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    ALEXANDER KIRA Can you imagine trying to cram some of the most important activities of your day into a space measuring not more than five by seven feet? Yes, you can, if you think of the bathroom as the locus for activities you probably don't like to think about. It is undoubtedly the first place outside of bed where you begin your morning and the last place short of bed where you end your evening. You wash yourself, your chil- ‘dren, and some of your clothing there; you shave, apply make-up, comb your hair there; you do all of those unmentionable forms of elimination there; you probably ‘even use the place to escape to for a quiet moment of reading, elaxing in the tub, ‘or whatever itis you do when you're all by yourself, In other words, the bathroom is perhaps the most important private place in the house, and it's also unquestionably the most badly designed for each and every one of these functions. In 1966 Alexander Kira of Cornell University published a study of bathroom design, the result of seven years of research, and, as it tured out, a quickly ac- claimed classic of its kind. The New York Times hailed it as a “serious, knowing, fascinating, and—in just the right deadpan, disarming way—a witty book, certainly the most pioneering and probably the most consequential of any on this list..." and Ralph Nader recommended it as an “illuminating study of inadequate safety, hy- giene, and convenience features in bathrooms.” The author maintained that not only were bathrooms inconvenient to use and inadequate in terms of safety and hygiene, but, because they had been the subject of embarrassment for so long, they were rarely designed as a whole but thrown together from ill-fitting component arts (often disguised to look like what they were not). Until publication of this study, no one had taken a serious look at the bathroorn’s function—sinks were invariably too small and too low, medicine cabinets badly located, faucets incon- veniently placed, tubs difficult to get in and out of, and toilets both inefficient and difficult to clean. Alexander Kira is Professor of Architecture at Comell University and has special- 22d in the problems of human needs and behavior as related to design. He acts as. consultant to industry and government in Europe and the United States. He is a member of the Building Research Institute and the Human Factors Society and is a frequent contributor to journals and seminars. ‘THE VIKING PRESS 625 Madison Avenue New York 10022 ‘SBN 670-00612-2 NEW AND REVISED EDITION ALEXANDER KIRA UB, avicinc compass Book ! TO PHILIP AND HELEN CAmNV Bib bi aa BIBLIOTHEQUE Phanbing—Eaviomen na uppen 3 et ISDN oeroseaH7.0 Pras USA aan 1 ‘The present volume, founded on the fist edition of this work published in 1986, which reported fn the seven-year research project carred out at what was then the Center for Housing and En- vironmental Studies at Cornell University, has been extensively revised and considerably en- larged in scope on the basis of almost a decade of continuing study. The original material has been reorganized, revised, and ampliied. Two ‘major new parts have been added: one hat with the particular problems posed by public facilities and one that examines some of the unique personal hygiene problems faced by aged land disabled persons. In addition, completely now illustrations have been prepared which, it is hoped, are clearer, more thorough, end more natural than seemed possible a decade ago. A limited number of photographs of current pro- ‘ducts have also been included to illustrate the response the industry has begun to make over the past several years PREFACE TO THE NEW EDITION ‘The focus ofthis second eaition remains, asbe- fore, upon the examination of our personal hy- tiene needs from the following viewpoints: our attitudes toward personal hygiene activities and the facilities we use to accommodate them; our bbasle physiological requirements; our patterns of performing the necessary actions; and the de- velopment af design criteria to fulfil those needs. ‘The emphasie remains essentially on “what” to provide; the consideration of such “how” prob lems as hydraulics, sanitary engineering, manu: facturing technology, and building codes | leave to others far more compatent in these areas than vam, ‘The likeingad of fully realizing the substantive Improvements described and suggested in the {following pages depends very much on the con- sumer's level of concern and willingness to demand and pay for more rational, more conver jent, and safer solutions, As has been amply de- rmonstvated time and time again, @ society can vil have anything it cares enough aboutandie willing to pay for. | obsorved previously that the ultimate responsibilty fora rational approach to personal hygiene rests not only withthe producers but also with the architects, the buliders, and consumers in fact, with all of us. The producers must be willing to continue the development of sound and Useful products and to promote their availabilty directly tothe ultimate user—who, unfortunately, |s most generally not the purchaser. Perhaps most Important, the architects and. builders—who Actually ae the purchasers and who actually are responsible for the design of our bathrooms— ‘must begin to think of hygiene faclties as an im- portant part ofthe home and as an important ae- Peet of our daly lives rather than as a necessary feu to be accommodated according to the dic: tates of some obsolete handbook or drawing template in whatever space is ett over with what- lever part of tho budget is minimally required to ‘meet legal standards. The ultimate tragedy is that here, as in so many other aspects of human ex: Istence, all too many of us have allowed our {taboos and guits to interfere with the fullest de velopment and realization of our physical and ‘mental well-being, Over the years that | have been studying the Problems of personal hygiene and its accommo- ‘ations, | have been privileged to receive invalu- f2ble help, advice, and encouragement trom hundreds of persons the world over; persons who contributed richly ofthe time, of themselves, and