctor or nurse. In fact, many people with Aids in the 1980s knew more about their condition than their own clinicians, and some clinicians were willing to listen and learn. The idea of patients as participants in or even consumers of healthcare, whose experiences and views should be valued by biomedicine, had been building since the 1950s and was given a huge boost by patient expertise and advocacy during the first decades of HIV and Aids. With no known cause, no certainty over the mode of transmission, and all early signs indicating that Aids was invariably quickly fatal, the dread of infection was overwhelming. Nurses recalled being scared of their patients, caring for them in isolation while wearing two sets of gloves and gowns, using disposable cutlery and plates and burning bedsheets after use. “Nurses didn’t even touch a patient’s notes (which had ‘Infectious’ written at the top) without gloves,” one recalled. “It was just horrendous.” Life and death on the margins The virus causing Aids, now known as HIV, was identified in 1984. Soon thereafter a test for HIV antibodies – indicating exposure to the virus – was approved for use in the UK. The ability to test individuals, including those showing no symptoms, was transformative in terms of gathering data about the epidemic, but the results were alarming. Initial testing revealed that perhaps as many as three-quarters of people with haemophilia already had HIV, as did some of their sexual partners. Haemophilia was commonly treated with products generated from blood donations from large numbers of people, and around 1,200 people in the UK with haemophilia were infected with HIV in the 1980s. For the press, they were the “innocent victims” of the virus. That label naturally also served as a reminder that there were supposedly “guilty” ones, too, and fear quickly turned into hostility and discrimination. Those affected by Aids were mostly gay men, with drug users the second-largest group. These were already marginalised communities who could easily be blamed for their own misfortune, and Aids soon became deeply stigmatised: a marker of deviant living. Some of those with Aids were glad to be informed that their condition had finally led to a form of cancer, because at least cancer was something that you could tell people about without shame. In Edinburgh, heroin use had become particularly prevalent in the early 1980s; testing carried out by one doctor, Roy Robertson, revealed that more than half of his patients were HIV positive. The scarcity of needles and syringes, which were often seized by police, meant that drug users shared and repeatedly reused their injecting equipment, and infection had been spreading rapidly. Public health policy regarding drugs in Scotland underwent a dramatic shift in response, with attention turning to ways of minimising the harms of drug use instead of insisting on abstinence. It became a priority to reduce injecting drug use as much as possible, for example by prescribing methadone to those addicted to heroin, and for those who continued to inject, to provide sterile equipment. The anxiety surrounding HIV/Aids and its high profile made such radical policy changes possible. The availability of a test for HIV brought its own problems, though. Many people were tested without their knowledge and permission, misinformed of the meaning of their test result, or not told at all. Eighteen-year-old John Campbell, who would later set up the Coalition of People Living with HIV and Aids and advise the government on HIV in prisons, had been arrested in 1986 for “male importuning” and was tested on arrival into prison. But the charges were dropped, he was released, and he had no idea that he had tested positive for another 10 months. Fear and loathing The profile of HIV/Aids increased in the second half of the 1980s. Many people in the UK had remained entirely or mostly oblivious to the unfolding disaster, but this soon changed. Although emerging research indicated that HIV could not be transmitted by casual contact, such as a handshake or a shared cup, a lot of the media coverage became increasingly hyperbolic. “I’d shoot my son if he had Aids, says vicar” ran one lurid headline in The Sun in October 1985. Such coverage often quoted the extreme views of people from all walks of life, from publicans seeking to ban people with Aids from their establishments, to the chief constable of Greater Manchester who said that people with Aids were “swirling around in a human cesspit of their own making”. The fact that people with HIV or Aids might hold down jobs seemed particularly horrifying. Newspapers anxiously reported that people with HIV or Aids might work as airline cabin crews, bus drivers, teachers – or most worryingly of all, as doctors and dentists. Many people with, or suspected of having, HIV or Aids were fired: the Terrence Higgins Trust dealt with about 100 cases of employment discrimination each year. This period has been characterised as one of “wartime emergency”, with mounting panic finally leading to government action. The Conservative government appointed a cabinet committee to tackle Aids in autumn 1986, and on 21 November there was an emergency debate in the House of Commons. Opinions diverged dramatically, between those favouring regulatory measures such as quarantines and compulsory testing, to those who preferred a more liberal