Intolerant Bodies: A Short History of Autoimmunity by Warwick Anderson and Ian R. Mackay (review)

This is a book that resulted from long-term fermentation. It not only provides a concise history of autoimmunity but also aims at telling an unnatural story of immunology. In 1994, as a young scholar in the history of medicine with clinical experience in the 1980s in Australia, Warwick Anderson, along with other scholars, had argued the need to render the history of immunology unnatural, the need to move beyond the evolution of immunological theory carefully delineated by prominent immunologists like Frank Macfarlane Burnet and Niels K. Jerne, the need to look into the clinical, institutional, and cultural spaces of immunology, and the need for prehistories and alternative histories of immunology. Coauthored by Anderson and Ian R. Mackay, a senior clinical immunologist and an important contributor to autoimmunity studies, this book could be read as a reply to the task raised by Anderson himself twenty years ago, with an emphasis on the archetype disorder of immunology, autoimmunity, and autoimmune diseases like rheumatoid arthritis, systemic lupus erythematosus, childhood (type 1) diabetes, and multiple sclerosis.

It begins with fever. The authors consider fever in the nineteenth century to be the conceptual equivalent of autoimmunity in our time, because both of them have great influence on identity and sense of self. While autoimmunity could be explained as a destructive reaction of the immune system against the body’s own tissues, fever happened when normal functions and regulatory mechanisms went awry, when the system became overexcited and began to damage itself. Whether conceived as a disease of the nerves in the eighteenth century or attributed to an essential disturbance of the blood in the nineteenth century, fever is a disease with its own biography but without any specific lesion, closely related to suffers’ own temperament and predisposition, that is, personal diathesis. It was not until the latter part of the nineteenth century, with the advent of germ theory, that practitioners began to view fever as having distinct ontological forms. By drawing readers’ attention back to concepts and experiences of fever, the authors remind us of the transformation of thought styles and the historical distinction between ontological and physiological (biographical) explanations of disease. And autoimmune disease, a concept that emerged from the mid-twentieth century, is predicated on the idea of disease as a biographical process, a personalized pathology.

Intolerant Bodies then provides a concise overview of the development of immunology from the late nineteenth century onward, with special reference to various clinical observations related to autoimmunity or altered reaction of immune response. The rise of germ theories in the late nineteenth century ushered in an era of enthusiastic microbe hunting and the ontological concept of disease. Physicians and physiologists were eager to identify the species of germs that incite distinct types of disease and to evoke matched antibody and immune responses. Against the backdrop of the application of standardized vaccines and sterilization, and inspired by strange clinical observations, a few researchers, many of them living in or around Vienna and sharing a culture of sensitive nerves, continued to prefer a more physiological and biological view of immune response in the early twentieth century. For example, Karl Landsteiner’s research on paroxysmal cold hemoglobinuria made him wonder if an individual’s immune system is attacking the body’s own cells, and studies on anaphylaxis by Charles Richet suggested there are individual differences in immunological character and susceptibility. Coining the term allergy in 1906, Clemens von Pirquet introduced a new concept for interpreting antibody in which, in addition to guarding against diseases, it could also cause disease by attacking the body’s own tissues. In the 1930s, the Polish serologist Ludwik Fleck used the Wassermann reaction as a conventional test for syphilis. Fleck believed that the reaction actually detected antibodies directed against damaged tissues rather than the pathogen, and he argued it was the dominant immunological “thought collective” that continued to resist explanations of biological individuality, a social constraint on...