In this chapter we explore health of populations within a context of intensifying urban industrialization and the consequent economic, social, and political relations generating particular forms of pathogenicity in the 19th century UK and US. Life expectancies actually went down during the course of the century as poverty deepened, sanitation remained largely ignored, and domestic and work conditions were suboptimal for many. Epidemics did find these conditions optimal, and outbreaks of smallpox, yellow fever, and malaria were common, in addition to the upward trend of tuberculosis. Colonization, the end of slavery, and high immigration rates fueled race-based theories of disease susceptibility as well as policies of blame that made life even harder for nonwhite populations. The rise of statistics made these policies easier, with the ability to pinpoint those urban neighborhoods more heavily burdened with disease than others. Infant and maternal mortality were also remarkably high. By the second half of the century, sanitation had become more widespread, and its interventions led to a gradual decline of tuberculosis and epidemic diseases. With no “magic bullets,�? the 19th century in many ways parallels health patterns in our current antibiotic-resistant existence, with burgeoning cities, deepening inequalities, and policies of neglect and individual responsibility that have little means to improve life expectancies that once more, for the first time since the 19th century, are showing a decline in two of the richest countries in the world.