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 unappealing qualities of the most popularly recognised fungal infections have undoubtedly contributed to the neglect of that whole class of micro-organisms by historians, even as the discipline of the history of medicine has burgeoned in the past 30 years. This is perhaps unsurprising, since the generally most familiar mycoses are ringworm and athlete’s foot, the former the scourge of Victorian classrooms, the latter of the modernist lifestyles of the interwar and immediate post-Second World War years. Field sports, swimming pools, and socks and shoes made of new materials which kept feet moist, inflicted new physical indignities on generations of school children and college students. But mycoses have since then broadened their fields of activity in humans through developments in modern medicine, and it was the enthusiasm for the subject manifested by the Director of the British National Aspergillosis Centre at Manchester, that opened the eyes of the city’s medical historians to the potential of the subject. The result is this oddly engaging little book, which takes the reader on an intriguing journey from the grimy occupants of Victorian classrooms to the most up-to-date medical facilities of the late twentieth century. If the first two chapters disarm the reader by their uncovering of forgotten social history, the last three intrigue and appal in their deft depiction of the havoc wrought by the forces of later twentieth-century social, economic and scientific progress.

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

GIScience 2016 Short Paper Proceedings Pedestrian Navigation Aids, Spatial Knowledge and Walkability Jia Wang, Michael Worboys Department of Mathematical Sciences, University of Greenwich, 30 Park Row, London SE10 9LS, UK Email: {J.Wang, M.Worboys}@greenwich.ac.uk Abstract This study attempts to demonstrate the impact of pedestrian navigation aids on spatial knowledge acquisition and its link to walkability in an urban environment. Spatial knowledge is important for pedestrian travel. Rich spatial knowledge contributes to a good mental image of the walking environment, which consequently increases travel confidence and potentially allows more active walking. While there are plenty of studies on walkability, little work has been done on how navigation aids influence walkability. Using a pilot wayfinding experiment, we examined the effect on users’ acquired spatial knowledge of two major pedestrian navigation aids used in London in comparison to direct experience of routes. 1. Introduction and Background Walkability has become a widely discussed topic in urban and transportation planning and gained public interest since 2005. A walkable city that provides an accessible walking environment encourages more pedestrian walking. This results in benefits to the economy, improved public health and reduced ground emissions. Existing walkability studies focus on the assessment of street pattern, land use diversity and housing density (Frank et al. 2010), and relate to local routes and subjective pedestrian perceptions (Ewing and Handy 2006). Spatial knowledge is important for pedestrian travel. Better spatial knowledge contributes to richer cognitive maps and thus allows improved understanding of the walking space. Acquired spatial knowledge of an environment can be differentiated depending on whether it comes from direct resources associated with travel experiences or from indirect resources such as signs and maps. Researchers conducted several experiments to compare spatial knowledge obtained from different resources (Ishikawa et al. 2008). The design and placement of signage systems clearly affect pedestrian orientation during their journeys (Arthur and Passini 1992), and thus have impact on spatial knowledge. Recently various types of pedestrian navigation aids (PNA) have been developed as aids in wayfinding. These systems assist pedestrians in gaining the ability to get from one place to another, without getting lost (most of the time). Existing work focused mostly on GPS-based mobile devices (e.g., Huang et al. 2012). Little work has been done on how different PNAs, digital or non-digital, static or dynamic, influence spatial knowledge acquisition of pedestrians. In this paper, we aim to demonstrate the influences of different types of pedestrian navigation aids on spatial knowledge acquisition. A navigation aid was assessed by its support of spatial knowledge acquisition of its users. We conducted a pilot wayfinding experiment to assess the two major PNAs used in London (Google Maps & Legible London) in comparison to direct experience of routes as a base line. The Legible London system is a citywide signage system for pedestrian wayfinding initiated by Transport for London in 2007. It is designed to help visitors and local residents to easily gain local spatial knowledge and so

