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Establishing Causality in Medicine and Koch’s Postulates

Donald Angus Gillies


This paper considers Koch’s Postulates for establishing causality, particularly in relation to his research on tuberculosis and cholera. In 1882, Koch showed that his claim regarding the tubercle bacillus satisfied all of his postulates, and this claim was then accepted by the medical community. However, he was not equally fortunate in his research on cholera. In 1884, he presented evidence in favor of the comma bacillus being the cause of cholera, but this evidence failed to satisfy one of his postulates; therefore, not all of the medical community was convinced with his research on cholera. Yet, when he presented more evidence for his views on cholera because of the Hamburg cholera epidemic of 1892, this view was finally accepted. This historical material suggests that Koch’s Postulates omit some types of evidence, which are important regarding causality. The postulates are, therefore, analyzed in light of some contemporary philosophical views of causality. Because of this analysis, a gap in Koch’s Postulates does indeed become apparent. It is shown that if the postulates are modified to fill this gap, they do then explain the acceptance of Koch’s views concerning cholera.

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