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Science of the Total Environment 408 (2010) 52545264

Contents lists available at ScienceDirect

Science of the Total Environment

j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / s c i t o t e n v

Review

Wastewater management through the ages: A history of mankind

Giusy Lofrano a,, Jeanette Brown b
a
University of Salerno, Department of Civil Engineering, via Ponte don Melillo, 1-84084 Fisciano (SA), Italy
b
Stamford Water Pollution Control Authority, Harbor View Ave., Stamford, CT 06902, USA

a r t i c l e i n f o a b s t r a c t

Article history: Although much has been written about the history of water supply systems, there is a lack of corresponding
Received 14 December 2009 information on wastewater management. This is surprising since the lack of sanitation affects human
Received in revised form 26 July 2010 development to the same or even greater extent as the lack of clean water. While there may be an added
Accepted 26 July 2010
stigma to discussing waste treatment, sanitation is widely perceived as meriting a signicant claim on
nancial and political resources as well on the evolution of mankind.
Keywords:
A literature review is presented on the evolution of wastewater management through the ages and its
History
Wastewater treatment
concurrent impact on human health and environment. Hopefully this information will improve the
Ancient civilizations awareness of the past with a view to impacting future policies and technical developments. The review
Sanitation highlights the connection of environmental contamination with the ability to measure it, as well as the ways
Society pollution control has been changed by advances in scientic knowledge. Attention is also drawn to the
effects of political and societal events on wastewater management. A sanitation timeline has been
constructed pointing out signicant developments in the treatment of wastewater and improvements in
analytical environmental chemistry.
This review has been written in the belief that historical research showing the collective experience and
philosophy of sanitation can provide inspiration to face future challenges.
2010 Elsevier B.V. All rights reserved.

Contents

1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5255
2. Historical aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5255
2.1. Early history . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5255
2.1.1. Mesopotamian Empire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5256
2.1.2. Indus civilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5256
2.1.3. Egyptian . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5256
2.1.4. Greek civilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5256
2.2. Roman period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5256
2.3. The Sanitary Dark Age: from the Middle Ages to the industrial revolution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5258
2.4. Age of Sanitary Enlightenment and the Industrial Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5259
2.4.1. Britain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5259
2.4.2. Germany . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5259
2.4.3. France . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5259
2.4.4. Italy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5260
2.4.5. United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5260
2.5. Age of stringent environmental standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5260
3. Technological evolution of wastewater treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5260
3.1. Primary treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5260
3.2. Secondary treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5260
3.2.1. Attached growth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5261
3.2.2. Suspended growth-activated sludge processes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5261

Corresponding author. Tel.: + 39 089 969337; fax: + 39 089 969620.

E-mail address: glofrano@unisa.it (G. Lofrano).

0048-9697/$ see front matter 2010 Elsevier B.V. All rights reserved.
doi:10.1016/j.scitotenv.2010.07.062
 Author's personal copy

G. Lofrano, J. Brown / Science of the Total Environment 408 (2010) 52545264 5255

3.3. Advanced treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5261

3.3.1. Membrane systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5262
3.4. Disinfection practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5262
3.5. Solid processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5263
4. Sociological aspects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5263
4.1. The future challenges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5263
5. Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5263
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5264
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5264

