In the 1880s and 1890s, Moscow’s city administration launched important urban reforms in the field of public health and sanitation. The largest project was the construction of the new sewage system. Due to their “late” start, the sanitary reforms in Moscow could benefit from the bacteriological discoveries and a shift in the understanding, prevention and treatment of epidemic diseases. These reforms were a part of the global process of spreading expert knowledge that did not circulate in linear or hierarchical ways but rather followed multi-directional horizontal connections among administrations, institutions and experts. In this exchange of ideas and best practices, Moscow looked not only at “older” European metropolises, but also at smaller cities outside of Western Europe, for example, Memphis, United States, where innovative solutions in urban sanitation had been successfully tested. The sanitary reforms in Moscow are best understood as an eclectic synthesis of several models from both established and emerging urban centers.