The disease of saints

Warning - some of this has turned out to be a bit gory. If you dislike stuff about diseases, this might be the post you want to skip ... There will be a less gruesome one about St Gabriel's Shrine, soon-ish :-)

I had never heard this expression used until yesterday, when Fr Bob Coward CP, who lives and works in Rome, used the phrase to describe tuberculosis (TB) or, as it was once known, 'consumption'. He was speaking in relation to the deaths of St Gabriel Possenti (right) and St Gemma Galgani (below, left). St Gemma definitely did have tuberculosis - of the spine - and St Gabriel is thought to have had it, as the symptoms of his long illness match the disease.

It was known as the disease of saints because so many religious, priests, nuns and brothers belonging to religious orders, contracted the disease and died. The chances of cathcing TB, and passing it on to others was high ... especially as they lived mostly in community, sharing dormitory bedrooms and common dining areas ... just the sorts of places for a sneeze or cough to spread the bacteria which causes TB, to an unknowing group of new hosts.

This horrible illness has a long and morbid history, and it is sad to think that some of the things which bring the past to life so vividly and solidly for us - such as the crumbling ancient walls a metre thick, the marble floors and the tiny slit windows with their iron shuttering, the huge dormitory bedrooms with their vaulted ceilings and pitched windows - were the very things which helped tuberculosis to establish a hold on its victims, and made it almost impossible to eradicate until the advent of modern, scientific medicine and techniques.

Even sadder is that TB continues to be a major killer today, when we know not only what causes it, but how to cure it. In fact, one third of the world's population is currently estimated to have TB!! That's THIRTY per cent. That's a lot of people. Wow. And almost two million per year die as a direct result of TB. That's the ones who are known about and 'official', of course. And I bet we can all guess where most of them live. yep, that's right ... not in Vaucluse. Or Blacktown for that matter.

The World Health Organisation (WHO) says TB is 'a contagious disease' which, 'like the common cold' is spread through the air. Their web site, at http://tinyurl.com/rsxbt goes on to say: "only people who are sick with TB in their lungs are infectious. When infectious people cough, sneeze, talk or spit, they propel TB germs, known as bacilli, into the air. A person needs only to inhale a small number of these to be infected.

"Left untreated, each person with active TB disease will infect on average between 10 and 15 people every year. However, people infected with TB bacilli will not necessarily become sick with the disease. The immune system 'walls off' the TB bacilli which, protected by a thick waxy coat, can lie dormant for years. When someone's immune system is weakened, the chances of becoming sick are greater."

More men than women are likely to die from TB, but nevertheless, almost a million women die of TB every year. According to WHO: "In most of the world, more men than women are diagnosed with tuberculosis (TB) and die from it. TB is nevertheless a leading infectious cause of death among women. Annually, about three-quarters of a million women die of TB, and over three million contract the disease, accounting for about 17 million Disability Adjusted Life Years (DALY). As tuberculosis affects women mainly in their economically and reproductively active years, the impact of the disease is also strongly felt by their children and families. The mortality, incidence, and DALY indicators do not reflect this hidden burden of social impact."

Come to think of it, re-reading that sentence is a little chilling. More men than women are diagnosed with TB and die from it. Maybe that's because the primary bread winner is going to get the medical attention? The guys go to the doctor but the women don't? Whichever way you look at it, some of these women are going to be getting a raw deal, and quite possibly an under-reported one, too.

For example, according to WHO: "Some studies indicate that women may have higher rates of progression from infection to disease and a higher case fatality in their early reproductive ages ..." Naturally, the scientists will make their own decisions, but to me there's just a suggestion here of 'too little, too late' as far as medical treatment.

Of course, for both men and women in the poorer parts of our world, too little too late is probably a fairly standard verdict about many deaths from diseases which are like a bad cold for those of us living in the richer countries.

WHO even have a 'Stop TB Day' which is on 24th March each year, which you can find out about here: http://tinyurl.com/nljam

Although tuberculosis has a recorded history that stretches back into antiquity - Hipocrates wrote of a disease he called "phthisis" (a Greek work meaning consumption) as "the most most prevalent disease of the times" in 460 BCE, according to a team of Microbiology students at Goshen University ( http://tinyurl.com/qsbp5 ) - a reliable cure was only finally developed in 1943, when Selman A. Waksman developed the antibiotic streptomycin. Using a body of knowledge built up over centuries, Waksman developed streptomycin and first used it on a human in 1944 with impressive results.

TB is a tricky little so and so, though, and resistant strains promptly developed. Fortunately, the world's chemists were onto it at that point and, the Goshen Uni team say, so did a swag of new anti-TB drugs which countered the resistant disease. Combination drugs are still in use today for the same purpose.

Unfortunately, as the (US) National Institute of Health points out, the treatment regimen, although fairly 'easy' in the sense of taking certain drug combinations for a set time, is also hard because the set time is quite long, up to a year. Many people go for treatment, take the pills until the first prescription - or their money - runs out, and reappear months later with the disease further advanced and resistant to the previous drug combination.

In Australia, most of us have probably forgotten all about the TB X-ray vans that were a common sight on our streets when I was a teenager. And, public spitting no longer creates the same sort of antagonism it once did, at a time when people were often sent away for 'cures' to break a cycle of recurrent consumptive episodes. (For the sake of vanity however, I feel the need to point out that it was not THAT long ago!)

