Until the Progressive Era and the rise of hygiene agitation, big cities were population sinks, with more people dying than being born there, and only rapid immigration accounting for growth.
I was just reading, apropos of another thread completely, that Stephen A. Douglas, "the Little Giant", lived in small-town Illinois. He moved his family to Chicagos to further his political career in 1847, and within five years his first wife died a young woman (leaving him two kids). He remarried three years later, in 1855 or so, and then he was dead of typhoid himself six years after that -- still a man of relatively young middle years.
Metropolises are a good deal for the people who own and run them. They suck for others.
I agree; I was watching something on the History Channel about our “crumbling infrastructure”, and couldn’t believe that a number of cities dump raw sewage into rivers when their older systems can’t handle the volume. As someone who lives around some very nasty cities, I don’t recall the smell of raw feces when I’m near the river, so I assume we’re not doing it around here. That was a real eye-opener for me!