In contrast to London, where typhoid fever had been steadily declining since the 1870s, the rate in Tokyo remained high, more so in the upper-class residential northern and western districts than in the densely populated working-class eastern district. An explanation is the decline of waste disposal, which became particularly serious in the northern and western districts when traditional methods of waste disposal collapsed due to urbanization. The 1923 earthquake led to record high morbidity due to unsanitary conditions following the earthquake, it prompted the establishment of antityphoid measures and the building of urban infrastructure.