1. Introduction
It is incredible how much history is found at the end of a sewage
system; from food to hygienic habits, from the use of pharmaceuticals
and birth control pills to more intimate sexual habits. There is no more
reliable source of customs and behaviour of a society than its waste
products and this fact is beyond the perception of the civilization. A
sociological analysis that is more truthful than the analysis of a
wastewater does not exist. The history of men is reected in the
history of sewers wrote Victor Hugo (1892) in Les Miserables, it has
been a sepulchre, it has served as asylum, crime, cleverness, social
protest, the liberty of conscience, thought, theft, all that the human
law persecute or have persecuted is hidden in that hole.
What is in the sewer does not lie and it brings everything back to
balance like the accuracy of a level. In its residue is the search for truth.
It is within this apparent ephemeral and yet explosive contact point
between the civilization and its wastes that disclosure happens:
There, the bottom of a bottle indicates drunkenness, a basket-handle
tells a tale of domesticity, there the core of an apple which has
entertained literary opinions becomes an apple core once more, the
efgy on the big sou becomes frankly covered with verdigris, Caiaphas'
spittle meets Falstaff's pukin, the louis-d'or which comes from the
caming-house jostles the nail whence hangs the rope's end of suicide, a
livid foetus rolls along, enveloped in the spangles which danced at the
Opera last Shrove-Tuesday, a cap which has pronounced judgment on
men wallows beside a mass of rottenness which was formerly
Margoton's petticoat; it is more than fraternization, it is equivalent
to addressing each other as thou. All which was formerly rouged, is
washed free. The last veil is torn away. A sewer is a cynic. It tells
everything (Hug, 1892).
What ows in sewers today is somewhat different from that in
Hugo's description. Today wastewater is typically classied according
to its origin; domestic, industrial, commercial (WEF, 2009) or urban.
Domestic wastewater comes from residential sources including
toilets, sinks, bathing, and laundry. It can contain virtually anything
from cleaning chemicals, soaps, and detergents to bacteria and other
pathogenic organisms. Industrial wastewater is discharged by
manufacturing facilities and commercial wastewater from ofces,
hotels, stores and other enterprises. Municipal or Urban wastewater is
typically a mixture of domestic, industrial and commercial wastewa-
ter. If a community has a combined sewer system rather than a
separate system, then stormwater is also included in the mixture.
However, no matter its source, wastewater has a stigma associated
with it that makes any discussion a social taboo.
Sanitation is a term primarily used to characterize the safe/sound
handling and disposal of human excreta as well as other waste products
(Avvannavar and Mani, 2008). It is well known that the relationship
between humans and water and sanitation has seen substantial
changes, due to the inuence throughout the ages by cultural, social
and religious factors (Sorcinelli, 1998; Wolfe, 1999; De Feo and Napoli,
2007; Avvannavar and Mani, 2008). However in all the ages of water
(Maneglier, 1994), wastewater has been considered lthy.
The importance of good quality drinking water for urban
populations was realized since the antiquity. Yet the importance of
proper sanitation for the protection of public health was not
understood by modern cities until the 19th century (Brown, 2005;
Vuorinen et al., 2007; Cooper, 2007).
For centuries wastewater management was not given much, if any,
consideration. In most cultures, wastewater was disposed of in the
streets and near population centres creating serious impacts on public
health and the environment. This is evident by the numerous
epidemics which occurred throughout Europe until the nineteenth
century (Lucking, 1984; Brown, 2005; HDR, 2006; Aiello et al., 2008).
Sadly, when it came to waste management and sanitation, countries,
even those that suffered epidemics, tended to have short memories.
Throughout history wastewater management has presented
people and governments with far reaching technical and political
challenges. The story of waste and wastewater management is at once
a story of human ingenuity and human frailty (Sorcinelli, 1998; HDR,
2006). A number of keystone events dened the speed at which
environmental management evolved through the ages. Some of these
events were scientic, such as stream purication models, while
others were socioeconomic such as two World Wars (Seeger, 1999;
Shifrin, 2005; Cooper, 2007). However according to the recent Human
Development Report (2006), the lesson from the past is that progress
in wastewater management and sanitation was driven above all by
political coalitions uniting industrialists, municipalities and social
reformers. This means that if on one side developing new technologies
as well as appropriate strategies for wastewater management is
required, on the other side there must be an urgent need to overcome
the stigma of a polluted environment.
Although several historians and economists have described the
evolution of wastewater management through the ages (Tarr, 1985;
Maneglier, 1994; Sorcinelli, 1998; Viale, 2000; Sori, 2001; Neri
Serneri, 2007), they, as it is normal, often lack an engineering
perspective. Several studies have reconstructed traces of ancient
dams, aqueducts and pipes (De Feo and Napoli, 2007) which provided
water for human consumption but archaeological research has largely
neglected the difculty of wastewater management (Tolle-Kasten-
bein, 2005). Sewers and primitive treatment is omitted from
archeology and historical researchand forgotten.
This paper intends to highlight those sanitation systems and
wastewater management strategies that were developed in different
periods and cultures, why they were developed and where we are today.
2. Historical aspects
In drawing a timeline, the evolution of sanitation practices could
be divided into ve main periods (Fig. 1).
Early history
Roman period
Sanitary Dark Age
Age of Sanitary Enlightenment and the Industrial Age
Age of stringent environmental standards
2.1. Early history
Modern humans (Homo sapiens) have dwelled on earth for over
200,000 years, most of that time as huntergatherers, and with ever
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5256 G. Lofrano, J. Brown / Science of the Total Environment 408 (2010) 52545264
Early
Historic RomanTimes Sanitarydark
Times ages
3500 800 0 476 1800
SANITATION TIMELINE
Fig. 1. Evolution of sanitation.
increasing populations (Vuorinen et al., 2007). The rst human
communities were scattered over wide areas and waste produced by
them was returned to land and decomposed using natural cycles.
Disposal problems were limited primarily because they were small
communities of nomadic huntergatherers. A new era started when
mankind established permanent settlements about 10,000 years ago,
