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Theories of Disease
Causation
Dr. Parus Saleem Faiz
 Learning Objectives:
The participant will be able to define:

 Theories of Disease Causation.

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 Introduction
 Up-to the time of Louis Pasteur (1895-
1922), various Concepts of Disease
causation were in vogue.
 For Example: Old Theories
 The supernatural theory of disease.
 The Theory of Humors.
 The Concept of Contagion,
 Miasmatic Theory of Disease etc.
 Discoveries in microbiology marked a
turning point in our aetiological concepts.
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 Theories of Disease Causation
 Old theories
 Modern theories
 Germ theory
 Epidemiological triad
 Multifactorial Causation – Socioeconomic,
Cultural, Genetic & Psychological factors.
 Web of causation
 Wheel of causation

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THEORIES OF DISEASES CAUSATION
1. Supernatural Theory of Disease.
 Since the human knowledge was limited,
the Primitive Man attributed Disease and
all human sufferings due to:
 The anger of gods.
 The invasion of body by “evil spirits”.
 The malicious influence of stars &
planets.

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Continue……….
 At that time the medicine, humans practiced
consisted in:
 Appeasing gods by prayers, Rituals & Sacrifices.
 Driving out “evil spirits” from the Human body
by witchcraft & other crude means &
 Using Charms & Amulets to protect himself
against the influence of evil spirits.
 The administration of certain herbs or drugs.
 Prehistoric man used sharp instruments by
which he performed circumcisions &
amputation.
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 Continue……….

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 Witchcraft in Zimbabwe.

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 Amputation

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 2. Theory of Contagion
 Spreading of disease by being close
contact or touching other people.
 Example: Leprosy, Trachoma & Scabies,
STDs

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3. Miasmatic Theory of Disease Causation
 This theory says that diseases such as cholera or
Plague were caused by a noxious form of “Bad
air", also known as “Night air".
 This theory was accepted from ancient times in
Europe, India, and China.
 This theory was eventually replaced in the 20th
century by the discovery of Germ Theory Disease.

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 4. Germ Theory of Disease
 Proposed by Robert Koch and Louis Pasteur.
 Every human disease is caused by a
microorganisms or germs, which is specific
for that disease.

ROBERT KOCH LOUIS PASTEUR

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 4. Germ Theory of Disease
 Discoveries in microbiology marked in turning
point in aetiological concepts.
 Germ Theory gained momentum during the
19th & early 20th Century.
 This theory emphasized that the sole cause of
disease is microbes.
 The germ theory of Disease generally referred
to as one-to-one relationship between causal
agent and disease.
Disease agent Man Disease

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Continue……….
 The germ theory of disease, led many
epidemiologists to take one-sided view of disease
causation.
 They could not think beyond the germ theory of
disease.
 But now it is recognized that a disease is rarely
caused by a single agent alone, but rather
depends upon a number of factors which
contribute to its occurrence.
 Therefore, modern medicine has moved away
from the strict adherence to the germ theory of
disease.
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 5. Epidemiological Triad Concept
 The germ theory of disease has many
limitations.
 For example it is well – known that;
not all exposed to Tuberculosis bacilli
develops tuberculosis.
 Similarly not every one exposed to
bete-heamolytic streptococci develops
Acute Rheumatic Fever.

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Continue……….
 There are other factors relating to the host
& environment which are equally
important to determine whether disease
will occur in the exposed host or not.
 This demanded a broader concept of
Disease Causation that is:
 Agent,
 Host &
 Environment.

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 Epidemiological Triad

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 Epidemiological triad

Agent

Time

Host Environment

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Continue……….
 The above model Agent, Host &
Environment has been in use for many
years.
 It helped to focus on different classes of
factors, especially with regard to
Infectious Diseases.

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Continue……….
 This triangle is based on the
communicable disease model.
 It is useful in showing the interaction and
interdependence of agent, host,
environment, and time as used in the
investigation of diseases and epidemics.
 Agent is the cause of disease.
 Host is an organism, usually a human or
an animal, that harbors the disease.

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Continue……….
 The environment is those surrounding
conditions external to the human or
animal that cause or allow disease
transmission.
 Time accounts for incubation periods, life
expectancy of the host or the pathogen,
and duration of the course of illness or
condition.

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 Epidemiological triad
 Agents
 Biological
 Physical
 Chemical
 Mechanical
 Insufficiency or excess of factors, hormones,
nutrients, chromosomal factors &
immunological factors.

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Continue……….
 Agents of infectious diseases include
Bacteria, Viruses, Parasites & Fungi.
 With regard to non-infectious disease
(Non communicable disease), disability,
injury, or death, agents can include
chemicals, tobacco smoke, radiation or
heat, nutritional deficiencies, or other
substances, such as poison.
 One or several agents may contribute to
an illness.

