When life was short and unhealthy . . .

Children under the age of five accounted for more than half of all deaths, although if you managed to survive until you were five, you had a much better chance of living until you were about 40.

Even so, taking all the figures into consideration, tradesmen lived on average only until they were 27, while for 'operatives' (mechanics, servants and labourers) it was only 19.

It makes depressing reading (and makes us thankful that we weren't around in those days!) but it was no wonder when you think of the living conditions.

Many families lived in hovels or were crammed into cellars, food was bad, water contaminated, and sewage was simply put outside or into the River Croal in the hope that it would wash away.

One Boltonian John Entwistle, in 1848 wrote to the Mayor reporting that in Gaffers Ginnel, a back street between Deansgate and Bridge Street, he had seen 70 residents of one building living in squalor beside a tobacco factory and a cesspool. More than one in five deaths, he said, resulted from epidemic infections 'encouraged by the lack of space, sun, nutrition and hygiene'. Serious epidemics of typhus fever in 1847 and cholera in 1848 aroused the consciences of those in charge, and the prime necessity was seen to be an ample supply of pure water. So a big programme of expansion was started, with the building of the Wayoh, Turton, Entwistle, Heaton and Rumworth reservoirs. At the same time the first public baths were opened.

This helped, of course, but didn't solve the problems. By 1873, when Bolton produced its first report on public health, the population had increased to about 90,000, but the overcrowding was just as bad, and the likelihood of death in infancy just as great. The average age of death for all classes in the town was 22, and in some central areas, only 18. Male cotton spinners were so stunted in growth, that a random 100 of them averaged less than 5ft. 5in. in height.

The main killer was infection, with the most deadly diseases being smallpox, measles, scarlet fever, whooping cough, typhus, typhoid, cholera, and 'diarrhoea' (it would now be called gastro-enteritis).

Dr Livy, the Medical Officer of Health in those days, suggested that if the working folk of Bolton were crude, passive and corrupt, then that could be attributed to the filth in which they were expected to live.

But epidemics and contagious diseases were not the only problem. Heavy drinking of spirits was a common pastime for adults and children, and liver cirrhosis was not unknown to occur before puberty. Even worse, youngsters frequently died of convulsions brought on, it seemed, by parents who administered gin and opiates in the form of cordials to their children.

But I transgress (in other words, it's time I got back to the diseases . . . ) Nowadays, of course, most of these illnesses, if not eradicated, are well under control, and Dr Robert Aston, the Wigan and Bolton Health Authority Consultant in Communicable Disease Control, is full of praise for those in the Victorian era who began the fight against these diseases, mainly by improving living and social conditions.

Oh yes, things got better, and have been helped since by mass immunisation; something, about which Dr Aston is passionate. He says that since 1994 there have not been any cases of mumps locally, only one recently of measles (and that was 'imported' from another country where the immunisation has not been taken up as widely as here); a few years ago there was also a number of cases of German measles. And how often these days do you hear of whooping cough, or diphtheria, in Bolton? (He is quick to mention, though, that even in 1919, more young people worldwide died from an influenza epidemic than had been killed in the whole of the first world war.)

I remember when I was young -- yes, all right, you've no need to remind me, it was a long time ago, in the 1940s and 1950s! -- the two most feared diseases seemed to be polio and tuberculosis. I am sure, like me, many of you recall the 'iron lungs' into which polio sufferers were put, sometimes for months on end, to help them breath while hopefully the muscle wasting disease improved. As Dr Aston says: "Thousands of patients went into iron lungs, and many of those thousands died." So frightening was it, that when vaccinations were offered, people would queue in the streets for their jabs.

And, of course, there were the isolation hospitals for TB sufferers -- locally such as Hulton Lane, Wilkinson's Sanatorium, Fishpool (the old part of what is now the Royal Bolton Hospital), and others, where patients were often put outside in their beds for the 'fresh air treatment', and very little visiting was allowed by families, sometimes for months on end, in case they also caught it.

Thankfully, polio is now eradicated from this country (although not worldwide). TB also had almost disappeared, although in Bolton it now stands several times above the national average. Studies show this is mainly confined to the ethnic minority, and that there is no evidence of transmission to the indigenous population, where figures have remained lower than the national average.

But just to show how bad TB used to be among the indigenous population, Dr Aston points out that if the 1900 rate of TB still applied in Bolton, there would be 1,000 deaths a year from it in the town. Which only proves what massive steps to improve health there have been.

Dr Aston is firm in his beliefs that much of the good work was carried out in the Victorian years by doctors and others fighting to improve conditions; but this was continued by the immunisation programmes which have gone on in the last five or so decades.

He warns, though, that sometimes complacency does set in, immunisation is dropped, and the diseases reappear. At least, though, the medical authorities now know how to deal with these situations, which is more than can be said for much of the Victoria years!