adopting an agrarian way of life. With human settlement came the
ecological impacts.
Until the birth of the rst advanced civilization, the disposal of
human excreta was managed through holes in the ground, covered
after use as explained by the Mosaic Law of Sanitation (Deuteronomy,
Chapter 23).
Because of the lack of any kind of records, it is practically
impossible to evaluate the health of ancient populations. It is,
however, quite safe to conclude that despite the impressive measures
used to obtain pure potable water, urban centres had serious public
health problems due to a lack of management of their wastewater
(Vuorinen et al., 2007; Larsen, 2008).
2.1.1. Mesopotamian Empire
According to the literature, Ancient Civilisation covered parts of
Africa, Southern Europe, the Middle East and Asia to India. Historical
records show that the Mesopotamian Empire (35002500 BC) was
the rst civilization to formally address sanitation problems arising
from community living. In the ruins of Ur and Babylonia, there are
remains of homes which were connected to a drainage system to carry
away wastes (Jones, 1967) as well as latrines leading to cesspits.
Unfortunately, although this sophisticated system existed, most
people in Babylon threw debris including garbage and excrement on
to the unpaved streets which were periodically covered with clay,
eventually raising the street levels to the extent that stairs had to be
built down into houses (Cooper, 2007).
2.1.2. Indus civilization
The Indus Valley was far advanced in wastewater management. A
sophisticated and technologically advanced urban culture is evident
in that region (261700 BCE) (Pathak, 2001). The quality of life in the
community suggests an extensive knowledge and use of urban
planning coupled with efcient municipal governance and a high
priority on hygiene. Avvannavar and Mani (2008) observed that this
may be due to the fact that Indus civilization was a dense settlement
and that the practice of open squatting was frowned upon.
Even as early as 2500 BCE, Harappa and Mohenjo-Daro included
the world's rst urban sanitation systems as did the recently
discovered Rakhigarhi (Webster, 1962). Houses were connected to
drainage channels and wastewater was not permitted to ow directly
to the street sewers without rst undergoing some treatment. First,
wastewater was passed through tapered terra-cotta pipes into a small
sump. Solids settled and accumulated in the sump, while the liquids
overowed into drainage channels in the street when the sump was
about 75% full. The drainage channels could be covered by bricks and
cut stones, which likely were removed during maintenance and
cleaning activities (Wolfe, 1999). This most likely was the rst
attempt at treatment on record.
Towards even stringent
The ageof sanitary enlightenment and the industrial revolution: environmental standards
Developing the basic The age of process development: Process
treatment processes refinement
1914 1965 2000
2.1.3. Egyptian
According to the description of Herodotus (Histories II), ner houses
in the city of Herakopolis (B.C.E. 2100), had bathrooms and toilets seats
made of limestone. The bathroom would be tted with a slightly
inclined stone-slab oor and the walls were typically lined to a certain
height (about half a meter) with battered stone slabs to protect against
dampness and splashing (Breasted, 1906). Drainage of wastewater was
provided by setting a basin beneath the spout of the oor slab in the
bathroom, or sometimes by drainage channels running through the
outer wall into a vessel or straight into the desert sand.
The less wealthy who could not afford to have a limestone toilet,
used toilet stools, under which a ceramic bowl was placed.
Furthermore, toilet stools with a hole in the middle and a clay pot
beneath were also used as portable toilets and they were often buried
with senior ofcials (Breasted, 1906). The excrement, which was
collected in jars containing sand, was emptied into pits outside the
walls of the house, in the river and even in the streets.
2.1.4. Greek civilization
The Greeks were forerunners of modern sanitation systems.
Archaeological studies have established unequivocally that, the origin
of modern technologies of water management dates back to ancient
Greece. The status of urban sewage and stormwater drainage systems in
ancient Greece is well documented by Angelakis et al. (2005, 2007).
They reported that toilets similar to Egyptian ones were found at the
Palace of Minos in Knossos and in the west side of the so called Queen's
apartment at Phaistos. They were connected to a closed sewer which
still exists and is working after 4000 years (Angelakis et al., 2005)
(Fig. 2). Angelakis and Spyridakis (1996) provide a detailed description
of the sewage system of Knossos which exceeds 150 m.
The Ancient Greeks (300 BC to 500 AD) had public latrines which
drained into pipes which conveyed the wastewater and stormwater to
a collection basin outside the city. From there, brick-lined conduits
conveyed the wastewater to agricultural elds where it was used for
irrigation and to fertilise crops and orchards. Based on archaeological
information, we understand the design of the piping system (Tolle-
Kastenbein, 2005). Wastewater owed in one set of pipes from the
building to a larger channel in the road, which in turn owed to larger
main channels and then owed into a single collector. A system like
this was found between the Acropolis and the hill of the Pnyx where
archaeologists have unearthed a series of channels converging in a
single collector. Of course not all the villages needed this complex
series of pipes and channels, but they were certainly present in cities
like Athens, Thasos, Pergamum and Pompeii and perhaps many other
cities that have not yet been studied.
Tolle-Kastenbein (2005) reported that these channels were
constructed of stone slabs on the bottom, topped by two orthostats
at a distance of 1 ft apart, and then covered with stone slabs to form a
box culvert.
2.2. Roman period
The Romans were brilliant managers and engineers and their
systems rivalled modern technology. Rome's water system is one of
the marvels of the ancient world. Much is known and has been written
 Author's personal copy
G. Lofrano, J. Brown / Science of the Total Environment 408 (2010) 52545264
Fig. 2. Parts of the sanitary and storm sewage systems of Knossos Palace.
about Rome's water supply (Hodge, 2002; Cooper, 2007; De Feo and
Napoli, 2007). Much less has been said of the impact wastewater
management had on the Roman lifestyle.
Although sewer and water pipes were not inventions of the Romans,
since they were already present in other Eastern civilizations, they were
certainly perfected by the Romans. The Romans resumed the engineer-
ing works of the Assyrians, and turned their concepts into major
infrastructure to serve all the citizens. Fig. 3 shows the famous Roman
Baths at Bath, England (a) and Roman Aquaduct of Pont de Garde
(France) (b). Inventors of the rst integrated water service, the Romans
managed the water cycle from collection to disposal, providing dual