approach, including the promotion or provision of condoms and guarantees of confidentiality for those testing positive. Perhaps most memorable, in terms of government response to the crisis, was the nationwide health education campaign launched in January 1987. In the face of a significant lack of enthusiasm from then prime minister Margaret Thatcher, this included television spots, billboards and a leaflet for every household. Actor John Hurt lent his voice to the now-notorious television advert. Over footage of the word “Aids” being chiselled into a tombstone, he intoned: “If you ignore Aids, it could be the death of you. Don’t die of ignorance.” This campaign has often been remembered as a success. It was a clear sign of action, and expensive too, costing around £20m. Polls afterwards suggested that viewers felt more confident of their understanding of Aids, and ultimately, the worst predictions for the epidemic in the UK did not materialise. However, the campaign also relied heavily upon generalised impressions of death, disaster and doom, doing little to dispel rumours or to educate and help those already affected or most at risk. Artist and activist Leigh Neal received her diagnosis just as these adverts aired; she remembered their clear message that Aids meant death, and the environment of fear and hostility that this created towards her – including bricks thrown through her window. For those who were not white gay men, this lack of information and support could be particularly acute. The later 1980s saw the creation of more specialist advocacy and support groups to fill these gaps. One of the founders of Positively Women, a group set up in 1987 by and for women with HIV, remembered feeling “doubly isolated” in most HIV/Aids support groups, as a woman and a former drug user. Mainliners, a support group run by and for HIV-positive drug users, was founded in the same year. So, too, was the Broderip Ward at Middlesex Hospital in London: a specialist ward for those with HIV and Aids. It was opened by Princess Diana, who took pains to shake hands multiple times with patients at the ward before the cameras, without wearing gloves. Garnering huge press coverage, many recalled this as a vital moment, helping to dispel some of the myths swirling around Aids at the time. This ward and others like it represented greater resources and medical expertise dedicated to HIV and Aids, but also many more people suffering and dying. Specialist wards could provide a sense of community and even fun, in dark times. HIV nurse Barbara von Barsewich described one patient, “a tall, Italian, glamorous man who came out of a side room [in the ward] at night-time in a blue ball gown and six-inch heels... he swung around and just looked so gorgeous. And then he started coughing up bits of his lung... It was just so hard. It was so painful. You knew exactly what was happening.” Love and loss For the most severely affected communities, the extent of the loss in the late 1980s and early 1990s was overwhelming. Julian Hows recalled the deaths of four lovers over these years. One was passionate about cars and was eventually driven to hospital by Hows and friends in a Mercedes-Benz, borrowed for the occasion. As they arrived at the hospital and opened the car door, Hows remembered: “A really nice nurse said, ‘You realise your friend has gone.’” He had died on the journey. Gay men and their friends experienced years of countless funerals, with social circles of young people all but obliterated. At many of these funerals, it remained taboo to mention Aids. Many families felt, as writer and activist Simon Watney put it, “condemned to silence, to euphemism”. In the mass media and popular discourse, Aids stubbornly remained something that happened to “other people”. Generalised fears became more deeply racialised, as news emerged of the epidemic’s disastrous spread and possible origins in Africa. Continuing the tradition of self-help and community organising among those affected by HIV and Aids, volunteers set up the Black HIV/Aids Network in 1989 and began to deliver literature, films and services specifically addressing black and Asian people in the UK. Towards the end of the 1980s, activism surrounding Aids reached a high point. Members of the newly formed London branch of ACT-UP – the Aids Coalition to Unleash Power – organised a series of eye-catching protests designed to attract headlines. Targets included Australia House, in response to new laws requiring immigrants to take an HIV test, and Pentonville Prison, where helium-filled condoms were released to carry leaflets about Aids over prison walls. Read more: From Sappho to It’s a Sin: 9 LGBT+ histories, chosen by experts The London branch of ACT-UP soon disbanded, though, and in the 1990s Aids gradually disappeared from the headlines. The arrival of much more effective drug treatments from the mid-1990s onwards transformed HIV into a chronic but manageable condition. And, although there had previously been a great deal of interest in deploying insights from history to understand and contextualise responses to Aids, historical attention to the epidemic also waned. HIV/Aids had transformed attitudes, practices and policies around sex and sexuality, drug addiction, activism and community-building, as well as hospital hygiene, clinical research and doctor-patient relationships. As the sense of urgency and, later, the memory of the epidemic began to fade, not all of these changes were sustained. Roy Robertson, still working in addiction studies in Scotland, reported that HIV had reappeared in a vulnerable population of injecting drug users in Glasgow in 2015, in a political and policy context that bore striking similarities to that of the early 1980s. Four decades on from the first diagnoses and deaths, there is now a resurgence of interest. Oral history projects are springing up, and new research is beginning to investigate less well-known experiences. There is a campaign for a public memorial to the lives lost to Aids, and a clear desire to ensure that all the losses and gains of those years are not forgotten. After all, a generation of people diagnosed in the 1980s are now the first people with HIV to reach retirement age. The history of HIV/Aids in the 1980s is still unfolding. A global concern: 7 key moments in the world’s battle with HIV/Aids in the 1980s United States 1981 Clinical reports began to describe clusters of a rare type of pneumonia and other unusual infections among gay men and then injecting drug users, in California and New York. News of this novel disease was picked up by the gay press. Different names and possible explanations were floated and the term “Aids” was coined in 1982, but the original idea of a “gay plague” proved difficult to dislodge. Cuba 1983 The government set up a National Aids Commission and ordered the destruction of all blood products imported from overseas. Law 41 was passed, giving the Ministry of Public Health power to enforce the quarantining and mandatory treatment of anyone affected by diseases deemed to pose significant community risk. The first case of HIV was diagnosed three years later, and the quarantining in sanatoria of anyone diagnosed with HIV or Aids began. This remained in place until 1993. Zaire 1984 Research in Kinshasa provided strong evidence of the transmission of HIV between heterosexual couples. Here, there were just as many women with HIV or Aids as men. These findings were not easily accepted by the scientific community but were finally published in The Lancet. The prospect of a global epidemic affecting not only gay men, drug users and haemophiliacs, but also heterosexual couples, began to stir more governments to action. Netherlands 1984 A drug users’ “union”, known as a junkibonden and active since 1980, began to provide sterile needles and syringes to injecting drug users in Amsterdam. Initially introduced to tackle the spread of hepatitis B through shared needles, the scale of needle provision was stepped up considerably in light of HIV and Aids and eventually received government funding. The union published literature by and for drug users, and offered peer support and advice on safer injecting. Senegal 1986 The first cases of Aids were reported. This was a different and less virulent strand of the virus, first identified in West Africa by Senegalese researchers the year before. It brought international recognition and encouraged national political attention to HIV and Aids. Rates of infection remained consistently low, thanks not only to the different viral strand, but also factors including the legalisation and regulation of sex work and high safety standards concerning blood products, both of which pre-dated the epidemic. USSR 1987 The first Aids-related death was recorded, a few years after Russia’s health minister declared that it was a “western disease” that would have no impact on a country without drug addicts or prostitution. There were more than 500 known cases by 1990, but the Soviet authorities emphasised that most of these were foreign nationals. A few years after the collapse of the USSR, reports of rapid HIV spread emerged: by the mid-1990s Russia was said to be on the brink of a vast epidemic. Japan 1989 Haemophiliacs infected with HIV filed lawsuits in Tokyo and Osaka, demanding compensation from the government and pharmaceutical companies. Contaminated blood products imported from the US meant that around 40 per cent of Japanese people with haemophilia were infected with HIV. This “tainted blood” scandal dominated headlines and perceptions of HIV and Aids in Japan: plaintiffs and their families finally received a formal apology and compensation in 1996. Janet Weston is assistant professor at the London School of Hygiene and Tropical Medicine. An episode of the BBC Two series Saved by a Stranger covered the HIV/Aids crisis. You can catch up with that on the BBC iPlayer This article was first published in the June 2021 edition of BBC History Magazine
One family was an ever-present force in European affairs from the Middle Ages to the modern era, but, as Jonny Wilkes explores, the Habsburgs’ desperate bid to keep power within the family gave them a distinctive physical callsign, as well as dynastic longevity…
For centuries, the Habsburgs were one of the most prominent royal dynasties in Europe. They ruled as kings of Germany, from the 13th century, and as archdukes of Austria from the mid-14th century. They sat on the throne of the Holy Roman Empire from the 15th to 19th centuries. Their house dominated swathes of the continent with Habsburg rulers in a host of countries, most notably Spain. But there was something else that became prominent about the Habsburgs: their jawline. What was the Habsburg jaw? Many members of the dynasty had the same physical trait of a protruding bottom jaw – a mandibular prognathism, medically speaking. The jutting chin could be so pronounced that the flattering portrait artists of the day could not manage to hide them. The condition even prevented some members of the dynasty from eating or speaking properly. Read more | The Habsburgs: the dynasty that wouldn’t die The ‘Habsburg jaw’ was a biological result from generations of inbreeding. In a bid to keep their power, the Habsburgs kept everything within the family. They relied on ‘consanguine’ marriages that partnered close relatives, such as first cousins, or uncles with their nieces. View Green Video on the source website Why did the Habsburgs intermarry so much? It’s true that close-family marriages weren’t exactly unusual among the royal houses of Europe, but the Habsburgs were the champions of consanguinity. Of the 11 marriages during the reign of the Spanish Habsburgs, from 1516 to 1700, only two were not incestuous. “The arrangement made good political sense, guaranteeing that the two lines would support each other militarily,” writes historian Martyn Rady, “which paid dividends in the Thirty Years’ War (the bloody religious conflict fought across central Europe from 1618–48). “Biologically, however, it was a disaster. As first and second-cousin and uncle-niece marriages became the norm, madness and deformity followed.” In 1517, Italian diplomat Antonio di Beatis described the future Holy Roman Emperor Charles V as having “a long, cadaverous face and a lopsided mouth (which drops open when he is not on his guard) with a dropping lower lip”. In 2019, a scientific study confirmed the link between inbreeding and the Habsburg jaw. By analysing dozens of portraits for signs of mandibular prognathism and maxillary deficiency (where the bones of the upper jaw do not develop properly, causing the upper lip to appear sunken), the results showed that the more evidence of inbreeding, the worse the jaw. Who had the worst Habsburg jaw? The five family members with the ‘worst’ Habsburg jaws, as far as that study was concerned, were the Holy Roman Emperor Maximilian I (1493–1508), his daughter Margaret of Austria, Charles I of Spain, his nephew’s great-grandson, and the King Charles II of Spain (1665–1700). Charles II suffered from a host of conditions and disorders, among them epilepsy, as a result of 16 generations of inbreeding. His grandmother and aunt were the same person, while his mother was also his father’s niece. Such was his physical deterioration, as well as his mental decline, that his autopsy recorded that his body: “did not contain a single drop of blood; his heart was the size of a peppercorn; his lungs corroded; his intestines rotten and gangrenous; he had a single testicle, black as coal, and his head was full of water.” As for Charles’s Habsburg jaw, it was so pronounced that his upper and lower rows of teeth did not meet all. He could not chew his food, which served to exacerbate his health issues as he had multiple stomach concerns, and he had an oversized tongue that meant he could not speak clearly. One British envoy in the 17th century later documented the king’s eating habits, reporting that Charles II “swallows all he eats whole”. How 'inbred' were the Habsburgs? The 2019 study calculated an ‘inbreeding coefficient’ in order to analyse the Habsburgs. The typical ‘F value’ of this coefficient is 0.0625, which is indicative of a child with parents who were first cousins. Philip I, the founder of the Habsburg dynasty in Spain, had an F value of 0.025; Charles II, his great-great-great-grandson, had an F value more than 10 times that, at 0.254. “The Habsburg dynasty was one of the most influential in Europe,” said the lead researcher, Professor Román Vilas from the University of Santiago de Compostela in Spain, “but became renowned for inbreeding, which was its eventual downfall.” Did Marie Antoinette have a Habsburg Jaw? Marie Antoinette was a descendent of the Habsburg line. She was the daughter of Empress Maria Theresa and Holy Roman Emperor Francis I. Maria was in the Habsburg line of succession, ruling between 1740–80. She did not have the same prominent Habsburg jaw of some those in her family tree – though she did have a protruding lower lip, thought by some to be a version of the genetic pattern. Does the Habsburg chin still exist? Many of the descendants of the royal German-Austrian Habsburg family are still alive today – though the chin is no longer a feature of the family. Charles II would be the last Spanish Habsburg king. He became known as ‘El Hechizado’ (‘the bewitched’) and was doomed to end the line with his death, with no heir, at the age of 38. Martyn Rady writes how it “was followed by a war of succession across Europe.” Read more | What if Charles II of Spain had produced an heir? “Although the central European branch of the Habsburgs hoped to capture the dead king’s inheritance,” writes Rady, “its rulers failed to keep hold of Spain, which passed to the French Bourbons.” More from us HistoryExtra members can explore more weird and wonderful history with exclusive content from our archives Weird and wonderful history quiz Medieval magic at work: 7 spells and charms our ancestors used “Ninety years of horror: nine films that reflect society’s changing anxieties Not a HistoryExtra member? Explore our latest membership offers