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

Whether in the worlds of medical practice and healthcare or in historical scholarship, fungi have not been fashionable. Despite the ubiquity of fungal infections in Western civilization, what we now consider to be an entire biological kingdom has been systematically neglected in histories of medicine and biomedical science (before Robert Whittaker proposed a separate kingdom for fungi in 1969 they were formally classified as plants). In Fungal Disease, Aya Homei and Michael Worboys set out to redress this imbalance and move the focus away from higher-profile disease-causing agents – bacteria, viruses, prions – which have dominated our understanding of the historical relationship between animal hosts and agents of pathological occupation.

Underpinning their enterprise is a reanimation of the "seed-and-soil" metaphor employed by Jean and Rene Dubos in their 1952 history of pulmonary tuberculosis (The White Plague: Tuberculosis, Man and Society, London, Victor Gollancz, 1952; cited in the footnotes, curiously absent from the bibliography). In this case, their 'seeds' are fungal pathogens in whatever form they took while soil covers, it seems, nearly everything else, including "the human body, social relations and structures, and the medical, material, and technological environment" (4). Through a series of five Anglo-American case studies from the mid-nineteenth century to the turn of the twenty-first, the book interrogates links between fungi themselves, their manifestation as human infections, and their bio-social consequences. Chapters one and two focus on ringworm and so-called athlete's foot (both caused by an overlapping pantheon of species, including Trichophyton, Epidermophyton, and Microsporum); chapter three examines the thrush-causing genus Candida; chapter four focuses on a series of "endemic mycoses and allergies," while chapter five takes as its object the recent manifestation of invasive aspergillosis.

The authors begin with ringworm, framed as a disease of mass education and the school environment, which attracted a substantial degree of stigma among sufferers. Fashionable treatments were aligned closely with emerging medical technologies, such as X-rays from the early twentieth century, whose pattern of use by the 1930s was highly variable across England and Wales (in 1933 in the counties just 6.8% of cases were treated in this way, compared with nearly 90% in London, 41). Drawing on published medical reports of ringworm outbreaks in schools, the authors reconstruct the epidemiology of the disease, which was only classified as a fungal condition from the 1850s. The passing of the Education Act of 1870 and the resulting expansion of large-scale schools necessitated this increased focus on the spread of infectious diseases among groups of pupils.

Caused by a similar constellation of organisms as ringworm, athlete's foot was a hot topic within the American public consciousness in the 1930s, at the same time as institutionalized, hygienic programmes of exercise and physical education gained considerable traction. Perhaps most striking are the parallels which Homei and Worboys draw between public health campaigns designed to warn of the hidden danger of athlete's foot and similar narratives of sexually-transmitted infections.

Candida is a ubiquitous fungal infection in the Western world, yet we learn in chapter three that its elevation to this status was closely linked to the rise of antibiotic use through the twentieth century. Patterns of incidence changed dramatically over the century, with the infection shifting around the human body and lifecourse; from a disease of weak or immunocompromised children, it came to occupy a near-universal position as an infection of the genitals, especially in women. This was paralleled with the refinement of new classes of antibiotics that were effective against fungi.

Whilst Candida has little geographical specificity, the more spatially-bound infections of Chapter four, including the less well-known coccidioidomycosis, blastomycosis, and histoplasmosis, had distinct spheres of activity. Coccidioidomycosis, for example, was seemingly far more prevalent in certain areas of...