networks to collect spring water and dispose of storm and wastewater.
Romans realized that spring water had much better quality for human
consumption than that derived from surface water bodies which was
lower quality, but they also realized that surface water could be used for
other activities. Furthermore, they recycled wastewater from the spas
using it to ush latrines before discharging the waste into sewers and
then into the Tiber River (Jones, 1967).
Although the rich had their own baths and toilets, the majority of
Romans lived in tenement houses (Insulae). Unfortunately these
people usually disposed of trash by throwing it out of windows, a
practice that would be followed until the Middle Ages. Therefore
inhabitants of poor neighbourhoods were continually exposed to res
and epidemics. In an attempt to improve such conditions, latrines,
public baths, and water fountains were made available to even the
poorest citizens. Public latrines as discovered in Ostia (Rome, Italy)
are shown in Fig. 4. In addition to the famous aqueducts for supply of
fresh water, ancient Rome had an impressive sewage system. The
most famous as well the largest known ancient sewer is the Cloaca
Maxima It was built under the dynasty of Tarquin (6th century BC),
nearly three centuries before the rst aqueduct (Aqua Appia 312 BC).
Initially constructed to drain the marsh on which Rome was later
built, it originally stretched more than 100 m through the center of
the Forum Romanum, between the later Basilicae Aemilia and Julia. It
was 4.50 m wide and 3.30 m high, and was about 12 m below the
present ground elevation. It was built so solidly and with such
foresight that it was used by the Romans for over 2500 years and a
section close to the Torre dei Conti is still working today.
5257
Within decades of completing this monument, Romans added
smaller canals to drain nearby areas and began extending the main
duct to the Velabrum. In the following centuries, repairs, extensions,
additions and renovations changed the architecture and course of the
canal. The most famous manhole of cloaca, known as the Mouth of
truth is shown in Fig. 5. Engineers often made repairs only in broken
or severely outdated sections, and so the masonry of the system is a
patchwork of Roman building techniques (Hopkins, 2007). In Roman
times, they were rst constructed of stone or brick without mortar
following the slope of the land and therefore, they were not subject to
any limitation on the use of plaster, which was obligatory for conduits
of the aqueducts (Tolle-Kastenbein, 2005).
The sewage system of ancient Rome was very complex and
included many smaller sewers. In the area of the Campus Martius, two
mid-republican cloacae ran from the area of what is now the Pantheon
to the Porticus Octavia and the Tiber and from the north slope of the
Capitoline to the Tiber. Another system ran from the Pincian hill to the
Tiber, draining the area of the northern Campus (Hopkins, 2007).
The Cloaca Maxima spread throughout the city-center. New shafts
drained each of the imperial fora, the area around the Carcer, Temples
of Saturn and Castor, and a large duct running alongside the Via Sacra
fed into the main channel in front of the Basilica Aemilia. To the south,
the Cloaca Circi Maximi originally drained the area of the Circus
Maximus, but later connected to drainage systems for the Coliseum
and perhaps the area of the Baths of Caracalla (Lanciani, 1897).
The sewer of Judith, crossing Via del Corso, at a depth of about 8 m,
collected the waters of the Baths of Agrippa and the Pantheon and
ended in the area of the Sisto Bridge, where until 1889 fed the mill of
the Bella Judith (Narducci, 1889) The Chiavicone Schiavonia,
upstream of the port of Ripetta collected the waters of the northern
Campus Martius, and the Pincio Vicinale. According to Narducci
(1889), two sections of roman channels are depicted in Fig. 6.
Traces of Roman Channels were found in all major cities of the
empire and show a variety of engineering and construction
techniques which were used depending on the geology of slopes
and the distance to the receiving water body.
Different designs were adopted in the territory of ancient Pompeii
and Herculaneum. Cesspools were the most frequent solution
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5258 G. Lofrano, J. Brown / Science of the Total Environment 408 (2010) 52545264
Fig. 3. a) Roman Baths Bath, England b) Roman Aquaduct Pont de Garde (France).
attempted to manage wastewater in Pompei, which extended over
porous lava layers, able to easily absorb rain, urine and feces.
Cesspools were also used in Herculaneum, although much less
frequently and were located on sites with steeper slopes and a
compact subsoil of volcanic tuff (Sori, 2001).
At Ostia (close to Rome) the wastewater disposal system of the city
was based mainly on sewers rather than cesspools, because the
aquifer ran just 2 m below the surface. In northern Italy, in all the
cities of Italia Cisalpine and Cispadana, sewers were built for the
Fig. 4. Public latrines in Ostia (Rome, Italy).
Fig. 5. Manhole of cloaca Mouth of truth Foro Boario (Rome).
disposal of sewage and liquid wastes. Several archaeological discov-
eries have allowed us to verify that there were sewers in Milan dating
from the period after the Roman conquest of the city (Sori, 2001).
The end of the Roman Empire led to the deterioration of the
aqueducts and sanitation systems. Drainage and water supplies as
well as the coastal road were no longer usable.
2.3. The Sanitary Dark Age: from the Middle Ages to the industrial
revolution
When the Roman Empire collapsed, the sanitary dark ages began
and lasted for over a thousand years (4761800). The culture of water
as a source of health and wellness which had not only marked the
Roman civilization but many more civilizations before then, was
abandoned.
The impressive facilities built for the conveyance of water that
would have celebrated the Romans for centuries were neglected; the
great baths were plundered of all their possessions. In an unprece-
dented historical regression, water came to be drawn from rivers and
wells and to be discharged without treatment resulting in the spread
of disease (Sori, 2001).
It is hard to believe that at the end of the nineteenth century, only
half of the Italian communes were equipped with pipes for drinking
water and more than 77% had no sewers (Sorcinelli, 1998) when
considering the palace of Knossos had modern channels that removed
wastewater and the Romans were experts in the construction of
sewers.
While the 18th century brought about the Industrial Revolution, it
was not until the nineteenth century that any changes were made in
the way water was managed mostly hindered by economic, social and
institutional constraints. Certainly the conviction, crossing whole
social classes, that water was bad, was the excuse for the lack of
hygienic practices and the development of engineering techniques
aimed to an appropriate management (Aiello et al., 2008). Through-