of their institutional resources, it is impossible ‘even to begin to identity them all, but to all am profoundly grateful and deeply appreciative ‘To Doris Schwartz and Futh Stryker, however, | owe a particular debt of gratitude for ther long: standing interest, their encouragement, and thelr very special determination and akil in educating ‘me in some of the subtleties of the personal hy- ‘lene problems of the aged and the disabled. | also want especially to thank these persons who directly assisted mein the preparation of this second edition and who made the task a pleasure Instead ofa burden: Julia M. Smyth for her dedica- tion and her painstaking resoareh, checking and rechecking of endless details, and her editorial Judgment; Esther Dickson and Jean Warholie for their expert typing and willingness to work at all hours; my good friend Jan V. White for his en- ‘thuslasm and invaluable counsel on the design ‘and preparation of the new illustrations; Gertrude ‘and C, Hadley Smith for their professionalism and CLEANSING AND REJUVENATION ‘The third major purpose of body cleansng is to produce the sensations of being refreshed or ‘lated and sometimes simply to get warm oF to ool ot. Simply getting clean of course, produces a fooling of wol-being, but what we are dealing With here we might regard as a “pseud-bath” in that the primary object isnot really to cleanse but rather to use water to produce an easing of mus- cular and nervous tensions. This practie dates back at least as far aa the Roman Empire and unquestionably beyond, since it I esseraly the ‘same as “bathing” in the sea, though now we call it ewimming, In some societies this aspect of bathing has been clearly recognized and institutioralizes— ‘most notably today among the Japanese, who have very distinct sets of practioes and facies for the cleansing function and for the relaxing function. Most of the rest of us do not make such nice aistinctions in purpose, so that if we take a nice fong relaxing bath itis in our dirty bath water. Throughout Europe at least, where every tub is ‘also equipped with a hand shower, ities" posst- ble to rinse oneself clean after soaking. The Japa- nese soaking bath or “turo” serves another major urpose besides hygiene: water conservation. Because of chronic water shortage on the Ja nese islands, tho practice, for centuries, has been to treat the soaking bath much as we reat our ‘swimming pools, which Is to say that the water remains in the tub for months and is simply reheated by an attached stove or water heater ‘each time it is used. This alows each member of a {amily to enjoy ahot bath without enormous waste of water, particularly since their tubs, in order to ‘permit full immersion of the body, hold consider- ‘bly more water than the average American bath- tub. In between uses the tub Is covered with a tight-iting lid. Proper body cleansing beforehand is therefore a necessity if this finely balanced eys- tem is to work ‘Another important, though generally unrecog- ‘nized purpose o the psoudo-bath’ isto get warm. “tappears to me to be quite evident that it is not the water, but the warmth, to which most, it not all, the good effects experienced from. warm bathing ought to be ascribed. Among those nations where warm bathing has been most gen- aly practiced, water has seldom been ‘employed, except occasionally, and merely for ‘washing and cleansing the skin. This is espe- aly true in Japan, for example, and in Great Britain, where the bath enjoys particular favor because of a generally damp, raw climate and the lack of central heating. In at least some respects, the popularity of the sauna in Scandinavia is attributable to a similar combination of condi- tions. At the end ofa day when one i always cold ‘and bundled up in heavy clothes, a hot bath is @ Particular luxury that many of us today can scarce- ly appreciate, This also accounts in large measure for the general lack of showers throughout most of Europe, for example. To take a shower comfort ably one must take it in a heated bathroom. Con- versely, the popularity ofthe shower inthe United ‘States isa least partly attributable to central heat- Ing and to a milder, not actually tropical, climate Indeed, the notorious American penchant for @ «ally shower or two may well have more to do with revival and refreshment than with cleansing, in View of climatic factors and the stresses of con- temporary urban its, ‘The therapeutic value of water has, of cours long been recognized medically, and water is often used as a oatment for a varity of arthritic land muscular ailment. Although not as much in favor as it once was, mineral wator therapy has Iso been used in the treatment of numerous physical disorders, most particulary in the various spas of Europe, some of which have been in oper- ation since antiqully. Much ofthe effectiveness of SOCIAL NO PSYCHOLOGICAL ASPECTS OF BODY CLEANSING AND CARE 19 20 ‘water therapy Is due to tho romarkable neural and thermal sensitivity of the skin, Water can be ‘soothingenoughtotull onetosieep:Itean belnvig- oratingand increase blood circulation; oritcanbe ‘employed as a massage, particularly in the case of some ofthe recently developed “impulse” shower heads. In addition to producing markedly clitferent physical sensations, each of the two primary bathing methods, the tub bath and the shower, has also had develop around it a set of quite differnt responses and attitudes. ‘THE TUB BATH ‘The tub bath may be sald to be generally consid fered more relaxing, more luxurious, and more feminine in usage than the shower. Its probably {rue thatthe tub s the more relaxing since it does, Infact, permit sitting or semi-recumbent posture, and undoubtedly stl or gently moving water can produce a more soothing sensation than a forceful shower spray. This I not to suggest that people 0 not find shower relaxing, but there does, however, seem to be a significant dliference in how the term “relaxing” is interpreted. The show- fer is generally described as "retreshing” and ‘evitalizing” whereas thetub bath calls forth terms. such as “soothing” and “calming.” The person ‘seeking to calm down or to forget anxieties or