[Infection or epidemic? On the problem of mono-causal thinking in medicine. The contribution of Adolf Gottstein...

Robert Koch (1843-1910) had by the end of the 1870 invented a definite and reproducible method of determine bacteria. During the first decades after the origin of bacteriology he and his disciples developed in practice a strictly monocausal theory: where there is a specific germ, only the specific disease occurs. The importance of Adolf Gottstein (1857-1941) must be viewed against this background. As a general practitioner Gottstein noticed that there are considerable differences between the single specific infection and its massive spread as an epidemic. As one of the first clinical epidemiologists he learnt how to verify his experience and presumptions by systematical, quantitative analyses. His epidemiologically founded publications were a key factor in the process of abandoning the monocausal theory of illness of the early period of the Koch era and giving way to a multicausal view. The dynamic aetiology of Gottstein was a major contribution to the development of social hygiene and public health care.