The Lifeblood of Cities: Medical Metaphors and Modern Life

How our cities reflect our worldview and values.

Posted Jul 14, 2020

Courtesy of Datuk Seri
Source: Courtesy of Datuk Seri

In 1628, English physician William Harvey put forth a radical theory: blood circulates.

This idea may sound simple, but it flew in the face of centuries of medical orthodoxy, and over the next few centuries, it had an unspeakably large impact on physicians, economists, philosophers, and political thinkers. In the words of sociologist Richard Sennett, “A new master image of the body took form.”

One particular area affected by Harvey’s ideas was urban planning. Cities expanded at an exponential rate during the modern era, and city planners adopted Harvey’s idea that healthy living required free circulation. 

Accordingly, they sought to make modern cities that resembled the human body. Wide, arterial streets enhanced the movement of people and goods, carrying them swiftly to the commercial heart of the city. A bowel-like system of sewers and pipes efficiently emptied the city of waste. And great green expanses functioned like lungs, letting people breathe freely. 

In short, our cities were modeled on us, which makes them a direct reflection of our worldview and values.


Starting in the 1740s, European cities began putting their new visions of the “healthy city” into place, and by the nineteenth century, the campaign was fully underway. One of the most obvious innovators was Baron Haussmann, a French official who carried out a massive urban renewal program in Paris starting in the 1850s.

Unsplash / Rodrigo Kugnharski
Arterial boulevards converging on the Arc de Trimphe in Paris.
Source: Unsplash / Rodrigo Kugnharski

Haussmann demolished a number of narrow, dead-end-filled medieval neighborhoods, and in their place, he constructed wide, straight boulevards that shot through the heart of Paris. Haussmann freely likened these streets to arteries and veins, as did other European and American designers. They argued that if motion was blocked, the city would suffer, much like a person suffers during a stroke.

By design, these circulatory cities also facilitated the free flow of labor and capital. In fact, economic thought was equally influenced by Harvey’s ideas of circulation. For example, the group who coined the term “economist” (now known as Physiocrats) promoted the idea that the economy is a circulating flow of income and output, made healthy through free trade. Their founding father was François Quesnay, a prominent physician who frequently relied on medical analogies. 

Bodily metaphors promoted the vision of free-flowing traffic, efficient financial transactions, and smooth supply chains. Today, the value of circulation has triumphed in our cities.


During the nineteenth century, urban cities began earnest campaigns for drainage. A subterranean network of pipes and tunnels carried sewage, water, and waste to their proper places, allowing the “skin” of the city—its streets—to remain clean.

Haussmann described the underground tunnels as “the organs of the great city, functioning like those of the human body, without ever seeing the light of day.” All the unsightly and unhygienic aspects of public life disappeared.

Meanwhile, medieval street paving was replaced with close-fitting flagstones, which allowed for more thorough street cleaning. Thanks to well-functioning organs, the city’s surface could become unblemished and deodorized. 

Wikimedia Commons
The Paris Catacombs.
Source: Wikimedia Commons

Effluvia weren’t the only targets of the new anti-waste campaign. For centuries, the Parisian dead had been consigned to mass graveyards that, thanks to urban expansion, occupied prime real estate in the midst of city life. In the wake of the French Revolution, reformers proposed moving the bodies to two places: the underground catacombs or large, green cemeteries at the outskirts of the city. Decay did not belong in the open air or thriving heart of a healthy city. 

Of course, this hygienic push created real public health benefits, but there were a number of ways reformers could have approached their solutions. It’s noteworthy that engineers and planners used the human body as their metaphorical inspiration. Innovators didn’t just aim to improve the health of the body; they sought to mimic it.


The campaign against the putrid odors of corpses and mass graves formed one component of a larger campaign: to rid the city of foul air and flood it with fresh, clean, open air. If sewers formed the bowels of the city, parks were its lungs.

Unsplash/ Jacob Creswick
The National Mall in Washington, D.C.
Source: Unsplash/ Jacob Creswick

In Washington, D.C., the swampy climate encouraged Charles Pierre L’Enfant to design lung-like breathing spaces through which people “could stream and refresh themselves”—a garden-lined avenue now known as the National Mall.

In 1848, the landscape designer Andrew Jackson Downing advocated public parks as “salubrious and wholesome breathing places” that would bring “the perfume and freshness of nature” into the smelly city. He was a major supporter of the 1851 proposal for People’s Park in New York City (now Central Park). 

Parks served as the metaphorical lungs of a city, but ironically, it took years before reformers became equally concerned with air pollution. In the tightly packed cities of the modern era, many people believed that having room to breathe was adequate protection.  

A Truly Healthy Body

Our cities are organic and dynamic, not least because we have modeled them on ourselves. During the rise of the modern city, planners and engineers modeled the fabric of the city’s infrastructure on the fabric of the human body itself.

Knit together with veins, bowels, and lungs, modern cities promoted circulation as the most vital value of the social body. Efficiency and motion became unmitigated goods, written into the skyscrapers and underbellies of our land.

But humans—and the human body—are also so much more than circulation. On a physical level, our health requires more than the unobstructed movement of blood. And on a metaphorical level, we are more than capital, motion, and efficiency.

There is nothing wrong with circulation; in fact, it’s important. But if our cities truly reflect us, we would do well to reimagine them in a more holistic way. They shouldn’t simply fulfill the goals of productivity, goods, and labor. They should reflect our total health and deeper needs, including the need for non-commercialized human connection and mental well-being.

Our understanding of the body and human health have changed. Isn’t it time for the city to change as well? 


Corbin, Alain. The Foul and the Fragrant: Odor and the French Social Imagination. Cambridge: Harvard University Press, 1986.

Haussmann, G.E. Mémoire sur les eaux de Paris présenté à la commission municipal. Vol. 1. Paris: Vinchon, 1854.

Kiechle, Melanie A. Smell Detectives: An Olfactory History of Nineteenth-Century Urban America. Seattle: University of Washington Press, 2017.

Legacey, Erin-Marie. Making Space for the Dead: Catacombs, Cemeteries, and the Reimagining of Paris, 1780–1830. Ithaca: Cornell University Press, 2019.

Sennett, Richard. Flesh and Stone: The Body and the City in Western Civilization. New York: W. W. Norton & Co., 1994.