tensions is essentially seoking an escape. This is also attested to by the fact thal persons who have 4 cholce say that they take a shower bath when they are ina hurry but a tub bath when they have the time and are tense and wish to relax. Some of the popularity of the tub bath is due simply to the fact that it doos take time—to draw the bath, to soak, to wash, and 20 forth. For many people, particulary the mothers of young children the tub bath offers a convenient and socially acceptable ‘way fo withdraw into seclusion for @periog of time thatthe shower does not offer. As we have noted clsewhere, a significant funetion ofthe bathroom today is its social role in providing more or less ‘guaranteed privacy with no questions asked Rocently, it was discovered that the bathtub has ‘also emerged asa favorite place to study in univer- sity dormitories because it was again the only place where some students felt they could escape {rom thelr roommates and from the general noise {and confusion ‘The tub bath also serves, ike sleep, asthe ut mate escape—the symbolle return to the womb, ‘hich in this instance is cirectly analogous since ‘one's immediate environment is, indeed, warm, ‘et, and enclosing and presumably offers the user ‘high degree of psychological security. The relax- ing effect 's generally pronounced, so much so that a hot bath has long been a recommended Procedure for people who have trouble sleeping. For a variety of cultural and historical reasons, the tub bath also has the connotation of being more luxurious than the shower. Largely this is because of the strong historical association of tub bathing with lavishness and extravagance. We ‘also find ample evidence In the legacy of extrava gant and elegant tubs that have survived to the Present day. The skill and imagination with which they were fashioned testify to their importance in the lives of their owners. tis probable that this dea of luxury is responsible forthe image of tub bathing’s being, rightly or wrongly, essentially {eminine, Throughout history, and in fiction ane the films, desirable women are found languishing in ‘tubs—usually elegant—and often while enteriain- Ing intimate fiends. The acceptance of this con- rotation can be explained by the fact thatthe two concepts, luxury and femininity, go virtually hand Inhand in our society. The "desirable" woman has historically been able to command luxury; and luxury, being defined as an “excessive indulgence in creature comforts and sensual pleasures,” Is regarded in our culture largely asthe prerogative land characteristic of women. Some men, to be sure, may equally indulge in luxuries inthis sense, but they tend to be somewhat of an exception and are often regarded with some suspicion There are, however, persons who take exception to this notion—at least insofar as American bath tubs have been concerned. Professor Parkinson, SOCIAL AND PEYCHOLOGIGAL ASPECTS OF BODY CLEANSING AND CARE ‘echoing the sentiments of many, complains that ‘some Puritanical tradition underlies the American bath in which one ean sit but eannot le, Clean: ness isnot to be made the excuse for luxury." ‘These attitudes are most clearly revealed in advertising, where, for example, men are generally shown in showers—rarely in tubs, Advertising directed at women, on the other hand, tends 10 divide clearly into two images: the tub image, Which suggests luxury and eroticism, and the shower image, which is more neutral—what some commentators on the American scene have described as the new “pal” image of the woman, ‘and what the advertisers themselves term as “the young moderns," "the fun people,” “tne lively ones," and s0 on. The models who pose in the shower generally have what is known a6 the ‘wholesome American look.” Tha models who pose in the tub are generally of a type that might be called “sultry” and are often depicted only \vaguely—in silhouette or through a filmy haze—to create @ drearmike quality, a relative subtle approach to eroticism that is presumably accepta- bie, since one can scarcely be held accountable for one's dreams. (On the other hand, from a purely practical standpoint, the tub would algo seem to otter great er possibilities for both luxury and sensual enjay- ‘ment, A tub bath for example, ready permits the use of a variety of additive substances such as scents, lls, and bubbles, nat to mention exotica such as champagne and milk. Or perhaps wo should say erotica Instead, as exemplitied by the following racent advertisements for bath products appearing in national magazines. One advertise- ment consisted of a virtually blank black page beating the following message: “Take a bath in the dark tonight and let the water make love to your skin." ‘and atthe bottom of the page: ‘Recipe for an intriguing experience: 1. Sur round yoursolt with 2. Turn out the lights. 2. Lean back. Relax. 4. Letthe fragrance fire your imagination. The other asked What's the sltterence between an American ‘bath and a French bath? What's the difference batween an American lover and a French lover? With —— you get stroked along your arms land legs and under your chin and in the crook ‘of your elbow and Kissed on the back of your ‘heck and behind your ear where you love it $0, with an expert French sofiness and sweetness you've never felt in the bath before. Certainly, ite imagination is needed to under- stand the implications or the appeals in these two very respectable advertisements. This potential for ‘roticlam in the tub is also attested to by the fact, hich many psychologists have noted, that a great eal of masturbatory activity is associated with it particularly among women, When we consider the ‘general atmosphere that can be created, either unconsciously or deliberately, and the natural ree- sons to explore one's body, this isnot too surpris- ing. In some instances, the tub also offers the possibiliy of shared bathing, Whereas the average ‘American tive-foot tub is scaresly more comforta ble than a two-seater sports car, many European tubs are large enough to accommodate two in comfort. A number of manufacturers have, how ‘ever, recently Introduced tube specifically de- signed to hold two (see Figure 