As the locus of modern life, urban planning is crucial in the prevention and reduction of both communicable and noncommunicable diseases. Architects and urban planners perform essential roles in creating healthier spaces for humans to live, work and play. Even with clear national guidelines, effective disease prevention and outbreak response and recovery depend on local government coordination and action.
Today, more than half of the world's population lives in urban areas, and the United Nations (U.N.) projects that by 2050, 66% of people will live in cities. When plague visited Bombay (present day Mumbai) at the beginning of the 20th century, only 10% of the global population was urban, and yet, between 1896 and 1914, the plague claimed 8 million lives on the Indian subcontinent, including nearly 184,000 in Bombay alone.
Eschewing the colonial Victorian and Gothic styles, the striking Bombay Deco architecture with characteristic large, deep-set, chajja-covered balconies and windows arose when Indian architects adapted the popular Art Deco style to suit the hot and humid climate, which required an influx of fresh air to cool residential interiors. Newly invented, reinforced concrete made organically flowing lines possible. The distinctive curvilinear forms and ornate exteriors addressed the unique needs and sensibilities of the Indian people. The epidemic response in Bombay shows how the built environment can be deliberately made into a healthier place for its residents.
1896: Plague Spreads in Bombay
The British called Bombay "Urbs Prima in Indus," the first city in India. At the end of the 19th century, Bombay was India's largest city and a major trading port. With industrialization, the number of people working in the mills and on the docks grew. They were often impoverished and lived in tenement housing, or "chawls." Landlords did not consider ventilation or light in the design of the densely populated buildings. Heavy monsoons and ineffective sewage systems meant that the city was often damp, and standing water was a perfect breeding ground for pathogenic microbes (and the rodent hosts carrying them) to spread from house to house. Recurring smallpox, diphtheria, cholera and other diseases were persistent problems because of these conditions.
The first case of the Bombay plague was diagnosed in September 1896 in Mandvi, an area close to the docks that is still home to warehouses, grain merchants and dense, crowded dwellings. The disease was suspected to have entered Bombay aboard the ship Mandarin from British Hong Kong where a plague outbreak had been raging since 1894. The huge economic impact from trade meant that ships, cargo, crewmembers and any microscopic stowaways, including Yersinia pestis, the causitive agent of plague, were given easy passage into the city.
Y. pestis, a gram-negative coccobacillus, persists anywhere people and animals live in close proximity to one another. Fleas carry the bacteria in their guts, infecting their hosts, often rodents, through their bites. The 2 main forms of plague are bubonic and pneumonic plague, with bubonic being the most common and pneumonic the most virulent. Since pneumonic plague develops in the lungs, it can be spread via respiratory droplets between humans.
Although this first case was bubonic plague, pneumonic plague was seen shortly after. Overcrowded living conditions and poor construction along the port encouraged rapid spread, and by the end of 1896, approximately 2,000 people were dying weekly.
Colonial Response
At the time plague was spreading in Bombay, colonial medical opinion attributed disease to miasmas ("bad air"), local poverty and filth. This class-based understanding of the spread of disease, combined with xenophobia, led local officials to blame outbreaks on the lifestyles and dwelling spaces of the Indian population.
To address the "diseased air," colonial authorities focused on disinfecting neighborhoods and buildings to control the spread. As seawater was believed to be capable of cleansing infected spaces, 3 million gallons of salt water were flushed daily through the drains and sewers of Bombay in an attempt to flush out disease. Unfortunately, these containment measures were largely ineffective as they did not address the role of rats and fleas in plague transmission.
In March 1897, the death toll in Bombay surpassed 33,000 people. Lord George Francis Hamilton, India's Secretary of State, pushed for stronger measures, hoping to quickly eliminate the disease. Other Indian officials, mindful of the lessons of the 1857-1859 Indian Mutiny-an ultimately unsuccessful uprising ignited by decades of grievances with the British East India Company's cultural, social and legal policies-warned that infringing upon the rights and customs of the Indian people would provoke civil unrest. However, Hamilton's draconian approach, the Epidemic Diseases Act, was put into action.
The act gave the government wide-ranging authority to tackle the outbreak and created a municipal plague committee led by Indian Army Medical Services officers. Authorities were given control over both the dwellings and bodies of Bombay's citizens. These powers were used disproportionately against the poor with little care for cultural or gender sensitivities. Movement restrictions interfered with religious pilgrimages and, heedless of cultural and religious objections, male British doctors examined female patients.
Teams of soldiers and volunteers forcibly entered victims' homes and burned furniture and personal belongings. Once a dwelling had been "sanitized," it was declared unfit for human habitation. The former residents were then carted away to plague hospitals or camps with enforced segregation and low recovery rates. Families hid victims fearing that they would be taken to these camps to die alone and without proper funerary rites. In response to these policies, a mass exodus ensued, and approximately 6 months after the first plague case was identified in the city, the population of Bombay had dropped 50%. Fleeing workers carried the plague inland with them in their bodies and on their belongings. It would take 20 years for the Indian subcontinent to finally be rid of the epidemic.
