This article examines the history of debates around the creation of a ‘native village’ in Pietermaritzburg culminating in the construction of the city's first formal township. This, and the decision to locate the new township next to the city's main dump, have commonly been interpreted to corroborate Maynard Swanson's influential concept of the ‘sanitation syndrome’. Swanson first coined that term to explain the origins of racial segregation in Durban, but it struck a chord very widely, not only because it problematized science as metaphorical, but also because it shifted responsibility for the antecedents of apartheid onto urban, self-styled progressive English-speaking officials and voters. From the Pietermaritzburg evidence, however, I argue that the concept ‘sanitation syndrome’ now unhelpfully elides or oversimplifies a complex history. I thus question its continued utility as a critique of cultural racism within liberal or modernization discourses in the wider contemporary regional context.