The Big Necessity

"In the name of research, Ms. George waded through sewers and checked out latrines all over the globe. On paper, she glides with rueful and articulate poise through the biology, ecology, physiology, psychology and basic hydraulics of her subject, always articulate and persuasive. Even if you are inclined to think health-care dollars should be put into titanium rather than porcelain, you will be hard pressed to put this extraordinary book down."—Abigail Zuger, M.D., The New York Times

"Rose George's The Big Necessity should become a classic in the limited literary annals of coprology. George, who is British, is an ebullient descendant of the virtuous Victorians, including Thomas Crapper, who brought us modern plumbing. With wit and style, she goes to sewage school, ventures into the sewers of London and New York, attends international toilet conferences and visits cities, villages, townships and slums in Africa, Europe, the United States, India, Japan and China. Along the way, she shines a spotlight on unknown but charismatic leaders in South Africa, heroic campaigners in India and industrious Chinese reformers who have converted 15.4 million rural households to biogas digesters: a cheap and inexhaustible supply of clean energy. She even reveals the wonders of Japanese 'washlets'—'a generic word for a high-function toilet'—especially the warm toilet seat manufactured by Toto. With $4.2 billion in sales in 2006, Toto has entranced the Japanese . . . The Big Necessity is a valuable and often entertaining, if somewhat dismal, account of the travails of human waste disposal."—Anna Sklar, Los Angeles Times

"Let's get the cover-blurb pander out of the way up front: If you buy just one book about human feces this year, make sure it's Rose George's The Big Necessity. Most people older than 9 prefer not to think much about the organic amalgam the American sanitation industry, in an excellent example of corporate euphemism, calls bio-solids. (Other, more poetic cultures prefer night soil; Rose George's English compatriots once called it 'gunge.' The author herself typically uses the sturdy old s-word. The Big Necessity is nothing if not frank.) Yet George's lucid, intrepid book of globe-spanning reportage not only sustains this apparently mundane subject for 304 pages, but it also leaves a reader both outraged and unexpectedly inspired. Night soil will never seem the same again. First, of course, George must overcome the natural reflex to laugh at her subject. The Big Necessity isn't exactly dour—prepare to discover the She-Pee female urinal and a latrine-emptying device called the Gulper—but, as George establishes, gunge is serious business. After all, certain prerequisites underlie civilized human life, and police, fire and espresso service all come after sanitation. Rome built its Cloaca Maxima in about 600 B.C.; without it there never would have been an empire. George lays out a shocking indictment of what we've accomplished since then . . . [George] makes an engaging and hardheaded guide, the kind of reporter who doesn't mind recounting her own urinary experiences in rural China. In the far-flung and unplumbed corners of a very septic world, she discovers a welter of solutions to the planet's s-word dilemma. She introduces Indian toilet entrepreneurs, South African cleanliness evangelists, Tanzania's Gulper inventors and China's impressive biogas digesters, handy devices that ferment human and animal waste into heating, cooking and lighting fuel. These efforts are as diverse as the places they serve, but the successful ones share a few common characteristics: They're low tech, decentralized, cheap and grassroots. The most promising, like biogas, transform a liability into an asset. (In contrast to these earthy undertakings, George's enthusiasm for Japan's scary computerized super-toilets is a bit unseemly. Just what we all need: another home appliance we can't fix. Long live the ballcock, that handy little mechanism that fills the water tank in your flush toilet.) The Big Necessity connects one of the oldest problems in human life (man's gotta eat, and man's gotta—well, you know) with a future likely to fall somewhere between the high-industrial grandeur underneath London and ye olde gunge farmers. It is a striking book. Read it, and you'll think of it at least once a day."—Zach Dundas, San Francisco Chronicle

"OK, we have to say it. This book is full of s - - -. Still, Required Reading was wondering what got Brit journalist Rose interested in such a dirty subject, one she tackles with wit and seriousness. 'It was a slow burn, but the big trigger was coming across the International Museum of Toilets in Delhi,' Rose tells us. 'Because of that, I learned sanitation can be made entertaining.' She also learned that a child dies every 15 seconds from diarrhea, 'or what most of us think of as a bad take-out meal.'"—Billy Heller, New York Post

