HISTORY OF MEDICAL MYCOLOGY IN THE UNITED-STATES

The development of medical mycology as a discipline in the United Stat es was investigated within the historical context of the last 100 year s. Scientific contributions were conceptualized into five developmenta l eras. The era of discovery (1894 to 1919) was characterized by the r ecognition of certain fungi as etiologic agents of severe disease by p hysicians who were not trained as medical mycologists. The first medic al mycological research and training programs were established between 1926 and 1949, the formative years, when the high incidence and preva lence of mycoses among the troops during World War II demanded improve d patient care. By 1950, the high mortality rate for patients with sev ere mycoses led to a period described as the advent of antifungal and immunosuppressive therapies (1950 to 1969). During the 1970s, the year s of expansion, the increased incidence of mycoses in immunosuppressed patients and important advances in technology changed the direction o f development. Since 1980, a higher incidence of mycoses has once more brought major change to the discipline, as the AIDS pandemic ushered in the era of transition. Within the discipline, many leaders either r etired or died, and major reductions in government and corporate suppo rt eliminated training programs and prevented the replacement of facul ty. The result is a crisis in medical mycological training in the 1990 s, whereas research continues to change and expand with the influx of new specialists from other areas of medicine.