Intolerant Bodies: A Short History of Autoimmunity Warwick Anderson and Ian R. Mackay. Johns Hopkins University Press: 2014.


A terrifying incident opens Intolerant Bodies. In 1981, novelist Joseph Heller became paralysed within a few hours by the autoimmune disease Guillain–Barré syndrome. In this horrific physiological own goal echoing the catch-22 of his classic book, Heller's immune system turned on his peripheral nervous system.

A nineteenth-century watercolour showing the effects of lupus, an autoimmune disease. Credit: St Bartholomew's Hospital Arch. & Mus./Wellcome Images

It has been calculated that in any population, 5–10% of people — a large proportion of them women — will at some point have an autoimmune disease. Intolerant Bodies, by the medically trained historian Warwick Anderson and clinical immunologist Ian Mackay, draws on medical, scientific, historical and literary sources to highlight four such conditions: type 1 diabetes, rheumatoid arthritis, systemic lupus erythematosus and multiple sclerosis.

The term autoimmune first appeared in 1951, and autoimmunity in 1957, although neither was then — or now — universally accepted. Some immunologists continue to prefer 'autoallergy'; the late Robin Coombs, inventor of the first specific test for red-cell antibodies, declared that he would “go down fighting” in his opposition to 'autoimmune'.

Mackay and Anderson focus less on the heyday of autoimmunity in the past few decades than on its 'prehistory' and emergence as a defined field of medical research and practice. Early-nineteenth-century studies of fevers led to the recognition that the body's own physiological responses could be harmful, and germ theory later that century spurred knowledge of the body's defence mechanisms. Medical luminaries such as Robert Koch and Joseph Lister struggled to understand basic mechanisms and isolate causative agents. In the 1880s, the Russian biologist Élie Metchnikoff argued that circulating cells, the phagocytes, digested invading cells. In the first half of the twentieth century, in public-health labs and early pharmaceutical companies, the development of serotherapy — treating infectious diseases such as diphtheria by injecting serum raised in an immunized animal — stimulated much research on the immune system.

The authors emphasize how after the Second World War, an increase in government and private funding led to the expansion of research laboratories, including Henry Kunkel's at the Rockefeller Institute in New York City, Macfarlane Burnet's at the Walter and Eliza Hall Institute in Melbourne, Australia, and those at industrial concerns such as pharmaceutical giant Merck. Researchers developed tools, techniques and languages based on cellular and molecular approaches. In Britain, Peter Medawar unravelled the mechanisms of rejection after tissue transplantation. In New York City, Jules Freund demonstrated that an emulsion of paraffin oil and dead mycobacteria, the causative organisms of tuberculosis, enhanced and prolonged immune reactions in animal models of disease. Burnet, who shared a Nobel prize with Medawar in 1960, recognized Freund's contribution as key to the experimental study of autoimmunity. The subject was now high on the agenda of many biomedical scientists. Work on subsets of lymphocytes, human-tissue antigens and the genetics of histocompatibility factors all contributed to the understanding of cellular mechanisms, and to devising diagnostic and therapeutic strategies for an array of disorders.

But Intolerant Bodies is more than a history of scientific concepts, clinical practices and experimental activities. It explores fundamental questions such as 'What is self?' — how and why the body's sophisticated defence mechanisms fail to recognize its cells and tissues and start to destroy them. The authors draw on immunological, philosophical, psychological and religious literature for this intriguing discussion. They mine thoughts from the likes of philosopher Jacques Derrida and anthropologist David Napier for their reflections on the definitions, boundaries and limitations of self.

Furthermore, Anderson and Mackay reveal an expert understanding of how to use 'lived experience' to bring a biography of disease to life. Personal accounts demonstrate how, as theories about the causes of inexplicable chronic and debilitating diseases abounded, the variety of treatments devised to alleviate or 'cure' them expanded. The nineteenth-century German poet Heinrich Heine was treated with leeches, sulphur baths and morphine, but these did little for an aggressive neurological complaint that the authors suggest was multiple sclerosis. And in 1957, US novelist Flannery O'Connor, who had lupus, wrote to a friend, “Every time something new is invented I get in on the ground floor with it. There have been fine improvements in the medicine”. But steroids also destroyed her bones, a therapeutic stalemate that made her final years miserable. Particularly harrowing is the case of English diarist W. N. P. Barbellion (the pen name of Bruce Frederick Cummings), author of the 1919 Journal of a Disappointed Man. Barbellion, diagnosed with multiple sclerosis in his twenties, began to hoard laudanum and to keep a pistol close by. The disease killed him less than five years after diagnosis.

Unlike many biographies, Intolerant Bodies has no neat ending. With more than 80 conditions now considered to be autoimmune, diagnosis remains irregular and treatments unsatisfactory. Although more and more is understood about mechanisms, the causative stimuli are still unknown. The history of autoimmunity is far from over.