Sanitation has been chosen as the "greatest medical milestone since 1840" by readers of the British Medical Journal (BMJ), which was launched in London that same year. Over the last 10 days, more than 11,000 people (mostly physicians) from around the world have voted in the BMJ's Web site poll (www.bmj.com) to find the greatest medical breakthrough since the journal began. Sewage disposal and piped-in water beat 15 other medical advances, including the discovery of antibiotics, the development of the contraceptive pill and vaccines, according to the announcement on Thursday. Despite the strong field, sanitation was the undisputed winner with 1,795 votes out of a total of more than 11,000. Antibiotics was a close second with 1,642 votes, and anesthesia took third place. Leading doctors and scientists championed each milestone. Speaking after the results were announced, Prof. Johan Mackenbach of Erasmus University Medical Center in Rotterdam, who championed sanitation, said: "I'm delighted that sanitation is recognized by so many people as such an important milestone. The general lesson which still holds is that passive protection against health hazards is often the best way to improve population health." The original champions of the sanitary revolution were John Snow, who showed that cholera was spread by water, and Edwin Chadwick, who came up with the idea of sewage disposal and piping water into homes. Inadequate sanitation is still a major problem in the developing world. In 2001, unsafe water, sanitation and hygiene accounted for over 1.5 million deaths from diarrheal disease in low and middle-income countries. Clearly, sanitation still plays a vital role in improving public health now and in the future, he said. BMJ editor Dr. Fiona Godlee said: "The response to our poll has been overwhelming, it is deeply heartening to see science and medicine provoke such passion and debate. Selecting just one winner was always going to be difficult, but I'm delighted that the BMJ has helped to remind everyone of the great contribution that medicine and science has made to our lives now and in the future."