out the Middle Ages, water was considered not healthy, dirt was
covered with glitter and wigs and hygiene was associated with the
occasion of guilty pleasures. Rumors spread the theory that the
bathroom was responsible for opening the pores of the skin, exposing
the body to every type of illness (Cooper, 2007). Water was bad for the
soul and body!
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G. Lofrano, J. Brown / Science of the Total Environment 408 (2010) 52545264
1.15
0.80
-13.35
Fig. 6. Sections of roman channels.
(adopted from Narducci, 1889).
Households rarely had sanitary facilities, and the practice was to
empty the chamber pot directly on the street. In a 1985 Italian lm
Non ci resta che piangere, the famous actor Massimo Troisi is shown
in a scene walking in a medieval town and experiencing rst hand
wastewater disposal. The expression, Look out Below is very
relevant to the practices employed during this time. However, there
were some exceptions to this. In some medieval cities, particularly in
central and northern Italy, there appears to be well intentioned
programs using municipal statutes to control environmental condi-
tions to improve city life. In the Statutes of the streets and waters of
the countryside of Milano, 1346, much space is devoted to the
problem of cesspits. A regulation, repeated endlessly, prohibited the
emptying of cesspits and transporting the contents in summer
months. The emptying of the cesspits in Milan, was conducted by
navazzari (or cisternari), a word that described the operators of the
navazze, the carts that carried the waste collected households
cesspits for transport outside the city. The regulations ensured that
the public understood the advantage of using wastewater as fertilizer.
The regulations also prohibited the contents of cesspits being emptied
in streets, or in any of the numerous rivers crossing the city.
Unfortunately, not all rivers were protected. The Nirone River which
means black river was named because of the wastewater discharged
into it (Sorcinelli, 1998; Sori, 2001).
In the 14th century in Florence, the votapozzi had the task to
empty cesspits, distinguishing sludge which was sold to farmers for
use as fertilizer from liquid waste which was disposed of in the Arno
River according to a practice that was in existence for centuries
(Mantelli and Temporelli, 2007).
In 1539, when plagues swept Europe, King Francois I ordered the
homeowners of Paris to build cesspools for sewage collection in new
houses. These continued to be used until the late 1700s (Cooper,
2007). This practice helped to reduce contamination of drinking water
supplies. However it is interesting to note that water from
contaminated wells along the left bank of the Seine was used by
bakers (Sori, 2001) and had no negative on the reputation (or maybe
enhanced the reputation) of extraordinary baguette! It was estimated
that in 1883 in Paris there were 25,00030,000 wells for municipal
drinking water which were heavily polluted because of the leaching of
cesspits and cesspools especially during rainfall (Sori, 2001).
In London, wastewater was collected in cesspits beginning in 1189
and the contents conveyed to the countryside for land application
(Wolfe, 1999). This was done by rakers or gongfermors who
removed the foul sewage from cesspools and sold it to farmers just
outside the city walls. By the 1300s the city of Norwich, the second
largest city in England after London, was selling night soil to farmers
outside the walls of the city as fertilizer (Clapp, 1994; Campbell,
2000). In 1596 Sir John Harington designed two water closets for
Queen Elizabeth I but these did not achieve popularity until adopted
by Londoners late in the 1700s (Cooper, 2007). Cesspits continued to
be used for general domestic waste disposal until 1880 (Tarlow,
2007).
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0.65
1.59
0.65
-13.35
The processing of faecal matter through sewers in Paris, by the
vendageurs, as well as in many other European cities, was seen as an
archetype of wastefulness, resented by many.
In Zurich the idea of disposing wastewater through sewers
encountered also resistance both by property owners as well as
farmers that used the waste as fertilizer. In Geneva and Basel urbane
drainage systems existed since the early days of modern times,
however, Basel, used the Birsig River as its main sewer.
2.4. Age of Sanitary Enlightenment and the Industrial Age
2.4.1. Britain
With the high rate of industrialization and urbanization through-
out the eighteenth century, preceding and accompanying the
industrial revolution, came the realization of the importance of
waste and wastewater disposal (Lucking, 1984; Wolfe, 1999; Melosi,
2000; Tarlow, 2007). Britain was one of the rst countries to begin
experimentation with organized action to improve environmental
conditions in the cities.
The principle employed was to assume the solution of pollution is
dilution. The construction of the Bazalgette sewer system in London,
started in 1858 and completed in 1865, is an example of this principle.
Through a series of collection sewers and pumping stations
wastewater was conveyed from the streets and discharged to the
Thames. There was no understanding of assimilative capacity in the
river and no understanding of the need to remove pollutants prior to
discharging to the river (Clapp, 1994; Sori, 2001; Cooper, 2007).
The Thames was already pollution by the beginning of the 14th
century, but in 1859, it became the protagonist of a crisis in London
that would be passed into history as the great stench caused at least
by two events: the Industrial Revolution and the closing of London's
cesspools following the introduction of the ush toilet. Victorians
called the Thames a monster soup.
2.4.2. Germany
Although a sewer system had been constructed as early as 1842 in
Hamburg, the general introduction of sewers in the German cities
started with the construction of a system in Frankfurt/Main in 1867
(Seeger, 1999). The citizens of Basel rejected both a law on sewers
(1876), as well as a remediation plan of Birsig (1881). It was not until
1896 that they accepted a collection system for black water.
2.4.3. France
On June 29, 1853 George-Eugene Haussmann took the oath as
prefect of the Seine and the transformation of Paris began. Starting in
1854, Eugne Belgrand was charged by Haussmann to undertake an
extensive reorganization of the network of sewers that were already
in the city. Collectors were installed in the boulevard de Sbastopol
and rue de Rivoli. Building owners were compelled by law to
gradually modify usage so as not to increase the amount of water
being directly discharged and to discharge it further downstream, at
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5260 G. Lofrano, J. Brown / Science of the Total Environment 408 (2010) 52545264
Asnires. The networks on both banks of the river were joined
through a siphon at the Pont de l'Alma. However, the resulting
pollution of the Seine due to the discharge of sewage caused the