"Save the poop jokes, because Rose George has heard them all. When the London-based journalist decided to write a book on human waste, toilets and the world sanitation crisis, she knew that she'd be the butt of a few jokes around the pub. What she didn't realize—at least not fully—was just how important her subject was. George's new book The Big Necessity: The Unmentionable World of Human Waste and Why It Matters delves into the taboo subject of bowel evacuation, with tact, sensitivity—and the right amount of style. Reporting on the sewers of London and the slums of New Delhi and the high-tech toilets of Tokyo, George comes to understand that sanitation is no laughing matter—it's the difference between life and death. 'I thought a toilet was my right,' writes George in the book's introduction. 'It was a privilege' . . . In The Big Necessity, George makes a passionate argument for putting sanitation at the top of the global development agenda, profiling the efforts of redoubtable activists fighting a war for toilets. One of them—the practical world leader of sanitation advocacy—is Jack Sim, the irrepressible founder of the World Toilet Organization, otherwise known as the other WTO. Sim, a retired Singaporean entrepreneur, built the WTO from a group of one—himself—to a sprawling network of 151 organizations in 53 countries. Among his innovations is World Toilet Day, this Nov. 19, which is meant to publicize the plight of billions of people who go without toilets and fight the taboo that nearly all cultures have about business in the bathroom. That quiet embarrassment—similar to the hush around sexual practices that once muffled AIDS activism—keeps sanitation out of the world's top health priorities, and ensures that even those who go without toilets suffer in silence. Sim, his fellow activists and George are determined to make their voices heard. In The Big Necessity, George introduces the reader to a fascinating and enlightening universe. In India, Bindeshwar Pathak, an ordinary idealist, invents a basic and cheap latrine, and proves that even the most destitute Indians will pay for a clean toilet. In China, George meets Wang Ming Ying, a tiny woman from the rural province of Shaanxi who promotes the use of biogas—energy created from the fermentation of human waste—which can be used for electricity and cooking fires, and helps slow the deforestation ravaging her country. In Japan, George recounts the history of Toto, maker of the world's most advanced toilets, which can do everything including check your blood pressure—and wonders why they never caught on in the West. But what lingers after you finish reading The Big Necessity is characters like Champaben, an outcast woman from the untouchable Dalit caste in India whose job is to clean the country's dry, filthy latrines. She regularly contracts dysentery, giardiasis and brain fever from her exposure to human waste. No one deserves that fate, and as George makes clear, the very least we can do for every person on this planet is to give them a place to go."—Bryan Walsh, Time magazine

"Death, once referred to in euphemisms, if at all, has been reborn as prime-time television drama. Sex and money are now topics for documentaries, even after-dinner conversation. The last taboo, surely, is shit. The byproducts of digestion are so hard to mention—adolescent jokes aside—that symptoms of bowel cancer are often ignored until it is too late. A few frank and indignant souls are trying to help. Ms. George meets activists who travel around rural India, provoking villagers to see with fresh eyes the vile heaps deposited close to their homes—and who strike, while disgust is hot, to get them to build latrines. She visits Chinese peasants who light their homes and cook their food with biogas generated from their own and their pigs' fermenting excreta. And she learns about the 'Gulper,' a prototype manual pump, light enough to be carried on a motorbike, that could empty pit latrines in slums, thus saving residents from the hazard of 'flying toilets'—plastic bags filled with faeces and flung away. In Japan techno-toilets wash and blow-dry users’ bottoms, and innovation abounds. Elsewhere in the rich world, though, citizens are strangely indifferent to the parlous state of a vital piece of infrastructure. London’s Victorian sewers, built for 3m people, must now cope with 13m; New York’s often overflow. Yet here too Ms George finds heroes: the 'flushers' who don crotch-high waders and do battle with everything that is dropped down drains or stuffed down manholes, from cotton-buds (the perfect size to block filters) to congealed fat from restaurants; from mobile phones to the occasional dead Mafioso. But as Rose George explains in this fascinating and eloquent book, there is a great deal that needs to be said about excretion that is not remotely funny. Two-fifths of the world’s population has nowhere to defecate except open ground. That is 2.6 billion people whose drinking water contains their and their neighbour’s faeces; whose food is contaminated by the flies that lay their eggs in human waste; who live in filth and very often die because of it. And yet this particular curse of poverty is all too often overlooked. Politicians and celebrities are enamoured of 'clean water'—but less keen on posing next to the latrines that must be built to keep water that way."—The Economist

