Sanitation (from the Latin sanitas, meaning health) refers to the maintenance and delivery of clean, hygienic conditions that help prevent disease through services such as drinking water supply, garbage collection, and safe disposal of human waste. Sanitation is the focal point of public health policy, but in the experience of local communities much more than health is at stake in “sanitation.”
World Health Organization (WHO) reports show that in 2004, 5.3 billion people (83% of the world population) had access to clean water sources (in 1990 that percentage was 78). Of the 1.1 billion people without access to clean drinking water, 84 percent live in rural areas. The situation is particularly critical in sub-Saharan Africa, where 44 percent of the population remains without clean drinking water, and in Eastern and Southern Asia.
Similar statistics apply to the coverage of “basic sanitation” (improved toilet facilities). According to the same 2004 WHO report, only 59 percent of the world population had access to a hygienic toilet in 2004. It is again sub-Saharan Africa (38 percent) and Eastern Asia (45 percent) that have the highest populations without basic sanitation.
Unsanitary conditions are the main cause of ill health and premature death in poor societies. WHO statistics of 2004 report that 1.8 million people die every year from diarrheal diseases (including cholera), 90 percent of whom are children under five. Eighty-eight percent of diarrheal disease is attributed to poor sanitation. Malaria, another sanitation related disease, kills 1.3 million people each year; again, 90 percent of these deaths are children under five. Other diseases that originate in poor sanitary conditions include schistosomiasis (a parasitic infection), intestinal helminthes (ascariasis, trichuriasis, hookworm), and hepatitis-A. Although the health consequences of sanitation are overwhelming, people often have reasons to pursue—or refuse—better sanitation.
Social scientists have developed various theories to interpret or explain human concern about avoiding dirt and promoting hygiene. Evolutionist thinkers believe that there is medical wisdom in the human fear of dirty things. Dirty objects and activities pose a danger, so it is wise to avoid them. Disgust of dirt is a survival strategy (usually a non-conscious one). A 2001 study by Valerie Curtis and Adam Biran list five disgust elicitors derived from research in India, Burkina Faso, The Netherlands, Britain, and an international airport. The five elicitors are: (1) body excretions and body parts; (2) certain animals; (3) decay and spoiled food; (4) certain categories of “other people;” and (5) violations of morality. Bodily excretions were mentioned most frequently as causing disgust and among them, feces topped the list, but vomit, sweat, spittle, blood, pus, and sexual fluids were also regarded with aversion. Animals that were mentioned most often included pigs, dogs, rats, snakes, worms, cockroaches, maggots, lice, and flies. People that were found disgusting were those with signs of sickness, dirt, or deformity, and strangers with whom one was forced to come into close contact, for example in crowded places. People who behaved immorally also evoked aversion.
Curtis and Biran’s hypothesis is that humans have evolved behavioral defenses against disease and that “disgust is one of the mechanisms crafted by natural selection to keep our distance from contagion” (Curtis and Biran 2001, p. 22). The researchers found support for their hypothesis by checking the routes of transmission for a selection of common infectious diseases. In all of them, one or more elicitors of disgust were mentioned as playing an important role in transmission. Feces were named as the source of more than twenty infectious diseases. Breath, saliva, lice, rats, and sexual organs were also important sources or transmitters of infection. All of these score high for human disgust.
William Ian Miller’s 1997 study of disgust is difficult to place in any disciplinary tradition. His own expertise mainly lies in literature and history but his study also draws on psychologists, moral philosophers, and political and social theorists. Trying to decipher the origin and working of emotion, Miller derives most inspiration from psychology.
The disgust Miller discusses applies to many phenomena and activities, such as defecation, sex, food, and drink. He distinguishes two types of disgust. The first, which is clearly Freudian, prevents the activation of unconscious desire. It defends against pollution, denies access to objects and acts that would block the psychic development of the human person. The evolutionist perspective of disgust as a survival instinct returns here at the level of the human psyche. The second type of disgust is “disgust of surfeit,” it punishes after having indulged in a “disgusting” activity. The two types complement each other. In the aversion of things perceived as dangerous because of their power “to contaminate, infect, or pollute by proximity, contact, or ingestion” it is first of all the unconscious reaction to psychic dangers that is at work (Miller 1997, p. 2).
