Place the pathophysiologic process of a tuberculosis (tb) infection in the correct order.

The clinical manifestations of tuberculosis represent a complex interaction between the causative organism, Mycobacterium tuberculosis, and the human host immune response. Although the disease of consumption was recognized many centuries ago, the modern understanding of what has remained one of the world's great public health problems is usually traced to the work of Robert Koch. Koch assuredly deserves his status as one of the great founding figures of medicine and microbiology, although at least two other individuals made major contributions during the “pre-history” that led to Koch's discovery. One of these men is familiar to most students of medical history; the other is not.

The author is grateful for the helpful comments of Rany Condos, Joseph Burzynski, and Charles Powell. Excellent discussions of the early scientists who studied tuberculosis can be found in Pioneers in Medicine and Their Impact on Tuberculosis, by Thomas M. Daniel (University of Rochester Press, 2000). Much of the discussion of Laennec, Villemin, and Koch in this article was informed by Daniel's essays. Finally, the most rudimentary Medline search for the term “tuberculosis pathogenesis” yields over 50,000 citations. The author apologizes to the scores of outstanding investigators whose important contributions were not mentioned in this article, either due to lack of space or his own ignorance in not realizing their significance.

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