Aya Homei and Michael Worboys, Fungal Disease in Britain and the United States, 1850–2000: Mycoses and Modernity (Basingstoke: Palgrave Macmillan, 2013), pp. xiii, 225, $23.00, paperback, ISBN: 9781137392633. - Volume 59 Issue 3

Aya Homei and Michael Worboys. Fungal disease in Britain and the United States 1850–2000: mycoses and modernity. (November 2013) Palgrave Macmillan. Available as a free download from: http://www.palgraveconnect.com/pc/doifinder/10.1057/9781137377029.0001

Flurin Condrau and Michael Worboys , editors. Tuberculosis Then and Now: Perspectives on the History of an Infectious Disease . (McGill‐Queen's/Associated Medical Services Studies in the History of Medicine, Health, and Society, number 35.) Ithaca, N.Y.: McGill‐Queen's University Press. 2010. Pp. viii, 243. Cloth $85.00, paper $29.95.

Linda Bryder, Flurin Condrau, Michael Worboys (eds), Tuberculosis Then and Now: Perspectives on the History of an Infectious Disease, McGill-Queen's/ Associated Medical Services Studies in the History of Medicine, Health, and Society, No. 35, (Montreal: McGill-Queen's University Press, 2010), pp. viii + 243, $29.95, paperback, ISBN: 978-0-7735-3601-2. - Volume 55 Issue 4

With the rise of HIV/AIDS and an increase in multidrug-resistant forms of tuberculosis (TB) in the twenty-first century, TB has reemerged from the shadows. Although no longer the leading cause of death, TB claims almost two million lives each year. Medical professionals, politicians, and historians increasingly look to previous treatments and understandings of the disease as they approach this global health problem. In Tuberculosis Then and Now, Flurin Condrau and Michael Worboys provide a fresh perspective of TB by presenting a collection that considers the “continuities and discontinuities” from the late nineteenth century to the present (3). The majority of the essays in Tuberculosis Then and Now look at social contexts that helped shape medical treatment and public health campaigns in Great Britain, Australia, Spain, and India. In doing so, the authors give voice and agency to patients of TB and other disempowered groups, especially those considered “alien,” “undesirable,” or “other.” For example, Helen Valier draws attention to the ethics of drug trials in developing nations through a skillful examination of the Madras chemotherapy center testing in the 1950s and 1960s. The Madras trials in India provided irrefutable evidence that combination therapies did not need to be administered within a confined institutional setting. The findings were undeniably significant, especially for those countries that lacked funds for building and maintaining sanatoria, but Britain's use of a former colony retained elements of exploitation rather than mutual gain. The British Medical Research Center often clashed with the local Indian government and drew attention away from contributing factors to TB, such as poverty. Valier's essay serves as a reminder to researchers and scholars alike of the importance of balancing the goals of the larger drug trials with the needs of the local population.

Flurin Condrau and Michael Worboys (eds), Tuberculosis Then and Now: Perspectives on the History of an Infectious Disease

