Fungal Disease in Britain and the United States, 1850–2000: Mycoses and Modernity by Aya Homei and Michael Worboys (review)

Fungal Disease is distinctive in focusing on diseases that usually lack the drama of fatal infections and epidemics—diseases causing “inflammation, irritation and discomfort” rather than “illness” in the majority of instances (p. 1). Yet fungal diseases can be very dangerous. Although conditions such as aspergillosis are rarer, they are potentially deadly for people who are immunocompromised.

The choice to study Britain and the USA is not intended to be comparative but to highlight where change and activity in the field was greatest, with these two countries dominating work on medical mycology. The book begins with infections caused by tinea and then moves toward fungal infections that result from a change in the ecology of the human body, including iatrogenic diseases (illnesses occurring as a consequence of medical care). Four sets of diseases are examined: ringworm and athlete’s foot, thrush (candidiasis), endemic North American infections (coccidioidomycosis, blastomycosis and histoplasmosis), and mycotoxins and aspergillosis. The ntroduction explains that there were three ways in which fungi made people unwell: parasitic development in tissues, such as athlete’s foot and aspergillosis; toxins produced by fungi or by growth of fungi on food; allergic reactions to fungi; and a potential fourth way, the contested and often medically rejected idea of “fungal overgrowth.” But the authors explain the importance of the public perception of this fourth concept, which is linked to diseases such as Chronic Fatigue Syndrome: “diseases of modernity” (p. 8).

The structure of the book is well-crafted, framed around particular conditions caused by fungi, but moving chronologically forward, with references to diseases discussed in previous chapters continuing, demonstrating the developments in treatment for fungal diseases as a whole. The Introduction is particularly useful in explaining the long history of knowledge of fungal diseases and the development of medical mycology, contextualising fungal diseases within infectious diseases more broadly, and “good” fungi as well as “bad” (p. 5). The chapters present the medical research and practices and, increasingly, the pharmaceutical research in relation to the diseases, together with the groups at risk from these infections or conditions. The concise conclusions at the end of each of the chapters are particularly well written and useful summaries of the authors’ findings.

Connecting the chapters are themes such as the relation of “modernity” to medicine, for example mass schooling and ringworm, college sports and athlete’s foot, and modern medical technology and aspergillosis (p. 3). In the Conclusion, these environments that produce fungal disease are referred to as the “soil,” expanding the definition of “seed” and “soil” in connection with microorganisms and the constitution of individual bodies (pp. 137–38). One chapter (chap. 4) has a major focus on soil itself—new populations were at risk from endemic mycoses in their new location, and the changing industrial environment could transform and transport soil. AIDS increased incidence of these diseases, including in non-endemic areas. The chapter is comparative; fungal diseases relating to soil and climate were not an issue in Britain, whereas occupational diseases such as farmers’ lung, a form of aspergillosis, were.

The authors’ review of the literature argues for the originality of the book in looking at the subject from historians’ perspectives rather than from within the discipline of medical mycology. Aya Homei and Michael Worboys point to the marginal status of the specialism in comparison to other fields, and representations of the diseases as “minor” (pp. 12–13), allowing for self-treatment. This results in one of the original contributions of the book, as there is a lack of historiography on self-care. In addition, the authors contend that historians’ neglect of mycology may result from these diseases being tackled as part of the role of a range of practitioners, from dermatologists and bacteriologists to general practitioners, more often than by specialists.

One criticism of the book is that the authors mention...