In the Colonial period, the city of Lima featured such overcrowding that it generated all sorts of garbage and faced problems regarding the final disposal of solid, liquid, and gas waste. The purpose of this article is to discuss the active participation of the cabildo (council) in the city's public health, from a cultural perspective and on the basis of administrative documents and secondary sources. The study shows that the cabildo was engaged in disease prevention, sanitary control, the city's supply system, and even the conservation of its resources. Through commissions, the regidores (council members) supervised markets, butcher shops, slaughterhouses, mills, bakeries, tanneries, corner shops, and pharmacies. However, these and other efforts were never enough to keep the city clean and free of epidemics.