These infrastructures established and maintained
separation among living areas, clean water, and
waste management. Though perhaps imple-
mented as much as for aesthetic purposes as for
health reasons, the health benefits of such separa-
tions were clear to ancient Romans who wrote
about them, such as Marcus Vitruvius Pollio
(90–20 B.C.E.) who wrote extensively about
Roman architecture and engineering.
Not until the 19th century and its many discov-
eries in microbiology did physicians finally con-
nect community sanitation, PERSONAL HYGIENE, and
public health. In the millennia between, unsani-
tary and crowded living conditions fostered rav-
aging epidemics of CHOLERA(from contaminated
water); bubonic plague (from flea-infested rats);
yellow FEVER (from mosquitoes); and infectious
diseases such as TUBERCULOSIS, SMALLPOX, and FOOD-
BORNE ILLNESSES. In such times and circumstances
personal bathing was more likely to spread disease
than result in cleanliness.
By the start of the 20th century most industri-
alized countries incorporated public sanitation
practices to separate sewage from drinking water
supplies and to promote community as well as
personal hygiene. Throughout the United States
today strict regulations govern community sanita-
tion, establishing processes for disposing of
garbage and sewage as well as for maintaining the
purity of drinking water and controlling living
conditions. However, inadequate sanitation
remains a key cause of disease and death in devel-
oping parts of the world that lack appropriate
mechanisms for community and personal hygiene.
See alsoHAND WASHING; HEALTH EDUCATION; HEALTH
RISK FACTORS; WATERBORNE ILLNESSES.18 Preventive Medicine