Abstract: In modern times of China, like other cities throughout the country, Chengdu experienced reforms, revolutions, and warlord conflicts, and its society remained the state of rapid change. The city’s public spaces were rebuilt and incorporated into a modern system of urban management. As an important component of modern urban management, public health services have become increasingly prominent. From the late Qing Dynasty to the Republic of China, the administrative institutions for public health management in Chengdu were established from scratch and gradually grew, reflecting the refinement and specialization of public health management. Chengdu has gradually established environmental sanitation management institutions, formulated policies and regulations, formed cleaning teams, and continuously carried out street cleaning, toilet management, and fecal waste treatment. Although the municipal government has implemented various regulations to manage public toilets and sometimes taken strict measures, significant results were not achieved as expected. From the late Qing Dynasty to the Republic of China, big challenges were caused by the management of urban environmental sanitation in Chengdu, but there were still some commendable aspects that made positive contributions to the modernization of the sanitation.