"The Big Necessity covers the need for better sanitation when dealing with human excrement. Not the most pleasant subject in almost any forum, but a very necessary one when you confront the facts that Rose George lay out: disease spread by human waste is the number one world wide killer of people; 2.6 billion people do not have access to any sanitation facilities, and 1.95 million people in America do not have an indoor toilet. Getting into great detail, George moves from the overtaxed first world sanitation facilities to the non-existent third world ones. The book is written with style, amusing and extensive, giving plenty of causes for action. Not only does she provide a clear history of sanitation (high heels became popular when chamber pots were emptied in the streets of London), the political issues (Myanmar's refusal to allow help in creating healthy sanitation facilities), the societal (introducing latrines in schools, increased attendance from female students by 15%) and the critical (disease spread by excrement kill more people than any other source). Sure it isn't a pretty subject, and not one for casual conversation, but George makes a clear, convincing argument that it should be a topic of interest for anyone interested in human rights, well being and the future."—Sacramento Book Review

"Let's not be clever. The Necessity: The Unmentionable World of Human Waste and Why It Matters, Rose George's perfectly disquieting new book, is very good. How do I know? Because as i sat reading it in a small park in my Manhattan neighborhood, I became acutely aware that the soaring condos surrounding me were only possible because they served as chutes for the disposal of human excrement: All around me thousands of gallons of human waste and wastewater plummeted to the earth to be swallowed by New York City's perennially overtaxed sewer system. It was like seeing through the Matrix. I was suddenly a filthy-minded Roquentin. Not a pleasant experience. To flush or not to flush became a question of moral courage, or cowardice. I realize that what I've written is not so much an analytical or aesthetic judgment as it is a visceral response, but that's all part of Ms. George's plan . . . With wit, narrative skill and compassion, The Big Necessity, all feculent humor aside, re-humanizes shit, allowing us to examine a major international public health nuisance."—Laura Orlando, The New York Observer

"Journalist Rose George has done what you and I will never do: travel the world just to study human waste. And the weight of information that she brings to her book, The Big Necessity, is astonishing: Eighty percent of the world's illness is caused by fecal matter, George reports. Diarrhea—usually caused by feces-contaminated food or water—kills a child every 15 seconds. Ninety percent of the world's sewage ends up untreated in oceans, rivers and lakes. Some 2.6 billion people don't have toilets, the device that geneticist Gary Ruvkun believes is the single biggest variable in increasing human life span. Mahatma Gandhi himself declared that sanitation was more important than independence. But The Big Necessity is not just a book of facts, the kind you can leave by the john. Complex concepts and technologies are at stake. What is the best procedure to create and use biogas and biosolids? Why are there so many disparate theories about sewage treatment? What sorts of influences do cultures play? Is a flush toilet actually the answer for everyone, everywhere? (No, it's not.) George, educated at Oxford University and the University of Pennsylvania, is diligent. She goes directly to where the problems are and talks with people who are trying their best to manage human waste in dire circumstances. She spends time in the slums of Africa and India and talks with farmers in China who spray their crops with untreated human waste. The United States is no bed of roses, either . . . There are so many interesting stories in The Big Necessity that I wanted to tell everyone about what I learned."—Sarah Willis, The Plain Dealer (Cleveland)

"It may not be fodder for dinner discussion. Or book clubs. Or, come to think of it, polite conversation of any kind. But journalist Rose George, author of The Big Necessity: The Unmentionable World of Human Waste and Why It Matters, was undaunted delving deep into the history and implications of a daily act that dare not speak its name . . . Potty humor may make you giggle, but world sanitation standards should make you cringe. We can put our waste to work for us, but not until we get over the taboo of discussing it."—Samantha Henig, Newsweek