Reviewed by: Typhoid in Uppingham: Analysis of a Victorian Town and School in Crisis, 1875–77 Michael Worboys (bio) Typhoid in Uppingham: Analysis of a Victorian Town and School in Crisis, 1875–77, by Nigel Richardson; pp. xix + 268. London and Brookfield: Pickering & Chatto, 2008, £60.00, $99.00. In the early months of 2010, British newspapers reported that the independent schools’ Headmasters’ and Headmistresses’ Conference (HMC), sensing dissatisfaction with university standards, were thinking of establishing an elite private university on the American liberal arts model. They proposed to name the university after Edward Thring, the nineteenth-century educationalist who founded the HMC and was the headmaster of Uppingham School from 1853 to 1887. He is known today for transforming Uppingham from a local school to an important national institution and for his widely emulated curriculum and pedagogic innovations. Indeed, it is now accepted that he had greater influence on independent school education than the more famous Thomas Arnold of Rugby, who was immortalised in Tom Brown’s Schooldays (1857). In his lifetime, however, Thring was best known for an extraordinary episode in 1876, when he relocated boys, staff, and equipment some two hundred miles from Uppingham in Rutland in the east Midlands to Borth on the west Wales coast, to escape persistent outbreaks of typhoid fever in the school and town. Nigel Richardson’s new book is an exemplary history of this episode, meticulously researched and carefully analysed from the exceptionally rich records of the school, personal papers (including Thring’s diaries), and the files of local and central government. His narrative certainly throws new light on Thring and independent schools in the Victorian era, but its great novelty is that it provides the first history of English public health reform that is about rural rather than urban sanitation. Although his book is focused on a single small town over three years, Richardson’s great achievement is that he manages to illuminate the wider picture of medicine and public health in rural England in the mid-Victorian period. In the 1870s Uppingham was a small town of some two and a half thousand people in Rutland, England’s smallest county. It was unusual in being dominated by Thring’s school, which by the 1870s contributed significantly to the local economy. This was welcomed by the community, yet there was also resentment that local children no longer had access and that Thring often acted as though he was head of the town as well as the school. Matters came to a head in 1875 in disputes around two outbreaks of [End Page 642] typhoid fever. Richardson sets the scene for this in the first three chapters, which detail the economic and social history of the town, the structure and operation of its local government, and the character of its medical community. The book is worth reading for these alone, for what they reveal about the complexities of small town governance and its crowded medical market place. Typhoid fever was a major challenge to doctors and public health officials at this time; its outbreaks were sporadic, mortality could be high, and though there was a consensus that the best preventive was to improve water supplies and waste removal, its spread was capricious. Once the disease developed, isolation of sufferers was recommended, for while direct person-to-person contagion was infrequent, medical officials thought it prudent to be inclusive in their approach. Outbreaks of epidemic diseases had occurred regularly in the town and school, but in 1875 typhoid fever was concentrated in the school, and its spread in the autumn caused alarm amongst staff and parents. Medically the questions concerned the cause of the outbreak and the proper actions to take, but in Uppingham they became focused on who was to blame and whose responsibility it was to take action. Thring pointed to the poor condition of the town’s sewers, water supply, and streets, and to the inaction over many years of the Poor Law Guardians. The town’s officials pointed to the school, its rapid expansion without adequate infrastructure, and the laxity of its medical officer, Thomas Bell. Outbreaks continued over the winter of 1875 to 1876, and the dispute...

Mark Bostridge, Florence Nightingale: the woman and her legend, London, Viking Books, 2008, pp. xxii, 647, illus., £25.00 (hardback 978-0-670-87411-8).

This is a response to the recent contribution by Flurin Condrau and Michael Worboys on epidemics and infections in the nineteenth century. We present data from New England showing that infectious disease deaths were in the majority in the nineteenth century. In the data we examine, the epidemiologic transition is intact.