For those that stayed behind, mutual suspicion and distrust festered until, in early 1898, a large riot broke out after colonial authorities attempted to remove a young plague victim from her home in a predominately Muslim neighborhood. Resistance grew, and riots and strikes became more common.
Eventually, contemporary research led to a better understanding of the role of rats and fleas in spreading disease, and rodent control became a focus for anti-plague efforts. Additionally, extensive use of Waldemar Haffkine's plague vaccine contributed to lowering infection rates, and the colonial government developed a more cooperative method of controlling the spread.
1898: The Bombay Improvement Trust
Established in 1898, the goal of the Bombay Improvement Trust was to address systemic issues that were believed to have enabled the plague to spread, such as overcrowding, poorly constructed housing, ineffective or nonexistent sewage systems and damp, dark chawls that offered safe places for rodents to hide and multiply. The Trust members were responsible for remaking the city to address these issues, and many of current-day Mumbai's most recognizable features can be traced back to their policies.
The north-south Mohammedali Road and the east-west Princess Street and Sandhurst Road corridors were created to cross-ventilate the city and bring in fresh air from the sea to densely congested quarters. Homes were torn down, and drainage pipes and sewer lines were laid, displacing many people in the process. The Trust's original goals included rehoming the working classes ousted by these measures, but as the panic subsided, these efforts were largely left incomplete.
The physical character of Bombay was forever altered. Many Bombay Deco buildings in Mumbai, like those seen along the iconic Marine Drive, were built in accordance with the Trust's guidelines. Prominent architect Claude Batley compared the waterfront to an ill-fitting set of false teeth, because of the gaps and setbacks used between buildings to create a breeze and sense of space.
Sunlight and ample supplies of fresh air are crucial in humid climates like Bombay to help dry surfaces and limit opportunities for pathogens and rodents to thrive. To this end, apartment building designs included green spaces and cross ventilation to fight against infection. To allow improved light and airflow, anti-epidemic building regulations included the "63.5 degree light angle rule," which determined the allowable distance between 2 buildings based on a minimum angle of 63.5 degrees from the top of one building to the base of the next. Regulations were created for working class chawls. Tall windows that extended down to the base of the wall were required. This allowed for adequate light, as well as nocturnal ventilation, since many people slept on the floor.
The Trust reclaimed land from the sea to create affordable homes in the north and offered tracts of land to the south for wealthier citizens. Planned suburbs were created in former plague camps with sewage systems, roads, public transport and other civil amenities to create self-sufficient neighborhoods. This distribution of areas of economic and personal activities throughout the city makes opportunities locally available to more of the population. It also reduces the number of interactions between distant residents, and can inhibit the spread of pathogens among otherwise disparate groups.
The Plague of Bombay made the plight of the urban poor visible, shifting focus from solely upon working conditions to also include living conditions. Education around bodily hygiene became an important feature of social reform, in keeping with the new understanding of how diseases spread.
Building the Future
Out of the ashes of colonial control and a plague epidemic, Bombay was remade. The ability of Bombay to adapt and thrive after a devastating epidemic is a testament to the importance of the built environment in helping people to live healthier lives. Many of the actions of the Bombay Improvement Trust were controversial and imperfect. However, the people of the city ultimately transformed a crisis into something beautiful and unique.
By learning from and building upon the foundations of the past, we can design a healthier future. For example, modern building design should move beyond touchless solutions and antimicrobial surfaces and adapt available technology for improved airflow and filtration within commercial and residential buildings. A 2020 study in the journal Cities and Health warns that residents of affordable-housing complexes in Mumbai with little natural light or breeze are more likely to develop tuberculosis. Additionally, water supply and filtration systems should be thoughtfully implemented in building design to reduce the spread of pathogens.
Local officials are positioned to ensure enactment and compliance with public health and social policy measures-known as non-pharmaceutical interventions (NPIs)-to restrict transmission and reduce the burden of disease. NPIs include measures like hand hygiene, PPE use and ultraviolet lighting. The World Health Organization's comprehensive resource on urban planning and well-being includes many NPIs and covers areas including sanitation, injury prevention, biodiversity and resilience in alignment with healthy urban planning.
Strategic resource allocation and management can maximize benefit for greater numbers of people in the context of their living situations, and not all problems require a high-tech solution. Simply paving mud floors in homes can significantly reduce the spread of parasites, bacteria and viruses that can cause long-term health problems and even lead to cognitive development delays in children. Individual ventilation and filtration units can provide more cost-effective solutions in locations that may be resource limited.
The effects of climate change and emerging diseases will present new challenges to cities all over the world. To meet these challenges, city planners and architects will need to adapt and learn quickly. History has many lessons to teach us in our approach to building modern, healthy spaces. Sometimes the best way forward requires looking back.
Looking for what to read next? Learn about the role of urban microbiomes in public health in this next article.
