The Sinister History of U-Shaped Toilet Seats

IF YOU’VE EVER used a public restroom, you’ve encountered the U-shaped toilet seat. While most of the toilet seats in our homes are O-shaped, most toilet seats in public restrooms feature this odd opening in front. Why?

Some explanations offered are that U-shaped seats are less expensive to manufacture and less likely to be stolen. Another explanation is cited in recent Mental Floss and Slate articles on the topic. Both articles quote Lynne Simnick of the International Association of Plumbing and Mechanical Officials, who claims the U-shape was designed for hygienic purposes, to make it easier for women to wipe themselves, back to front.

This hygiene defense is strange when one considers that wiping back-to-front is actually a sure-fire recipe for a UTI and runs counter to the recommendations of the American Congress of Obstetricians and Gynecologists. But however bizarre, Simnick’s “hygiene”explanation echoes that of pediatricians and public health officials in the early twentieth century, who lobbied urgently for these strangely-shaped seats in an attempt to stamp out a hidden epidemic, one that had raged since the 1870s.

When the Neisseria gonorrhoeae bacteria was isolated in 1879, hospitals began testing the vaginal discharge of their youngest female patients, and they were astonished by the findings. In 1890, for example, when Dr. Henry Koplik of NY’s Mount Sinai tested the girls in the children’s ward, he found that every single one had gonorrhea. [1.Lynn Sacco, Gonorrhea and Incest Break Out,Unspeakable (2009): 96] Similarly, four gonorrhea epidemics struck the wards of NY Babies’ Hospital between 1899 and 1905, [2. Charles Camblos Norris, Gonorrhea in Women (1913): 376] and 344 little girls were treated at the Vanderbilt clinic on the Upper West Side. The patients’ average age? Just five years old.[3. cited by P. Brooke Bland in Gonorrheal Infection in Childhood,New York Medical Journal (20 March 1920): 490]

Humans are ingenious at mediating moral horror— through language, rituals, hierarchies, through silence and through science. The idea that gonorrhea was sexually transmitted had been widely accepted since the Middle Ages. Scientists had already shown that gonorrhea was exceedingly difficult to culture in a lab— the bacteria dried very quickly, and even in moist environments could only live for a few hours. Yet doctors and public health officials preferred to believe that the gonorrhea bacteria was stronger, more contagious, more easily communicable than previously thought. They chose to believe that this disease (rather than the carriers of the disease) just happened to target little girls because of the (deficient) shape of their genitalia: “infection being easy in them because of the prominence of the external genitals…contagion is often conveyed indirectly.”[4. Dr. John Morris of Baltimore qtd in Alice Hamilton Gonorrheal Vulvo-Vaginitis in Children,The Journal of Infectious Diseases (1908).]

The usual sort of victim-blaming ensued: little girls who tested positive for gonorrhea were doubly victimized, excluded from hospitals, barred from public school, and often further isolated at home with their abusers. The moral horror was further diffused by blaming fomites, inanimate objects— such as bedding, thermometers, nurses’ hands— as sources of transmission. In some cases, this could have been true, given that some overcrowded hospitals reused rectal thermometers and bath sponges. But even if fomites could be blamed for the spread of gonorrhea, they couldn’t account for Patient Zero— how did even one little girl acquire a sexually transmitted infection in the first place?

This gonorrhea epidemic wasn’t restricted to New York (hospitals in Baltimore, Chicago, and other cities had their own epidemics) or even to hospital wards. Cases were being reported by the family doctors of middle-class families too. And so other fomites were made into fall guys, and the first among them was the toilet seat. Consider the evident relief expressed by one Dr. J.C. Cook in the Journal of the American Medical Association in 1901: “It is trying to our credulity to find a 4-year-old daughter and a 35-year old father having gonorrhea at the same time with no other source of infection to the daughter than the father, and yet I have observed this in a family of educated and refined people. I am glad to hear it restated that it is possible to contract the disease in a water-closet.”[5. J.C. Cook, Journal of the American Medical Association Vol 37 (1901): 830]

Since women were tasked with most cleaning chores, men were completely absolved of any blame. Doctors would go so far as to admit that a father may have contracted gonorrhea from a prostitute, but if his children went on to contract the disease, his slovenly wife or maid was to blame: the bedsheets were not properly washed, the toilet seat was not clean enough.

Even if mothers kept a pristine house, little girls could still be infected at school. It was thought that a little girl might deposit gonorrhea bacteria on the front edge of the toilet seat as she hopped off, thereby infecting her schoolmates. As a result, some pediatricians declared that “in the schools, the chief means of transmission is probably the common toilet seat.”[6. Dunn and Rotch, Pediatrics, the Hygienic and Medical Treatment of Children Vol 3 (1922): 284]

As a result, in 1916 a committee of the American Pediatric Society urged the nation to immediately adopt shorter toilets with U-shaped seats in all schools, hospitals, and public restrooms. Their recommendation was incorporated in 1945 into the Uniform Plumbing Code, where it remains today in Section 409.2.2: “All water closet seats, except those within dwelling units, shall be of the open front type.”

The belief in the toilet seat as a fomite persisted well into the 1980s, a view that could have only enabled, perhaps emboldened, sexual predators. In 1979, Drs. Gilbaugh and Fuchs published “The Gonococcus and the Toilet Seat” in The New England Journal of Medicine, chiding colleagues who still believed in nonsexual transmission methods: “Our data in no way prove that such transmission can occur, and demonstration of this mechanism may be impossible.” [7. Gilbaugh and Fuchs, The Gonococcus and the Toilet Seat,The New England Journal of Medicine 301 (1979): 93] It took the medical community a full century to admit that gonorrhea in children was usually the result of abuse, and even longer to get us to the current American Academy of Pediatrics guidelines: “Physicians should assume that children with gonorrhea have acquired it by sexual contact and that most such contacts are sexually abusive.”[8. American Academy of Pediatrics. Committee on early childhood. Gonorrhea in prepubertal children. Pediatrics 71.4 (1983):553]

How America dealt with an epidemic of gonorrhea in little girls at the turn of the century has an awful lot to say about how we have handled, and are still handling, the public health crisis of sexual abuse— whether in working class Catholic parishes, prestigious prep schools like Philip Exeter and St. George’s, or, most recently, in former Speaker of the House Dennis Hastert’s Indiana hometown. Abuse requires not just that others remain silent, but that they actively manufacture excuses—and some of these excuses are immortalized in the form of molded fiberglass.


About Shelley Puhak

Shelley Puhak is a poet and essayist from Baltimore. She is the author of two poetry collections, the more recent of which is the critically-acclaimed Guinevere in Baltimore. Her essays have appeared in Black Warrior Review, Creative Nonfiction, and Fourth Genre.
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