Sewage systems changed the world by helping stop the spread of diseases and making everyday life and activities clean and more convenient. The spread of malaria, typhoid, and yellow fever all were aided by insufficient sewage systems and the development of increasingly modern plumbing have made a drastic change in the rate of death and health throughout civilization. After the creation of sewage systems the world was cleaner and life was more satisfactory. It is obvious how important plumbing was in life even in Roman mythology where there was a goddess of the name Cloacina, the goddess of sewage (Sewer History). In early centuries, however, sewage systems were not planned, designed, or constructed by trained engineers because they were not thought of as complex systems requiring the service of engineers, and therefore they did not remove the three materials that are to be removed by sewers which are: subsoil water, surplus rain water, and sewage. These are major factors and causes of disease Around the time of 8000 BCE there were signs of plumbing in Scotland, the evidence showed pipes running from indoor homes that carried waste or water to nearby creeks. In 2000 BCE in the palace of Knossos in Crete there were the first toilets that flushed, they placed pans on the roof of the palace that then collected rain water that ran down the pipes and washed away the waste. The people of Knossos placed a wooden cover over the seat to cover the system and keep the person using the toilet dry. Even a small palace in Crete could make an extensive sewage system and understood the importance of a productive and effective waste management system. Knossos was probably the first European settlement with a well organized water system for incoming clean water, regular waste water disposal that ended up in the gardens outside of the settlement, and storm sewage canals for the times of heavy rain (Sewer History). In South Asia in 2500 BCE there were well-planned sewage systems that made their first appearances in history. The drains that were constructed were seven to ten feet wide and two feet under the ground, the drains led the waste into cesspools, or pits, and had stairs leading down to them for periodic cleanings. In the Indus civilization the restrooms and latrines were located next to each other or in adjacent rooms inside each home, this indicates that people understood the importance of cleanliness. The Egyptians only had the privilege of having a place to go to the bathroom if they were wealthy(The Early “Roots”). The “toilets” used sand to catch the waste and it was the job of servants to empty them regularly. Cloaca Maxima, which translates to mean “Greatest Sewer”, may have been constructed around 600 BCE (Samuel Merrill Gray, 5). It was constructed in Ancient Rome in order to remove the waste of one of the most populous cities of that time. The Ancient Romans overuse of lead is thought to have been a contributor to their shortened life expectancies. The Romans were proud of their "rooms of easement" or latrines. Public baths included such rooms adjacent to gardens. There, Roman officials would sometimes continue discussions with visiting dignitaries while sitting on the latrines. Elongated rectangular platforms with several adjacent seats were utilized, some with privacy partitions, but most without. Water from the public baths, or brush water from the aqueduct system, flowed continuously in troughs beneath the latrine seats; the sewage was delivered to the sewers beneath the city, and eventually to the Tiber River (The Early “Roots”). The Greeks had a system of aqueducts much like the Romans but unlike the Romans, the Greeks understood that waste could be used as fertilizers for their crops. In Greek civilization wastes were taken to a basin from which brick lined conduits took the waste to fields as fertilizer for the Greek fruit orchards and field crops. If sewage systems are not well thought out or constructed properly then the sewage can play a great role in the creation or spread of diseases. The first sewer that was engineered in Paris in the 1200’s was an open trough in the middle of the road, that system was not very effective and therefore contributed to the spread of the Black Death. Even without an understanding for germs, many ancient civilizations had a good understanding for the need of careful sewage disposal, this knowledge however was lost or ignored during the Middle Ages. From around the time of 500 to 1450 CE in the Middle Ages, sanitary precautions were disregarded, flush toilets and sewage systems disappeared and people started relieving themselves outside or used chamber pots. There were open sewers in the street, where people threw there garbage as well, and these sewers were emptied into the nearest river. With such an unsanitary living environment where many fleas and rats could live peacefully this problem was a major contributor to the spread of the Black Death. Richer people in the 1500’s started using chamber pots that they called close stools. The well-off made them to look like a box and the lid opened up to show a seat decorated in velvet and lace to show wealth and under the seat was a pot to catch waste. Sewage systems that were not planned thoroughly and carefully usually drained to water sources and also helped the spread of diseases due to unsafe drinking water. In the 1600’s after people started living in cities the civilians began to urinate and empty their chamber pots in the streets, this waste ran into rivers and wells and contaminated the water. People were very uncivilized and careless about what was done with the waste and people gradually became accustomed to the stench. In Vienna the Danube River was contaminated due to garbage landing in the streets and waste run off to the River. Some 40,000 Italians died in the 16th century due to an outbreak of malaria that was caused by unsanitary water systems in Rome (Plagues and Epidemics). The great fire of London in 1666 brought some attention back to sanitation and the construction of drains for removing the surplus amount of water from the cities (Samuel Merrill Gray, 6). The build up of human wastes can lead people to extreme measures such as in Berlin where the government made a law stating that every peasant that came to sell wares was required to carry a bag of garbage out with them when they left. When looking for a place to build castles engineers generally looked to build at least a part of the castle over water, waste from the castle would then be discharged to the surrounding moat or into a large cesspool that was constructed beneath the castle, in some parts of the world this has not changed. In Paris engineers built landfills for human wastes and underground sewers began to be built, people were so accustomed to the smell and proud of the sewers they had made that the people of Paris started to give weekend tours