Medical mycology in the United States: 100 years of development as a discipline

The development of medical mycology education and research in the United States was investigated within the historical context of the last 100 years. Scientific and educational contributions were conceptualized into five developmental eras by the author of this dissertation. "The era of discovery" (1894-1919) is characterized by the recognition of certain fungi as etiologic agents of severe disease by physicians who were not trained as medical mycologists. The first medical mycology training and research programs were established between 1920 and 1949, "the formative years", when the high incidence of mycoses among military personnel during World War II demanded improved patient care. By 1950 the high mortality rate for patients with severe mycoses led to the development of effective antifungal agents and the era of "the advent of antifungal and immunosuppressive therapies" (1950-1969). During the 1970s, "the years of expansion", the increased incidence of mycoses in immunosuppressed patients and important advances in technology changed the direction of development. Under the influence of new revenue sources, established training and research programs also prospered. The first two generations of trained medical mycologists were instrumental in the development and dissemination of knowledge and in the creation of new centers and programs. A higher incidence of mycoses again brought major change to the discipline, as the advent of the AIDS pandemic ushered in "the era of transition" between 1980 and 1994. Within the discipline, however, many of the leading medical mycologists either retired or died. These coincided with numerous reductions in government and corporate support, which eliminated training programs and prevented the replacement of faculty at a number of centers. The result was a crisis in medical mycology training in the early 1990s, whereas research continued to change and expand with the influx of new specialists from other areas of medicine. The future of medical mycology depends on recruiting and training new leaders in the field to maintain research creativity in the midst of technological development and goal-oriented studies. In addition, the funding needed to continue advances should be balanced between applied and basic medical mycology education, training and research.