Why Poor Hygiene Was a Virtue in the Medieval Era

Guest Post by Ravi Saraogi

What if I told you that poor hygiene in Western countries was an important reason for them being wealthier than Asian countries during the medieval era (circa 1400 – 1800). Sounds quirky right? But this is indeed true.


Medieval Europe: Human excreta was collected in pots and thrown into the street Source: http://www.haciendapub.com/medicalsentinel/medical-history-hygiene-and-sanitation

Really? How is this possible?

Prior to the Industrial Revolution (circa 1800-1850), civilization was subject to the Malthusian Trap. This trap worked in two ways. Every time efficiency growth outstripped the growth in population, birth rate would increase. This would lead to per capita income remaining constant as the extra income generated out of growth in efficiency had more mouths to feed. Similarly, every time efficiency growth lagged the growth in population, population would fall. This is because the fall in efficiency growth would lead the income to be insufficient to support the growth in population. Again, per capital income would remain constant in this case too as the income fall was accompanied by a fall in population.

So, under the Malthusian Trap, there are three ways in which per capital income can be increased,

  • Higher growth in efficiency
  • Lower birth rate
  • Higher death rate

Before the Industrial Revolution, growth in efficiency was very slow, so option (1) is out. That leaves us with lower birth rate or higher death rate. With this background, we can answer the question – why was there a positive link between poor hygiene and higher incomes prior to the Industrial Revolution? Simple, poor hygiene lead to higher death rates.

But how do we know hygiene in Western countries was poorer than Asian countries?

Gregory Clark, in his book ‘A Farewell to Alms’ devotes a nice section on this. For instance, he mentions that,

Another factor favoring high living standards for Europeans compared to Asians is that throughout the preindustrial era Europeans were—by modern standards and also those of preindustrial China and Japan—a filthy people, living in dirt and squalor. The low standards of personal and community hygiene are everywhere apparent in preindustrial Europe. Indeed the travel diaries of European visitors to Japan in the years 1543–1811 frequently stressed the extreme cleanliness of the country by contemporary European standards.” [1]

Particularly interesting is Clark quoting in his book an extract from a certain Samuel Pepys’ diary in October 1660, “Going down to my cellar . . . I put my feet into a great heap of turds (lumps of excrement), by which I find that Mr. Turner’s house of office is full and comes into my cellar.[2] It appears that overflowing faeces matter from your neighbour’s house was not a big deal in medieval England!


Medieval Europe: People used to pee and poo in pots kept under their beds. Source: http://www.littlethings.com/shocking-hygiene-practices/?vpage=1

Furthermore, “In contrast in China and Japan human waste, urine as well as feces, was a valuable property which householders sold to farmers, and which various groups competed for the right to collect. Waste was not dumped into cesspits, sewers, and streams, contaminating water supplies. Instead in cities such as eighteenth-century Osaka contractors found it profitable even to provide public containers on street corners in order to profit from the waste deposits.” [3]



People changed clothes only occasionally: King James VI of Scotland went months at a time without changing his clothes. Source: http://www.littlethings.com/shocking-hygiene-practices/?vpage=2

This is apart from other poor hygiene habits in medieval Europe like rarely taking baths and only occasionally changing clothes. Asians were apparently way more hygienic. “… in Japan bathing in hot water was popular and frequent. The Chinese also bathed whenever possible, and they employed plenty of soap. The Japanese washed their hands after urinating or defecating, and they kept privies clean.


Showers and tubs were rarely found in the home. When people did bathe, it was usually in a common area where hundreds of others had bathed. Source: http://www.littlethings.com/shocking-hygiene-practices/?vpage=2

Unfortunately, the rules of the Malthusian Trap was such that better hygiene and sanitation led to a lower death rate in Asian countries and they were “punished” as meagre incomes had to support larger populations.

