<p>In this article, we investigate the effects of drought on public health in the British Straits Settlements (Singapore, Malacca, Province Wellesley, and Penang) during the 1880s. In so doing, we make three core scholarly contributions. First, we add to a growing body of work on the British Straits Settlements that positions rainfall variability as a key feature of their nineteenth- and early-twentieth century histories. Here, we argue that the 1880s stand out as a period of heightened hydro-resilience in urban areas during a longer-term context in which the effects of drought have generally been understood to have become more deleterious over time. We also contrast this urban resilience during the 1880s with diametrically opposed conditions in rural areas. Second, we add to the history of colonial waterworks in the British Empire. We show how colonial capacities to supply and manage treated water to urban areas shifted dramatically over time, which left a significant imprint on public health, especially in Singapore. We attribute the rapidity of historical change in this context to urban population growth and the Straits Settlements’ secondary importance in the British Empire behind, for example, India and several settler colonies. These factors led to a quick deterioration of water supply and quality following ostensible gains during the 1880s. Finally, we add to the history of colonial medical science. Medical understandings of the relationships between drought and public health shifted over time between approaches that emphasised meteorological, racial, and infrastructural explanations. We show that they did so at least partly in response to shifting colonial capacities to manage the effects of drought on public health. In short, we position the supply and management of water as central to the British Straits Settlements’ social and medical histories in the late nineteenth century.</p>