A killer disease is lurking: it attacks the lungs, little is known how it spreads and there's no cure. Health experts discover it's an airborne disease and they create a vaccine to curtail its deadly rampage.
While it sounds eerily familiar, the illness striking down workers around the world at the end of the 19th century wasn't coronavirus, it was tuberculosis (TB).
Desperate to stop its spread, town planners and public health professionals around the world formed an unlikely alliance to rethink housing and street design and create a healthier environment for residents, design expert Julie Collins says.
Dr Collins, who has studied how Adelaide dealt with TB, says these planners began contributing to public health discussions about how to control the disease after they noticed links between people and their housing conditions.
Supplied: Architecture Museum, UniSA
)"[TB] was actually the main cause of mortality," Dr Collins tells ABC RN's Sunday Extra.
"Tuberculosis, which is ... an airborne bacterial disease, was referred to as consumption because it consumed or wasted the body of the sufferers. [Symptoms included] coughing... chest pain, weakness, fever and weight loss."
Pulmonary tuberculosis mortality rates peaked in South Australia at 107 deaths per 100,000 people between 1885 and 1889.
So, can the lessons learnt from managing a deadly disease more than a century ago be applied to our current predicament? How do town planners consider our health when designing communities? And will the pandemic permanently change how we live?
Sick in cramped conditions
According to the city's health board in the 1880s, Adelaide was full of overcrowded cottages "unfit for habitation" and stank from "one end to the other".
Dr Collins, a research fellow and architectural historian at the Architecture Museum at the University of South Australia, says people with TB were initially shuttered off in dark, damp and dusty rooms, forced to breathe in the same foul air.
Then a shift in medical thinking revolutionised their treatment. Based on the theory that fresh air would aid blood circulation to the lungs and improve the sufferers' health, open-air treatment became the norm.
"This was a prescription of exposure to fresh air, good food, exercise, good hygiene and isolation," Dr Collins says.
As a result, tuberculosis sanatoriums with large gardens were built across the country.
Planners on a crusade
Dr Collins, who co-authored Consumption crusade: the influence of tuberculosis on the emergence of town planning in South Australia, 1890-1918, discovered town planners became "crusaders" against the disease.
The measures they implemented ranged from flattening the slums to creating outdoor areas for recreation.
Supplied: History Trust of South Australia
)She says town planners believed in the "science of design".
"They believed the design of spaces, from room interiors, buildings, streets and towns, could be reworked as therapeutic and preventatives instruments for public health," Dr Collins says.
The slums were replaced with new houses with better design principles, including windows that opened to improve ventilation, washable surfaces, damp proofing and more rooms for inhabitants.
The "sleep out", often a veranda enclosed with flywire, became a common way for people to sleep in the open air, while also creating an extra room in crowded homes and flats.
Supplied: Architecture Museum, UniSA
)The layout of cities, towns and suburbs also came under the microscope.
Dr Collins says planners set out to improve street layout by maximising air, light and space and minimising dust and dirt.
Later curbing, asphalt and tree planting were added to the streetscape.
"[Planners] understood that [these things] not only [helped] to cut down the dust but actually improved the environment in terms of the health and wellbeing generally of people."
Rates of infection fell dramatically after these interventions. These days medical experts believe most of Australia's 1,300 annual cases are acquired overseas.
Design in a post-COVID world
More than a century on from Adelaide's TB outbreak, the world is dealing with another deadly airborne disease, COVID-19.
Design expert Jason Byrne says modern-day urban planners regularly think about people's health when designing communities and until recently, many were exploring ideas to reduce obesity and depression rates.
But, with the COVID-19 pandemic showing little signs of easing, Professor Byrne, from the University of Tasmania, predicts density levels and the ability to access fresh air and nature will drive planning trends for housing, neighbourhoods and public transport for years to come.
ABC Radio Sydney: Amanda Hoh
)Just as those planners improved house design in the fight against TB, today's planners will prioritise improved ventilation in bedrooms and bathrooms, he says.
Yet the largest driver of change to the way we live comes from people who discovered during lockdowns that they want more from their neighbourhoods.
"[Many neighbourhoods] are simply not good enough. They're not attractive, they're not lively, they don't have the green space. [Residents] don't have access to healthcare ... or even nice cafes and restaurants," he says.
And so, influenced by the pandemic, a reimagining of our cities, suburbs and regional areas is underway.
Professor Byrne's predictions include a shift away from high-rise apartment towers in city centres to suburban low-rise apartment buildings or townhouses with access to backyards.
He also predicts more green space, common areas for casual interactions with plenty of space for social distancing, improved access to public transport from the suburbs and more employment opportunities nearby.
Meanwhile cycleways and dining in open-air parklets on the street, many of which sprung up during the pandemic to cater for social distancing, are likely to stay.
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But there will also be challenges ahead for both urban and regional areas after the widely reported exodus from cities post-COVID.
Cities will have to tackle an unexpected emerging transport issue. "We've seen paradoxically a drop off in public transport use across Australian cities ... and that's creating some real headaches for us in terms of rising levels of [traffic] congestion," he says.
He warns against "knee jerk reactions" in regional planning decisions as they deal with the thousands of city dwellers seeking relaxed lifestyles in places like the Sunshine and Gold coasts or Byron Bay.
"The challenges for planners [will be] how do we look into a crystal ball that's incredibly clouded and uncertain and how do we make calls that won't actually amplify problems in the future."
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2021-08-24 20:00:00Z
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