Serious studies of the provinces as important centers of education, knowledge, culture have only recently emerged in American academia. Generally, Egyptian history has overly represented Cairo’s role in the modernization project and has cast the Delta and Upper Egypt as rural space or defined provincial Delta cities as subsidiary to the core in Cairo. Delta cities such as Tanta played an important role in urban development, the global economy, national politics, religion and public health, but has remained largely unstudied. In fact, from the 1850s to the 1890s, Tanta, the largest city in the Egyptian Delta appeared in print media throughout the world outside of Egypt as an epicenter of Cholera. Medical journals, periodicals and missionary tracts reproduced the death tolls from the 1848 Cholera epidemic that killed 3000 in Tanta. Collectively, colonial administrators, missionaries and physicians pigeon-holed Tanta as an epicenter of Cholera that threatened to spread the disease westward. While the 1848 cholera outbreak shaped how the many outside of Egypt understood Tanta, the government in Cairo response to the 1848 epidemic changed over the course of the 19th century. Initially, the Cairo-based government appointed a chief medical examiner, made changes to the streets that surrounded the mosque and made public health a priority. The changes to the arterial streets and provisions to make Tanta a safer city fit within the larger objective of urban development in the city. What followed was the development of a public health system that sought to compete with a local system that blended both “folk” healers and modern medical practitioners such as physicians, pharmacists and nurses. This paper will explore this period of development and examine the ways that locals embraced, negotiated and changed modernization efforts at the local level. It hopes to show that the relationship between Cairo and Tanta was dynamic and local realities affected public health efforts in a much greater way than has been previously understood.