Sanitation Has Been The Greatest Medical Advance

According to a poll of more than 11,000 readers worldwide, the British Medical Journal (BMJ) says that sanitation is the greatest medical advance since 1840, the year that the BMJ was born.

Sanitation, defined as access to clean water and the disposal of sewage, got 15.8 per cent of the votes, just ahead of other advances such as antibiotics (14.5 per cent), anaesthesia (13.9 per cent) and vaccines (11.8 per cent).

The poll was conducted to celebrate the launch of the new format BMJ. The poll was launched by asking readers to say what they thought the best medical advance was since 1840. They received more than 70 categories, which a panel of experts narrowed down to 15 "milestones".

Readers were then invited to vote for one of the 15. Each of the 15 categories also had a "champion" in the form of a leading doctor or expert with some connection to the "milestone". For instance Doctor Stephanie J Snow, a descendant of John Snow, who developed the first anaesthetic, ether, that was later replaced with James Young Simpson's chloroform.

The champion for sanitation was Johan Mackenbach, Professor of Public Health at the Erasmus University Medical Centre in Rotterdam. He was said to be delighted that so many people acknowledged this important milestone. He said that the general lesson that still holds true "is that passive protection against health hazards is often the best way to improve population health".

In his defence of the sanitation milestone where he explains why he thinks that deserves the number one place, he describes the history of sanitation. John Snow, the same guy again, proved that cholera was being spread in piped water when he shut off a pump in a district of London and stopped the spread of the disease in that area.

Edwin Chadwick thought about linking up homes to clean drinking water and properly drained sewage to reduce the spread of illnesses. Between 1901 and 1970, as a result of taking up his ideas, deaths due to diarrhea and dysentery went down by 12 per cent in England, Wales and the Netherlands.

Professor Mackenbach says that "environmental measures may be more effective than changing individual behaviour", explaining that installing pipes and sewers is more effective at reducing death and disease than trying to persuade people to change their health and hygiene habits.

Poor sanitation is still a significant problem in the developing world says Professor Mackenbach.

In the developed world sanitation has advanced technologically to include not only the removal of sewage but also the treatment of wastewater, including for reuse in cities and urban areas.

A more recent advance, and in most instances still at the experimental stage, in the technology of sanitation has been the idea of ecological sanitation, where urine and feces are separated at source. This removes the fecal pathogens from the wastewater which can then be treated as "greywater" which is kept for non-sanitary use such as to water the garden.

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