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 Epidemiological triad
 Host
 Demographic
 Biological – Genetic, Biochemical,
Immunological.
 A host offers subsistence and lodging for a
pathogen and may or may not develop the
disease.
 The level of immunity, genetic makeup, level of
exposure, state of health, and overall fitness of
the host can determine the effect a disease
organism will have on it.
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 Epidemiological triad
 Environment
 Physical
 Biological
 Psychosocial
 The surroundings in which a pathogen
lives and the effect the surroundings have
on it are a part of the environment.
 Environment can be within a host or
external to it in the community.

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Continue……….
 Time includes severity of illness in relation
to how long a person is infected or until
the condition causes death or recovery.
 Delays in time; from infection to when
symptoms develop, duration of illness, and
threshold of an epidemic in a population
all; are time elements with which the
epidemiologist is concerned.

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Continue……….
 The primary mission of epidemiology is to
provide information that results in
breaking one of the legs of the triangle,
thereby disrupting the connection among
environment, host, and agent, and
stopping the outbreak.

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 6. MULTI-FACTORIAL ETIOLOGY
 The Germ theory of disease or Single cause
of disease is always not true.
 As a result of advancement in Public
Health, chemotherapy, antibiotics & vector
control communicable diseases began to
decline and are replaced by new type of
diseases the so-called “Modern Diseases of
Civilization”.
Ex. Coronary Heart Disease (CHD), Diabetes
Mellitus, Cancers, Mental Illnesses.

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Continue……….
 These diseases can not be explained only on
the basis of the germ theory of disease; nor
could they be prevented by the traditional
methods of Isolation, Immunization or
Improvements in sanitation.
 There are other factors in the aetiology of
disease like social, economic, cultural, genetic
& psychological are equally important.
 Mostly applied to non-communicable
diseases but can also be used to
communicable disease.

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Continue……….
 For Ex: T.B is not merely caused by tubercle
bacilli but poverty , overcrowding & malnutrition
are its contributing factors to its occurrence.
 For Ex: Coronary Heart Diseases are due to
multiple factors:
 Excess of fat intake.
 Smoking
 Lack of physical exercise
 Obesity
 Most of these factors are liked to Lifestyle &
Human Behavior.
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Continue……….
 Epidemiology has contributed significantly
to our present day understanding of
multifactorial causation of disease.
 Medical men are looking "beyond the "germ
theory" of disease into the total life
situation of the patient and the community
in search of multiple (or risk) factors of
disease.
 Behaviour, lifestyle factors, environmental
causes, ecologic elements, physical factors
and chronic diseases must be taken into
account.
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Continue……….
 The term AGENT is replaced by CAUSATIVE
FACTORS, which implies the need to identify
multiple causes or a aetiologic factors of
disease, disability, injury and death.
 The purpose of knowing multiple factors of
disease is to Quantify and arrange them in
Priority sequence for Modification to
Prevent or Control particular Disease.
Example: Lung cancer, Coronary Heart
Diseases (CHD) & Cancers etc.

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 7. WEB OF CAUSATION
 This model is ideally suited in the study of
Chronic Disease, where the disease agent is
often not known, but is the outcome of
interaction of multiple factors.
 The web of causation considers all the
predisposing factors of any type and their
complex interaction with each other.
 The basic purpose of epidemiology are to
study the clusters of causes and combinations
of effects and how they relate to each other.

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Continue……….
 Removal or elimination of just only one
link or chain may be sufficient to control
disease.
 In a multifactorial event, therefore,
individual factors have no means but all
factors are equal weight.
 The relative importance of these factors
may be expressed in terms of “Relative
Risk”.

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WEB OF DISEASE CAUSATION MI
Changes in life style
Stress

Smoking
Emotional stress

Aging

HTN
Obesity

Hyperlipidemia Changes in the walls

of arteries
Coronary Occlusion

Coronary Myocardial ischemia Myocardial Ischemia

Atherosclerosis
Fig: Web of causation of MI
41

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 Web of Causation of Tuberculosis
Overcrowding
Malnutrition

Exposure to
Mycobacterium

Susceptible Host Infection Tuberculosis

Tissue Invasion and

Reaction

Vaccination Genetic

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 8.Wheel Causation of Disease
 As medical knowledge advanced, an additional
aspect of interest that came into play is the
comparative role of “genetic” (intrinsic factor
and the “environmental factors” (extrinsic
factors) outside the host in Causation of
Disease.
 It emphasizes the interaction of Biological,
Physical and Social environments in causation
of Disease.

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 Wheel of Causation

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 Wheel of Causation

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 Assignment
 Describe Epidemiological Triangle by
Agent, Host & Environment in detail?

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