How Infectious Disease Shaped American Bathroom Design : Short Wave We're all spending more time these days at home — including our bathrooms. But why do they look the way they do? From toilets to toothbrush holders, bioethicist and journalist Elizabeth Yuko explains how infectious diseases like tuberculosis and influenza shaped American bathroom design. And, we explore how the current pandemic could inspire a new wave of innovation in the bathroom.

How Infectious Disease Shaped American Bathroom Design

  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript



You're listening to SHORT WAVE from NPR.

Lots of us are spending more time these days at home, including in our bathrooms. Stay with me here.


SOFIA: The next time you go to take a trip to the loo, look around because Elizabeth Yuko, a bioethicist and journalist, wants you to know that a lot of the things in our bathrooms are designed the way they are, in part, because of infectious disease.

ELIZABETH YUKO: The sink, the toilet, the bathtub, the toothbrush holder.

SOFIA: Well, didn't expect that one.

YUKO: Towel racks, the floor. I have white tile floor and white tiles on the wall.

SOFIA: So pretty much, you're telling me, like, almost everything in a bathroom (laughter).

YUKO: All of the above, yes.

SOFIA: Elizabeth wrote about this in a story for CityLab. Tuberculosis, cholera, the flu; as our understanding of these diseases evolved - how they spread, the role hygiene plays in preventing them - so did the American bathroom.

YUKO: And when we realized that built architecture and design could have some sort of influence on our health, that became something that people wanted to then adopt within their own homes.


SOFIA: I'm Maddie Sofia. Today on the show, we present a brief toilet timeline, and we talk about how the current pandemic could bring about a new wave of bathroom-related innovation.

Now I think I'm going to be thinking about the bathrooms a lot more than usual.

YUKO: You're welcome.


SOFIA: We're talking with Elizabeth Yuko about how infectious disease influenced the American bathroom. So let's start in the mid-to-late-1800s, when Elizabeth says we started seeing the first sanitation and sewer networks in urban centers around the country. This made indoor plumbing possible. So if you were wealthy, there might be a small sink in the corner of your bedroom. But it did take folks a while to come around to the indoor toilet.

YUKO: The toilets, at this point, were still outdoors. Even though wealthier families could put them in the house, there was this idea that sewer gases or miasmas were coming up through the toilet and could make you sick. So they were still using chamber pots in the house and then having an outhouse, you know, to go outside. So these chamber pots - if they, you know, wanted to spruce the place up a bit - had a wooden box that went over it. And they were, you know, pretty-looking, sometimes intricately carved wooden boxes, just to hide the fact that it's a pot that you go to the bathroom in in your home (laughter).

SOFIA: Yes. Right, right, right. Yes. I wasn't sure how you were going to end that sentence, either, so I'm glad...

YUKO: (Laughter).

SOFIA: ...we found out together.

YUKO: It was a journey.

SOFIA: Yeah.

YUKO: So yeah. So once that kind of became a fixture, then when bathrooms themselves started springing up and bathtubs became the norm and indoor plumbing became more prominent, the fixtures in the bathroom were typically covered in wood - not the insides, but kind of the exterior parts...

SOFIA: Sure, sure.

YUKO: ...of the toilet, the bathtub, the sink; anything to make them look like real furniture and not part of a bathroom because at this point, you know, we still don't want - we don't want to think about what we do in the bathroom.

SOFIA: Right, right, right.

YUKO: And, you know, anything that could make it look classier than that was seen as a good idea.

SOFIA: And that changed, right? Like, in the early 20th century, early 1900s, we kind of shifted away from wood. Why was that?

YUKO: So wood was dark and, you know, porous. And at this point, we realized that germ theory was a thing and that these little crevices could house dirt and germs and dust. And so the idea was to make everything as clean as possible and as easy to clean as possible. So wood really was not a great option, especially this, like, intricately carved, Victorian-patterned wood that they had all over their bathrooms.

SOFIA: Yeah.

YUKO: And then also, in Victorian bathrooms, you had heavy drapery around the windows, wallpaper, sometimes rugs or carpeting. So it was very kind of ornate, plush, kind of fussy setup in these Victorian bathrooms. And that will change.

SOFIA: Thank God. Eventually, medical folks were able to convince people that indoor toilets connected to a public sewer system were better at stopping the spread of infectious disease. Also, around this time, Elizabeth says, there was a, quote, "sanitation craze," which meant goodbye, wood; hello, enamel.

YUKO: So a lot of brands would use sanitation as kind of a marketing technique. Like, we're the most sanitary restaurant or something like that. So this was something that was catching on. And Kohler - who you probably know from toilets and bathtubs (laughter)...


YUKO: ...They pioneered a type of enamel that went over cast iron for bathtubs, which then became - the enamel became used in the rest of the bathroom as well. And that was marketed as being sanitary and hygienic.

SOFIA: Right. And, like, somewhat around that time there was, like, a huge amount of tuberculosis in these communities. And tuberculosis actually played a role in our bathroom design, right?

YUKO: Yes, because in the time before antibiotics, rest, sunlight and fresh air were the best-known cures or treatments for tuberculosis. And when people got sick, they - if they had the opportunity - went to a tuberculosis sanatorium to cure. And these were purpose-built buildings which really had, you know, big windows, had to make sure there was enough ventilation and sunlight and air. Everything on the inside was white and easily cleaned. And this idea of having this sterile, white healing environment caught on first in hospitals but then also in people's homes.

SOFIA: Yeah. So what about influenza? How did that shape things in bathrooms back then?