Most authors writing on hygiene and sanitation from a sociological point of view refer to Norbert Elias’s study on the civilization process. Elias studied etiquette books, letters, and other documents in France and England from the eleventh century onward and describes how the authors of those guides for proper conduct gradually became more particular about body functions, body parts, and body products.
He talks about a general process of civilization, which implies a “privatization” or “intimization” of human behavior. More and more, public activities became shameful and were confined to the private world. The human body was a focal point. The body itself had to be well covered and activities such as sex, sleep, urination, and defecation became embarrassing when carried out in front of other people. Modern hygiene facilities are regarded as expressions of the civilizing process.
The symbolic anthropologist Mary Douglas, in her classic Purity and Danger, turns away from evolutionist and “medical materialist” (a term used by American psychologist and philosopher William James, meaning reducing ritual to its supposed positive medical effect) explanations of hygiene and presents dirt as “matter out of place,” a definition that became famous for its beautiful simplicity and provocation. Shoes on the table (Douglas’s example) are dirty; under the table they are clean. Saliva safely caught in a handkerchief is hygienic, but when it falls in a plate it turns disgusting. Her claim that absolute dirt does not exist opened new windows in the study of hygiene as a cultural phenomenon. Dirt is defined by its context. It is disorder and carries an invitation or rather an obligation to restore order: “Ideas about separating, purifying, demarcating and punishing transgressions have as their main function to impose system on an inherently untidy experience” (Douglas 1970, p. 15). Hygiene, in short, is a basic cultural act: it distinguishes dirt from what is clean and thus, creates cultural order. Enculturation of small children starts with teaching them what is clean and what is not clean. Hygiene is the essence of culture. What is dirty is of less importance. Crucial is that dirt exists. Without the concept of dirt people could not formulate the norms and values of culture.
What makes an object abject and threatening? Douglas suggested: its out-of-place condition. Others claimed it depends on the matter itself. Too little attention has, however, been given to the identity of the person who is directly associated with something dirty, to the social life of the dirty matter. The answer to the question “whose?” determines the experience of disgust much more than has been suggested by Douglas and other authors who wrote about the cultural meaning of dirt. By adding a sociological dimension to dirt, Douglas’s theory of matter out of place becomes more true to life and effective as an interpretative tool.
The humanist Erasmus’s dictum that one’s own shit has a pleasant smell (Suus cinque crepitus bene olet ) is a humorous exaggeration, but it is not exaggerating to say that people usually are not disturbed by the smell (and sight) of their own feces. Objects, substances, and acts become dirtier as the person behind them is less close or less liked. Animals that produce dirt are also placed in categories of less and more disturbing. Animals that are “part of the family” are experienced as cleaner than those who belong to another family. And so on. Acts and gestures from a loved person that are cherished as dear and intimate (bodily contact, sex) turn into horrifying violence when another person performs them. Good or bad, clean or dirty, in this case, depends entirely on the actor. The “matter” remains the same. The urge for “hygienic action” also depends a great deal on such relational concerns. Washing hands after toilet use or before eating, for example, is as much a social as a healthful act.
Hygiene, in the medical sense, is a core value in modern societies. Objects, activities, and people are judged by their medical qualities. Food, houses, streets, markets, working places, holiday camps, public transport, and visitors should be clean and not pose a danger to health. Dirty things and people are rejected and rejected things and people are called dirty.
Anthropologists and historians argue, however, that people do not always make that explicit link between health and dirt. After studying the hygienic ideas and practices by mothers in Burkina Faso, Curtis concluded that their cleanliness and dirt avoidance were primarily a matter of “etiquette and social acceptability rather than to avoid illness” (Curtis 1998, p. 110). In a 2005 study, conducted in Bénin, Jenkins and Curtis observed that modern toilets were popular because they were seen as a sign of social prestige and success.
