The Making of Intolerant Bodies: A Short History of Autoimmunity. The Promise and Peril of Collaboration between Scientist and Historian

by Warwick Anderson and Ian R. Mackay

Anderson and Mackay believe their unusual writing collaboration, which produced Intolerant Bodies: A Short History of Autoimmunity (Baltimore: Johns Hopkins University Press, 2014), demands a correspondingly unusual commentary and explanation:

Mackay and Anderson

Ian R. Mackay and Warwick Anderson

Warwick Anderson recalls Ian R. Mackay as a formidable and rather unnerving senior physician at the Royal Melbourne Hospital (RMH) in the early 1980s. Mackay’s ward rounds were daunting theatrical exercises, slowly grinding from patient to patient, presenting countless opportunities, so it seemed, for Mackay to invigilate and sometimes intimidate medical residents and students. He would examine carefully every case history, sensitive to any inadequacy or omission or evasion. What he couldn’t stand was slackness of any sort. Approaching sixty years of age, bearing an uncanny resemblance to Herbert von Karajan, Mackay was at the height of his powers, a leading clinical immunologist, and collaborator with Nobel laureates and other distinguished scientists who tagged along occasionally on these intermittently excruciating rounds. As a medical student on Mackay’s Clinical Research Unit (CRU), Anderson tried to disappear among the crowd. A few years later in 1984, as a resident, he came to admire the bravura performances and even to participate cautiously in the drama, careful to sidestep or slip away during the more confronting scenes. He remembers Mackay as demanding and unrelenting toward his colleagues, but kind and thoughtful with his patients, who often adored him. Above all, it seemed that Mackay, while undoubtedly “difficult,” was one of the few real intellectuals on the staff of the hospital.

Ian R. Mackay, however, has less recall of Warwick Anderson, the somewhat timid medical student and rather more intrepid resident. In the course of a long career, physicians see medical students and residents come and go, with few ever making much of a mark. Anderson took reliable case histories, worked efficiently, was good at multitasking, and seemed to engage closely with some more medically complicated patients, though he never struck his teachers as especially dedicated to clinical care or research. But Mackay had been impressed enough to offer him a residency on the CRU. (Later, he was surprised when the young doctor showed him some of his published poetry—he started paying attention then.) Mackay remembers the period as one of exceptional productivity for the CRU, enlivened by skirmishes among the exceptionally mettlesome personalities that populated the medical staff. The daredevil registrar (or senior resident) Bryan Youl, a fearless practical joker, went on to become a clinical neurophysiologist and pianist in London. Ian Frazer later developed the human papilloma virus vaccine against cervical cancer; John Mathews (who earlier had been involved in kuru research) became the foundation director of the Menzies School of Health Research in Darwin; and Mathew Vadas now directs the Centenary Institute at the University of Sydney. Sir Gustav Nossal still ran the adjacent Walter and Eliza Hall Institute (of which the CRU remained an important part), and his predecessor Sir Macfarlane Burnet lingered on, though he no longer attended clinical meetings. Former visiting fellows Carleton Gajdusek and Joshua Lederberg frequently came up in conversation. Inspired by the stellar cast, one of our medical students, Ken Smith, became an immunologist and later head of the Department of Medicine at Cambridge University. Anderson’s role in this show seemed, at the time, relatively minor. Certainly, he showed scant interest in immunology. At one point during their collaboration on Intolerant Bodies, Anderson told Mackay that he had learned through studying history the immunology he should have known as a medical resident. Mackay fixed him with his steely eyes for a while, then said: “Yes, indeed.”