60). In addition to its erotic possiblities, shared bathing is also very much a family matter in many societies, particulary In Japan and Scandinavia ‘This concept ofa “family” bathroom witha large tub is also fincing expression in the recent devel- ‘opment of the German Wohnbiider or “ving bath.” Perhaps the most common form of shared ‘bathing the world round, however, is that done by parents and their small children. Many young tath- 5, in particular, seem to delight in bathing and playing with their infant sons inthe tu. Not oniyis this 2 practice that finds enthusiastic approval from many psychologists, but also itis a pleasure that is essentially not possible to enjoy in the ‘shower, particularly since many infants are ter fied of a-shower. The tub, moreover, has tradtion- ally afforded young children the pleasurable SOCIAL AND PSYCHOLOGICAL ASPECTS OF BODY CLEANSING AND CARE. a1 opportunity of playing with water toys, an oppor tunity again absent in the show In conclusion, the tub emerges ultimately 28 a source of "relaxation" In a variety of ways, some purely physical and direct, some purely psycho- logical. Both conscious “dreaming” or an uncon- scious state of sensual semi-gratification can be ‘equally diverting and relaxing and may be com- ‘monly resorted to not only inthis context but in many others. ‘THE SHOWER BATH ‘As has been suggested, the shower bath repre- sents a series of attitudes and images that are almost directly opposed to those of the tub, It “refreshing”; it is fat, efficient, Spartan; i also ‘appears sometimes tobe sexless in the sense that Itdoes not seem tobe as overtly erotic ether in is se orinits image, even though shared showering 's fairly common. This neutrality holds, however, only for female use and co-exits witha distinctly masculine image. its speed and efficiency, ite Invigorating quality, and its generally businesslike, ‘no-nonsense character are all parts ofthis image. “The shower has also been described as somewhat like getting caught in the rain—casuel, uncontrol lable, destructive, rough—a circumstance that & man ls expected to take in stride, The popular stereotype of the man singing in the shower may be directly related to this rain asculine Image. In these circumstances, the singing” is more nearly apt to be akin toa bellow ing, in spirit if not in quality, and may be taken to represent a primitive expression of vily rather than an art form. If we consider the circum stances—standing naked under @ buffeting stream of water—we can see that at least in @ physical sense this represents tree and elemen- tal condition, one that madern urban man does ‘not commonly experience and one that can take fon a special significance on occasion, We can thus see how the shower image can be ‘manipulated in several ways. Primarily, it is mas cline; secondarily, it becomes essentially neutral when assumed by a woman, since in using a shower the woman symbolically shares the man's World and behaves like him—in effect, tending to remove sexual differentiation. This general trend toward an assumption by women of what has traditionally, in our culture, been regarded as mas- culine behavior is & phenomenon that Is both Widespread and reasonably accepted. The con- verse situation is also true, though perhaps more limited in its applications. In the last several decades, men have increasingly shared in "wom- an's work” and relinquished more and more of their former male prerogatives, with a resulting tendency toward a more neutral sex image.™ Inthe past, the shower has also had an associa: tion with “public” facilities, an association that has now largely disappeared, showers in the home having become so common. Some elder per sons, however, still maintain that @ shower is inap- propriate in the house or is impossible to get clean im or is too uncomfortable—presumably because ofthe standing posture ‘The shower also has associated with it certain simple and relatively obvious attitudes. Some ‘women fel, for example, that they “cannot seam to.getas clean" in the shower. This may be due to not “soaking” as one commonly does in a tub, though in view of the general frequency of wash- Ing, this is more ofan imaginary than a real prob- lem, since people, particularly women, are rarely 0 dity that this could bea significant factor. The ‘most likoly explanation is that ths attude refers, Perhaps unconsciously, to genital cleanliness, since its true thatthe shower ints present design {does make it virtually impossible for a woman to cleanse herself properly there, Tho irony inthis i, of course, thatthe shower is, In all other respects, inherently a more hygienic method of body cleansing than the tub bath unless special paine are taken to rine the body afterwards. In the United States atleast, the show ® is also becoming the preferred method of hair washing for both man and women for the same reasons of cleanliness. Although the shower has Certain limitations ite probably safe to say that it Js the overwhelmingly proterred method of SOCIAL AND PSYCHOLOGICAL ASPECTS OF BODY CLEANSING AND CARE bathing by adults in the United States. in tact, there is good reason to believe that most of the bathtubs in the United States that are als fited with a shower head are rarely used as a tub but rather as a shower receptor—a circumstance that mitigates to some extent the fact that shay are really unsuitable as bathtubs in the first place. Nevertheless, there ie litte question that tub bathing has devotees equally as dedicated as ‘shower bathers and that both methods wif contin- Ue to exist for some time to come. PERINEAL CLEANSING AND THE BIDET In adaition to attitudes and concepts associatod with body cleansing in general and with is related ‘equipment, we must also consider the ecmewhat ‘special circumstances surrounding the ceansing ‘of the perineal region and the use of the bidet Both the activity and the equipment in tis case are, in some instances, highly charged emotional- ly and offer striking example of the way in which ‘objects can become Invested with powerul aszo- Ciations and psychological sets ‘Through misunderstanding and misinformation, not to mention lack