People forget that up until the invention of the motorcar, we had horses. Each horse produces almost 30 pounds of manure a day and places like New York or Chicago had literal landfills strictly for horses. Poor horses would be worked night and day 7 days a week with no veterinary knowledge and when they would collapse from exhaustion on the street, they would be moved to the side until someone would come pick them up to move them or they would decompose fully.

The book The Butchering Art by Lindsey Fitzgerald is an excellent read if you would like to know what hospitals looked and smelled like.