successors of Haussmann to adopt a different system of disposal:
the collectors were extended to Acheres, where wastewater
was dispersed on especially reserved elds. Starting from 1930
wastewater treatments plants were in use at Acheres, Valenton,
Noisy-le-Grand and Colombes.
2.4.4. Italy
In Italy the period of great public works started later (18701915),
the aqueduct of Serino for water supply to Naples, the aqueduct of
Selino for water supply to Palermo and as last the pugliese aqueduct
that conveyed water to Bari from the Sele River were completed.
Infrastructure for the noble drinking water was almost always
considered a priority rather than the construction of sewers to collect
wastewater in part because the cost for aqueducts was low due to the
recovery of old Roman existing pipelines and construction and
operation was nanced by foreign companies (Sorcinelli, 1998; De
Feo and Napoli, 2007).
The debate dealing with construction of the Neapolitan sewers
began in 1870, involving doctors, architects, and engineers and with
unusual modernity, it also faced the problem of management of solid
waste. However it wasn't until 1889 that the sewer project started
(Varriale, 2007).
Based on data collected by the investigation on public health
carried out in Italy in 1899, sewer systems were present in almost all
major Italian cities.
Giovannini (1996) reports that of the 69 cities involved in the
investigation only Udine, Milan and Turin boasted efcient sewers.
Sewers in the southern cities, Syracuse, Catania, Caltanissetta, Reggio
Calabria, Catanzaro, Cosenza, Potenza, Bari, Lecce, Avellino and
Caserta, were considered inefcient. The small northern cities such
as Treviso, Vicenza, Verona, Mantua, Bergamo, Como, Pavia, Novara,
and Portomaurizio were equally as bad. The sewers in Naples,
Palermo, Messina and Rome were not much better; however, it was
clear that the conditions of small towns were on average worse than
in major cities.
2.4.5. United States
In the early 1800s, new community sewers were initially (and
primarily) installed to take care of storm water; privies and leaching
cesspools were used for human wastes. Still, a lot of human wastes
from the early residents of the larger towns (following the model of
their European forefathers) were unofcially put into the sewers
those wastes were either thrown out (from chamber pots) into the
streets, leaked onto the ground from poorly designed/maintained
privies/cesspools, or were directly deposited on the ground; wastes
were then conveyed by storm water into the streets and on into the
sewers.
Large cities such as Boston and Chicago installed sewers begining
as early at the 1700's using hollowed out logs. In 1647, the rst water
pollution control regulation was put into effect in the British colony
of Massachusetts.
2.5. Age of stringent environmental standards
The 20th century witnessed a revolution in wastewater manage-
ment, environmental science and societal views towards pollution.
Scientic discovery, debates on societal priorities and government
interest evolved through the century beginning with unhindered
pollution and ending with attempts an increasing control (Shifrin,
2005).
A milestone was the Eighth Report (1912) of the Royal Commis-
sion on Sewage Disposal which introduced the concept of biochemical
oxygen demand (BOD) and established standards and tests to be
applied to sewage and sewage efuents which were copied by many
other countries. Streeter and Phelps (1925) and Imhoff and Mahr
(1932) pioneered aeration/deaeration models that allowed scientists
to predict allowable BOD loads to surface waters.
Governments began to mandate waste treatment. Before the First
World War led to the interruption of installation of wastewater
treatment facilities, they were constructed in the main cities of Europe
(Seeger, 1999; Cooper, 2007).
However political ideology interfered with wastewater manage-
ment in some countries. For example, when the national socialist
party came into power in Germany, they brought with it a change in
the practice of wastewater treatment: the priority was given to
agricultural utilisation in the form of widespread irrigation of
wastewater according to the Blood and Soil ideology rather than
treatment of the pollutants prior to use.
The Second World War also delayed development of wastewater
treatment until 1948 causing increasing pollution to the waters. In
addition many wastewater plants were damaged during the war and
not rebuilt for many years (Seeger, 1999). After the end of the war
there was rapid progress in wastewater treatment in the United
Kingdom and the United States, but not Europe (Cooper, 2007).
By 1950 pollution debates focused on water quality standards and
stream use classication, necessary precedents to the development of
a waste management policy (Shifrin, 2005). As early as the beginning
of the twentieth century, there was an understanding of the general
association between chemical water pollution and toxicity (Shelford,
1912). A further advance in the understanding of environmental
contamination came about with commercially available gas chroma-
tography and atomic absorption spectrophotometry in the late 1970
(Ettinger, 1965; Sugar and Conway, 1968). This allowed for accurate
characterization of pollutants. A time line for the evolution of
analytical methods developed in the twentieth century is presented
in Fig. 7.
3. Technological evolution of wastewater treatment
Although it is important to understand various wastewater
treatment processes, it is not the intent of this paper to give detailed
explanations which can be found elsewhere, but instead to describe
the most signicant developments in the evolution of wastewater
treatment (Fig. 8).
3.1. Primary treatment
Primary treatment is dened as the removal of heavier solids by
gravity sedimentation (Metcalff and Eddy, 2008). The earliest form of
primary treatment was trenches and pits used for many centuries to
remove heavier solids prior to application with the objective of
reducing the load on the land to avoid clogging (Vuorinen et al.,
2007). Sedimentation tanks were found in Minoan Tylissos, Palace of
Knossos and Hagia Triada (Chatzakis et al., 2006).
In the 1860s, L.H. Mouras designed a cesspit in which inlet and
outlet pipes dipped below the water surface thus forming a water
seal: the fosses Mouras. Septic tanks improved on this design and
were patented by Donald Cameron in 1895. The Imhoff tank, designed
by Karl Imhoff in 1906 was a further advance and it is still in
worldwide use.
Primary treatment was the most common form of wastewater
treatment in the United States until the passage of the Clean Water Act
in 1972 which mandated secondary treatment.
3.2. Secondary treatment
Secondary treatment uses micro-organisms to convert the carbona-
ceous (organic) materials in the wastewater to carbon dioxide, water
and energy for re-growth. There are two basic types of Secondary
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G. Lofrano, J. Brown / Science of the Total Environment 408 (2010) 52545264 5261

