This wide-ranging study offers a unique perspective to examine the conditions, constraints, and concerns of city government during the first half of the nineteenth century. Decisions concerning wastewater disposal in New York City reflect nineteenth-century notions of disease, the environment, and city responsibility. The decision to construct a comprehensive sewer system was a complex one that pitted individual liberty against the common. good and political considerations against those of professional physicians and engineers. This history of policy formation is, then, a story of changing values and ideas that must be understood within the context of the social, economic, political, and intellectual milieu of the middle of the nineteenth century.