Yet we regarded each other with mutual respect, enough for us to make efforts to stay in touch over the years. As a graduate student in the Department of History and Sociology of Science at the University of Pennsylvania, Anderson wrote with Mackay and Youl an odd little case study, now rather dated, of theophylline intoxication; and he published in Social Studies of Science a historical critique of the CRU’s pioneering computer-diagnosis program in the 1960s, an article that Mackay recalls as an irritation and distraction. At the time, Mackay insisted on major changes to the final draft, to Anderson’s chagrin. Much later, when Anderson came to write The Collectors of Lost Souls, his history of the investigation of kuru, the fatal brain disease among the Fore people of New Guinea, he interviewed Mackay, who thus came to erupt regularly in the book as a sort of sardonic Greek chorus, commenting on the unfolding tragedy. Gajdusek, who was the chief instigator of kuru research, had developed with Mackay in 1957 the autoimmune complement-fixation test, which determined that active chronic hepatitis was an autoimmune phenomenon, caused when the body’s immune system attacked the liver. It became a landmark in the history of immunology.

When Anderson began to write Lost Souls at the Institute for Advanced Study, Princeton, he read the original articles announcing, in effect, this autoimmune hepatitis in Nature and Archives of Internal Medicine. As he did so, he remembered having looked after some of the patients, first diagnosed with the disease in 1957—by the 1980s, their case histories often ran to six or more thick volumes, full of progress reports and notes from social workers, among others. Anderson asked Mackay whether the RMH would have kept these records. Mackay hoped so, since he had written across the folders: “Please preserve—of historical importance.” Anderson approached Charles E. Rosenberg, his former PhD advisor, suggesting he and Mackay might write for Rosenberg’s book series at Johns Hopkins University Press a collective biography of autoimmune hepatitis using these wonderfully rich records. Having written a dozen or so articles on the history of immunology, Mackay was eager to collaborate on the book. But when he inquired about the records, he learned the RMH had destroyed them—ironically in 1998, when the institution was celebrating its 150th anniversary and proclaiming its commitment to history. Mackay still wanted to proceed (and, not trusting the hospital, he’d made copies of sections of the case records). As it turned out, Rosenberg would prefer a general conceptual history of autoimmunity for his series. However, Anderson had mixed feelings, confirmed when some colleagues in the United States warned him that such a book would confuse readers, who expected him to write on medicine, race, and colonialism. But as he was moving to a small-scale scholarly community in Australia, where academic selection favored the generalist not the specialist, he eventually decided he could ignore these concerns. For him, it became a sort of “legacy” project, a chance to make sense of his clinical training.

Both of us were apprehensive about collaboration. As a scientist, Mackay was inured to the arrangement, but he suspected Anderson’s philosophical proclivities, what he perceived to be the historian’s inclination toward esoteric theory. In contrast, Anderson was generally wary of collaboration and feared the scientist would simply want to write a textbook of contemporary immunology, lacking historical perspective and conceptual suppleness. As a test, Anderson asked Mackay to read Jacques Derrida’s essay on how “autoimmunization” might substitute for deconstruction. To his surprise, the eighty-something immunologist was intrigued by the philosopher’s deployment of a fairly “accurate” version of autoimmunity. The response reassured Anderson. Mackay then tested Anderson by asking him to revise a draft essay for the Journal of Neuroimmunology on the historical relations of experimental allergic encephalomyelitis and the autoimmune disease multiple sclerosis—and this time the historian’s contribution seemed sympathetic and compatible, and not rebarbative as expected. Together we then wrote a proposal for a research grant from the Australian Research Council (ARC), which proved successful. (Mackay believes he might be the oldest person to receive an ARC grant.)

The grant enabled Anderson to fly regularly to Melbourne, where Mackay is based, and to discuss research and to work through drafts there. We could employ two dedicated research assistants, Edmund McMahon and Cecily Hunter. Anderson usually wrote the first draft of each chapter, often drawing closely on Mackay’s historical articles. Mackay would then go painstakingly though every sentence, often expressing approval, sometimes finding fault. He had more at stake in getting the science right: if there were any mistakes, he would likely be blamed, rightly or wrongly. Both of us found the process exhausting and time consuming, but it soon became clear that neither of us could write the book without the other. Immunology is exasperating in its technical complexity and obscurity—so much so that it has mostly resisted any thorough and accessible historical analysis. As an ordinary medical doctor, Anderson knew little of the intricacies of recent immunology. As an immunologist seeking to chronicle his field, