Public Toilet Design: History, Health, and Inclusivity

Introduction

In modern society, public toilets have become a fixture wherever human activity takes place. Shopping malls, restaurants, and filling stations all provide these places of convenience for travelers, diners, and shoppers. However, when considering the nature and function of public toilets, many question their cleanliness and safety for public use. Cultural and gender issues have also played a role in these debates. Women, for example, are obliged to make physical contact with public toilet surfaces, while this is not necessarily the case for men.

In terms of cultural issues and sanitary concern, critics such as Isbit (2001) have suggested a toilet design whereby human skin does not need to make any contact with the fixture, and where both men and women squat to relieve themselves. To take these concerns fully into account, the history, background, and design of the public toilet must be considered in detail.

Historical Background

According to Keating (2010), there is some disagreement over the inventor of the sit-down flush toilet found in most public places today. Some give credit for the valve-and-siphon design to Thomas Crapper (1837–1910), an English sanitary engineer. Others place its invention much earlier in human history, crediting a nameless Minoan who lived in ancient Crete some 4,000 years ago. A third group places the invention of the modern flush mechanism in 1775, when Alexander Cumming patented a flushing device. In addition, Sir John Harrington published a pamphlet titled the "Metamorphosis of Ajax" in the 16th century, in which he provided full instructions for a valve closet. Somewhat later, in the 18th century, George Jennings made plumbing inventions considered to be the forerunner of today's toilet.

Biddle (2010) confirms that the history of the toilet is difficult to trace from ancient to modern times. There is ample evidence of ancient cultures with advanced plumbing systems long before the 16th or 18th centuries. Cultures as far back as 3,000 years ago had some sort of flushing system to provide a hygienic way of life. Specifically, the Harappa civilization had toilets in their homes with subterranean chambers to drain waste. Inhabitants of Skara Brae in the 31st century BCE had a drainage system that led to a nearby river. The most common image of the public toilet in ancient times, however, is probably that of Rome, where public baths included toilets that drained into a meticulous sewage system.

Biddle (2010) also notes that private toilets were a luxury reserved for the elite. The concept of the public toilet all but vanished when the Roman Empire fell, and it was only during the 16th century that sewage systems received renewed attention, in the form of Harrington's pamphlet. It is largely because Thomas Crapper popularized the private flushing toilet in Europe that many today credit him with its invention.

After this era of invention, the toilet underwent no significant leaps in design. The most recent development has been the proposal for a squat toilet, which is claimed to offer many health benefits that the conventional sit-down toilet does not. In addition to physical health benefits, the squat toilet is also believed to accommodate diverse cultural needs.

Cultural Issues and Toilet Design

Biddle (2010) points to a growing body of research suggesting that squatting to relieve oneself, as opposed to sitting, could carry greater physical benefits than commonly supposed. According to Isbit (2001), squatting could reduce the risk of serious conditions such as hemorrhoids and other gastrointestinal problems. Several designs in this regard have already emerged, although none is yet in popular use.

Isbit (2001) identifies seven basic advantages to using the squatting position over sitting. First, elimination occurs faster, more easily, and more completely in the squatting position. Second, it prevents "fecal stagnation," a common factor in colon cancer, appendicitis, and inflammatory bowel disease. Third, squatting protects the nerves that control the prostate, bladder, and uterus — nerves that the sitting position risks stretching or damaging. Fourth, sitting carries the risk of leaks in the ileocecal valve, which could contaminate the small intestine; when squatting, this valve is securely sealed. Fifth, squatting relaxes the puborectalis muscle, resulting in easier defecation. Sixth, it prevents straining, which can cause hernias, diverticulosis, and pelvic organ prolapse. Seventh, squatting has significant benefits for pregnant women by avoiding pressure on the uterus and preparing the body for a more natural delivery.

Isbit (2001) bases his theories on the observation of historical cultures and primates. He argues that an upright sitting position to relieve oneself has only been a recent addition to society. In their natural environment, human beings and primates have always used the squatting position. This is also the natural position taken by infants of every culture, leading the author to conclude that the human body was designed to function this way.

Indeed, until the middle of the 19th century, when the chair-like toilet was popularized for society at large, such fixtures had been used only by royalty and those who were disabled. The design of the "throne-like" water closet was built around the concept of "dignity," which until then had been reserved for the most privileged members of society. It symbolized the advances and civilization assumed to be part of modern Western society. Even more significantly, the assumptions surrounding a seated position while relieving oneself were intertwined with Victorian condescension toward cultures other than the dominant European white classes. The squatting position was regarded as "humiliating" and even "base."

Having established this attitude, the British plumbing industry drove the installation of indoor plumbing and water closets in homes throughout the country. Improvements in sanitation and convenience overshadowed the ergonomic flaws of the new design, which caused users to strain, making elimination both difficult and incomplete. Although some critics noted this, it was not considered a mentionable subject in polite society, and the water closet was forcibly accepted in Britain. This acceptance was quickly followed by the rest of Western Europe, Australia, and North America, none of which wanted to appear less civilized than the British Empire.

The long-term outcome is that many physicians today blame the modern toilet for several serious ailments affecting the colon and pelvic area. Alongside the already mentioned hemorrhoids, irritable bowel syndrome, colon cancer, and appendicitis, other potentially toilet-related conditions include polyps, ulcerative colitis, and diverticular disease. In support of this assertion, Isbit notes that South African whites and other populations in prosperous Western countries suffer high rates of these diseases, while rural South African populations and other poorer communities are almost entirely unaffected.

To further support his points, Isbit provides detailed information relating to each of the colon and gastric conditions he attributes to the sitting toilet. His conclusion is that the squatting toilet should re-enter society as a better and safer alternative — one that could cater to the cultural requirements of many, the hygiene requirements of women in particular, and the general health of society as a whole. One difficulty, however, is the potential resistance from a public that is neither informed about nor willing to make the fundamental change that such a radically different toilet design would require.