Public toilets down the drain? Why privies are a public health concern.

Whether you call it the loo, john, privy, lavatory or toilet, this facility is essential wherever humans gather or live: toilet provision has even been called the barometer of civilization. The modern development of public toilets dates from the late 19th century when sewer systems and water supplies provided hygienic means of dealing with waste, facilitated by public health legislation that also permitted local authorities to provide toilets in town centres. Yet the statutes in the United Kingdom, where the flushing toilet as we know it was invented, never went so far as to require provision of these facilities outside the home. Pressure on resources during the last 20 years has led to many public toilets being closed, for example, 40% of those in London, or to entry charges that reduce accessibility. At the same time an increasingly mobile population has made public toilets even more necessary. Recent public inquiries into public toilet provision in the UK have revealed the impact of the paucity of facilities on the elderly, women, families with young children, ill health that increases the need for toilet use, visitors and poor or homeless members of the community. There has been little attention in public health on the provision of public toilets. With street urination on the increase and less free access to toilets, it is time for public health to recognize a great need and to campaign to turn the tide on public toilet closures, with imaginative planning strategy and associated opportunities to encourage hand washing and other hygiene health promotion.

Estimating molecular preservation of the intestinal microbiome via metagenomic analyses of latrine sediments from two medieval cities.

Ancient latrine sediments, which contain the concentrated collective biological waste of past whole human communities, have the potential to be excellent proxies for human gastrointestinal health on the population level. A rich body of literature explores their use to detect the presence of gut-associated eukaryotic parasites through microscopy, immunoassays and genetics. Despite this interest, a lack of studies have explored the whole genetic content of ancient latrine sediments through consideration not only of gut-associated parasites, but also of core community gut microbiome signals that remain from the group that used the latrine. Here, we present a metagenomic analysis of bulk sediment from medieval latrines in Riga (Latvia) and Jerusalem. Our analyses reveal survival of microbial DNA representative of intestinal flora as well as numerous parasites. These data are compared against parasite taxon identifications obtained via microscopy and ELISA techniques. Together, these findings provide a first glimpse into the rich prokaryotic and eukaryotic intestinal flora of pre-industrial agricultural populations, which may give a better context for interpreting the health of modern microbiomes. This article is part of the theme issue 'Insights into health and disease from ancient biomolecules'.

Chinese liver flukes in latrine sediments from Wong Nim's property, San Bernardino, California: archaeoparasitology of the Caltrans District Headquarters.

Parasitological analysis of 5 sediment samples from San Bernardino, California latrine deposits spanning the time period from about 1880 to the 1930s are presented. Two sediment samples are from a latrine used by European-Americans. Three sediment samples are from latrines used by Chinese-Americans on the property of Wong Nim, an important member of the Chinese community. Two of the Chinese latrines were positive for human parasites. The human parasites encountered include the human whipworm (Trichuris trichiura), the giant intestinal roundworm (Ascaris lubricoides, c.f.), and the Chinese liver fluke (Clonorchis sinensis). Evidence of the liver fluke is especially important. This parasite cannot complete its life cycle outside of its endemic range in Asia because suitable intermediate hosts are not present in the American continents. Its presence signals that at least some of the Chinese-Americans who used the latrines were immigrants who were infected in Asia and then sustained infections while in the Americas.

Felicjan Slawoj-Skladkowski (1885-1962): The only known doctor-soldier-politician with an outdoor-wooden-toilet named after him.

Felicjan Slawoj-Skladkowski was a Polish physician, General and politician who served as Polish Minister of Internal Affairs and was the last Prime Minister of Poland before the Second World War. The lack of basic sanitation in many of Poland's villages caused him to issue a decree that every household in Poland must have a latrine in working order. Wooden sheds were built in the backyards, subsequently named 'slawojkis'.

Intestinal parasites from the 2nd-5th century AD latrine in the Roman Baths at Sagalassos (Turkey).

The aim of this research was to determine the species of intestinal parasite present in a Roman Imperial period population in Asia Minor, and to use this information to improve our understanding of health in the eastern Mediterranean region in Roman times. We analyzed five samples from the latrines of the Roman bath complex at Sagalassos, Turkey. Fecal biomarker analysis using 5ß-stanols has indicated the feces were of human origin. The eggs of roundworm (Ascaris) were identified in all five samples using microscopy, and the cysts of the protozoan Giardia duodenalis (which causes dysentery) were identified multiple times in one sample using ELISA. The positive G. duodenalis result at Sagalassos is particularly important as it represents the earliest reliable evidence for this parasite in the Old World (i.e. outside the Americas). As both these species of parasite are spread through the contamination of food and water by fecal material, their presence implies that Roman sanitation technologies such as latrines and public baths did not break the cycle of reinfection in this population. We then discuss the evidence for roundworm in the writings of the Roman physician Galen, who came from Pergamon, another town in western Asia Minor.

Archeological evidence of parasitic infection from the 19th century company town of Fayette, Michigan.

Archeological deposits from the 19th century company town of Fayette, Michigan were analyzed for evidence of endoparasitic infection in the human population residing in the town between 1867 and 1891. Three privies were associated with upper-income and middle-income neighborhoods; 2 household refuse disposal areas were found in a predominately lower-income immigrant working class neighborhood. Sediment samples from 2 privies associated with dwellings in the middle-income neighborhood were positive for eggs of the human whipworm Trichuris trichiura. The parasite was probably also present among residents of the lower income neighborhood, but the shallow nature of the refuse deposits in that locality precluded preservation of the eggs. Contemporary epidemiologic studies of helminth infections support the belief that T. trichiura may have been a common parasite of 19th century school-age children given the natural inclination of young children to defecate indiscriminately, play freely in the dirt, and eat without washing their hands.

First recovery of Schistosoma mansoni eggs from a latrine in Europe (15-16th centuries).

Schistosoma mansoni eggs were found in a latrine dated AD 1450-1550 in Montbéliard, France. This is the first record of intestinal schistosomiasis in archaeological material. Because the parasite has an African origin, its presence in Europe at that time may be due to African slaves. However, intestinal schistosomiasis has never been established in Europe.

Archaeoparasitology at a 17th century colonial site in Newfoundland.

Excavations at the 17th century site of Ferryland during the past 2 summers have revealed thousands of artifacts and the remains of several structures. Of particular interest here was the discovery of the remains of a privy and associated stable. Examination of privy contents revealed the presence of eggs of 4 parasites: Ascaris, Trichuris, Taenia, and Dicrocoelium. Their identification represents the first reported discovery of parasite remains in an archeological context in Canada. Due to possible contamination by domestic animal feces, it was not possible to determine with certainty if the eggs are of human origin.

[The Bourdaloue urinal in all its forms]. / Le Bourdaloue dans tous ses états.

The author draws the attention of his urologist as well as nonurologist colleagues to the "Bourdaloue" urinal describing its dual aspect of a utilitarian and artistic object. A rapid study situates it in its particular historical context and in the more general context of urine collection bottles.

First World War German soldier intestinal worms: an original study of a trench latrine in France.

For the first time in the study of ancient parasites, analyses were carried out on samples taken from a First World War settlement in France (Geispolsheim, region of Alsace). Microscopic examination of sediment samples revealed the presence of 3 common human parasites, i.e., Trichuris trichiura , Ascaris lumbricoides , and Taenia sp. A review of paleoparasitological studies in Europe shows that these 3 parasites have infected humanity for centuries. Despite this recurrence, literature shows that knowledge regarding many helminths was limited, and their life cycles were only relatively recently elucidated. Finally, the present study provides additional information about the health of the German soldiers and the sanitary conditions in the trenches during the first modern world conflict.