This essay traces the historical relationship between the construction of the Nile River and the prevalence of disease in Egypt in the long twentieth century, with an eye to the relevance of this history to other regions on the African continent impacted by the construction of large dams. Beginning in the second decade of the nineteenth century and stretching through the 1970s, the Nile River underwent a dramatic process of transformation. Two large dams–the 1902 Khazan Aswan and the Aswan High Dam–were constructed on the river. Networks of perennial irrigation canals facilitated the practice of year-round agricultural production and the High Dam provided electricity. The remaking of Egypt's riparian ecologies also had important implications for the health of Egypt's population as these ecologies were associated with new landscapes of disease and approaches to biomedical treatment.