This article situates the 1830 cholera epidemic in the provincial Russian city of Kazan within the context of broader local discourse on endemic disease and public health over the first half of the nineteenth century. In the decades before cholera, the city gained important local institutions, and began to perceive itself as a potential site of public health intervention. During the outbreak, Kazan’s local institutions supported a comparatively robust response to the disaster. And, afterward, the resulting trauma helped spur those institutions to implement long-discussed public health improvements. Thus, the article emphasizes the interplay between cholera as an emotional catalyst, and the broader institutional and conceptual frameworks necessary to enact lasting change.