As a product of the Industrial Revolution, many cities in Europe and North America grew in the 19th century, frequently leading to crowding and increasing concerns about public health. As part of a trend of municipal sanitation programs in the late 19th and 20th centuries, many cities constructed extensive sewer systems to help control outbreaks of disease such as typhoid and cholera. Initially these systems discharged sewage directly to surface waters without treatment. As pollution of water bodies became a concern, cities added sewage treatment plants to their systems. Most cities in the Western world added more expensive systems for sewage treatment in the early 20th century.