Although there is evidence of surface-based storm drainage systems in early Babylonian and Mesopotamian Empires in Iraq (ca. 4000–2500 BC), it is not until after ca. 3000 BC that we find evidence of the well organized and operated sewer and drainage systems of the Minoans and Harappans in Crete and the Indus valley, respectively. The Minoans and Indus valley civilizations originally, and the Hellenes and Romans thereafter, are considered pioneers in developing basic sewerage and drainage technologies, with emphasis on sanitation in the urban environment. The Hellenes and Romans further developed these techniques and greatly increased the scale of these systems. Although other ancient civilizations also contributed, notably some of the Chinese dynasties, very little progress was made during the Dark ages from ca. 300 AD through to the middle of the 18th century. It was only from 1850 onwards that that modern sewerage was “reborn”, but many of the principles grasped by the ancients are still in use today. This paper traces the development of the sewer from those earliest of civilizations through to the present day and beyond. A 6000 year technological history is a powerful validation of the vital contribution of sewers to human history.