for the citizens (Sewer History). In the summer of 1858 in London there was an incident called the “Great Stink” the smell was so terrible that even members of the government left town to avoid it. The Stink was caused by house waste that was being carried to the Thames River by the sewage systems for seven years and building up to then be potentially pumped back to households for drinking, bathing, and cooking. There were also 200,000 cesspits in London but due to laziness and the fact that it cost a shilling to clean a cesspit every time, a price that citizens could not afford, the cesspits were not cleaned for years adding to the stench. It took years to clean the sewers, when it was finally finished the stink went away and people who lived in the cities lived longer and had fewer diseases. Even after the sewers were repaired however, waste continued to be emptied into the Thames (Elizabeth Raum,13). To aid in the problem of drinking water being contaminated by sewage Baron Haussmann engineered a sewage system that contained separate passages for drinking water and sewage using iron pipes and digging techniques that were made possible by the Industrial Revolution, by 1878 this system was 360 miles long. Human waste kills animals in the water and clogs rivers, to avoid this some cities in 1890 started to use filters and chemicals to treat the waste before putting it into rivers and lakes. In the 18th and 19th centuries the United States was struck repeatedly by Yellow Fever and caused 100,000 to 150,000 deaths because of insufficient sewage systems (Plagues and Epidemics). Malaria hit India hard in 1852 and wiped out entire villages, it is affecting Africa even now and kills millions of people every year because of unsanitary living conditions. During World War Two Vienna’s sewer systems suffered badly from bombings and it was not until the 1950’s that it was entirely repaired. Vienna today has one of the most modern sewage systems. When people started migrating to the New World the immigrants tried to do things better then how it was done back in Europe, it was slow but large cities developed systems to carry wastes to nearby water sources. Boston was the first site of the “interceptor” system, a sewage system that contains large sewer lines that combine to control the flow of sewage to the treatment plant, in a storm the system is made to allow some sewage to flow to a stream, keeping it from overflowing onto the streets. In 1590 Sir John Harington designed a flush toilet, there was a tank near the ceiling that released water when the toilet handle was pulled, few people were willing to try it and most people mocked his invention. J.F. Blondel created a better flush toilet in 1738. This toilet included a flap, or valve, to keep odors out of the house. People started using Blondel’s toilets in homes and in 1870, S. Hellyer invented a flush toilet similar to the one people use today. In 1916 two American scientists first treated waste with bacteria before returning it to rivers or lakes and it is a system that many cities continue to use today to treat their water (Elizabeth Raum). There is a Cholera outbreak in Haiti presently that is being spread and worsened by insufficient living environments and sanitation that contaminates water. An outbreak of Typhoid Fever, a disease caused mainly by water that was contaminated by feces, in the Democratic Republic of Congo in 2005 that killed 214 people out of 42,000 cases. In India in 2007 waste was a major issue effecting the peoples, 80 percent of untreated waste in India ends up in the rivers, specifically the Delhi. Samples taken from the Ganges River near Varanasi show that levels of fecal coli form, a dangerous bacterium that comes from untreated sewage, were some 3,000 percent higher than what is considered safe for bathing (Choking on Pollution in India). According to the Center for Science and Environment around 80 percent of the waste that pollutes the rivers is raw sewage, it totals to over 3 billion liters of waste per day and is greatly above the limit that the rivers are able to take in. As populations began to notice that the spread of diseases was linked to waste disposal methods, more innovative ideas were created. It is apparent that throughout history people gradually began to realize how important sewage systems were to society. There have been many different developments in every civilization on sewage systems because people noticed how changing the way that waste is disposed of can change the quality of living within the community. People began to see that life is easier when it is sanitary and you are healthier when there is no sewage in the streets or polluting the water. The growth of sewage systems throughout history is extravagant and has changed from century to century, sometimes it changed for the worst due to peoples laziness and misunderstanding of what is sanitary and what could be life threatening situations but every mistake was learned from and changed until an effective system was produced. It became evident that in order to preserve supplies of water to drink, protect fish and other water life, or to minimize public odors and debris they had to treat sewage to a degree before they disposed of it. As long as the importance of sanitation that is well thought out and effective stays clear to people from every civilization then this world will continue to become cleaner, healthier, and a more enjoyable place to live. Major causes of epidemics and disease outbreaks throughout the world are or have been caused by unsanitary sewage systems that contaminate water and aid in the spread of the disease. Even today sewage systems around the world are not all in the conditions that is up to par. There is still a lot of room for improvement in modern plumbing and treatment of waste especially in places such as India and Africa where the living conditions are unsanitary and have an abundance of pollution and these people need at least a way to deal with the waste that works. The importance of sewage systems is not fully realized until people start seeing the effects of waste build-up or how it can affect their everyday lives, in societies that do not have sufficient systems the death rate is much higher and life is less pleasurable. Quality of life is much worse because of lack of cleanliness, smell, and inconvenience in life from day to day, such as having to go out of your way to go to the bathroom instead of conveniently going to the nearest restroom. A survey was conducted by the British Medical Journal in 2007 and asked a group of experts and doctors what they consider to be the greatest medical advance since 1840. The answer that beat out any antibiotics or surgical methods was sanitation (Diseases and Sanitation). Sewage systems have changed the world and will continue on doing so until everyone’s lives are sanitary in every part of the world.