of information, the bidet has, In both the United Statos and Great Britain, become associated in the avarage person's mind with sox and sex-related usage—i, that s, he or she even had any idea what the fixture was inthe first place. Essentially, however, as more and ‘more people today are coming to realize, the bidet 's an innocent washing fixture intended fcr use by both soxes for the general cleansing ofthe entre perineal or anal-gental region ater delecation, Urination, or intercourse—or simply for quik par tial bathing. ‘The misconception, unfortunately stil widely held, is thatthe fixture ie solely to be used for douching the vagina, contraceptvely a other wise, and for washing the vulvar region afer inter- ‘course. The errors sometimes further conpound- ed by the bella that this genital-cleansing fixture is used only by prostitutes or “loose women.” From a historical standpoint, itis relatively easy to ‘see how such an association could come about first, Because the vell of secrecy and consequent misinformation about sex has persisted until fairly recently; and, second, because the first large- scale contact Americans and Brish have had with the fixture was in France during World War I— often presumably under circumstances that could ‘ive rise to these impressions the traditional male double standard also possibly being involved. ‘The fact that thie association has initially and largely been transmitted via men would also ‘account for the fact that American men as wall as ‘women tend, by and large, to reject the fixture and its essociation. Furthermore, the plumbing fixtu manufacturers have, in some instances, not helped this situation. One leading United States manufacturer, for example, who is apparently also 2 victim of this attitude, has seen fit to call its made! of bidet the “Carmen’"—a name that can ‘scarcely be considered likely to correct the pub- lie's Image! (t might have better been promoted by borrowing an idea from the marketers of that other unmentionable, the "sanitary napkin,” and ying "A bidet Because..." On the other hand, ‘one medical wag, with apologies to Rodgers, Ham- rmerstein, and Mary Martin, has suggested the theme song ''m Gonna Wash That Man Right Out (of My Hal") It would appear that so long as the bidet is ‘associated in the public mind with the sexual act, whether lct or il, there will be some persons who will reject it because of this association. ts acceptance under present circumstances would be, for some, tantamount to according the same Lunselfoonscious status tothe role of sex as tothe role of elimination physielly symbolized by the tollt. The range of responses tothe bidet, among persons who knew what it was, extended, for ‘example, from “I don't need it” and “I wouldn't want anyone to know | needed to use it to “it ‘ight be allright it! could have it in a separate compartment where guests couldn't eee it” and “What would Itell the chilren?" In New York City 1 few years ago, a number of the people moving Imo one of the city’s most luxurious and expen- 24 sive new cooperative apartment buildings, fully equipped with bidets by the forward-thinking builder, actually had them torn out at thelr own ‘expense. This isa particularly interesting situation because one would have expected most of these people to have been abroad and to have devel- ‘oped a certain sophistication. Indeed, for many sophistcates, or would-be sophisticates, a bidet has for years been the ultimate status symbol the other end of the spectrum, the “averag ‘American or English tourist, who does in tact exist, asks “What is It?" or "ls that one of those "European things?", or uses It for doing hand laundry or for cooling bottled drinks, or, asin one ‘of Henry Miller's novels, assumes that itis simply different kind of water closet or urinal From the standpoint of personal hygione, how- ‘ever, itis totaly immaterial whether there is such a fixture as the bidet or whether this anogenital Cleansing is accomplished in some other way. It ‘would not matter seriously it we rejected the bidet fon the basis of our prejudices against Its sup- Posed sexual connotations if we otherwise ‘observed and practiced proper hygiene with respect to this part of the body. The blunt facts that we do not—as every physi cian and anyone who has ever laundered a pair of In this connection, note that the Japanese origi- nally developed the tampon—a vast hycienic and ‘aecthatic improvement over “the rag” universally used formety ‘Although the story of wiping with paper may rot have been a vicious libel, it has, in some Instances, seemed to Americans, atleast avicious practice, most particularly inthe case of European Diapers, which are generally regarded as “unsuita bie,” being either to0 coarse, too hatd, or too lazed. In terms of cleansing this presents a some: what curious situation since a classic reply to the American who is used to sot tissue is, "You don’t ‘wipe, you bot!” Blotting with a nonabsorbent paper is obviously the least effective cleansing method-—and the ane most favored in Great ri in2* On the continent, blotting is compensated far by the use of the bidet. Americans can be said to strike a middle ground by simply wiping with soft, absorbent tissue. From a historic viewpoint ‘one must suppose thatthe Anglo-Saxon penchant {or mortification ofthe flesh must have its origins in Puritanism, since before the commercial aval bility of toilet tissue as such, discarded printed ‘matter was used, often with unhappy results. Not only the texture of the paper (particularly news- print) ut also the chemicals in the paper and ink ‘commonly resulted in skin irtations and inflam= mations, In those circumstances one would have thought that the idea of simple washing would have occurred to someone. At the other extrameis the recommendation made by Rabelais’ charactor Gargantua thatthe finest "wipe" inal the world is the nack of a white swan. ‘While fecal contamination is perhaps the most bvious(?) and widespread problem with our per- sonal hygiene habits, much the same criticism can be leveled against men's urinary hygiene, for the plain fact again, i that since men, unlike women, don't customarily