In an ironic twist for Saint Gabriel, and other young religious like him, a popular 'cure' for TB during his lifetime was for the patient to be sent to a retreat or 'sanitarium' in a mountain region, where lots of rest, gentle exercise, good food and clean mountain air was thought to cure the disease. It seems almost certain that, because TB preys on people who are already not well, through disease or poor nutrition and general ill health, a mountain sanitorium probably DID help many people break the cycle of disease and apparently recover.

And, if they didn't, at least they were not being prescribed 'cures' which the US National Institute of Health reminds us were tried in the past:

"Attempts at cures were varied, but uniformly ineffective. Roman physicians recommended bathing in human urine, eating wolf livers, and drinking elephant blood. Fresh milk—human, goat, or camel—figured in many treatment regimens. Depending upon the time and country in which they lived, patients were exhorted to rest or to exercise, to eat or to abstain from food, to travel to the mountains or to live underground. And yet, tuberculosis continued to claim victims by the millions." http://tinyurl.com/p8fhu

(Probably because they were so miserable from being bathed in urine, force fed wolf liver - come on, what is THAT going to taste like - drinking milk and camel blood and living underground. Many of us would want to die too, with or without TB. I know I would. Just a thought.)

At the same time operas, poems and books were being written which romanticised consumption as a disease of poets such as Keats, and the beautiful young, such as Camille and La Boheme, TB continued to wreak its way across the world, killing people in its very UN-glamorous way ... "the emaciation is frightful and the most mournful change is witnessed...the cheeks are hollow…rendering the expression harsh and painful. The eyes are commonly sunken in their sockets...and often look morbidly bright and staring. "At this point, throat ulcers made eating difficult and speech was limited to a hoarse whisper. Once the distinctive "graveyard cough" began, diagnosis was certain and death inevitable. Rarely, wrote Dr. Sweetser, "life, wasted to the most feeble spark, goes out almost insensibly." More typically, severe stomach cramps, excessive sweating, a choking sensation and vomiting of blood preceded the victim's demise."

Unfortunately for young people such as St Gabriel, tuberculosis was rife - and incurable - during his lifetime. One can easily imagine that in that past era, when life was much tougher and more difficult in Italy than it is now, a few months or years in a cold, damp monastery or convent, with conditions and work that to our modern standards seem impossibly harsh, a young person who may not have been very strong to start with or whose system had been weakened, would easily succumb to the disease.

Those beautiful stone walls, a metre thick and embellished with the handiwork of gifted masons throughout the ages, look so romantic as we walk past them on our guided tours, but in reality would hold in the cold and damp all winter long, during snow, frost and melt. Dressed only in a woollen robe and coat, with a pair of leather sandals and perhaps a hat, the young novices shivering in their dormitory rooms were already be somewhat better off than many of their era - they had made it through the dangerous years of childhood, when so many died.

In fact, at the time St Gabriel was born, peasants in central Italy had a life expectancy of 35 years ( http://tinyurl.com/z8ppj ). I don't know about you, but I cannot imagine the effect the knowledge that you would probably live only about three and a half decades, would have on an individual person, let alone how it would affect the society and culture that developed around these people and their lives. It must change one's expectations, and the expectations one has of those around them.

St Gabriel knew, of course. He was the eleventh of 13 siblings. Three of those children died during infancy, and so did his mother. And his father had a fairly decent job, a legal assessor, so he probably was fairly comfortable by the standards of the time. Comfortable enough anyway to send the kids to school instead of to work, and for young Gabriel to enjoy dancing and hunting and going to the theatre.

But he had already had two long-ish, dangerous illnesses by the time he became a Passionist religious, both of which he had come through thanks to his prayers to god and devotion to the Sorrowful Mother.

And so he joins the Passionists and he goes to the very beautiful Passionist Retreat House at Gran Sasso in the Pyrenees mountains, in the Italian state of Abbruzzo. This is an ancient medieaval monastery building, dating from the 1300s, which had previously been the home of Franciscan monks, who have left behind many ancient frescoes and decorations, as well as building which exhbits the fine design elements for which the Italian nation is justifiably renowned. The monastery sits on a level part of the land, with the majestic Gran Sasso (Big Rock) mountain towering above it. This extraordinarily beautiful setting is reflected in the beauty of the interior of the church and the monastery. It is simply breath taking, inside, and out.

That is, on a fine sunny day, when the afternoon is mild and the air feels fresh and wonderfully cool, not icy and blowing sleet against walls already damp and cold, with perhaps not quite enough wood for a fire and nor quite enough to eat because the winter has been a long one, and certainly no time for bed rest because there is work to be done so the community as a whole can get through the winter. Add to that a routine of deliberate hardships (this is in our terms, of course, to the people then it was probably no worse than digging potatoes, or having to carry water) that was practiced as an aid to religious devotion, and it is easy to understand how TB set upon St Gabriel, and killed him.

What is hard to grasp is how he remained cheerful in the face of it, how he remained focussed in those things that were important to him - his religious devotions and his love of the Sorrowful Mother.

(No, I didn't take the photos in this entry. Find these and other illustrations at: http://www.stgemma.com/index.html and http://tinyurl.com/p88xm.)

It's hard to grasp, or even explain because that's the point at which belief and faith come into it. St Gabriel didn't really care, I don't think, that he would die. To him, THAT wasn't the important bit of the story. Which is a conversation for another blog entry.

In the meanwhile, TB continues to sweep away a million boys like St Gabriel and a million girls like St Gemma every year.