ate last year, Italy’s Lega Nord proposed abolishing a decade-old law that prohibited doctors from reporting illegal immigrants in their care. Amended legislation designed by the Lega called on National Health Service physicians, who are also public officials, to report patients who were in the country illegally.
When news media announced the proposal (which was also approved by the Senate), some immigrants panicked and many native Italians worried that extracommunitari suffering from contagious diseases would avoid treatment and infect the larger population. The biggest threat was tuberculosis, a contagious lung infection that can be lethal if untreated.
By the time German bacteriologist Robert Koch identified the tubercle bacillus in 1882, the spread of TB had reached epidemic proportions. Though the the advent of antibiotics in the mid-20th century all but extinguished it, TB has made a significant comeback over the last two decades, with the World Health Organization monitoring it carefully. Its Western resurgence is due in part to the HIV virus, an increase in unvaccinated migrants and resistance to anti-TB drugs.
My friend Paul contracted tuberculosis as 12-year-old boy in England. It was diagnosed during a routine school checkup. He probably caught it on a public bus.
Paul was sent to a sanatorium in the northern hill country. Most sanatoriums were built far from cities. Before antibiotics, a patient’s only hope was to rest, eat well and breathe the clean air of higher altitudes.
Every day, Paul’s mother made the two-hour bus trip to visit him. On weekends, she came in the car with his father. Paul recalls a sense of doom. His mother’s brother died of tuberculosis. Seeing caskets leave the hospital didn’t help.
Most patients stayed in wards of 20 or 30 beds but Paul, an only child, lived in a glass cubicle under constant observation. His school friends were not allowed to visit, nor could he receive books, toys or anything else from the outside world.
Every morning he had a shot. Three times a day he had to swallow a streptomycin tablet large as a stack of euro coins and enclosed in a lidded, rice paper box. The whole thing had to be dipped in water until slimy and then gulped down before the horrible, bitter powder got out.
Every few weeks there were X-rays. Sometimes the doctor would slide a long rubber tube down his throat to extract sputum from his lungs. These tests continued every few months until he received an all-clear at age fifteen.
The first week in the sanatorium, Paul gained seven pounds. Three weeks later he was allowed to leave his cubicle and walk down the men’s hallway. He played board games and cards with fellow patients and with motherly nurses who set him to work copying written material, passing out tea and carrying messages for bed-ridden patients. He learned basket weaving and leatherwork from an occupational therapist. Another patient, a man in his late twenties, taught him card tricks and marquetry, whereby images are created from thin wood veneers. Using a template, Paul made a Mediterranean scene for his mother’s birthday.
Paul describes long hours spent in his cubicle, listening to music and stories on the radio and watching the lawns and woods, outside his glass wall. After eight weeks, he was allowed to walk outside, first for one hour, then two, then three. In the beginning, he had trouble maintaining his balance.
Three months after his admission, Paul returned home. When he went back to school in September, he found that his illness had changed him. I imagine a child version of the adult Paul I know — reserved, thoughtful, sensitive to others. Not a pushover. After his illness, he said he no longer feared the Catholic brothers — his teachers —who had beaten him and terrorized him with threats of hellfire. He didn’t believe in it anymore. He stood up to them and they backed off.
Paul eventually married an Italian woman and moved to Italy, where he taught at a state university. He began writing a book about St. Augustine. Although an atheist, Paul was drawn to Augustine’s concept of predestination. He said the feeling of finality, first experienced as a tubercular child, had accompanied him all his life, especially during his final illness. Paul had a brain tumor. He was fascinated by Augustine’s struggle to understand consciousness and its relation to time, memory and language.
In April, shortly after Paul’s death, the Lega proposal was dropped, allowing all tuberculosis sufferers, including illegal immigrants, to seek help without fear. Call it Paul’s amendment.