History has been acknowledged for 20 years as an important research element for river management that has been applied, for example, to define reference conditions and assess the level of degradation. The evolution of river uses and related ecological conditions, especially in recent decades, has been utilized to show the impact of humans on these ecosystems. Integrating a historical perspective into river management can, however, go beyond these targets (see, e.g., Haidvogl et al. 2014, 2015; Higgs et al. 2014). Just as present river management decisions will influence future conditions, paths trodden by users in the past have a bearing on today's ecology. Sound long-term studies of the natural and societal drivers shaping historical river changes can thus support our understanding of the present situation and identify trajectories of change. In long-term studies taking into account the dynamics of natural forces-in particular climate change and subsequent altered hydrologic and temperature conditions-as well as social dynamics (e.g., decision-making processes, main energy sources and technologies, superordinated practices and values) can reveal distinct overarching patterns of river use and management. This can contribute to developing future strategies and plans with lower ecological impacts. This chapter describes major milestones of human river uses and ecological impacts. With some brief mention of Asian river case studies, it highlights especially examples, which are representative of industrialized countries of Europe and North America. In Europe, larger environmental changes of aquatic ecosystems occurred already in ancient and medieval times. European colonists spread practices and techniques of river uses to other areas of the industrialized world after they reached