Michel Foucault argues that in the modern state, medicine is a major instrument of control by societal and political institutions. His concept of “Bio-power” suggests that the state can reward or punish its citizens by providing or withholding health. Sanitation, preventive heath care, implies the imposition of a regime. Sanitary policy legitimizes the state’s interference in households and private lives of people and thus helps to establish more effective disciplinary power. Bio-power—and sanitation in particular—constitutes the link between macro and micro (Foucault 1990; Gastaldo 1997).
Sanitation policies have been most successful when they also appealed to other values in people’s lives, such as social decency, respect, comfort, and religion. Cultural ignorance and lack of respect for local knowledge and practices of hygiene are major problems in sanitation projects by both foreign organizations and local governments in low-income societies. Tiokou Ndonko’s 1993 anthropological study in Cameroon for example, analyzed cultural and religious resistance against the government’s sanitation policy. Hygiene, seemingly a purely medical concern, lies at the heart of culture and is both a means of political control and resistance.
SEE ALSO Civilization; Cultural Relativism; Disease; Freud, Sigmund; Health in Developing Countries; James, William; Public Health; Taboos; Toilets
Curtis, Valerie. 1998. The Dangers of Dirt: Household, Hygiene and Health. PhD diss., Agricultural University Wageningen.
Curtis, Valerie, and Adam Biran. 2001. Dirt, Disgust and Disease: Is Hygiene in Our Genes? Perspectives in Biology and Medicine 44 (1): 17–31.
Douglas, Mary.  1970. Purity and Danger. An Analysis of Concepts of Pollution and Taboo. Harmondsworth, U.K.: Penguin.
Elias, Norbert.  1982. The Civilizing Process. New York: Pantheon.
Foucault, Michel. 1990. The History of Sexuality, vol. 1: An Introduction. London: Penguin.
Gastaldo, Denise. 1997. Is Health Education Good for You? Rethinking Health Education through the Doncept of Biopower. In Foucault: Health and Medicine, ed. Alan Petersen and Robin Bunton, 113–133. London: Routledge.
Goudsblom, Johan. 1986. Public Health and the Civilizing Process. Milbank Quarterly 64 (2): 161–188.
Jenkins, Marion W., and Val Curtis. 2005. Achieving the “Good Life”: Why Some People Want Latrines in Rural Benin. Social Science and Medicine 61 (1): 2446–2459.
Miller, Ian. 1997. The Anatomy of Disgust. Cambridge, MA: Harvard University Press.
Ndonko, Flavier Tiokou. 1993. Répresentations Culturelles des Excrements. Münster, Germany: Lit Verlag.
World Health Organization. 2004. Water, Sanitation and Health. http://www.who.int/water_sanitation_health/publications/facts2004/en.
World Health Organization. 2005. Meeting the MDG Drinking Water and Sanitation Target. The Urban and Rural Challenge of the Decade. Geneva: World Health Organization.
Sjaak van der Geest
"Sanitation." International Encyclopedia of the Social Sciences. . Encyclopedia.com. (December 18, 2017). http://www.encyclopedia.com/social-sciences/applied-and-social-sciences-magazines/sanitation
"Sanitation." International Encyclopedia of the Social Sciences. . Retrieved December 18, 2017 from Encyclopedia.com: http://www.encyclopedia.com/social-sciences/applied-and-social-sciences-magazines/sanitation
Sanitation is a basic, as well as a long-standing, public health issue. When early peoples settled in communities and started to cultivate crops and raise animals, sanitation became a primary concern for society. The Book of Leviticus, in the Torah, includes specific guidelines regarding the disposal of wastes, the placement and disinfection of wells, and related issues. Today, as urban areas grow, more pressure has been put on local water supplies, for the quality of the water that is available to a community greatly impacts all aspects of health. Worldwide, 40 percent of the population does not have ready access to clean, safe drinking water, and approximately 60 percent does not have satisfactory facilities for the safe disposal of human waste. Infectious agents in drinking water and food cause the diarrheal deaths of several million children annually.