YUKO: So after the 1918 flu epidemic, which also coincided with high levels of tuberculosis, there was an idea of having a second bathroom on the ground floor of your home. And this is in wealthier homes, where, you know, you had an indoor bathroom, let alone two. And the idea here was that because you were getting daily deliveries of things like ice and coal, you had this delivery person who was traipsing around your neighborhood, going into all of your neighbors' homes, picking up who knows what type of diseases and then coming into your home. So if this person needed to wash their hands or use the restroom while they're in your home, they could do so right on the ground floor without having to go up the stairs and use the family's personal bathroom and spread germs up there.

SOFIA: Which is so brilliant. I mean, it's like - it makes so much intuitive sense to me. And I guess I never really thought about, like, the powder room being a bathroom for the stranger. I thought about it in, like, weird - I don't know what kind of, like, weird Puritan things are going in my mind. But it was, like...

YUKO: (Laughter).

SOFIA: ...A bathroom away so you don't have to use my bathroom and I don't have to be embarrassed. But it makes way more sense that it's, like, a bathroom that keeps people from coming all the way into your house.

YUKO: Yeah.

SOFIA: Brilliant. Brilliant bathroom stuff. OK. So can I just ask about one specific thing?

YUKO: Sure.

SOFIA: What is going on with, like, the fuzzy rugs and, like, the fuzzy toilet seat covers? Why, Elizabeth? Tell me why those exist.

YUKO: I wish I had better answers (laughter). But once we got to a point where we understood germ theory, we had antibiotics, we were pretty confident in our ability to, you know, cure ourselves of a lot of these illnesses, we got a little lazy when it came to decoration - although, well, lazy is not really the word.

SOFIA: Mmm-hmm.

YUKO: It's less focused on sanitation and hygiene. And we had a vacuum cleaner and a washing machine. We could just toss that thing in the washer and everything would be fine. So we stopped thinking as much about how easy things were to wipe or clean, and that's when stuff like that came into bathrooms.

SOFIA: So how do you think - you know, it's hard to talk about this without thinking about the fact, obviously, that we are in the middle of a pandemic that might shape, you know - or probably will shape us in a lot of different ways. Do you think bathrooms are going to change now after this coronavirus outbreak?

YUKO: I don't know if they're going to change, but one thing that I did write about was Lloyd Alter, one of the people I interviewed from the Ryerson School of Interior Design. He predicted that we'll see a rise of vestibules and sinks specifically in vestibules - so sinks that you'll encounter as soon as you walk into someone's home so you could wash your hands right away.

SOFIA: Mmm. Mmm-hmm.

YUKO: And I think that absolutely makes sense.

SOFIA: Yeah. I've started coming in my house through the back door because my kitchen sink is right there, just to, like, wash my hands immediately when I come in the house if I leave.

YUKO: Yeah. So I think that will be - moving forward, that will be a focus. And I think any design is really going to be made with, what if we have to self-isolate for months at a time again?

SOFIA: Right.

YUKO: You know, we might have a bidet, for example, because, you know, that's not something that is as common in America as it is in other parts of the world. But now, as people are running out of toilet paper, they are seeing that it's actually a pretty great invention.

SOFIA: You know, I know that as journalists we're not supposed to be political, but, I'll just say it - I'm pro-bidet. And I just keep thinking about how much toilet paper I wouldn't need right now if I had one.

YUKO: Yeah. I am pro-bidet as well and (laughter) a user as well. So it's - yes, I'm a fan. And I'm glad that - I mean, I wish it didn't take a global pandemic for us to realize this is a useful thing, but I'm glad we're there.

SOFIA: Yeah. So you wrote about how, over time, humans kind of went back and forth between responding to, you know, like, trauma that comes along with massive infectious disease by trying to make ourselves feel a little bit more comfortable, or by implementing design features that make our homes and bodies easier-to-clean. And I just think it's going to be kind of interesting, you know, what combination of those things happen with coronavirus. Have you thought about that?

YUKO: Yes. I think a lot of people probably have, even if they haven't realized it, because for the past few weeks, we've been spending almost all of our time in our own homes, staring at the walls of our house or apartment in ways that we probably never had before. And so whether we're in the bathroom washing our hands for 20-second intervals or sitting in the kitchen or living room looking at how we've decorated, moving forward, we're probably going to take this pandemic and this time we've spent at home into consideration when making design choices

SOFIA: Right. And I just think there's going to be, like, kind of a renewed focus about even just, like, thinking of those spaces because, you know, I didn't think about the fact that I needed to come in and wash my hands as soon as I came from the outside until this.


SOFIA: And so now, like, I know this seems silly, but, like, I enter my house differently now.

YUKO: It's not silly. I mean, we have to adapt our changes because of public health situations all the time. And this is just another example of that.

SOFIA: OK, Elizabeth. Honestly, thank you so much for this piece. It was so, so, so interesting.

YUKO: Thank you so much. I'm glad someone else is enthusiastic about bathrooms also.

SOFIA: I mean, yes. I mean, seriously, though, I will not think of a bathroom the same way when I enter it now. And that's on you.

YUKO: Aw, I'm touched.

SOFIA: If you want to check out Elizabeth's piece in CityLab, you can find a link in the episode notes. This episode was produced by Brit Hanson and edited by Viet Le. Emily Vaughn checked the facts. I'm Maddie Sofia. Thanks for listening to SHORT WAVE from NPR.


Copyright © 2020 NPR. All rights reserved. Visit our website terms of use and permissions pages at for further information.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.