successive developments depended (Cooper, 2007) which led to the

1990
20 Ed Standard Methods: 350 separate methods concept of the tricking lter (Fig. 9a). In 1893 the rst trickling lter
Dioxin analysis > 1 part per quadrillion
was installed at Salford near Manchester, England and starting since
1980 First EPA manual on hazardous waste analysis 1895 until about 1920 many others were used to treat wastewater
from cities and towns throughout the United Kingdom (Stanbridge,
PCB Aroclor and separation refinement
1970 GC refinements (cleanup,flame ionization, electron capture) 1976). The trickling lter as we know today was never patented.
EVOLUTION OF ENVIRONMENTAL ANALYTICAL CHEMISTRY

Ms and Nucelar magnetic resonance refinements The rst patent issued for attached growth processes was to Wigand
Inductively Coupled Plasma Aromic Emission Spectraphotometry ICP
First EPA manual on organic and trace metal analysis
in 1900 for a concept which consisted of a moving cylinder with wooden
slats. The second patent was issued to Poujoulat in 1916 and used
11 Ed Standard Methods: wet chemistry inorganics
GC advances agglomerated slag or porous brick fashioned as a hollow cylinder and
1960 Fluorescence spetroscopy rotated about its horizontal axis. Although neither option attracted
IR Advances
PCB and DDT detection by GC much attention at the time, these designs should be considered
First commercial AAS predecessors to another attached growth process called Rotating
Biological Contactors (RBCs) (Fig. 9b). The wooden slats were prone
Portable DO
1950 Introduction of mass spectrometry (MS) to clogging, so they were replaced by metal disks in the 1930s. In the
Introduction of Atomic Adsorption Spectroscopy (AAS) 1950s, the metal disks were replaced by expanded polystyrene disks. In
IR methods advances
Column Chromat. 1960 RBCs were rst installed in West Germany and later introduced in
Infrared (IR) method for some inorganics > 500 mg/l UK and USA. In the 1970s polyethylene disks were introduced so as to
Benzene >100 mg/l reduce the fabrication costs (Patwardhan, 2003).
1940 DO by mercury electrode
The effects of various operating parameters on RBC performance
UV photometry for some organics > 30 mg/l
total petroleum were nally compiled by Antonie (1976) by using pilot-plant data
8 Ed Standard Methods: general parameters from various installations.
1930 BOD, COD, and DO methods improvements
phenol >10 mg/l
3.2.2. Suspended growth-activated sludge processes
petroleum hydrocarbon fractions
The rst experiments on the aeration of wastewater to remove
BOD and DO methods improvements pollutants were carried out at the Lawrence Experimental Station in
1920 phenol >10 mg/l
Lawrence, Massachusetts. Building on these experiments, the activated
3 Ed Standard Methods: general parameters sludge process was perfected and patented in 1913 in the UK by two
1910 BOD and DO methods improvements
phenol >100 mg/l
engineers, Edward Arden and W.T. Lockett who were conducting
research for the Manchester Corporation Rivers Department at
1900 1 Ed Standard Methods: general parameters Davyhulme Sewage Works (Ardern and Lockett, 1914). They conducted
experiments on treating wastewater in a draw-and-ll reactor, similar
Fig. 7. Evolution of analytical chemistry.
(modied from Shifrin, 2005).
to a sequencing batch reactor, producing a high quality efuent. They
believed that the sludge had been activated during the process so they
named it activated sludge. It was not until much later when they
treatment: attached growth (biolms) and suspended growth (activat- understood what had actually occurred which was the concentration of
ed sludge) (Metcalff and Eddy, 2008). Attached growth systems have a micro-organisms which mediated the conversion of carbonaceous
xed substrate such as rock or plastic on which micro-organisms can pollutants to carbon dioxide, water and energy for re-growth.
attach and grow. Wastewater ows over this aerated biolm resulting in Because of the wide application of trickling lters in the UK the
reduction of BOD. In a suspended growth system, the biomass and implementation of activated sludge processes was not very rapid;
wastewater are constantly mixed resulting in BOD reduction. The solids however, in the US many of activated sludge plants were the rst form
are then removed in a subsequent sedimentation step and the majority of wastewater treatment ever used and their use was far more rapid
returned to the process. than in Europe This was in part because of the Clean Water Act
mandating secondary treatment promulgated in 1972.
3.2.1. Attached growth
The idea that there was a way to purify wastewater through the 3.3. Advanced treatment
use of micro-organisms gradually began to emerge around the end
of the nineteenth century. In 1870 Edward Frankland established the With greater understanding of the impact of wastewater on the
fundamental principles of ltration through the soil on which much of environment and more sophisticated analytical methods, advanced

Nutrient Phosphorous
Denit
removal removal
Nitrif.

Secondary Filtration Trickiling AS CW RBC UASB MBRs MBBR

treatment process Filters SBR

Radial
Primary Fosses flow
Septik Imhoff
treatment Mouras tank
tanks tank

1860 1870 1893 1895 1902 1905 1914 1950 1960 1970 1974 1980 1990

Fig. 8. Evolution of wastewater treatment. AS - Activated sludge; CW - constructed wetlands; RBC - Rotating biological reactors; UASB - Upward-ow anaerobic sludge blanket;
MBRs - Membrane biological reactors, SBR - Sequencing Batch Reactors; MBBR - Moving Bed Biolm Reactors.
 Author's personal copy

5262 G. Lofrano, J. Brown / Science of the Total Environment 408 (2010) 52545264

a 3.3.1. Membrane systems

Rotating Domed Membrane systems are the newest process to produce high quality
Influent Enclosure
Distributer
efuent and are being used more and more (Fig. 11). With scarce
water resources, membranes allow for direct water reuse since they
not only remove suspended solids but also much of the bacteria and
viruses present in secondary efuent.
Media Although most engineers think of membranes as a very recent
development, they have been used for many years typically in industrial
applications. Dorr-Oliver Inc developed Membrane Sewage Treatment
Air Air
Influent
in the 1960s. Ultraltration, as a replacement for sedimentation, in the
activated sludge process was rst described by Smith et al. (1969). In a
Effluent
Filter
Trickling Filter
successive report Hardt et al. (1970) used a 10-liter aerobic bioreactor
Treated Water treating a synthetic wastewater with a dead end ultraltration
membrane for biomass separation. In 1970 the technology rst entered
Clarifier
in Japanese market. Full scale commercial aerobic membrane bioreac-
tors (MBR) processes rst appeared in North America in the late 1970s
Recycle Sludge and then in Japan in the early 1980s. By 1993 external membrane
bioreactors systems had been reported for use in sanitary application in
Pump Europe (Aya, 1994). In the late 1980s to early 1990 Zenon Environ-
mental continued the early work of Dorr Oliver in developing systems
b for industrial wastewater treatment, resulting in two successful patent
One media applications (Stephenson et al., 2000).
Media discs pack
or panels Media disc Media
or panel Support
35-40%
Motor submerged 3.4. Disinfection practices
Shaft
Disinfection is the process by which pathogenic organisms are
killed or inactivated to protect public health. In the 19th Century,
many scientists believed that odor was the cause of disease so
chemicals such as chlorine were used as deodorants (Aiello et al.,
2008; Gayman, 2008). In 1854, chloride of lime was used to deodorize
Side View Front View
Optional air London's wastewater. In 1859, the Metropolitan Board of Works,
distributor pipe London, showed that a dosage of 400 lbs/MG of Calcium Chloride
could delay purication of raw wastewater for as much as four days
Fig 9. a) Trickling lter, b) rotating biological contactor. (Routledge, 1996).
By 1880, scientists began to understand pathogenic bacteria and
their association with specic disease. For example, calcium chloride
treatment is becoming more common in developed countries. Once was used to treat feces from typhoid patients before disposal to
secondary treatment and the reduction of carbonaceous pollutants sewers (White, 1972). In 1893, in Hamburg, Germany, chlorine was
was employed at most treatment plants, the prevention of eutrophi- rst used on a plant scale for disinfection of wastewater and in 1906,
cation became the next goal for wastewater treatment. Depending on ozone was used in France as a disinfection agent. In 1909, compressed,
the receiving waters, many treatment plants are required to remove liqueed chlorine was commercially available and by 1914, equip-
nitrogen, phosphorous or both. Studies carried out by Downing et al. ment had been designed for metering and applying chlorine gas to
(1964) are now incorporated into design methods of biological wastewater. Some of the rst plants to use chlorine gas were in the
nitrication. In 1962 Lutdzack and Ettinger put forward the use of an United States in Pennsylvania, Wisconsin, and Kansas. But it wasn't
anoxic zone to achieve biological denitrication in an activated sludge until 1961 that the rst chlorine residual controlled disinfection
process, introducing a practice that is now commonly applied system was available. The rst recorded use of ultraviolet light for
(Lutdzack and Ettinger, 1962). The biological removal of nitrogen disinfection was in France in 1916. In the early 21st century, chlorine
and phosphorous in a single sludge system was developed and gas is no longer used and ultraviolet disinfection is becoming the
patented by James Barnard (Barnard, 1973, 1974, 1975) (Fig. 10). state-of-the-art.