blot themselves after urinating, their underpants and pants are stained and caked with erystalized urine deposits that no amount of dry cleaning will ramove, as every dog unerringly knows, ‘This situation represents the most curious anomaly in the entire picture of personal hygione Practices and attitudes and is especially striking in view of aur preoccupation with cleanliness in ‘most other respects, The most obvious explans- tion is that our concerns, in many respects, only 8 ‘cosmetic one—that we are primarily concemed with the appearance of cleanliness, with the appearance of Beauly, and withthe appearance of youth, What we eannot see or directly experience lr what others cannot really see we ignore. Inthe British study cited earlier, the author not- ed that For the greater part | was amazed that so many (of tha persons Involved considered this state of Stair to be "normal" The question "Does your wife enjoy washing your pants?" usually SOCIAL AND PSYCHOLOGICAL ASPECTS OF BODY CLEANSING AND CARE brought the roply “No—but she accepts it because she thinks all men are lke this."== Aside from some of the medical journals, per neal hygiene Is a subject that ls virtually ignored ‘except foran occasional aticle in one of the more sophisticated women's magazines supporting the bidet for feminine hygiene. Obviously, consider- ‘ably more education is necessary before we will take steps to correct thi situation. tis also likely ‘thatthe only way anal-genital cleansing may ever become a reality In the United States or in Grest Britain Is by accomplishing It in ways other than Using the bidet, which has become so emotionally charged—or possibly by hoping that another ‘businessman'" vil discover that here Is yet ‘another part of the body that has not been ade- ‘quately dealt with, SOCIAL AND PSYCHOLOGICAL ASPECTS OF BODY CLEANSING AND CARE ‘THE HUMAN SKIN ‘The human skin is made up of severs! distinct layers. The outermost layer, the epidermis, is a thin membrane containing pigment anc epithelial cells, lercod by sebaceous and sweat lands and hale flies, and nourished from the layer below, the corium. The corium contains the glends, mus cles, blood vessels, nerve endings, anc hair fo ‘les, The epidermis has been compared to a per- ppetual paper pad in the sense that, as each top sheet dias and ie discarded or removed, & new ‘sheet grows from the bottom to replace it. Inthe our89 ofthis constant regeneration, tha cells that come to the surtace die and undergo a chemical ‘transformation into @ horn-like materia similar to alls, This outermost horay layer is constantly being shed but is held together bythe cil rom the sebaceous glands and, combined with foreign matter, forms a relatively dense and impervious deposit covering the body. (This depesit is seen ‘most readily in dandruft. It is this dead layer that protects the skin against damage from most for- THE ANATOMY AND PHYSIOLOGY OF CLEANSING ign matter, but we must continually remove itt wwe are to keep the sebaceous and sweat glands ‘lear and the body functioning properly. Because it is @ living organ, the skin can vary considerably in certain aspects, depending upon ciroumstances, for example, the process of aging. [As a person ages, a number of marked changes ‘occur in the skin. These include a decrease of water, a decrease of fat, @ decroase in elasticity, ‘and a decrease in the capacity to regenerate ‘The decrease in skin elasticity appears to run parallel withthe actual degeneration ofthe olas- tic connective tissue fibers, The decrease inthe ‘subcutaneous fat may play a minor role. The ‘dryness ofthe aged skin is probably secondary to decreased secretion of the sebaceous glands..." AAs a result of these changes the person most ‘commonly suffers from an itching and an leltar tion, which ean largely be overcome by using superfatad soaps and oiling the skin regularly In contrast, the ¢o-called “animal” skin, even within the seme age group, can vary trom an extreme we call "dry" to one we call “ol tough strictly speaking, this refers primarily to the quantity of skin secretions and the appearance ofthe skin. The skin of infants and young chileren Is obviously a much softer and more delicate cov- fering than the skin of an adult and accordingly needs gentler handling and care. Most particu lary, Infants appear to secrete very lite natural olls, and itis commonly recommended that they ‘occasionally be given an oll bath in place of @ regular bath, much the same as in caring for aged skin. In spito of those variations, however, the basic cleansing problems remain essentially the same for al ages. Functionally, the skin serves @ number of dis- tinct, though interrelated, purposes: Protective The skin protects the body against the elementsand thegeneralexternalenvironment. \Whan cleanand heaithy tacts inasel-disintecting way to protect against microorganisms, such as streptococci,coliform bacteria, Salmonelleae, and Perhaps viruses.? An excess of dit, on the con: trary, not only provides additonal material fr the growth of microorganisms but also inhibits the process of sel-disintection. Sensory A rich nerve supply gives the skin an Important sensory function. Respiratory As a respiratory organ the skin Is capable of eliminating water vapor and carbonic ‘acid gas, though with respect to this function the role of the skin is minor compared with that of the lungs. Heat Regulating The skin helps to maintain @ constant body temperature by regulating the ‘amount of heat lost trom the body surface. Sur- plus heat is thrown off through perspiration. Undue loss of heat from evaporation of the per spiration is prevented by the olly layer of sebum. Excretory The skin performs an excretory func- tion of eliminating waste materials through both the sweat glands and the sebaceous glands. ‘Sweat is composed principally of water and salt but contains numerous other chemicals that must be excreted as well. Sweat Is normally acid THE ANATOMY AND PHYSIOLOGY OF CLEANSING land is a factor in protecting the skin from the ‘growth of microorganisms. The sebum provents the skin and the hair from becoming too dry of from absorbing moisture and holds the horny