First Wellcome Trust open access book looks at history of fungal disease

Earlier this year, the Wellcome Trust extended its open access policy to include monographs and scholarly publications, and today our first open access monograph is published, a history of fungal infections from 1850-2000. Aya Homei and Michael Worboys explain the potential benefits of their work being open access while giving us an overview of these often neglected diseases.

Fungal infections or mycoses are the great neglected diseases of medical history. There are numerous histories of viral, bacterial and protozoan infections, for all times and all places, but very few studies of those caused by fungi. Why?

It cannot be because of prevalence. Historical sources and contemporary epidemiological investigations show that fungal infections were and are ubiquitous. Everyone will have heard of, if not suffered from, athlete’s foot or thrush. In the first half of the twentieth century, children feared the school nurse finding ringworm on their scalp and having to endure, not only the pains of X-ray depilation or embarrassment of having their shaven head painted mauve with gentian violet, but also exclusion from school and the shame of being stigmatised as ‘unclean’.  The neglect of serious fungal infections might be explained by their relative rarity, but this situation is changing rapidly with invasive candidiasis and aspergillosis becoming increasingly prevalent in critically ill patients and those with compromised immune systems.

Mycoses cluster at the ends of the infections spectrum, being either common and quite mild, or rare and life-threatening.  The Wellcome Trust has recognised this situation and recently supported work on drug discovery for the next generation of broad spectrum antibiotics and research on the disease-causing genes in emerging lethal fungus infections.

In our new book on the history of fungal disease in Britain and America in the period 1850-2000, we consider four sets of diseases: (i) ringworm and athlete’s foot (dermatophytosis); (ii) thrush or candidiasis (infection with Candida albicans); (iii) endemic, geographically specific infections in North America (coccidioidomycosis, blastomycosis and histoplasmosis) and mycotoxins; and (iv) aspergillosis (infection with Aspergillus fumigatus). We discuss each disease in relation to developing medical knowledge and practices, and to social changes associated with ‘modernity’. Thus, mass schooling provided ideal conditions for the spread of ringworm of the scalp in children, and the rise of college sports and improvement of personal hygiene encouraged the spread of athlete’s foot. Antibiotics seemed to open the body to more serious Candida infections, as did new methods to treat cancers and the development of transplantation. The last quarter of the twentieth century also saw popular health concerns about whether chronic, internal Candida infection was responsible for all manner of ‘modern’ ailments, including chronic fatigue syndrome (CFS) and inflammatory bowel disease (IBD).  This was styled ‘the Yeast Connection’ and spawned an alternative health craze for dietary and other self-help regimes.

Regional fungal infections in North America came to the fore due to the economic development of certain regions, where population movement brought in non-immune groups who were vulnerable to endemic mycoses. Fungal toxins or mycotoxins were discovered as by-products of modern food storage and distribution technologies. Lastly, the rapid development and deployment of new medical technologies, such as intensive care and immunosuppression in the last quarter of the twentieth century, increased the incidence of aspergillosis and other systemic mycoses.  Overall, our book throws new light on man of the major developments of twentieth-century medicine, but rom an entirely novel perspective.

We are delighted that our book is being published open access in line with the Wellcome Trust’s new policy for monographs and book chapters.  We have found the process of manuscript preparation, editing and production to be the same as with the normal hardback.  The only difference was the extra work needed to obtain permission to use images, in large part to from having to explain the principles and practice of open access to copyright holders because of its novelty.  We are certain that open access will give our book a wider readership and encourage its use in teaching at many levels.  We were reminded many times at the recent International Congress for the History of Science, Technology and Medicine at the University of Manchester, which attracted over 1,600 delegates from 64 countries, just how difficult it is for teachers and researchers in many countries to acquire books for their library and personal use.  We are pleased that open access publication is accompanied by affordable hardback and paperback editions.  Lastly, and returning to our initial point about the neglect of fungal disease in medical history, we trust that open access publication will ensure that this important class of infections receives the scholarly attention it deserves and also reaches public audience, not last through linkages to patient groups such as that at the Aspergillus/Aspergillois website.

Aya Homei and Michael Worboys work at the Centre for the History of Science, Technology and Medicine, University of Manchester. Their book, Fungal Disease in Britain and the United States 1850-2000 – Mycoses and Modernity is now available for download at PubMed Central Books under an open access CC-BY licence.