This paper examines the history of Cairo between 1880s and 1920s from the “vantage point” of sewage and toilet refuse. A mosaic of intersecting and overlapping themes emerges from such an examination. Since 1880 there were numerous plans for constructing a drainage system in Cairo. These plans aborted due to various reasons, chief among them are the protracted financial crisis as well as legal complications related to the system of capitulations. A full drainage system was finally installed between 1915 and 1920 by C. Carkeet James, a British sanitary engineer who had just finished overseeing Bombay's drainage scheme. In the absence of sewers, there is a fascinating story to be told about what Cairenes did with waste, and the larger implications of this on Cairo's subsoil and water resources. This is closely related to how medical and sanitary experts as well as colonial officials were alarmed by the sanitary condition of Cairo, linking it to high death rates and the recurrence of cholera epidemics. Their perceptions of the sources of medical and sanitary dangers, as well as their prescriptions of how to avert them, were filtered in complex ways through categories of race and class. The paper seeks to shed light on these interconnected themes while engaging with broader debates in imperial, medical, and environmental history. I begin with examining the state's response to the 1883 cholera epidemic, a response that cannot be dissociated from the global context of previous cholera epidemics and the international scientific competition, and diplomatic conflict, over the etiology of the disease. I especially highlight the changing nature of medical theories and social discourses to which the epidemic gave rise, and the concomitant transformations of theories of public hygiene during the final decades of the nineteenth century. In the bulk of the paper I turn to examine various arrangements of the provision of potable water and sewage disposal, including drainage schemes, between 1880s and the 1920s. The paper attempts to be sensitive to the friction created by how the inhabitants of Cairo experienced the state's attempt to stem the spread of epidemics, construct a drainage system, or provide cleaner potable water.