scales together to form a protective covering. AS 2 result ofthis glandular activity ‘The skin is practically impermeable to the absorption of water or aqueous solutions of ‘salts, alcohol, or other substances, except a the orifices ofthe sweat lands and hai folicles. ‘The various body odors area natural and inevi- {able result ofthe glandular secretions of diferent substances and of their subsequent chemical alteration as they lle on the skin, are exposed to alr, and react withthe resident bacteria of the skin Since special circumstances can give rise to par ticular and Identiable odors, itis possible that ‘certain kinds of secretions are released only in response to particular stimuli. The hairy parts of the body, the armpits, and the genital area are ‘generally the most troublesome in this respect. First, they are more widely supplied with the epo- rine glands, which secrete a relatively highly ‘organic sweat and do so apparently more in response to emotions and exercise than to simple fises. in temperature. Second, these regions, because they are confined by the body and by clothing, are ideal sites for bacterial growth ‘There are four basle methods of combating body odor. One of the oldests simply to mask the ‘offending edor with another that is more pleasing, 1 when perfume or cologne is used with aban- don, Some “deodorants” apparently do litle more than that. The second, and simplest method, isto bathe and change clothing frequently. Curlously, ‘one often overlooked source of body odor Is Clothing that has become soaked with perspirs tion. Thus, a shirt or dress that has not been ‘leanod may stink, even though the person wear- ing it ay have just stepped from a bath. The thied ‘mathod is to impede the bacterial action by the tse of a soap or deadorant containing a bacter- cide. The fourth Is to use an antiperspirant or ‘some combination of antiperspirant and bacteri- cide or other agent, Unfortunately, recent research has considerably complicated the issue by revealing that many of the key ingredents used have produced severely adverse allergic reactions in numbers of users. Infact, many dermatologists fare coming to the view that bactercides should not be used generally but should be restricted to ‘special applications. They are not only felt to be ‘generally unnecessary, they also basically attack the normal resident bacteria, which are thought to lay an important protective role in combating ‘external disease-producing bacteria, There is con- siderable concer that, in ths instance, asin our enthusiastic overuse of antibiotics, we ata serious- ly weakening our innerent disease resistance.‘ For ‘most people, good hygiene practices and a simple antiperspirant are probably all thats necessary. ‘The head hair also presonts some spedialcleans- Ing problems. Because ot ite exposec position and its denseness, the head hair catches and retains more material from the atmosanere than the rest of the body does and also hides and retains the secretions and scales better, sepecially since tis generally cleansed relatively ifrequent- |y. The hairs also generally oilirthan other parts ‘ofthe body—natually, because the hairis heavily lubricated by the sebaceous glands, and unnat rally, because ofthe practice of using aly lotions land pomades to enable the halr to be ‘rained to assume desired forms. In some instances, one of ‘whieh isthe so-called “aryitchy scalp,"there is @ lack of normal sebaceous secretions, and the ‘ead cals are readily shed as “dandrutt” In other ceases, there is an overactivity of the sebaceous Glands that results In binding tho dirt together into thick pastestike layer Ifthe hale is net washed froquertly. In either case, the hal presents an aggravated problem of cleansing, AGENTS AND TECHNIQUES OF BODY CLEANSING ‘The essential problem in cleansing the skin isto Temove the accumulation of foreign matter, dead cells, horn, and sebum and other secretions. In ‘order to accomplish that most effectivaly, three things seem to be necessary: (1) & mechanical action that helps to dislodge and break up the horny layer, (2) 2 chemical agent that oreaks down and emulsifies the cis, and (8) @ solvent that picks ‘up and carros off the accumulated materials. This is accomplished most commonly by using the hands for @ massaging and lathering action, soap for an emulsifier, and warm water as the solvent “The mechanical action may be Increased by use of a coarser agant such as a rough cloth or a brush, the temperature of the water may vary consider ‘ably, and a variety of soaps and detergents of special solvents may be used, but these are minor variations and the basic steps remain essentially the same. ‘The mechanical action of soaping, lathering, and scrubbing is also useful in ways other than merely dislodging dirt. t serves purely massage {unctions as well, increasing the blood circulation, nourishing the skin, and maintaining nerve and muscle tonus. The added abrasion of a brush or washcloth isto be recommended 0 long as the ace is thoroughly cleansed between uses, De matologists often, however, advise against the use ‘of a cloth because of the cificuly of keeping it Clean and the reluctance to use a fresh one each time, From this standpoint, the hands are obvious- ly best since they can be cleansed more readily than ary Implement, ‘Soaps or detergents are necessaty in order to ‘emulsify the body oils and render them soluble ‘and henee removable in water Soaping is particu- larly important for the hairy parts ofthe body like the armpits and groin, since they tend to hold secretions more than other parts. Equally impor- tant, however, isthe thorough removal of al esi {ue of soap because even small traces can con- tinue to react with the body olls and result in iritation and odors. This is especially Important with certain kinds of soaps that tend to form a ‘chemical valance bond withthe skin and that re- ‘ue extra care in rinsing The most common solvent used for rinsing and carrying ofall the residues is, of course, water— generally warm water. Although other solvents might bo used, water is an almost universal sol THE ANATOMY AND PYSIOLOGY OF CLEANSING vent, is cheaper