"Excrement. Stool. Defecation. S___. This unlikely tour of the underworld of human waste grew out of the author's 2006 series on sewage for the online magazine Slate. George, an accomplished London-based writer, has inarguably hit on an important topic. As many as 2.6 billion people lack sanitation—meaning no access to a latrine, a toilet, a bucket or even a box. The health consequences are, not surprisingly, catastrophic: 'A gram of feces,' George writes, 'can contain 10 million viruses, 1 million bacteria, 1,000 parasite cysts and 100 worm eggs.' The privileged Westerner winces. Yet in an upbeat, inquisitive manner, George travels the sludge-filled world—from the sewers of New York City to the latrine pits of Tanzania to plumbing-deprived rural India—breaking one of our last taboos for an insightful discussion of health policy."—Andrea Sachs, Time

"In The Big Necessity: The Unmentionable World of Human Waste and Why it Matters Rose George gives an interesting look at a very unsavory and often unthought-of subject. From robotic toilets to the open sewage of India, the author gives examples of mankind's unseen toll on the Earth. George brings to light the threats that face us as well as the technologies, like biogas digesters and the use of lasers, which may save us. In the meantime, this book is an eye-opener to the many dangers that are inherent in our very existence."—Sean Davis, Courier & Press (Evansville)

"Although bodily functions is a topic usually treated as off-limits, the fact that 2.6 billion people are without adequate sanitation facilities is something to be loudly talked about, development activists say. 'Just as HIV/AIDS cannot be discussed without talking frankly about sex, so the problem of sanitation cannot be discussed without talking frankly about s**t,' one Nepali sanitation activist says. In her new book, The Big Necessity: The Unmentionable World of Human Waste and Why It Matters, the journalist Rose George embarks on a journey across the world to try to break taboos and erase the shame that accompanies the issue of human waste, as well as expose how big of a health threat the lack of sanitation can be. In the belief that 'anything can be made talkable,' George traveled for 18 months to the slums of India and Tanzania, climbed down into the sewage systems of New York and London, attended World Toilet Organisation (WTO) conventions in Russia and Thailand, and tested out the hi-tech toilets in Tokyo. George told IPS that one of the funniest moments on her journey was 'trying to pee in a public toilet with no doors in China with a line of women watching me. It didn't seem that funny at the time—it was my first ever experience of a doorless toilet—but now it does.' The facts presented in the book are less amusing. A single gramme of feces can contain 10 million viruses, one million bacteria, 1,000 parasite cysts and 100 worm eggs. Feces not disposed of properly can be carried on people's shoes, hands and clothes and contaminate water, food and cutlery. It is estimated that people living in areas with poor sanitation ingest 10 grammes of fecal matter every day. Salmonella and cholera, among many others, are considered water-related diseases because they travel from host to host in water that people use to drink or bathe in. George writes that some '2.2 million people—mostly children—die from an affliction that to most Westerners is the result of bad take-out food.' Diarrhea is the result of fecal-contaminated water or food and it kills a child every 15 seconds. According to the U.N. children's agency UNICEF, diarrhea is a bigger threat to children than AIDS, tuberculosis or malaria. Children without a toilet have to spend many days of the year being sick, and many eventually drop out of school. If you are lucky enough to be born a woman in Japan, you may own a hi-tech TOTO toilet that can check your blood pressure, play music, spray water and warm air to wash you, vent smells and ensure the seat lid is down. It is might also have a box called the "Flush Princess" that disguises the noise of bodily functions. If you are a woman in the poorest parts of the world though, and you don't have a toilet, it means that you have to wake up really early and do what you have to do in the darkness, risking rape and snakebites. Or you might be born one of the 400,000 to 1.2 million 'manual scavengers,' cleaning up feces from railway tracks or clogged sewers with your bare hands. Manual scavengers are Dalits, members of the lower caste of India's ancient social system. 'These people are still shitting in the pond. A fly that has touched their shit is not going to distinguish between Brahmin and Dalit food. If you have toilets and they don't, that means that your food is definitely being contaminated by lower-class shit,' Rose quotes Sojan Thomas, director of a sanitation programme, who hopes to appeal to wealthier Indians' egos. 'The most disgusting situations were encountered in India because open defecation is common,' the author told IPS. 'Especially in rural India, people are defecating on the roadside, which is pretty disgusting and shocking.' 'On the other hand, in the West, where we think we have the best form of sanitation, it is not working properly. It is certainly not as dramatic as in India, but with a rainstorm you can get raw sewage water being discharged in the rivers,' George told IPS. Societies like India require a lot of effort to convince people to stop open defecation. "You don't just supply people with free toilets because human beings are very complicated and they may not use them because they are used to going into a bush, in the woods and strangely enjoy it," George said. What many campaigners and reformers found out is that it is much harder to convince people that they need a toilet than make them want to own one. Wanting it even for reasons of prestige is much more powerful that telling them that they need it to protect their health. The Millennium Development Goal on sanitation set by the U.N.—to cut in half the number of people living without adequate sanitation or toilets—has been the hardest target to achieve. In order for it to be met by the 2015 deadline, 95,000 toilets must be installed every day. That translates to one toilet per second, every day, for the next seven years. Rose reports from China, where human feces is sprayed as fertiliser on vegetables and fruits. This is very unhealthy, but it is a practice that has been going on for 4,000 years. However, China is also the leader in making energy from human excrement. More than 15 million rural houses are connecting their toilets to a biogas digester and using the energy that is produced to run cooking stoves. Pigs are also very helpful in increasing the amount of excreta and therefore energy produced. 'You connect the waste from the pigs too in an underground tank that is digested and you can take out the methane that is produced by the digestion and process it, kind of like a human stomach,' George said. Biogas has a number of advantages. It saves on conventional energy and wood since it can be used for cooking and lighting. Not needing wood saves on hours of labour and cuts down on deforestation. In the end, George told IPS she is 'cautiously optimistic.' 'This year there has been a bit more attention paid to sanitation,' she noted. 2008, for example, was designated the International Year of Sanitation by the United Nations, and Nov. 19 is 'World Toilet Day.'"—Mirela Xanthaki, Inter Press Service News Agency

