Oliver Plunkett joins some of the many pilgrims to Lourdes

Nestling in the foothills of the Pyrenees in southern France, Lourdes has enjoyed international recognition since a local peasant girl, Bernadette Soubirous, witnessed the Marian apparitions in 1858. The Virgin Mary appeared to Bernadette at the Grotto of Massabielle by the river Gave and requested that a church should be built on the rock over the grotto. Today its sanctuary stands over the alcove in which Mary appeared. Beneath it, the spring welling up from the floor at the back of the grotto has become central to the beliefs and activities of pilgrims from the Catholic church who come to wash themselves in its waters, just as Mary told Bernadette to do.

Pilgrimages
Each season, pilgrimages organised by the Catholic Church and charities arrive in Lourdes. Numbering over 70 000 sick and disabled a year, pilgrims come to seek a miracle or a cure for their illnesses. I joined a pilgrimage as a guest of Father Péadar Murney, who led his parish of Johnstown in the 50th Dublin Diocesan pilgrimage in 1999.

We filled three jumbo jets with seven doctors, hundreds of volunteers and pilgrims, and one and a half tons of supplies and equipment. Prior medical vetting of pilgrims excluded those with alcohol or drug dependencies, difficult psychiatric problems, and those unable to manage without intensive hospital support. Patients who did not need continual medical care can attend, including those who were terminally ill, disabled, or with reduced mobility.

Medical staff base their support in the hostels Accueil Marie St Frai and Accueil Notre-Dame, which accommodate sick and handicapped pilgrims from all over the world. In the event of an acute decline in a pilgrim's condition beyond the capabilities of the pilgrims' doctors, the nearby hospital Hospice Bernadette is alerted and local doctors whisk them away to stabilise their condition. Language barriers between teams are rare as many local doctors are multilingual.

Volunteers supervise and escort sick pilgrims during the religious services around the esplanade, grotto, and baths in wheelchairs or hooded "voitures," allowing them to take part in the processions and ceremonies which are the essence of the spiritualism of Lourdes.

Thousands of young or professional adults volunteer to work in the Hospitalite De Notre-Dame De Lourdes for a time. "Brancardiers" are volunteers who wear symbolic shoulder braces, who lead the crowds of pilgrims about the area, preserving public order.

Cures and miracles
Near the busy medical bureau is a fascinating photographic display of pilgrims who have been cured, with notes about their conditions. This is open to the public. A lot of faith lies behind a cure but how do you demystify the beliefs surrounding Lourdes? Current medical opinion is hugely important in helping to define a miraculous cure, requiring an alliance between science and the church.

A miracle is "an extraordinary event, believed to be due to a benevolent divine intervention, to which is attributed a spiritual significance." Today, after intense medical and ecclesiastical refinement, the recognition of a cure or miracle requires four stages.

Submission to an examination by the medical bureau of Lourdes
When a pilgrim claims a cure he or she is examined by the pilgrimage doctor before being referred to the doctors at the medical bureau, which was established in 1947. This body is responsible for the first level of assessment when validating a cure. The pilgrim, along with their case notes, is examined by the presiding doctors, all witnessed by the rector of the sanctuary and the pilgrim's priest.

The medical criteria for a cure must be satisfied.

• The illness has been authenticated and the diagnosis is correct.
• The prognosis of the disease must be clear cut, including those regarded as permanent or terminal in the near future.
• The cure is immediate, without convalescence, complete, definitive, and lasting.
• The prescribed treatment could not be contributed to the cause of the cure or an aid to it.

When a cure is confirmed, collegial assessment requires the pilgrim to meet with the medical bureau over a further three years. If the majority of doctors wish, the file of the cured pilgrim will be sent to the Lourdes International Medical Committee (CMIL), which was established in 1954.

Submission to an examination by the international committee
The international medical committee assesses the cures over 10 to 15 years and observes the patient's development. It certifies medically any proposed file, so constituting the final judicial process. After a positive decision, the file of the cure is sent to the church authorities.

Convening of the Diocesan Canonical Commission
The duty of pronouncing a cure as a miracle rests with the bishop of the diocese of the person who has been cured. The Diocesan Canonical Commission of priests, canons, theologians, and doctors is called together and when its conclusions are positive the bishop asks the diocese to recognise the cure as a "sign of God," a miracle.

Faith or pharmacy?
It is interesting to compare the number of cures recognised before and after the establishment of the medical bureau in 1947. The ratio of cures to sick pilgrims before 1914 was 1:100. From 1914 to 1928 it was 1:700, but from 1928 to 1947 it was 1:1600. In all, 5000 cures were claimed before 1947. From 1947 to 1990, only 1000 cures were claimed and only 56 were recognised in that time, averaging 1.3 cures a year, against 57 a year before 1914.

It can be inferred from this that medicine has transformed society and the faithful sick no longer came to Lourdes for a cure but rely on medicine. Since the 1960s we have seen a consistent decline in the number of possible cures claimed. The doctors working in the medical bureau have presented philosophical problems in serving both science and the church. As we make progress in medical knowledge, the area of the medically inexplicable grows smaller and deciding that treatments did not play a part in a cure is more difficult. Medical progress has, in a way, threatened the church for which miraculous healings were supreme in the worldly manifestation of faith.

But perhaps there is something beyond our own understanding going on. Since its foundation, the international medical committee has examined 1300 files and presented 29 to the church, which recognised 19 as miracles. Since 1858, the church has declared 66 miracles at Lourdes.

The most recent miracle acclaimed was that of Jean-Pierre Bely, a Frenchman with a 15 year history of multiple sclerosis. At the age of 51 he was cured in October 1987 and authenticated as a miracle in February 1999.

Other recent miracles include Delizia Cirolli, from Italy, who was cured of Ewing's sarcoma aged 12 in December 1976 and whose case was authenticated in June 1989. The Frenchman Serge Perrin had his cerebral vascular insufficiency cured in May 1970, when he was 41. His case was authenticated in June 1978. Vittorio Micheli, also of Italy, saw an entire remittance of his pelvic osteosarcoma at the age of 23 in June 1963; this was authenticated in May 1976.

Further information

www.lourdes.com

Theillier P. The vocation of the medical bureau. Journal of the International Medical Association of Lourdes 1998; Numero Special: 1-45.