Shit happens

Humanity built the toilet. It’s one of our greatest inventions, but still not one shared by all

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‘If I were not a prince’, the future King Edward VII – or Bertie to his friends – is said to have mused, ‘I should like to be a plumber’. The year was 1871 and Bertie was recovering from a severe case of typhoid. His condition had been closely followed by outlets like The Lancet whose hunt for the origins of the prince’s ailment spurred something of a public frenzy.

Discussing the event’s significance, 19th-century sanitary engineer Samuel Stevens Hellyer called it the ‘single greatest factor in advancing the principles of sanitary plumbing’. Indeed, in the history of sanitation it is always in the wake of severe disease outbreaks that change happens.

Bertie’s pipe dreams notwithstanding, by the end of the nineteenth century, Britain and the world stood on the brink of a revolution: one that would bring toilets into our homes, connected to pipes carrying clean, fresh water, that could swiftly and safely remove dangerous waste. It’s an engineering triumph that has saved innumerable lives, the kind to make a future king long to be a plumber.

Starting in the late nineteenth century, infant mortality declined precipitously across the world. For most of human history, 1 in 2 babies died before their fifth birthday. Today, the global average is 1 in 37. Evidence suggests that, in some cases, up to a third of that reduction is related to sanitation improvements.

Sadly, the sanitary revolution remains incomplete. Today, some 2 in 5 people still lack access to safe sanitation. The consequence is that infant mortality varies widely across the world. For that reason, on 19 November 2001, the World Toilet Organisation established ‘World Toilet Day’, to ‘celebrate toilets and raise awareness of people living without access to safely managed sanitation’. To understand why sanitation matters so profoundly, it helps to look at how waste has been managed over time, and what happens when humans get it right.

The most basic form of human waste disposal is a hole in the ground. This is what experts refer to as ‘on-site sanitation’. Historically, these could be located in a shelter, known as a ‘privy’ or ‘latrine’, and might include a raised seat on which to perch. Occasionally, these systems were connected to rudimentary drains or ditches. For most, however, these cesspits had to be emptied in a process of night soil removal that defies easy description. But as human settlement patterns grew more dense, the dangers posed by ineffective waste disposal systems became serious. Water-based diarrhoeal diseases like typhoid, cholera, and dysentery, grew, spread and killed.

Counterintuitively, sewers predate sewerage. As Rose George writes in The Big Necessity, ‘sewers have always been a carriage for dirtied water, but the degree and manner of dirt has changed’. In fact, the rising popularity of the toilet in the mid-19th century only compounded London’s waste problems. With industrialisation and urbanisation came ever greater demand for potable water, and with it, the idea for a water-propelled waste-disposal system. For this, we should thank Edwin Chadwick.

In the year of Bertie’s baptism, Chadwick published his famous Report on the Sanitary Condition of the Labouring Population of Great Britain, revealing the grim realities of urban life. Chadwick and his contemporaries, John Snow, Henry Whitehead and Joseph Bazalgette, would go on to revolutionise sanitation, epidemiology and public health administration in Great Britain. London’s sewer system, likely responsible for saving ‘more lives than any other public works’, turns 160 this year.

The flushing toilet, though, is not a recent invention. The oldest one dates to the second millennium BC in the Palace of Knossos on the Island of Crete. In its modern manifestation, though, the flush toilet emerged first in the 19th century. A handful of names are important: Alexander Cummings, Joseph Bramah, George Jennings, Thomas Crapper, and Thomas Twyford, each of whom modified elements of an appliance that remains relatively unchanged to this day. As Rose George observes, ‘the modern toilet would still be recognisable to Joseph Bramah. He could probably fix it.’

Closer to home, entrepreneur and patron saint of South African cricket, James (“Jimmy”) Logan, is said to have had the first flush toilet in South Africa. Sadly, sources are vague and dates unclear. Matjiesfontein, where Logan built his miniature empire, claims to have had the first water-borne sewerage system in the country, an outcome of Logan’s ingenious idea to sink boreholes in the arid landscape.

It’s hard to say exactly which city or town had the first water-borne sewerage system in South Africa. Limited water supply and drainage systems would have been built, extended, and built over again in layers of development. Cape Town, as the oldest city, built water systems early on, but only began work to develop a serious drainage system from the 1890s. This system would be completed around 1904, just after Bloemfontein, which became the first city in South Africa with a fully-fledged sanitation system, including a waste treatment plant, earlier that year.

What did that revolution look like on the ground? In new research, Kelsey Lemon, Jan-Hendrik Pretorius and I follow one town – Paarl – through the three pivotal decades around 1900 to see how early sanitary works changed survival in infancy, and for whom. We digitised every registered death of children under one, matched each case to its street of residence, and combined this with reconstructed annual births to build race-specific infant mortality rates for 83 streets. Crucially, we then track a municipal drainage programme rolled out street by street between 1905 and 1907 and compare before–and–after changes on upgraded streets with those not yet improved. We do this separately for white and coloured households. In short, we ask whether this simple investment in sanitation – closing the foul open sluits into which households threw their waste– saved babies’ lives, and whether benefits were shared.

The answer surprised us. As expected, drainage sharply reduced deaths from water‑ and food‑borne disease. But, importantly, this happened almost exclusively for white infants. Our estimates point to immediate and persistent declines for whites – on the order of a 35 per cent fall in infant mortality on treated streets – while for coloured infants we find little if any comparable improvement. Evidence from illness duration and the town’s topography suggests why: drains cleared the high‑lying neighbourhoods first, conveying contaminated run‑off downhill and concentrating risk in the low‑lying, overcrowded quarters where many coloured families lived. Infrastructure mattered greatly for infant survival, but its gains were conditioned by where pipes were laid, who had access to clean connections, and the physical contours of the place.

These results suggest that the sanitary revolution was both a triumph and a tragedy: a technology that could save lives at scale, yet one that, when partially and unevenly provided, could leave the most vulnerable behind or even worse off. In a time before formal spatial segregation, when social, economic and political inequalities were hardening in Paarl, these improvements entrenched that divide.

Even today, toilet technology saves lives unevenly: transforming living standards for some, while millions still wait for its promise to reach them. With many African countries experiencing rapid urbanisation over the coming decades – just as in South Africa at the start of the twentieth century – sanitary investments that benefit the most vulnerable should be a priority for local governments across the continent. Bertie may have recovered, but the revolution his illness inspired is still incomplete.

This is an edited and translated version of my monthly column, Agterstories, on Litnet. To support more writing like this, consider becoming a paid member. The image was created using Midjourney v7.