In the late 19th and early 20th centuries, the Ottoman Empire’s centralization project was in full swing in the provinces of Greater Syria. While voluminous scholarship exists on the political, social, and economic reforms of the era, much less has been written about the widespread infrastructure modernization projects, and most of that discussion focuses on the construction of the Hejaz Railway. One of the major commitments of the Ottoman state in this era, however, was to improve the public health and sanitation of the region. From the late 19th century, the Ottoman Empire dispatched physicians and veterinarians that had the authority to impose sanitary cordons and other intrusive movement restrictions in case of cholera, cattle plague, or other epidemic diseases; built water-treatment systems to improve the public health of Damascus; built numerous quarantine stations first along the Hajj route and then along the Hejaz Railway; and even went so far as to propose building a microbial research institution in Damascus before settling on building a medical college instead. In fact, Ottoman attempts to dispatch personnel and build infrastructure to control the spread and impact of microbial populations constituted one of the most lasting legacies in the region. The level of state surveillance and control involved in controlling epidemic disease was unprecedented and challenged in many quarters, from newly settled Caucasian refugee populations, semi-autonomous Druze communities, and Bedouin tribes in the desert. Instead of considering public health a one-way system imposed from Istanbul, Ottoman efforts at controlling the spread of epidemic disease in Syria at the turn of the twentieth century are best understood as a complex interplay of imperial, provincial, and local contestations and negotiations which produced a dynamic understanding of the role of state and citizen in the late imperial period. My research draws on Ottoman and British archival resources to demonstrate how Ottoman infrastructure projects were just as important as capitalist penetration of the region or the development of imperial political institutions in contributing to new understandings of the role of citizen and state in Ottoman Syria.