So, should we infer that to become wealthy, countries should neglect sanitation and hygiene? Absolutely not. Luckily, the positive relationship between poor hygiene and per capita income during the Malthusian era broke down during the Industrial Revolution.

Industrial Revolution and the Escape from the Malthusian Trap

Something happened in England during the Industrial Revolution (circa 1800-1850). The rate of growth in efficiency multiplied by leaps and bounds. No longer was birth and date rates an important determinant of per capita income. Take a look at the graph below:


Source: Hoppe, Hans-Hermann, 2013, From the Malthusian Trap to the Industrial Revolution, Mises Circle Feature

For most of human history, per capita income was broadly constant. As highlighted earlier, this was because any gain in efficiency which resulted in additional income was just about enough to feed the growth in population, so that income per head remained more or less constant. But around 1800, things changed in Western countries when the growth in efficiency far outstripped the growth in population, leading to a sharp increase in per capita income.

Which is to say that post 1800s, efficiency became the central determinant of per capita income. No longer do birth and death rates play any significant role in influencing per capital income. With this, the “advantage” that unhygienic countries had over hygienic countries is gone. All countries now have the right incentives to push for better hygiene and sanitation facilities.

Aren’t we glad?

[1] Clark, Gregory (2005), A Farwell to Arms, Chapter 5, p105-108
[2] Ibid.
[1] Ibid.

Hapee Commode celebrated World Toilet Day in Chennai with children

On the occasion of the World Toilet Day (WTD), the Hapee Commode organized a two-day fun workshop for underprivileged children in a slum colony in Chennai. The workshop was held on consecutive Saturdays in November 2015 in a public hall in the colony to make the children understand the importance of hygiene, particularly the need for washing hands before eating and after using the toilet, through modules in the form of engaging games and practical exercises. The workshop was a great learning experience for the participants as well as the facilitators.

A child uses the tippytap to wash hands

On the first day of the workshop, we built a tippy-tap – a makeshift hand-wash – for the children who don’t have access to tap water. Before the children could experiment with the tippy-tap, we played with glitter to make them understand how germs pass from one hand to the other when they shake hands with one another. After that we went to the backyard to wash our hands. Children were brimming with happiness and excitement as they waited patiently in a queue to wash their hands. We spoke about Gandhiji and how he felt that sanitation was more important than political independence. We sang the national anthem to instil a sense of patriotism in them, telling them that sanitation was an integral part of national pride.



Children working on their drawings

The second day was even more interesting as we conducted a painting competition for the children. It was a rainy day in Chennai and so we chose rain as the theme. First, we asked them to name the things they associated with monsoons. They said dirt, unhygienic condition, water logging, umbrella etc. A few them shouted ‘bajji,’ crispy vegetable fries eaten on rainy days. Once we felt that the children had enough ideas to work on, we asked them to draw and paint about the monsoon. It was amazing to watch their sudden transformation. The boisterous kids got into pin-drop silence as they started sketching their thoughts on the canvas and drawing umbrellas, homes, toddlers, clouds, flowers, trees, water, love, etc…Once they were done, we put up all their paintings so that they would remember this special day of their lives.


A game visualized and created by Triple O Studio

The closing of the workshop was marked by another interesting game for the kids…Triple O Studio, a design and architecture firm, had decorated the backyard, hanging mugs on trees and ropes. We formed teams of kids – one team for each colour of mugs – and gave them balls to be dropped in the mugs meant for their respective team. The team which managed to drop the maximum number of balls in 60 seconds would be the winner. This game was electrifying as children jumped up and down the trees to try and win! At the end, we gave away the mugs to all the kids for use at home.


Monsoon Paintings by the kids

The two-day workshop brought out the best in me as I learned a lot from the energetic and enthusiastic kids. I also realized that children do not need tutoring – especially when it came to inculcating in them a sense of sanitation and hygiene. They just need an enabling environment to learn and adapt. All the children were aware of what was good and bad for their health and overall well-being. I am sure that the workshop removed some of their mental blocks and brought about the much-needed change in them to yearn for better sanitation, health and happiness.


