But with the new concentration of industry in the industrial city there was still a third source of stream pollution. This was from human excrement, recklessly dumped into the rivers and tidal waters without any preliminary treatment, to say nothing of attempts to conserve the valuable nitrogenous elements for fertilizer. The smaller rivers, like the Thames and later the Chicago River became little less than open sewers. Lacking the first elements of cleanliness, lacking even a water supply, lacking sanitary regulations of any kind, lacking the open spaces and gardens of the early medieval city, which made cruder forms of sewage disposal possible, the new industrial towns became breeding places for disease: typhoid bacteria filtered through the soil from privy and open sewer into the wells from which the poorer classes got their water, or they were pumped out of the river which served equally as a reservoir for drinking water and a sewage outlet: sometimes, be£ ore the chlorine treatment was introduced, the municipal waterworks were the chief source of infection. Diseases of dirt and diseases of darkness flourished: smallpox, typhus, typhoid, rickets, tuberculosis. In the very hospitals, the prevalent dirt counteracted the mechanical advances of surgery: a great. part of those who survived the surgeon’s scalpel succumbed to  “hospital fever.” Sir Frederick Treves remembered how the surgeons of Guy’s Hospital boasted of the incrustations of blood and dirt on their operating coats, as a mark of long practice! If that was surgical cleanliness, what could one expect of the impoverished workers in the new slums? (Mumford 1934:170-1)
MUMFORD, Lewis. 1934. Technique and civilization. New York: Harcourt, Brace and Company.