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An anonymous Canadian wood engraving from 1850 shows a medical inspector's office, with posters of ships arriving from New York and Britain. Cholera was first introduced to Canada in 1832 on crowded and unsanitary boats, and claimed more lives into the 1850s and beyond.

McCord Museum

In June, 1832, a ship called the Voyageur sailed down the St. Lawrence from Quebec City to Montreal. Some of the passengers were wracked with a severe illness, and one of them died soon after arriving. Days earlier, a ship from Ireland had arrived in Quebec City carrying a number of immigrants also grappling with some kind of ailment. Around 39 people had already died on the voyage.

Rumours spread that the passengers were afflicted with cholera, an extremely virulent disease sweeping Europe. The Montreal Board of Health denied the rumours, even as citizens noticed an unusual number of hasty burials in the city. The board soon dropped its stance as cholera exploded across Montreal, killing between 10 and 40 people every day until the epidemic subsided. The city botched its response and squandered the chance to prepare by not securing hospital space, forcing the sick to be treated in sheds lined with straw.

Such failures weren’t unique to Montreal, but the destruction wrought by diseases led to seismic changes in cities across Canada, the U.S. and Europe.

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People flocked to urban centres in the 19th century, and lived in squalid quarters with no plumbing and poor ventilation, where cholera, typhoid and other infectious maladies flourished. Cities were, in short, disgusting. Garbage was tossed on the street, and roads were craggy, allowing fetid water to pool. In Charlottetown, excrement seeped through the soil and contaminated drinking water. Toronto drew water from the same harbour in which it dumped sewage. One dismayed Vancouver resident wrote: “The whole refuse of the town, solid and liquid, is thrown out on the face of the earth.”

Cities responded with sewer systems and water plants, regulations to ensure buildings were sanitary, bylaws to parcel out residential and industrial land, and restrictions on livestock. These were radical changes for the time, altering how cities looked and functioned. With a pandemic upon us today, cities will change again.

Back in the 19th century, people believed disease spread through “miasma,” the foul air emitted from all manner of decomposing waste strewn around cities. Such was the case when cholera tore through Paris in 1832, killing some 18,000 people. Starting in 1853, Emperor Napoleon III began a massive reconstruction project to transform Paris and its tangle of dirty, narrow streets into a modern city bathed in fresh air and “beneficial sunlight.” Buildings were destroyed, neighbourhoods demolished, and wide, tree-lined boulevards took their place. (Historians have noted military considerations were at play, too.)

Over in London, sewage spilled directly into the Thames, which happened to provide the city with drinking water. During a heatwave in 1858, the stench wafting from the river was so noxious that the event became known as the Great Stink, stoking fears that illness was spreading through the fumes. To address the health hazard, London built an elaborate sewer system that not only allowed the city to support its growing population, but altered its physical character with embankments along the Thames.

London, 1862: Work crews build the northern outfall sewer into the River Lea, part of a monumental upgrade of water-treatment facilities.

Otto Herschan Collection/Hulton Archive/Getty Images

In American cities, sewer systems meant that roads became longer, straighter, and paved to accommodate the underground infrastructure and allow for a nightly wash-down. Two years after cholera killed 200 of Toronto’s 5,000 residents in 1832, the city’s first council passed bylaws focused on public health, including fines for anyone tossing waste into Lake Ontario. Around the same time, the fear of cholera returning to the city hastened plans to clean up Ashbridge’s Bay, where sewage was dumped. To store drinking water, the city built the open-air Rosehill Reservoir in 1873, which was covered with a green roof and incorporated into a public park nearly 100 years later. (A handful of Toronto parks lie on top of underground reservoirs.)

A smallpox outbreak in Charlottetown partly motivated leaders to build a waterworks in the mid-1880s, and council appointed a sanitation officer to enforce cleanliness bylaws. Within a few months, the officer declared hundreds of buildings unsanitary.

Vancouver saw public health as key to its prosperity, according to Margaret Andrews, an emeritus history professor at Washington State University. There were some hiccups, though. Vancouver’s first “night scavenger” in 1887, charged with emptying privies and cesspools, was fired for not doing his job. The daytime scavenger was bestowed with his responsibilities, on top of garbage collection. He quit.

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Montreal, 1901: A carriage rides through the Reservoir in Mount Royal Park, a greenspace originally designed by Frederick Law Olmsted.

Library of Congress

As cities grew and infectious diseases continued spreading, incorporating park space became more important.

Many cities turned to Frederick Law Olmsted, who designed New York’s Central Park beginning in 1857 and Mount Royal in Montreal in 1874. Olmsted, whose first child died from cholera, frowned on density and strongly believed that green space provided health benefits. “It is an established conclusion,” according to a letter from his firm, that urban neighbourhoods were a “prolific source of morbid conditions of the body and mind.” Olmsted was so convinced of the restorative effects of parks that he passed out flyers in the crowded slums of New York with directions to his creation.

Even as science advanced and the miasma theory waned, fresh air and sunlight were considered beneficial, especially for tuberculosis patients. That led to the construction of sanitoriums outside city limits in the 1900s, where the afflicted could bask in the sun and recover. The presumed medicinal features of those buildings – large windows, natural light, terraces and balconies – became fixtures of modern architecture, according to X-Ray Architecture, a book by Princeton University professor Beatriz Colomina.

The spread of tuberculosis also stirred up anti-urban sentiment in Canada.

Cities were cleaner by then, but still unsanitary – especially for the poor. While doctors advised people to ward off tuberculosis by sleeping outdoors or with the windows open to bring in fresh air, the poor had no such luxury. One writer noted in 1910 that it was better to keep windows shut to prevent getting a whiff of the “slop box or neighbouring stable.” A pamphlet published by the Saskatchewan Department of Agriculture claimed the “only cure is in getting back to nature in the same extreme that we have gotten away from it.”

But the nostalgia for the country and disdain for cities waned by the end of the First World War, according to The Weariness, the Fever, and the Fret, a history of tuberculosis in Canada by Katherine McCuaig. The prevalence of the disease in cities compared to rural settings wasn’t dramatically different, and rural communities lacked basic health care services.

Toronto, 1912: A young boy with tuberculosis lies in bed to enjoy the outdoor air.

Arthur S. Goss / City of Toronto Archives

These changes happened slowly, over many years, as the death and general misery caused by pestilence remained a daily fact of life. But COVID-19 – we hope – is a temporary aberration, making its impact harder to predict. Some thoughts are taking shape, though. "COVID-19 is the great accelerator,” says Andy Yan, director of the City Program at Simon Fraser University. “It’s amplified a lot of the social and economic fissures that have long existed in cities.”

The pandemic could force governments to seriously reckon with deep-rooted issues, such as income inequality, affordable housing and our long-term care model, while lending new urgency to old ideas. Urban planners have long decried the tyranny of the car, and argued for neighbourhoods where all amenities are a short walk or bike ride away. In the past few months, some cities have closed lanes to vehicles, allowing restaurant patios to spill out onto the street. Our time under lockdown has also made clear the need for adequate outdoor space, whether it be public parks or simply sidewalks wide enough to prevent people from bumping into one another. We could witness new social norms, like wearing masks in crowded spaces, even after the pandemic comes to an end.

What is clear is a pattern amid outbreaks and epidemics across history. The city is seen as rife with disease, people succumb to fear, and seek to escape. But in the end, the city adapts – and prevails.

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