Reviewed by: Fractured States: Smallpox, Public Health and Vaccination Policy in British India, 1800-1947 Jayant Banthia Sanjoy Bhattacharya, Mark Harrison, and Michael Worboys. Fractured States: Smallpox, Public Health and Vaccination Policy in British India, 1800-1947. New Perspectives in South Asian History, no. 11. Hyderabad: Orient Longman, 2005. x + 264 pp. Ill. Rs 630.00 (81-250-2866-8). This book by Sanjoy Bhattacharya, as the principal author, attempts to explore and break new ground while examining the public health policies, principally vaccination against smallpox, in British India, heavily depending on primary sources from the archival materials of two independent but closely related colonial administrations: the East India Company, and the British Government. The authors claim to have extended this research over about one hundred fifty years, yet there is very little effort to examine the vaccination or public health policy for the period 1800–1857—and this is the first weakness in the title, and thereby in the contents, of the book. Thus little is made known about the efforts by the East India Company and its officials to introduce and extend vaccination, and the evolution of the medical department and public health policies, during the first fifty-seven years of the nineteenth century. The authors fail to record whether there were significant changes in the funding, formulation, and approach to vaccination policy when the historical transfer of power took place from the Company to the British Government. Second, the complete absence of evidence demonstrating the extent and changing level of smallpox mortality during 1800–1947 leaves the uninitiated reader in the dark as to how important smallpox was as a cause of death in unvaccinated and vaccinated populations. There is not even one table or graph explaining how either smallpox mortality or patterns of vaccination levels changed due to new policies across or within the states over such a long period. Perhaps a less ambitious but more apt title for this book would have been "Fractured States: Public Health and Smallpox Vaccination Policy in British India 1857–1947." Having said this, the book definitely breaks new ground in referring to and judiciously using several new archival materials hitherto overlooked in the works of other medical historians of the subcontinent. For example, cogent and forceful arguments are built up using this new material to demonstrate how the formulation, implementation, and budgetary support of vaccination policies underwent a significant change in the twentieth century in different states, following the devolution of political power to the state and local governments. The authors are right in saying that previous studies on the subject have oversimplistically, and incorrectly, extrapolated from studies of specific places and limited periods to an all-India context and for the whole colonial period. Their efforts in the present work to dismantle this monolithic approach are laudable. Chapters 2 and 3, covering the period 1900–1947 and constituting the bulk of the book, are well written and address the issue of why there was passive resistance to vaccination on the part of the local officials. The inadequacy of funding to support the extension of vaccination staff to rural areas, and even within certain municipal bodies across the states—particularly in nonepidemic years—is well illustrated. Similarly, effort has been made to show how the quality of vaccines, [End Page 207] vaccine production and preservation methodology, vaccination techniques per se, and the growing realization of the limited efficacy of primary vaccination in granting lifelong immunity led to serious differences in opinion not only among the scientific community but also between the civil and public health administrators. This resulted in situations when, despite the known preventive efficacy of the vaccine, and despite consistent and continued support from the central government to the states, the implementation of the vaccination policy was neither uniform across the states of the subcontinent nor sustained with the same vigor. The authors could have been more prudent in differentiating terms such as "Bombay" and "Bombay Presidency," "Madras" and "Madras Presidency." On the whole, however, this is a readable book with interesting insights into the nuances of the historical and political aspects of twentieth-century vaccination, and some aspects of public health policy. Jayant Banthia United Nations...

At a time when colonial governments were reluctant to launch comprehensive anti-leprosy programmes in the first half of the twentieth century, international charity organisations and medical missionary workers were keen on tackling this highly moralised disease. The same applied in colonial Taiwan under Japanese rule. Following the works of Michael Worboys, Sanjiv Kakar and others, the present study looks into the work of charitable and religious organisations through a historical account of the career of the Canadian leprologist Dr George Gushue-Taylor (1883–1954).

At a time when colonial governments were reluctant to launch comprehensive anti-leprosy programmes in the first half of the twentieth century, international charity organisations and medical missionary workers were keen on tackling this highly moralised disease. The same applied in colonial Taiwan under Japanese rule. Following the works of Michael Worboys, Sanjiv Kakar and others, the present study looks into the work of charitable and religious organisations through a historical account of the career of the Canadian leprologist Dr George Gushue-Taylor (1883–1954).

SummaryFlurin Condrau and Michael Worboys recently denied that infectious diseases were part of the common experience of life and death in Victorian Britain and that epidemiological transition in this period was a ‘chimera’. This response argues that their ‘demolition’ of these shibboleths is itself an apparition. A substantial body of literature on Victorian mortality demonstrates that Condrau and Worboys's call for analyses of causes of death disaggregated by place, age and sex is outdated. Disputing Condrau and Worboys's narrow definition of infection, evidence presented here indicates that infectious diseases probably represented about 40 per cent of all deaths in England and Wales in the 1850s. This proportion easily exceeded 50 per cent in towns and cities, places where the majority of the population lived. Attention is drawn to published works on health gap measures and health expectancies which show that the decline of infectious diseases made a substantial contribution to improved life chances over the Victorian era. This shift in mortality patterns is interpreted as an integral component of the epidemiological transition.