“Every day, you handle the deadliest substance on earth. It is a weapon of mass destruction festering beneath your fingernails. In the past 10 years, it has killed more people than all the wars since Adolf Hitler rolled into one; in the next four hours, it will kill the equivalent of two jumbo jets full of kids. It is not anthrax or plutonium or uranium. Its name is shit—and we are in the middle of a shit storm. In the West, our ways of discreetly whisking this weapon away are in danger of breaking down, and one-quarter of humanity hasn't ever used a functioning toilet yet. The story of civilization has been the story of separating you from your waste. British investigative journalist Rose George’s stunning—and nauseating—new book opens by explaining that a single gram of feces can contain ‘ten million viruses, one million bacteria, one thousand parasite cysts, and one hundred worm eggs.’ Accidentally ingesting this cocktail causes 80 percent of all the sickness on earth. I once had a small taste of the problem. A few years ago, I was trudging up a hill in Caracas, Venezuela—through a vast barrio cobbled together from tin and mud and leftover plastic—when I saw a plastic bag filled with feces hurtling toward me. It splattered all over my chest and into my mouth. This wasn't an attack on a gringo intruder. In many of the slums that scar South America, there are no sewers, so the only way to dispose of your excrement is to squat over a bag and throw. It's called the ‘helicopter toilet.’ Today, 2.6 billion people live like this: ‘Four in ten people have no access to any latrine, toilet, bucket or box. Nothing,’ George explains. In an epic work of reportage—taking her from the sewers of London to the shores of Africa to the bowels of China—George investigates the slow road away from this shit-smeared existence . . . In her search for answers to what to do with our swill, George lyrically dives into the toilet bowl, sloshing about like Gene Kelly singin’ in the rain. ‘Of all the people of the world, the Chinese are probably most at home with their excrement,’ she explains. They defecate openly, chatting away with their friends in toilets with no dividers. Perhaps for this reason, the Chinese have been more creative than anyone else with their crap. Since the 1930s, they have been turning it into electricity . . . Toilet culture can change, and fast. Neither of my parents had a toilet in the house when they were children and thought the idea was vaguely disgusting. (Defecating? Next to the kitchen?) Another toilet-tide shift may happen in my lifetime. Will the drying up of water supplies—and a sewage system with nowhere left to spew its waste—force us to regress to earlier, dirtier worlds? Or will we begin a transition to greener options before the system breaks down and begins to spew our filth back at us? It's a sign of how superb George's book is that I am now bubbling with questions about the future of feces. The Big Necessity belongs in a rare handful of studies that take a subject that seems fixed and familiar and taboo and makes us understand it is historically contingent and dazzlingly intriguing. Jessica Mitford did it with her classic study The American Way of Death; Michel Foucault did it with Madness and Civilization. Rose George has produced their equal: a gleaming toilet manifesto for humankind.”—Johann Hari, Slate

