Sanitation, or the use of measures that prevent disease and promote health, was practiced by civilization long before the origins of illness were understood. Underground systems designed to transport waste and surface water away from human dwellings date back as far as 1700 B.C., when the Minoan Kingdom thrived on the isle of Crete. The Palace at Knossos featured sinks, lavatories, a primitive flushing water closet, and four separate drainagesystems that emptied into a sewer. Many of the homes in ancient Greece also included latrines that drained into subterranean sewers. In Rome, sewers designed to carry off surface water and provide drainage were built around 800 B.C.. Well-to-do citizens had water closets that drained into cesspools below their homes, and the Roman Empire assigned administrators to oversee the removal of rotting garbage and debris from city streets. Though today we equate such sanitary measures with an attempt to control disease, they were undertaken by the ancients primarily to reduce odor, increase human comfort, and improve the appearance of cities.

The link between good health and personal bathing was first suggested by theGreek physician Hippocrates (c. 460 - c.377 B.C.), who also believed that if water were boiled its impurities and poisons would be removed.In his day, most Greek cities had public hot and cold water baths. The Romans developed elaborate steam and hot water bathing facilities for pleasure andrelaxation. With an ample water supply, transported by overhead aqueducts and underground channels, the first Roman baths were emptied and refilled eachevening, after closing time. This practice undoubtedly reduced the incidenceof bacterial contamination in the public waters, but as bathing became more popular, the pools became crowded and remained open all night. Water was replenished less frequently and the public baths eventually became a breeding ground for infection.

For centuries after the fall of the Roman Empire, sanitation measures such aspersonal bathing, the disposal of decaying plant and animal matter, and theuse of indoor plumbing, were practiced only sporadically. During the medievalperiod in Europe, cities grew into crowded and unsanitary places. Homes wereoften infested with lice, fleas, and rats. Human and animal excrement frequently contaminated drinking water. Infectious diseases such as bubonic plague,typhus, typhoid fever, and smallpox took an extraordinary toll on human life. The prevailing view was that these illnesses arose from "miasmas", or deadly atmospheric vapors, and that such vapors could be created from foul smelling substances like human waste, rotting corpses, and decomposing food. Early European sanitation laws, dating back to the fourteenth century in France, were aimed at ridding cities of bad odors. In England, King Henry VIII passed anedict requiring homeowners to clear human waste and garbage from the systemof open streams that flowed past their dwellings towards the Thames River. The 1348 ordinance of Philip VI of Valois established a street cleaning servicein France. A century later King Charles IV created official waste dumping grounds outside of Paris.

The first comprehensive effort at improving sanitation in Europe did not occur till the nineteenth century. On the heels of a cholera epidemic in England,the civil servant Edwin Chadwick (1800-1890) started the Public Health movement. His Sanitary Report of 1842, in which he established the connections between overcrowding, squalor, and disease, led to the passage of the Public Health Act of 1848. The 1848 Act mandated that every dwelling have a human wastedisposal arrangement, such as a toilet or ash pit, and it set aside five million British pounds for sanitation research. In 1875 a second Public Health Act, calling for a complete overhaul of London's water and sewer systems, waspassed. At around the same time, sanitation efforts were beginning to take hold in America. The New York Board of Public Health was established in 1868, the first such health board of its time. In 1887, engineers devised a way to reverse the flow of the Chicago River, by creating the Sanitary and Ship Canal. The canal served as an efficient means of draining waste water from the city.

While these acts and engineering feats did much to improve public health, thebiggest advances in sanitation were made as the result of scientific breakthroughs. In the 1860s, the British surgeon Joseph Lister (1827-1912), introduced the use of antiseptic solutions in hospitals. Two decades later considerable evidence began to emerge that disease could be caused by microscopic infectious agents, and the bacteria responsible for cholera, tuberculosis, anthraxand other deadly illnesses were discovered. Louis Pasteur (1822-1895), French chemist and microbiologist, created a technique for reducing th the virulence of disease-causing organisms, known today as pasteurization. The German physician Robert Koch (1843-1910) demonstrated the use of sterilization, employing steam to kill infectious microorganisms on surgical instruments. By the early twentieth century, it was learned that insects and arthropods could spread diseases such as malaria, yellow fever, and typhus.

Thoughout the past one hundred years, our understanding of the cause and spread of illnesses has increased dramatically. Modern sanitary techniques and public health laws are based on this understanding. Today, in most industrialized countries the use of sophisticated filtration devices and chemical treatment assures a clean water supply. Antiseptic hospital environments and sanitary food preparation facilities help to reduce the risk of disease transmission. Many formerly common illnesses can now be prevented, or their virulence reduced, because of the development of immunizations. The use of antibiotic treatments has also helped curb the spread of many diseases, though bacterial resistance to antibiotic agents is an ever-present threat to public health.

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