The life of the institutionalized Ottoman mental patients was interrupted in a dramatic way twice between the 1870s and the 1890s due to outbreaks of contagious diseases. While the first—mysterious and contained—disease resulted in a major patient transfer and abandoning of the state insane asylum (Süleymaniye), the second one, the cholera outbreak of 1893, was dealt with differently. The new state asylum (Topta??) was identified as one of the first locations of the 1893 outbreak. In fact, some claimed that it was the recent arrival of a mental patient that started this particular outbreak in Istanbul. After many discussions about relocating patients to a remote area, the administration decided to deal with the outbreak where it started. This paper will look at the intersection of madness and contagious disease as it relates to concerns of public health in the Ottoman capital. I will primarily focus on the planned and actual responses of the Ottoman and asylum administration by analyzing the spatial dimensions of the outbreak and the responses inside and outside the asylum.