"What is humanity's cultural bedrock and the basis of modern living? According to Rose George, the answer is the toilet. Potty training, she says, is one of the first means of our socialisation and cities would be impossible without sanitation. The Big Necessity is the story of how we go to the toilet; it is the cultural, bacteriological and psychological landscape of poo ad pee. It is a masterly and intelligent work of reportage from a woman who, in the course of her research, has sat and squatted from Dar es Salaam to London, Johannesburg to Chengdu, Mumbai to Moscow. George has a serious purpose in all this. She is outraged at the vast death toll caused by 'water-borne disease,' a euphemism for shit-borne disease. Poor sanitation, she reports, causes as many as 1 in 10 of the world's illnesses. Access to a toilet adds 20 years to the average life, yet 2.6 billion people around the globe do not have one. George finds this division of haves and have-nots unacceptable. The Indian caste system, for example, forces millions of women to collect faeces from the toilets of the higher castes, transporting it in baskets on their heads for disposal, then denies them water sources to wash with afterwards. Access to a toilet adds 20 years to the average life. These are disturbing messages, but they are buoyed by a tide of gutter journalism and toilet humour. Here we find the true story of the world's most expensive toilet—a NASA folly for the space shuttle—and the development of Japan's robo-toilets, with their bewildering array of dials and nozzles. Researchers have worked tirelessly to determine the precise angle for a water nozzle to wash Japanese post-excretion posteriors, while engineers designing efficient low-flush toilets experimented for years with substitute faeces, including apples and golf balls, before settling on soybean paste in a condom. George's strongest material is on toilet culture. She explores the cultural abyss between those who use paper and those who use water; private and public excretion (European monarchs used to hold court on both kinds of throne); and cultures that abhor ordure and the 'faecal-philiacs.' The Chinese based an entire civilisation on using 'night soil' as a fertiliser and now power millions of homes with biogas. Why, George asks, do burglars worldwide leave excremental calling cards? And why are German males encouraged to sit for a pee, while many Swedish women like to stand? To sit or to squat: that is the question. George, we learn, is a reluctant squatter, but concedes its superiority. Sitting, especially on a high seat, 'impedes release' and may be causing colon cancer. The book includes a wealth of odd statistics. The average dump is 250 grams. The average American wipes him or herself with a staggering 57 sheets of toilet paper a day, yet most men still have faecal debris on their underpants. A gram of faeces can contain 10 million viruses and 100 worm eggs. One person's faeces and urine can fertilise 270 square metres of farmland. And did you know that the word 'shit' has the same ancient root as the word science? The Big Necessity salutes the heroes of the toilet. The name of Yorkshire's visionary Thomas Crapper became a British euphemism for the bodily function he helped ease. Engineer Joseph Bazalgette saved Victorian London from the 'great stink.' And in the 1930s, a Shanghai gangster known as the Shit Queen ran a cartel controlling the city's hundreds of night soil carts. In modern times there is Ronnie Kasrils, the flamboyant African National Congress guerrilla commander who became South Africa's 'minister for toilets', and Bindeshwar Pathak, whose organisation for constructing public toilets and banishing al fresco bowel movements employs 50,000 people, and is India's biggest charity. George is admirably intelligent on the sewage politics of slums. She condemns African 'flying toilets' (excrete into a plastic bag and throw) and describes in detail the problems of emptying an overflowing pit latrine. But she sees hope in home-grown sewer building and latrine digging programmes round the world. I was relieved that colonic irrigation fails to make an appearance and that the sexual fetish of coprophagy, while alluded to, is never described. Still, George passes up few chances to entertain and elucidate in this new must-have for every toilet bookshelf."—Fred Pearce, New Scientist

"George's smart new book on sanitation, The Big Necessity, doesn't advocate a flush toilet in every hut . . . 'Waterborne waste sewage was an excellent solution in the 19th century,' George says. in the 21st, clean water is too scarce a resource to contaminate with such abandon. She thinks that composting toilets might be a better idea, though no one yet has developed a system likely to work on a mass scale."—The Week

