CREATIVE, RICH or powerful personalities of either gender have a sexual magnetism out of proportion to their appearance or charm. It applies to both sexes and, as women achieve equality, its unisexual nature becomes more obvious.
Even in the past Queen Elizabeth l was more attractive to men than would have been warranted by her appearance in contemporary portraits. If Queen Victoria hadn’t been a monarch, it is doubtful that she would have been so attractive to such personalities as Lord Melbourne and John Brown.
David Blunkett attracts Kimberly Fortier, a woman who is powerful in her own right. Similarly, George Sand, a previously married woman and author, had an affair with Chopin. George Sand fed the appetite of the scandal-loving masses of her time by cross-dressing and setting up house with the apparently rather feminine Chopin. The amour survived the composer’s petulance, but foundered on his cough and the worsening signs and symptoms of tuberculosis. Chopin, like the majority of people with pulmonary TB in the 19th and early 20th centuries, died from the disease. Chopin appealed to women. This appeal has been attributed to the allegedly aphrodisiac powers of TB, but is more likely to have been the result of his fame and talent.
TB may have been romanticised in the 19th century, but then, as now, death from TB was unglamorous and pitiable. The death rate from it had always been highest among the overcrowded masses who toiled in the cities of the Industrial Revolution. TB accounted for one in every four deaths in 1815.
TB is now returning. As in the 19th century it is associated with overcrowding, homelessness, poor diet, too much alcohol and the other hallmarks of poverty. HIV is becoming an additional and important risk factor for TB, especially antibiotic-resistant TB.
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It is no longer country people flooding into the industrial cities who are destined to become TB victims, but migrants to the West from the developing world. TB affects 100 in every 100,000 of those who come to the UK from the Indian subcontinent, and 200 in every 100,000 of those from Africa. In the overwhelming majority of patients TB is curable, but to achieve good results early diagnosis is necessary and strict adherence to the regime laid down by the doctors. Early diagnosis together with prevention and compliance with treatment are the essentials for the control of tuberculosis.
The early diagnosis of acute TB is dependent on the maintenance of a high degree of suspicion among doctors and patients. They should be looking for the same classic signs and symptoms of those in the 19th and early 20th centuries. A cough is still the most striking feature. The cough is usually productive with sputum and may be bloodstained. There is an inexplicable temperature, night sweats and the patient loses weight and is pale and tired. Any cough that persists after flu, or a cold, should be investigated.
We also need improved diagnosis of latent tuberculosis — the large number of people who have been in contact with TB but whose infection is undiagnosed because the symptoms are so slight, or non-existent. These so-called asymptomatic cases are infectious.
Latent TB is particularly prevalent in immigrants. If we are to control the increase of TB in the UK it is essential that these, and all the other people who are asymptomatic but have latent TB, are detected and treated.
Currently TB diagnostic programmes rely on tubercu- lin skin testing, but a more specific test is needed than the current Heaf skin test. Even if a patient has been inoculated 15 years earlier with BCG this may make it difficult to interpret the test. As a result skin testing leads to many false positives. So difficult is the interpretation of the test that the British Thoracic Society code of practice for the control of TB no longer recommends skin tests on BCG vaccinated adults exposed to TB.
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Recently, a team of doctors — led by Dr Ajit Lalvani, of the department of clinical medicine at the University of Oxford — from Leicester Health Authority and from Copenhagen designed a blood test to determine the presence of latent, but infectious, tuberculosis.
It is an enzyme-linked immuno spot test that detects specific T cells in the blood that reveal the presence of Mycobacterium TB antigens. These antigens are absent from those with bovine TB, who have had BCG or who have been infected by most of the other mycobacteria found in nature.
The test is known as the Elispot. It is a more accurate approach to detecting people who have latent TB than skin testing. The test was an accurate marker of Mycobacterium tuberculosis in 96 per cent of patients examined. It should lead to improved methods of controlling TB by discovering those people who have been exposed to TB and who, despite being asymptomatic, could be infectious.