Nitrate
Primary
Anaerobic Anoxic
Anoxic Aerobic
Zone Zone Aerobic
Zone
Zone Zone

Fig. 10. Bardenpho process for nitrogen and phosphorous removal.

 Author's personal copy
G. Lofrano, J. Brown / Science of the Total Environment 408 (2010) 52545264
Hollow fiber shape
Fig. 11. Membrane bioreactors.
3.5. Solid processing
Since the beginning of time, wastewater solids have been used on
land as a fertilizer. These solids are high in pathogens and volatile
solids which putrefy and attract vector organisms which results in
disease. Anaerobic and aerobic digestion is used to reduce volatile
solids and pathogens making the solids safer for land disposal. In the
1990's US-EPA began to regulate wastewater solids disposal with 40
CFR 503. This regulation set classications for solids which could be
used on land safely as fertilizer. Class A can be used on most land with
Class B having more restrictions and testing requirements. Benecial
use of waste solids as fertilizer is practiced throughout the world;
however, because of the cost of energy, there is increased interest in
using these solids as a renewable energy source.
4. Sociological aspects
As stated by Viale (2000) for solid waste, wastewater is generally
accompanied by an imposition of sense that Heidegger (1969) claimed
to be its own modern technology, by identifying the cultural climate of
an entire era. By denition of imposition of sense Heidegger discovered
a fundamental attitude toward the world that reduces nature/humans
to resources in a dominating Gestell or enframing concept. He states
that: Enframing means the gathering together of that setting-upon
which sets upon man, i.e., challenges him forth, to reveal the real, in
the mode of ordering, as standing-reserve. Enframing means that way
of revealing which holds sway in the essence of modern technology
and which is itself nothing technological (Heidegger, 1969). The
world regarded as an object place-against, to use yet words of
Heidegger, has been the basis for an instrumental relationship
between humans and environment from which to draw resources
and where to discharge wastewater/waste without any care. So water
converted into wastewater has been neglected for a long time and has
become part of the vast universe of waste. As matter of fact, its fate has
been and in many cases it still is, the abandonment.
The imposition of sense, joined in the course of history, in the same
fate humans measure their value according to their being used. The
relationship between humans and waste could reveal the truth of
social relationships, conrmed by individualism which historically is
the biggest brutality committed against humanity (Viale, 2000). As an
example, since early times in India waste, human and animal manure,
are still manually collected by Harijan, which is the term identifying
the outside caste and that means exactly untouchables.
5263
Outer surface of
membrane
4.1. The future challenges
In the early of twentieth century health problems associated with
water pollution seemed to have been almost solved by industrialized
countries. However large populations living in developing countries
to this day have neither safe drinking water nor sanitation. Not having
access to sanitation means that people are forced to defecate in elds,
ditches and buckets. The ying toilets of Kibera, a slum in Nairobi,
Kenya, highlight what it means to be without sanitation. Lacking
access to toilets, people defecate into plastic bags which they throw
onto the streets. This is analogous to the waste disposal practices in
Europe during middle age. The absence of toilets poses particularly
severe public health and security problems for women and young
girls. In sanitation as in water, gender inequality structures the human
costs of disadvantage (HDR, 2006; Avvannavar and Mani, 2008).
Recent research shows that women in poor neighbourhoods of South
Africa cannot visit the commonly shared pit latrines without fear or
being raped (Avvannavar and Mani, 2008). It is sad to note that
currently (2009) three children die every minute because of lack of
sanitation and safe drinking water (Water for People, 2009).
5. Conclusion
When considering wastewater management what emerges is the
long history associated with urban ecology and disposal of wastewa-
ter and societal and cultural traditions. For the longest time,
dispersion and dilution have been the dominant but not the best
practice for management strategies. Unfortunately, they continue to
be practiced in many developing countries and not only. Wastewater
management has followed a very torturous path to proper regulation.
It is not because of ignorance that wastewater management practices
have not been implemented in many countries, but in many cases
corruption or a misunderstanding of the economic benets of
wastewater management. Technology exists for all people even in
developing countries. Many people in developing countries go
without sanitation in spite of the benets which could come from
decentralised systems for small populations and rural areas far from
large treatment plants. Improving sanitation and waste management
for developing nations needs technological evolution but taboos,
reservations and social boundary conditions need to be seriously
taken into account to be overcome.
Developed nations are now going beyond basic wastewater treat-
ment (removing of carbonaceous pollutants) to removal of nutrients
 Author's personal copy
5264 G. Lofrano, J. Brown / Science of the Total Environment 408 (2010) 52545264
and trace organics. In the near future, plants will be required to produce
efuent which has sufcient quality for direct water reuse. The
technology exists for this and it will be commonplace.
The British Medical Association and the American Medical
Association have stated the one thing that has had the greatest
benet to public health and longevity has been wastewater treatment.
This history shows how economic conditions, public health and
longevity have been improved by waste treatment. We need to
provide safe drinking water and sanitation to all people of the world.
This is the great equalizer and a human right.
Acknowledgements
The authors thanks referees for their precious suggestions.
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