In the United States, every person uses almost 100 gallons of drinking water per day, though only a small portion of this amount is actually used for drinking. Other uses include toilet flushing, bathing, cooking, cleaning, and lawn watering.
SOURCES OF WATER
Water sources are manifold. Many communities get their water from reservoirs. In 500 b.c.e., the Greeks supplemented local city wells with water supplied from the mountains as far as ten miles away. In later times, the Romans built aqueducts that were many miles long—there are more than two hundred that are still standing in the year 2001. Cities and other communities often provide for their water supply by allocating an open area that is pristine and protected as a watershed. The water is usually of high quality and free from chemical and microbial contamination. These sources are referred to as surface water sources and include lakes, streams, and rivers. Some surface water requires extensive treatment before it can be distributed for human consumption.
In other parts of the country, water is supplied to communities from groundwater sources through deep wells, often many thousands of feet down. Water from these sources is also usually free of chemical and microbial contamination. Groundwater is the main source of drinking water for almost half of the population in the United States. While it is usually free of solids and bacteria, as well as other chemical pollutants, it has often become contaminated by disposal of liquid waste and agricultural runoff. Groundwater is relatively inexpensive, but it is limited in volume and irreplaceable if depleted. By providing protection to the source, either through buffers from the reservoirs or by protecting the well head for the deep wells, water is available without much treatment.
Because of the increasing population and the increased use of water by each individual in the United States, there are less uncontaminated water supplies available. Many sources of water must be treated prior to consumption. Disinfection is an important step in the water treatment process to destroy pathogenic bacteria and other harmful agents. Most water is treated with chlorine, as it is a very effective and economical method of treatment. An important advantage to using chlorine is that it has residual properties and continues to provide germ-killing potential as the water travels from the distribution point to the end users. There are concerns, however, about the formation of disinfection by-products from the reaction of the chlorine with humic substances in the water. These by-products are referred to as trihalomethanes, or THMs. The most common THM is chloroform, which is a carcinogen.
Sanitation includes the appropriate disposal of human and industrial wastes and the protection of the water sources. Waterborne agents are the cause of many diseases in the United States and elsewhere in the world. These diseases may be caused by bacteria, viruses, and protozoans. Bacterial diseases include typhoid, shigellosis, and cholera. Viral agents cause diseases such as include polio and hepatitis. Parasites include the protozoa Entamoeba histolytica and Giardia lambdia, which cause amebiasis and giardiasis, respectively. For the last decade the primary agents in waterborne disease outbreaks in the United States have been the protozoal parasite Giardia, and the bacteria Shigella. Another common agent is Cryptosporidium.
Another example of sanitation as it relates to waterborne diseases globally is schistosomiasis. Schistosomiasis is a chronic debilitating disease with significant morbidity and mortality that affects more than 200 million people worldwide. Sanitation and water supply are important issues in an integrated schistosomiasis control program.
SANITATION AND WATER POLLUTION
Sanitation is directly related to water quality and water pollution. Water quality usually describes the level of certain compounds that could present a health risk. The quality of water is usually defined by guideline values of what is suitable for human consumption and for all usual domestic purposes, including personal hygiene.
In relating sanitation to water pollution, one must examine both point and nonpoint source pollution, as these are the two routes of entry of the pollution into the water supply. Point-source pollutants enter the waterways at well-defined locations, such as a pipe or a sewer outflow. The discharges are usually even and continuous. Industrial factories, sewage treatment plants, and storm sewer outflows are common point sources of pollution. Nonpoint sources enter the water system from broad areas of land. It is estimated that 98 percent of the bacterial contamination and 73 percent of biological oxygen demand are due to nonpoint sources.
Water containing human waste is generally referred to as wastewater. In the United States, the disposal of human waste must be handled in a sanitary manner. Usually, this waste is disposed of via a sewer system that uses water as the vehicle for the disposal. Treatment of wastewater is required to prevent pollution of pristine surface waters and groundwater sources. Wastewater treatment consists of physical, chemical, and biological processes. In a typical suburban or urban setting, wastewater from the home enters a domestic or sanitary sewer system. The sanitary sewer is a system of pipes that collects the wastewater, and the waste is transported to a wastewater treatment plant. The water goes through a series of processes that removes the solids from the water. Solids are composted or removed and disposed of via landfill or land application as fertilizer. Sewage consists of more than 99.9 percent water by weight, and the average domestic sewage contains 600 ppm of total solids. The amount of solids present in water has been one of the major water pollution control criteria, due to the relationship of the solids to the oxygen demand.
