The Big Necessity

The Big Necessity: The Unmentionable World of Human Waste and Why It Matters (2009), a nonfiction book by Rose George, traces the history and technology underlying one of the world’s most vital systems: Sanitation.

George begins with an introduction in which she describes two different experiences seeking a bathroom. The first is in Liberia, where a waiter leads her to a room with no fixtures or plumbing and sarcastically tells her to “do it on the floor” because they are not in America. The second is in the British Library in London, where the stalls are immaculate despite serving a large volume of people, and where she gets to flush and walk away without thinking. This, she realizes, is because access to sanitary plumbing is a privilege, not a right.

George notes that 2.6 billion people lack access to plumbing, which has a huge impact on the health and safety of people everywhere. This lack of sanitation leads to feces spreading everywhere and feces is a huge vector for disease. Sewers transformed London from a disease-ridden place of misery to a safe, modern city. Modern sanitation is usually thought to have begun in 1854 when Dr. John Snow made the connection between cholera and the dirty handle of a water pump. In the modern age, this has resulted in a clear distinction: rich people have toilets; the poor do not.



George recounts her experience entering a sewer in London with a crew of workers. She describes the safety gear she must wear, the common diseases the workers deal with, and the gases and sudden floods that threaten their health and safety. This leads to a discussion of the history of sewers and sanitation drainage. London began dealing with human waste via a cesspool system that drained the liquid into the ground and saw the solids collected by people who sold it to farmers as fertilizer. This system had drawbacks; one theory posits that high heels were a response to the waste overflowing in city streets. Sanitation and water-based sewage are not necessarily new ideas: London had sewers from 1531, and there were versions of the flushing toilet as much as 3,700 years ago. Modern sanitation came about simply because populations exploded, requiring more robust solutions.

George discusses the humble toilet, observing that its design and operation hasn’t changed significantly since its invention; in fact, its original inventor would likely be able to repair a modern toilet. One country, however, is different: Japan has spearheaded technologically advanced toilets. The Washlet, an advanced toilet foreigners find inscrutable, has become the icon for advanced toilets in that country. George explores how Japan went from a nation of poverty and squat-toilets to one of luxury toilet experiences, and why that revolution hasn’t spread beyond Japan. Although American toilets work via siphoning action and thus are prone to clogging, Americans remain simply not interested in the advanced toilets.

George tackles the difficulties and problems that beset the 2.6 billion people in the world without sanitation. Childhood diseases are rampant, which has an immense impact on populations and poverty. She examines India in detail, particularly the Dalit caste of untouchables—manual scavengers who are discriminated against, sometimes raped or killed simply for being the lowest caste—untouchable for the practical reason that their work often means they are covered in fecal matter. The idea that their very presence is polluting parallels the struggle to bring toilets to India, spearheaded by Dr. Bindeshwar Pathak, who founded Sulabh International in 1970. There are now so many Sulabh toilets in India, many simply say they are going to the Sulabh.



George visits China, where the government has actively harvested the resource potential of human waste by installing biogas digesters in many homes, generating methane gas. It has become a huge industry, and China is on the cutting edge of creating this clean fuel, but it requires an enormous amount of fecal matter to be workable.

George details the history of public restrooms throughout history and across cultures, observing such cultural differences as a lack of doors on Chinese stalls and the growing movement to have men sit when urinating in Germany. These are contrasted with America where privacy is paramount. She notes that people who advocate for more public access to toilets think of toilets as a sign of civilization and advancement.

George explores the concept of bio-solids made from sewage sludge. These bio-solids, which she describes as making a cake from a milkshake, can be used as fertilizer and have the advantage of being free (as opposed to artificial fertilizers), but there are serious health concerns regarding the collection of sludge and processing of it into bio-solids.



In India, a campaign is underway to discourage the age-old habit of open defecation, wherein people simply squat and defecate wherever they happen to be. Powerful cultural forces are pushing against the modernization attempts, but propaganda is beginning to burnish the reputation of the indoor toilet and slowly, open defecation is being eradicated. George illuminates the nature of slums in the world; the degree of horror perceived in a given slum can be measured by the access to toilets—the worst slums have few toilets. In African slums, she notes that instead of defecating onto the street, they defecate into plastic bags and throw them aside.

George contends that world governments spend incredible amounts of money on many things, but comparatively little on improving and spreading good sanitation; sanitation should be a bigger priority due to its immense impact on every single aspect of modern life.