"On Sunday, Dec. 7, Secretary of State Condoleezza Rice was interviewed on ABC’s This Week with George Stephanopoulos. In the course of Stephanopoulos’ questioning, Rice brought up an ongoing crisis in Africa, the refusal of Zimbabwe’s dictator, Robert Mugabe, to leave office. There is a new twist to the story, the secretary said. 'Now you have a cholera outbreak. You have this cholera outbreak that could really endanger southern Africa, not just Zimbabwe,' Rice said. This crisis is not news to Rose George. She knows what causes cholera: lack of sanitation. The title of her book is both an invitation and a warning. This is a book that employs frank language about a subject that many Americans are uncomfortable discussing or even thinking about. When the topic of sewage and water treatment comes up, many people react by making nervous jokes. George is used to that. She doesn’t let it stop her. She is serious about her subject and makes it clear why it is important . . . George’s clear writing style and her thoroughness eases the reader’s way through this book."—Greg Langley, The Baton Rouge Advocate

"Natural disasters, terrorist attacks, global warming—these are the most commonly considered threats to our world's stability. There is however, a much larger threat looming daily in our homes, under our streets and in our waterways. In The Big Necessity: The Unmentionable World of Human Waste and Why It Matters, journalist Rose George breaks the taboo and travels the world to expose the threat of sewage and investigates innovations in recycling and disposing of human waste. George descended sewers, used the facilities and talked to people who are working to improve sanitation (or in some cases simply install a bucket) in the most severe places. An interesting fact: 2.6 billion people worldwide do not have access to sanitation—an outhouse, a hole in the ground and a bucket all count as sanitation—so they do their business on the side of the road, by the train tracks, and in the woods. George explores what effects this has on worldwide health. If you only read one book about feces this year, this one seems as good as any."—Jeanne Kolker, The Capital Times & Wisconsin State Journal

"Rose George has squatted, sat, and defecated on just about every continent on the planet. She has gone in the slums of Dar es Salaam. She has used some of the most advanced Japanese toilets. She has pondered over which of the many clean W.C.s to use in the British Library of central London. And she has written it all down—excluding some of the personal details—in her new book: The Big Necessity: The Unmentionable World of Human Waste and Why It Matters. To gain perspective on the scale and scope on the global sanitation problem, George peppers the book with some by-the-numbers facts. The most expensive toilet ever made: $23.4 million dollars. The average weight of human feces: 250 grams (8.8 ounces). The average distance between the front of a toilet seat and a male anus: 28 cm (10.5 in). The amount of untreated human waste that finds its way into oceans, rivers, and lakes: 90 percent. The number of people without any form of a toilet: 2.6 billion. The average number of people—mostly children—that die every year from ‘sanitation’ related diseases: 2.2 million or about one every 15 seconds. Her point: There’s an unspeakable storm brewing. And it has to do with the unmentionable. George’s approach to exploring the world of human feces is peripatetic and rich with anecdotes. Traveling through time and space, we learn about the history of the sewers of London and New York. London’s are some 150 years old. They were built in response to rising health concerns and festering olfactory offenses. During the 'great stink' of 1858, a period of drought left the Thames a tepid, brown, smelly mess, prompting action. The sewers worked. But with time and an ever growing population even these mammoth systems are starting to fail. For example, New York’s sewer system, which mixes rainwater and human waste, dumps some 500 million gallons of untreated sewage and rainwater into the Hudson or East Bay about once a week . . . Cholera and typhoid, two diseases that most Westerns don’t give a second thought to, are as big a problem as AIDS, malaria, or TB. But sanitation isn’t sexy. There are no celebrities lining up to stand in front of a brand new latrine in Africa or India. The global water crisis, an epidemic in and of itself, has Matt Damon. Poverty, malaria, and AIDS in Africa all have Bono and Geldof. Sanitation has its unsung heroes: Jack Sim, Joseph Bazalgette, Ronnie Kasrils, but there are no celebrities—save perhaps George herself. Informative, witty, often wry, and undeniably important, George’s book is must a read for anyone that has every used a toilet, bush, or river to—you know—go."—C.T. Pope, Circle of Blue