Have a glass of tap water, take a shower, give a 21 flush salute! Sanitation has been rated the top medical advance since 1840 according to the British Medical Journal. The competition was tough (anesthesia, vaccines, the oral contraceptive pill, full list here), but clean water and sewage disposal gathered the most votes in an online poll that asked voters to rank the top 15 milestones, as selected by a panel of BMJ’s editors and advisers.

BMJ Summarizes:

In the 1800s acute infectious diseases that killed male breadwinners were a major cause of poverty. Believing that diseases were caused by air contaminated by poor urban drainage, governments built new sewage disposal and water supply systems. This revolutionised public health in Europe, and mortality from infectious diseases fell dramatically. Nowadays we know that better water supply and sanitation can cut diarrhoea among children in developing countries by about a fifth. The 19th century “sanitary revolution” shows that effective intervention does not always need accurate knowledge, that environmental measures may be more effective than changing individual behaviour, and that universal measures may be better than targeted measures in reducing health inequalities.

The poll was made to commemorate the launch of BMJ’s new website. The entire issue, including articles on all 15 milestones, is free online.

Photo of "Haiku and High Design", runner up in the National Kitchen & Bath Assoc.'s 2006 Bathroom Design Awards.