In addition to the workshop, we had an online campaign for WTD providing people a platform to write about sanitation, health and hygiene. Illustrators and cartoonists showcased their talent to present some awesome work for our facebook page and blog. Special thanks to Alicia Souza and Rajesh Rajamani of Inedible India for their work.

IMG_5285.JPGThe two days also saw the best of the volunteering spirit among organizations and individuals. We had no funds for this workshop but we pooled in our time, resources and a little bit of money. I thank each one of you for your participation in the workshop. Among the volunteers were: Triple O Studio (Tahaer, Anupriya, Sabarish and others), Prajnya (Ragamalika), Pudiyador (Udayan, Ruby) and Ravi.

– Somya Sethuraman, Founder, The Hapee Commode

For more information: https://www.facebook.com/hapeecommodepage/

Expectation versus Reality: Slum sanitation in Tirupati

Guest Post by Sindhu Chandrasekaran for the International World Toilet Day

tirupati12-v (2)
Source: ahunavairya.wordpress.com


As a part of a research project, I visited a slum in Tirupati to observe how community toilets work there and record the need for these toilets.

Many houses in the slum were built using loan given by MEPMA under the scheme INDIRAMMA  launched by Andra Pradesh in 2006. This scheme aimed at building “cozy and modern looking houses with individual sanitary latrines ” in urban areas. The amount earmarked per house was Rs 42,750 which included Rs 2,750 for building toilets and Rs.40,000 for construction of house.[1]

As of 2012, under this programme, in AP, 90,000 houses were built without a toilet facility. In a move to ensure sanitation facilities for each house, the State instructed officials from the Housing Department to withhold payments for roof construction to the beneficiaries who fail to build individual sanitary latrines in their households.[2]

A major proportion of families living in this slum are daily wage laborers. Many houses lack access to toilets and resort to open defecation near the adjacent railway tracks. Some families have constructed a toilet outside their house in the premises where there was vacant area available. These toilets are of the pour-flush type connected to a septic tank. The septic tank is never cleaned which results in over-flowing during rainy season. This is a threat to the overall health and well-being of the community.

Some families have individual toilets inside the house, a part of this group consists of Government employees who could afford to build a toilet inside the house. The number of shared community toilets was also low. There was only one shared community toilet used by 9 houses.This private toilet block served over 40 men, women, and children, who paid a subscription fee of Rs. 20 monthly for access to the facility.

Clearly, several reforms need to be undertaken in the slum so that basic necessities such as water and sanitation are available. Building community toilet blocks that are clean, safe and affordable in slums can really help improve sanitation conditions of the urban poor. Community toilets can also be managed and run by the communities themselves which can lead to new livelihood opportunities for the poor. Construction and maintenance of these blocks by community based organizations will also instill responsibility, ownership and commitment towards the toilet facility.


[1] http://ipr.ap.nic.in/release/Indiramma.pdf

[2] http://www.thehindu.com/todays-paper/tp-national/tp-andhrapradesh/centre-to-fund-sanitation-programme-in-gram-panchayats/article3971191.ece

Train your child to wash hands after toilet use!

Anku Bhardwaj, a mommy of a three year old, shares her thoughts with Hapee Commode on hand-washing as part of the guest blog series for International World Toilet Day

I care about sanitation because it helps me and my family to stay fit and prevent many diseases. Being a mother, I am concerned about my three year old’s health, and one of the basic things I can teach her at this age is to wash hands especially after using the toilet, after her playtime, and before she sits down to eat. Hand washing is the first line of defense against the spread of many diseases — from the common cold to other serious infections.


A song I found for parents to sing while helping their kids wash hands:

Washing hands can be Fun, Fun, Fun

Germs on the Run, Run, Run

Power’em out—Pow

Power’em out–Ka-zow!

