Biology & Philosophy

, 33:37 | Cite as

The doctrine of specific etiology

  • Lauren N. RossEmail author


Modern medicine is often said to have originated with nineteenth century germ theory, which attributed diseases to bacterial contagions. The success of this theory is often associated with an underlying principle referred to as the “doctrine of specific etiology”. This doctrine refers to specificity at the level of disease causation or etiology. While the importance of this doctrine is frequently emphasized in the philosophical, historical, and medical literature, these sources lack a clear account of the types of specificity that it involves and why exactly they matter. This paper argues that nineteenth century germ theory involves two types of specificity at the level of etiology. One type receives significant attention in the literature, but its influence on modern medicine has been misunderstood. A second type is present in this model, but it has been completely overlooked in the extant literature. My analysis clarifies how these types of specificity led to a novel conception of etiology that continues to figure in medicine today.


Causation Biomedicine Biology Medicine Explanation 



I would like to thank Ken Schaffner, Maureen O’Malley, audiences at the Medical Humanities Colloquium at the University of California, Irvine, audiences at the Issues in Medical Epistemology Conference in Cologne, Germany, and two anonymous reviewers for helpful feedback on this paper.


  1. Agar M (1994) Recasting the “ethno” in “epidemiology”. Med Anthropol 16:391–403CrossRefGoogle Scholar
  2. Ahmed PI, Kolker A (1979) The role of indigenous medicine in WHO’s definition of health. In: Ahmed PI, Coelho GV (eds) Toward a new definition of health. Springer, Boston, pp 113–128CrossRefGoogle Scholar
  3. Aronowitz RA (1998) Making sense of illness: science, society, and disease. Cambridge University Press, CambridgeGoogle Scholar
  4. Blaxter M (1990) Health and lifestyles. Taylor and Francis, New YorkCrossRefGoogle Scholar
  5. Blaxter M (2010) Health, 2nd edn. Polity Press, CambridgeGoogle Scholar
  6. Broadbent A (2009) Causation and models of disease in epidemiology. Stud Hist Philos Biol Biomed Sci 40(4):302–311CrossRefGoogle Scholar
  7. Broadbent A (2013) New directions in the philosophy of science. Palgrave Macmilan, New YorkGoogle Scholar
  8. Calne DB (1989) Is “Parkinson’s disease” one disease? J Neurol Neurosurg Psychiatry 52(Suppl):18–21CrossRefGoogle Scholar
  9. Carter KC (1985) Koch’s postulates in relation to the work of Jacob Henle and Edwin Klebs. Med Hist 29(4):353–374CrossRefGoogle Scholar
  10. Carter KC (2003) The rise of causal concepts of disease. Ashgate Publishing Limited, New YorkGoogle Scholar
  11. Caspi A, Moffitt TE (2006) Gene–environment interactions in psychiatry: joining forces with neuroscience. Nat Rev Neurosci 7(7):583–590CrossRefGoogle Scholar
  12. Cockerham WC, Richey FJ (1997) Dictionary of medical sociology. Greenwood Press, WestportGoogle Scholar
  13. Detels R, Gulliford M, Abdool Karim Q, Chuan Tan C (eds) (2015) Oxford textbook of global public health, 6th edn. Oxford University Press, OxfordGoogle Scholar
  14. Downing R (2011) Biohealth: beyond medicalization imposing health. Pickwick Publications, EugeneGoogle Scholar
  15. Dubos R (1959) Mirage of health: utopias, progress, and biological change. Rutgers University Press, New BrunswickGoogle Scholar
  16. Dubos R (1965) Man adapting. Yale University Press, New HavenGoogle Scholar
  17. Egger G (2012) In search of a germ theory equivalent for chronic disease. Prev Chronic Dis. CrossRefGoogle Scholar
  18. Engel GL (1977) The need for a new medical model: a challenge for biomedicine. Science 196(4286):129–136CrossRefGoogle Scholar
  19. Harrison M (2013) Scurvy on sea and land: political economy and natural history, c. 1780–c. 1850. J Marit Res 15(1):7–25CrossRefGoogle Scholar
  20. Hernán MA, Taubman SL (2008) Does obesity shorten life? The importance of well-defined interventions to answer causal questions. Int J Obes 32:S8–S14CrossRefGoogle Scholar
  21. Hitchcock C (2018) Probabilistic causation. Accessed 5 May 2018
  22. Hull RT (1979) Why “genetic disease”? Genetic, counseling: facts, values, and norms. Alan R. Liss Inc., New YorkGoogle Scholar
  23. Hyman SE (2002) Neuroscience, genetics, and the future of psychiatric diagnosis. Psychopathology 35:139–144CrossRefGoogle Scholar
  24. Hyman SE (2010) The diagnosis of mental disorders: the problem of reification. Annu Rev Clin Psychol 6(1):155–179CrossRefGoogle Scholar
  25. Jablensky A (2005) Categories, dimensions and prototypes: critical issues for psychiatric classification. Psychopathology 38(4):201–205CrossRefGoogle Scholar
  26. Kendell R, Jablensky A (2003) Distinguishing between the validity and utility of psychiatric diagnoses. Am J Psychiatry 160(1):4–12CrossRefGoogle Scholar
  27. Kendler KS (2012) Levels of explanation in psychiatric and substance use disorders: implications for the development of an etiologically based nosology. Mol Psychiatry 17(1):11–21CrossRefGoogle Scholar
