Why do tuberculous patients reactivate.

A review of the literature reveals uniform acceptance of the fact that a relatively large percentage of tuberculosis patients reactivate regardless of extent of disease,8’ 14, 19 type of treatment whether bedrest,’” collapse therapy,9 long1’ or short term chemotherapy or resection.’8 Further, it is accepted that the rate of relapse is usually in proportion to the extent of disease and the amount of physical activity carried on after discharge12 and is inversely proportionate to the period of hospitalization, with relapse occurring more commonly in men1’ and most relapses occurring within the first three years after discharge. In an article regarding relapse in pulmonary tuberculosis published in 1928, Doctor H. Longstreet Taylor20 stated that “all apparent relapses are not true relapses, but are evidence of the inherent chronicity of the disease in cases that have apparently improved for a time, but in which the diseased areas have neither healed by resolution nor been encapsulated by the slow process of connective-tissue hyperplasia, and after an uncertain interval, in which no change has been apparent, tubercle has once more begun to spread. . . . Premature discharge of the patient is but an invitation for trouble, since the length of treatment bears an inverse relationship to the percentage of relapses. Relapses are due to attacks of intercurrent disease, serious accidents, childbearing and lactation, to disobedience of the rules in regard to proper methods of work and play, to mental or physical fatigue, to a return to an unhygienic environment, and to many other devious wanderings from the straight and narrow way.” . . . I disagree with this attitude which conveniently places responsibility for the relapse on the patient’s shoulders and absolves the physician from all blame.