Water reuse is an important concept that has only recently gained attention and interest in the United States. Water that is reused, commonly known as "gray water," cannot be used on food crops or in any type of domestic use. This water can be used to water landscape and turf. Water reuse will continue to expand as water resources become more and more limited.
Since approximately 1950, a common method of disposal of solids in the United States has been the use of a sanitary landfill. The landfill, which typically is located outside a populated area, is a place where wastes are dumped, compacted, and buried. Special care in siting the landfill must be taken to avoid runoff and leaching of the waste materials into surface water and groundwater. Landfills that are properly designed with the correct engineering and liners can provide adequate protection. In many locations in the United States, these landfills have been sited on marginal land that was unsuitable for industry or agriculture. Many of these sites are sensitive wetland areas that serve as habitat for plants and animal species.
The 1974 Safe Drinking Water Act established a set of primary standards to protect human health. These standards consist of maximum contaminant levels for specific inorganic contaminants, volatile organic chemicals, and radioactive materials, as well as limits for turbidity and coliform organisms. Secondary standards are set for temperature, color, taste, and odor. The Environmental Protection Agency has identified treatment via conventional coagulation, sedimentation, and filtration as effective processes in removing or reducing the levels of contaminants. Societal concerns for the quality of water resources continue as many streams and coastal waters do not meet water quality goals. States report that 40 percent of the waters surveyed are too contaminated for drinking, fishing, and swimming. Since the Clean Water Act was signed in 1972, it is estimated that more than $5 trillion has been spent on water pollution control in the United States.
Mark G. Robson
(see also: Ambient Water Quality; Biological Oxygen Demand; Chlorination; Clean Water Act; Disinfection By-Products in Drinking Water; Groundwater; Landfills, Sanitary; Municipal Solid Waste; Pollution; Wastewater Treatment; Water Quality; Water Reuse; Water Treatment; Waterborne Diseases )
McKenzie, J., and Pinger, R. (1997). An Introduction to Community Health. Sudbury, MA: Jones and Bartlett.
Merson, M.; Black, R.; and Mills, A., eds. (2001). International Public Health: Diseases, Programs, Systems, and Policies. Gaithersburg, MD: Aspen Publishers.
Morgan, M. T. (1997). Environmental Health. Madison, WI: Brown and Benchmark.
"Sanitation." Encyclopedia of Public Health. . Encyclopedia.com. (December 18, 2017). http://www.encyclopedia.com/education/encyclopedias-almanacs-transcripts-and-maps/sanitation
"Sanitation." Encyclopedia of Public Health. . Retrieved December 18, 2017 from Encyclopedia.com: http://www.encyclopedia.com/education/encyclopedias-almanacs-transcripts-and-maps/sanitation
SANITATION The word "sanitation" only entered the English language in the nineteenth century, and the term is inextricably linked with integrated water and sewer systems. Lacking such technologies, early modern Europeans are often reckoned to have lived without sanitation. Their epidemiology of the time might seem to support this contention: three out of every ten babies born in Geneva between 1580 and 1739 died by their first birthday and the infant mortality rate in late seventeenth-century London was over one in four. Many of these deaths were caused by dirt-related infections like infantile diarrhea—what contemporaries termed "griping in the guts." Moreover, there are many vivid complaints of noxious conditions in early modern cities—one account of 1670s Edinburgh, for instance, claimed that one could not step anywhere in the streets without treading on turds.
Appearing in an Englishman's denunciation of all things Scottish, this claim was designed to promote prejudice. The charge also reveals how early modern people did indeed discriminate between cleanliness and dirt. Their sanitary technology rarely consisted of more than cesspits, chamber pots, and carts to carry ordure from their communities, but early modern Europeans possessed notions of public health and collective salubrity. Furthermore, scholars are now revealing the extent to which they sought to regulate and cleanse their environments.