Germs On The Run, Run, Run

Poor sanitation and hygiene can affect the quality of your daily water supply!

World Toilet Day Guest Post by Akshaya Ayyangar

Water and sanitation are closely interlinked. For instance, toilets cannot function without water and without toilets, water bodies get contaminated in some way or the other. Therefore, solutions to water or sanitation infrastructure problems should be addressed in a comprehensive manner which combines both issues in a holistic manner.

Most cities and towns in India have a combination of formal and informal drinking water supply infrastructure consisting of government supplied piped drinking water and privately dug bore wells which we assume to be ‘clean’. But is it really so? Are municipal water treatment methods and indeed, any other commonly used water system robust enough to deliver clean drinking water? Probably not. These systems are plagued by intermittency, un-reliability and in many instances poor water quality because drinking water systems are not 100% leak free.

Our understanding of what’s actually in lakes, rivers, streams and ground water sources is limited and we don’t know if the chemicals (usually chlorine) added after treatment and before distribution is ‘cleaning’ the water of infiltrating contaminants before end use. In fact, unaccounted for water, which is defined as water lost due to leaks, cracks, thefts and water supplied to public stand posts, is estimated at 44% (average) by the Ministry of Urban Development. This, on one hand means tons and tons of water being wasted but on the other, more opportunity for infiltration from pipe bursts, cross-connections, poor sanitation practices and leaky sewer lines.

1Drinking water and sewer lines next to each other and over a water source for down-stream agricultural users. Source: ATREE Summer Course Group 2015

According to a WHO study in Nagpur in 2014, contamination in drinking water (govt. supplied piped water) was due to leaky sewers, open drains and poor pipe condition. Nearly 10-11% of pipes were in the high-medium risk (from faecal coliform which originates in the intestines of warm blooded animals) category, proof that open defecation and poor sanitation infrastructure directly affects drinking water quality. Further, the Water and Sanitation Programme (2011) estimates that total annual economic impact of inadequate sanitation in India amounted to a loss of Rs. 2.4 trillion ($53.8 billion2) in 2006. The economic impacts were the equivalent of about 6.4% of India’s gross domestic product (GDP) in 2006!!

And, if this were not enough, health-related economic impact of inadequate sanitation was Rs.1.75 trillion ($38.5 billion), diarrhoea (especially in children) being the largest contributor – two thirds of the total health impact – followed by acute lower respiratory infection (ALRI). Open defecation and lack of sanitation are the leading causes for water-borne diseases like diarrhoea and stunted growth in children. Over 300,000 children aged below five years in India die each year due to diarrhoeal diseases. These are staggering and rather daunting facts that emphasise the seriousness of the situation. A situation which is characterised by in-adequate sanitation infrastructure, unclean sanitation practices which affect women and children the most.

What we really need now is detailed and accurate research which tells us what’s in our water, how it gets there and implications of existing contaminants on human health, wildlife and trees and plants. Only with this data can we really develop frameworks to treat the water in the best possible manner. Also, as the country develops, more and more towns and villages require ‘urban like’ water and sanitation infrastructure which must be designed jointly, compatible with the watersheds they exist in, operated efficiently to achieve the desired public benefits at reasonable financial, energy and resource costs and most importantly match economic geography and the evolving needs of households and businesses.

Akshaya Ayyangar is a researcher at IIT Madras and her research interests include life cycle analysis of systems particularly water and sanitation, water – energy – food nexus and water governance.  

Toilets I Hate

Courtesy - Sixth Estate Not-so-deep thoughts on well, toilets I hate.

Toilets on trains,

Dingy toilets during rains.

Toilets with wet floors,

Without toilet paper rolls.

Toilets that are overused,

Toilets that are abused.

Toilets that smell,

And make my eyes well.

Toilets with grime,

Toilets with slime.

With floors to make you slip,

Pinch your nose with a clip.

Toilets without soap.

Toilets. Without. SOAP!