Reviewed by: The Rise of Causal Concepts of Disease: Case Histories Michael Worboys K. Codell Carter . The Rise of Causal Concepts of Disease: Case Histories. The History of Medicine in Context. Aldershot, U.K.: Ashgate, 2003. ix + 237 pp. $99.95 (0-7546-0678-3). Codell Carter here sets out a revisionist history of nineteenth-century medicine, in which he directly or indirectly attacks almost all received accounts and approaches. His main claim is that in highlighting such developments as pathological anatomy, physiology, and bacteriology, historians have missed the single most important project of the age: the search for universal necessary causes of disease. Methodologically, he criticizes historians for concentrating on empirical discoveries and professional developments, and neglecting the development of medical theory. It is great to have such a challenge, not least because much history of medicine avoids methodological issues and large problems. Carter's approach is based upon the ideas of two philosophers—Karl Popper and Imre Lakatos—who were influential in the 1960s in major debates with Thomas Kuhn over the history and philosophy of science. As is well known, it was the work of Kuhn that went on to influence the history of science, with the influence of Popper and Lakatos waning in the 1970s. In reviving these long-unfashionable ideas, Carter is also reopening questions about the nature of "rationality" and its place in historical analyses of science and medicine. Indeed, an unacknowledged theme in Carter's case histories is that the best medicine was (and should be studied by historians as) a "science." While he takes from Popper the overarching importance of theory and hypotheses (such as that all diseases have universal necessary causes), it is from Lakatos that he takes his main organizing concept—the research program, "a temporally continuous cooperative endeavour" (p. 4) that "consists of (mostly implicit) methodological rules" and a framework of ideas (p. 3). Although shifts in ideas and methods around germ theories of disease and bacteriology loom large in the book, Carter is at pains to stress that these were part of a broader movement in ideas in which disease was thought about causally in rigorous (i.e., rational) ways. He follows the progressive development of causal thinking from early nineteenth-century studies of parasites through to Freud's work on neuroses. The heroes of this book all contributed to what Carter claims, quoting F. Kräupl Taylor, has been "the final hope and aim of medical science . . . the establishment of monogenic disease entities" (p. 197). So, where stands the history of nineteenth-century medicine in the light of Carter's assault? Is he correct that most historians have missed its single most important development and the defining feature of modern medicine? Well, in my view there is no need to throw away standard texts or rewrite syllabi: Carter's account is open to the same objections that led historians of science a quarter of a century ago to reject Lakatosian "research programs" as heuristically useful. The whole approach relies upon the reconstruction of ideas by the philosopher-historian into an asocial "third world" of rational thought. This leads to a blinkered and judgmental approach that focuses on the work of those who followed the progressive rational program and that neglects alternative rationalities and ideas. [End Page 832] Carter is concerned with the development of medicine as a science—indeed, a particular "rational system" of thinking about disease causally. Of course, throughout the nineteenth century doctors were divided over whether medicine should aspire to become a "science," and, if their enterprise was to be "scientific," what type of science it should be. While Carter perceptively traces changes in the types of etiological thinking across the century, his approach obscures the key point—namely, that clinicians and emergent medical scientists were uninterested in etiology for much of the century: their interests lay in nosology, diagnosis, pathology, prognosis and therapeutics. Moreover, when clinicians did think causally—say with tuberculosis after the announcement of the tubercle bacillus in 1882—it was less in terms of the necessary causal organism, whose presence they could do nothing about, and more in terms of the predisposing conditions and ancillary causes that they might be...

Well known for his studies on the history of tropical medicine, Michael Worboys now offers readers a study of the relationship between medical practice and changing disease theory in his recent book, Spreading Germs. In essence, Worboys provides an intellectual history of the germ theory of disease. Throughout this volume, existing interpretations of the development of germ theory are expanded and revised.

Reviews of Books:Spreading Germs: Disease, Theories and Medical Practice in Britain, 1865-1900 Michael Worboys