URBAN DIRT AND URBAN ORDER
Such efforts were rarely entirely successful—early modern utopian writing appreciatively delineated the cleanliness of the ideal community—but civic authorities regularly commanded that streets be swept and nuisances removed. Such sanitary regulation was linked to wider conceptions of order. Noxious wastes shaped social and symbolic geographies. Offensive trades such as butchers and tanners were generally confined to particular districts, often downstream or outside city walls. In Paris the bodies of condemned criminals were buried in the municipal dump at Montfaucon. In central Europe the emptying of cesspits and the removal of waste were associated with other "dishonorable" trades. Between the sixteenth and nineteenth centuries, for instance, the "night-king" (chief latrine-cleaner) of Augsburg had to share a residence with the city executioner. Furthermore, precepts for cleansing streets often coincided with drives to rid communities of vagrants and "disorderly persons."
MIRE AND MEDICINE
Medical beliefs further encouraged sanitary care. Throughout the early modern period it was generally believed that plague and other epidemic diseases were caused or spread by corrupt airs or miasma produced by rotting organic matter. Environmental regulation thus sought to prevent evil smells. Perfumes and fumigants were used to purify infected spaces; street cleaning often intensified in periods of epidemic. In late-sixteenth- and early-seventeenth-century London, for instance, householders were required to sweep in front of their houses every morning and evening. During the early seventeenth century the boards of health of northern Italian states energetically sought to remove dunghills and other sources of miasma from the towns and villages under their jurisdiction.
Early modern doctors knew of "miasma" from a range of classical works, especially those of the ancient Greek physician Hippocrates. From the mid-seventeenth century medical authors became preoccupied with one strand of his work—the relation between epidemics and the airs, waters, and weather of particular places. Population statistics derived from bills of mortality and parish registers revealed geographical variations in the incidence of fevers and other fatal diseases; eighteenth-century analyses of air by natural philosophers like the English chemist Joseph Priestley sought to isolate mephitic substances that caused disease. Many eighteenth-century doctors proposed ways of reducing mortality by draining marshes, ventilating buildings, and reorganizing the environments and the ways in which people lived. Such interventions in the physical environment were often associated with proposals for the police of national populations. The term "police" had wider connotations than does its modern usage. It expressed a desire for the regulation of all aspects of life in order to achieve a smoothly functioning polity and (crucially) a healthy and productive population. The work of the German professor Johann Peter Frank exemplified the scale of this concept. His six-volume System of Medical Police (1779–1817) recommended the regulation of everything from midwifery and marriage to water supply and street cleaning.
The impact of medical police was less than the ambition of its advocates. Nevertheless, eighteenth-century Europe did see medically inspired reforms of daily life. In the 1750s, for instance, the British physicians Stephen Hales and John Pringle oversaw the installation of ventilators in the notoriously disease-ridden London prison of Newgate. In the 1780s the French Royal Society of Medicine not only declared that the Cemetery of the Holy Innocents in Paris was so full that it was a threat to public health but also had it closed and all human remains removed from it. More generally there was a considerable extension of new forms of sanitation, bathing and hygiene in hospitals, barracks, and similar institutions.
These reforms were restricted by the general scarcity of water in preindustrial Europe. Clearly, this was a pressing problem in arid regions like southern Spain, where elaborate systems of water regulation were developed during the Middle Ages. But water was also a limited and costly resource in northern European communities not associated with drought. In eighteenth-century Paris, for example, a cubic meter of water would have cost a laborer more than two days' wages. Households spent much time and energy fetching water from rivers, streams, and wells. Communal life literally revolved around water sources. In larger urban centers public authorities maintained wells and sponsored schemes to pipe water to public fountains or conduits. In 1585–1587, for instance, Pope Sixtus V established the Acqua Felice, redeveloping the waters of an ancient aqueduct, the Aqua Alexandrina, in order to supply the eastern districts of Rome. Princely and aristocratic fountains like those at Louis XIV's palace of Versailles were, by contrast, ostentatious displays of conspicuous consumption.