  28. Kendler KS, Zachar P (2008) The incredible insecurity of psychiatric nosology. In: Kendler KS, Parnas J (eds) Philosophical issues in psychiatry: explanation, phenomenology, and nosology. Johns Hopkins University Press, Baltimore, pp 368–382Google Scholar
  29. Kety SS (1974) From rationalization to reason. Am J Psychiatry 131(9):957–963CrossRefGoogle Scholar
  30. Kinzelbach A (2006) Infection, contagion, and public health in late medieval and early modern German imperial towns. J Hist Med 61(3):369–389Google Scholar
  31. Koch R (1876) The etiology of anthrax, founded on the course of development of the Bacillus anthracis. In: Carter KC (ed) Essays of Robert Koch. Praeger, Westport, pp 1–18Google Scholar
  32. Kunitz SJ (1987) Explanations and ideologies of mortality patterns. Popul Dev Rev 13:379–408CrossRefGoogle Scholar
  33. Lander L (1978) Defective medicine: risk, anger, and the malpractice crisis. Farrar, Straus & Giroux, New YorkGoogle Scholar
  34. Locker D (2003) Social determinants of health and disease. In: Scambler G (ed) Sociology as applied to medicine. Elsevier, pp 18–40Google Scholar
  35. Loomis D, Wing S (1990) Is molecular epidemiology a germ theory for the end of the twentieth century? Int J Epidemiol 19(1):1–3CrossRefGoogle Scholar
  36. Mackie JL (1965) Causes and conditions. Am Philos Q 2:245–264Google Scholar
  37. Meehl PE (1977) Specific etiology and other forms of strong influence: some quantitative meanings. J Med Philos 2(1):33–53CrossRefGoogle Scholar
  38. Mishler EG (1981) Social contexts of health, illness, and patient care. Cambridge University Press, MelbourneGoogle Scholar
  39. Murphy D (2006) Psychiatry in the scientific image. The MIT Press, Hong KongGoogle Scholar
  40. Nandipati S, Litvan I (2016) Environmental exposures and Parkinson’s disease. Int J Environ Res Public Health 13(9):881CrossRefGoogle Scholar
  41. Pritchard D (2015) Classification in psychiatry: From a symptom based to a cause based model? Psychiatria Danub 27(1):S7–S20Google Scholar
  42. Rosenberg CE (1992) Explaining epidemics. Cambridge University Press, New YorkCrossRefGoogle Scholar
  43. Ross LN, Woodward JF (2016) Koch’s postulates: an interventionist perspective. Stud Hist Philos Biol Biomed Sci 59:35–46CrossRefGoogle Scholar
  44. Rothman KJ (1976) Causes. Am J Epidemiol 104:587–592CrossRefGoogle Scholar
  45. Rothman KJ, Greenland S (2005) Causation and causal inference in epidemiology. Am J Public Health 95(Suppl):S144–S150CrossRefGoogle Scholar
  46. Rothstein WG (2003) Public health and the risk factor: a history of an uneven medical revolution. University of Rochester Press, New YorkGoogle Scholar
  47. Schaffner KF (2012) A philosophical overview of the problems of validity for psychiatric disorders. In: Kendler K, Parnas J (eds) Philosophical issues in psychiatry II. Oxford University Press, Oxford, pp 169–189CrossRefGoogle Scholar
  48. Smith GD (2002) Commentary: behind the broad street pump: aetiology, epidemiology and prevention of cholera in mid-19th century Britain. Int J Epidemiol 31(5):920–932CrossRefGoogle Scholar
  49. Smith KC (2007) Towards an adequate account of genetic disease. In: Kincaid H, McKitrick J (eds) Establishing medical reality. Springer, DordrechtGoogle Scholar
  50. Spirtes P, Glymour C, Scheines R (2000) Causation, prediction, and search, 2nd edn. Massachusetts Institute of Technology, CambridgeGoogle Scholar
  51. Stehbens WE (1992) Causality in medical science with particular reference to heart disease and atherosclerosis. Perspect Biol Med 36:97–119CrossRefGoogle Scholar
  52. Stephenson PH (1985) Gender, aging, and mortality in hutterite society: a critique of the doctrine of specific etiology. Med Anthropol 9(4):355–363CrossRefGoogle Scholar
  53. Stewart GT (1968) Limitations of the germ theory. Lancet 291(7551):1077–1081CrossRefGoogle Scholar
  54. Suls J, Wallston KA (2003) Social psycholoigcal foundations of health and illness. Blackwell Publishing Ltd, OxfordCrossRefGoogle Scholar
  55. Susser M (1973) Causal thinking in the health sciences: concepts and strategies of epidemiology. Oxford University Press, OxfordGoogle Scholar
  56. Tesh SN (1988) Hidden arguments: political ideology and disease prevention policy. Rutgers University Press, New BrunswickGoogle Scholar
  57. Weber GF (1999) Final common pathways in neurodegenerative diseases: regulatory role of the glutathione cycle. Neurosci Biobehav Rev 23(8):1079–1089CrossRefGoogle Scholar
  58. Woodward J (2003) Making things happen. Oxford University Press, OxfordGoogle Scholar
  59. Woodward J (2016) The problem of variable choice. Synthese 193(4):1047–1072CrossRefGoogle Scholar
  60. Wullf HR, Gotzsche PC (2000) Rational diagnosis and treatment, 3rd edn. Blackwell Science, HobokenGoogle Scholar
  61. Zachar P (2014) Beyond natural kinds: toward a “relevant” “scientific” taxonomy in psychiatry. In: Kincaid H, Sullivan J (eds) Classifying psychopathology: mental kinds and natural kinds. The MIT Press, Cambridge, pp 75–104Google Scholar

Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  1. 1.Department of Logic and Philosophy of ScienceUniversity of CaliforniaIrvineUSA

Personalised recommendations