Any toilet that’s less than fine,

Mostly ones that aren’t mine.

Guest Post by Anjaly Ariyanayagam

My thoughts on implementing a successful toilet campaign in rural India

SangeethaWorld Toilet Day guest post by Sangeetha Nair

A successful toilet campaign does not end by just constructing toilets and creating awareness about it, but it should also have regular follow-up visits to the households to ensure that toilets are being used and are in functional condition.

Let us try changing our approach from Big to Small. Why don’t we take a small rural district in India, provide each and every household with toilets; also construct public toilets so that even visitors have access to toilets? Let’s do an awareness campaign and ensure that every household in the district is reached and that they are aware of the social and economic impact due to open defecation.

Do daily follow-ups to each household in the district and speak to them to find out whether everyone in their family is practicing it. Gradually reduce the follow-up visits from daily to weekly until it becomes a part of their lifestyle.

Sanitation programmes follow an “all or nothing” logic. Hygienic sanitation practices should be followed by every member in the society, for if not, the efforts put by others will also be in vain.

Create one success story and then take it to other districts

O Toilet! My Toilet!

IMG-20150310-WA0005 (2)World Toilet Day Guest Post Series: by Rachel Joyce Laitflang

(A Tribute to A Dying Friend)

O Toilet! My Toilet!

Through tears I gaze on thee.

Misused, disused, abused, unused,

A smelly melody.

The splashing! The flushing!

Such music to the ears!

To know that water flowed abundant,

Washed away our fears.

But now, ‘tis sad

To see you all alone.

Because the popularity

Of trees and walls has grown.

Transformers, street corners,

                Are rivals to your fame.                 

But is it Parents, Children, Teachers?

Who can we really blame?

O Toilet! My Toilet!

Your days are very few.

But when the call of nature comes,

I’ll always turn to you.

World Toilet Day Celebrations – First time ever in Chennai!


Did you know that one in three people on the planet still don’t have access to a safe, clean toilet? Well, Chennai is no different.

Our vibrant culture, beautiful beaches, quality health care and education, and the right mix of traditional and modern values attracts thousands of people to our city every year. According to the Lonely Planet, Chennai is among the top ten cities in the world to be visited in 2015!

Clearly, Chennaiites have a lot to boast about.

Except one thing.


Chennai has a population of more than 5 million but did you know that we have only 714 public conveniences? The city also has a large floating population and an informal sector that depends on these public conveniences. Even within the household, several residents still don’t have access to a toilet.

Chennai’s residents have united several times to support various causes. But we have not given much thought to toilet use. It has always been somebody’s problem. Ever thought about where your poop-pee goes once you flush it out of your toilet, out of your sight? Have you asked your domestic help or cook if she has a toilet in her household? Ever imagined the plight of those who wake up early morning, even before the sun is up, to relieve themselves in the open because they don’t have a toilet in their household? Or those who have to hold their pee for an entire day before they can find a safe place to go? We bet each one of you must have found yourself in a similar position at least once in your lifetime!

Lack of sanitation affects all of us in one way or the other. Women and children are the worst affected. The UN reports that lack of sanitation leads to malnutrition and stunted growth in children. Inadequate sanitation also exposes us to a host of serious illnesses and even causes death.

So let’s not ignore this dark reality anymore.

This November, let’s get together, on the occasion of World Toilet Day, to begin a mass movement towards a healthier and smell-free Chennai. Let’s pledge that we will not stop until each one of us has access to a safe and clean toilet at all times of the day, wherever we might be in our beautiful city.

Let’s celebrate our toilets on World Toilet Day!

We have updated the World Toilet Day Celebration details here: https://thehapeecommode.com/world-toilet-day-2015/

Please visit our page in a few weeks for more information. If you are interested in partnering with us or looking for a volunteering opportunity, write to us at hapeecommode@gmail.com

Organized by The Hapee Commode in collaboration with the World Toilet Organization