The comparative scarcity of water remained a structural characteristic of European society throughout the early modern period. However, the sixteenth and seventeenth centuries saw the establishment of the first water companies piping supplies to the houses of private paying customers. The London Bridge Water Company (established 1582) and New River Company, which began supplying London in 1613, were among the first such concerns. They soon had imitators. By around 1700 one could rent a piped water supply in nine of the ten largest English provincial towns. Such companies were unevenly spread across Europe—no water company operated in Paris until after the French Revolution—and the supplies they offered were unreliable and intermittent. However, they did pioneer new technology. Eighteenth-century water companies were among the first users of steam power, and thus laid the foundations for the subsequent industrialization of urban water supplies. In the nineteenth century the intellectual heritage of medical police combined with such technological developments to produce the public reforms that are conventionally associated with the term sanitation.
See also City Planning ; Public Health .
Corbin, Alain. The Foul and the Fragrant: Odor and the French Social Imagination. Cambridge, Mass., 1986.
Jenner, Mark S. R. "From Conduit Community to Commercial Network? Water in London 1500–1725." In Londinopolis: Essays in the Cultural and Social History of Early Modern London. Edited by Paul Griffiths and Mark S. R. Jenner. Manchester, U.K., and New York, 2000.
Riley, J.C. The Eighteenth-Century Campaign Against Disease. Basingstoke, U.K., and London, 1987.
Roche, D. "Le temps de l'eau rare: Du Moyen Age à l'Epoque Moderne." Annales: Economies, sociétés, civilisations 39 (1984): 383–399.
Rosen, George. A History of Public Health. Reprint. New York, 1993. Chaps. 3–5.
Stuart, Kathy. Defiled Trades and Social Outcasts: Honor and Ritual Pollution in Early Modern Germany. Cambridge, U.K., and New York, 1999.
For a website devoted to the history of the water supply of the city of Rome: http://www.iath.virginia.edu/waters/.
"Sanitation." Europe, 1450 to 1789: Encyclopedia of the Early Modern World. . Encyclopedia.com. (December 18, 2017). http://www.encyclopedia.com/history/encyclopedias-almanacs-transcripts-and-maps/sanitation
"Sanitation." Europe, 1450 to 1789: Encyclopedia of the Early Modern World. . Retrieved December 18, 2017 from Encyclopedia.com: http://www.encyclopedia.com/history/encyclopedias-almanacs-transcripts-and-maps/sanitation
san·i·ta·tion / ˌsaniˈtāshən/ • n. conditions relating to public health, esp. the provision of clean drinking water and adequate sewage disposal.
"sanitation." The Oxford Pocket Dictionary of Current English. . Encyclopedia.com. (December 18, 2017). http://www.encyclopedia.com/humanities/dictionaries-thesauruses-pictures-and-press-releases/sanitation
"sanitation." The Oxford Pocket Dictionary of Current English. . Retrieved December 18, 2017 from Encyclopedia.com: http://www.encyclopedia.com/humanities/dictionaries-thesauruses-pictures-and-press-releases/sanitation
"sanitation." The Columbia Encyclopedia, 6th ed.. . Encyclopedia.com. (December 18, 2017). http://www.encyclopedia.com/reference/encyclopedias-almanacs-transcripts-and-maps/sanitation
"sanitation." The Columbia Encyclopedia, 6th ed.. . Retrieved December 18, 2017 from Encyclopedia.com: http://www.encyclopedia.com/reference/encyclopedias-almanacs-transcripts-and-maps/sanitation
"sanitation." The Oxford Companion to British History. . Encyclopedia.com. (December 18, 2017). http://www.encyclopedia.com/history/encyclopedias-almanacs-transcripts-and-maps/sanitation-0
"sanitation." The Oxford Companion to British History. . Retrieved December 18, 2017 from Encyclopedia.com: http://www.encyclopedia.com/history/encyclopedias-almanacs-transcripts-and-maps/sanitation-0