and more readily available than any other suitable substance, and is likely to can- tinue to be the normal agent for cleansing in spite of possible localized water shortages, Research has shown, however, that not all water Is equaly offective as a cleansing agent. "Hara! water, for example, which has a igh mineral con- tent, particularly of calcium and magnesium, reacts chemically with soaps, not only resulting in the need for more soap to get a decent lather but also making itmore dtficult to rinse the soap from the body. Incomplete rinsing with extremely hard water can leave a residue of precipitated soap ‘curds on the skin that can hold bacteria and leave ‘one witha sticky feling. This s particularly truein the case of alr washing and was the basis for the timerhallowed practice of collecting rain water for washing purposes. "Soft" water, in contrast, akes less soap and permits greater cleanliness in that it is @ more efficient solvent for carrying off waste ‘matter, including the soap residue, ‘The temperature ofthe water is also a factor in Cleansing. Aside trom the fact that “warm” water (approximately 32°C to 38°C [90°F to 10°F) 's more comfortable than either hot or cold, Its ‘also functional in two respects. First, the higher temperature helps break down the olls end makes it easier to carry them off; second, it dilates the blood vessels and the pores and permits more of the secretions to be removed. Cold water is less efficient from this functionsl stangpoint, Warm water also tends to have a marked sedative effect cleansing properties. Hot water (temperatures over 38°C (100°FD) tends to be stimulating in its effect—as does cold water (approximately 18°C (88°F); In fact, cold water is particularly useful forts tonic effects after ‘warm water, since it acts to contract the blood vessels and pores and stimulates the muscles and nerves in an opposed way. Because of thelr effects ‘on the vascular system, cold baths are atten used purely as a therapeutic device. This tonic etfect is. the basic premise underlying the Scandinavian practice of going sirectly trom the heat of the ‘sauna into @ cold lake or frolicking In the snow. THE ANATOMY AND PHYSIOLOGY OF CLEANING Because the skin temperature isso high, one does ot initially feel the cold, and as tong as one times the cold exposure propery one fesls only exhil rated. This phenomenon has also besn exploited in @ sophisticated transistorzed impulse “Futu- rum’ shower developed in Sweden in which pro- ‘grammed hot and cold water alternate in a multal= reetional spray. ‘The method by which we supply and use the water, that is, the passive pool or tub and the active stream or shower, also has an effect on thecleansing possibilities Whilethetub possesses certain real and psychological advantages over the shower, there is no question tha its the least ‘tfectve cleansing method as it Is commonly Used. There is no escaping the fact that in the tub the water becomes increasingly dirty and inevit- bly leaves a flim of dissolved and suspended air {and soap on the body. Depending upon a variety (of circumstances, including the kind of water, ‘80ap, or other substance used, it's possible to seo ‘a more or less thick scum on the surface of the water, @ scum thet clings as tenaciously to the ‘body a6 to the sides ofthe container. This is true irrespective of how “clean” or "dirty" one was ‘upon entoring the bath, because a certain faking ‘of dead skin cells wll inevitably take place, and so long as any soap or other additive is used, they wi remain in suspension in the bath water. This prob lem can, of course, be dealt with relatively simply by showering or rinsing with @ hand shower after ‘emerging through the scum. Other, more sophisti- cated systems have also been proposed, such as providing continuous eyeling as in a swimming ool where the scum can be drawn off atthe top and fresh water constantly added, Although tech- nicaly possibie they are not particulrly feasible ‘economically In this regard tub bathing has, for many years, been forbidden to pregnant women, because of the fear of contaminated bath water entering the Patient's vagina. While recent research tends to disprove this possibilty, many physicians remain apprehensive because of the basic unhygienic conditions * Perhaps @ more compelling argument against a tub bath during pregnancy is the very real saety hazard posed by the average tub instalation in wich no grab bars are available, Getting from a standing toa supine position in hard slifpery tub {not easy for any of us but is particular treach- ‘erous and dificult for a woman inthe late stages of pregnancy. Curiously enough, this problom—and its solu- tion—is almost universally recognized with reepect to face and hand washing and hair wash: ing where virally everyone today uses running water for face and hand washing instead of stop- ering the basin as formerly and uses « shower ‘whenever possible for hair washing instead of attempting to doitin the tub as formerly Although some find the idea offensive, one moasure of this recognition is that in many households where there is no shower, hair washing Is performed in the kitehen sink where there Is usually either @ hhand spray or the possibilty of rinsing the hair ‘under the tap, In both activites, however, there is ‘ universal and clear recognition of the problem— 2 recognition that thus far has not extended to body cleansing. This may be, again, another instance of ignoring something we dont resdly ‘908 oF foe, But like all arguments, the ons against the sanitariness of the tub is relative, particularly when viewed in the broad framework of human hygiene. Yet, since our goal i the clarification and establishment of objective standards, te present ‘American usage of the tub must be condemned ‘There are sovoral other unique mehods of water delivery and body cleansing that might also be mentioned. Ones the "fog gun developed by Buckminster Fuller during the 1990s. Extrapolat- Ing trom his earlier Navy experiences, Fuller found ‘that @ combination of wind and heayy fog wae extremely effective as a cleansing technique and

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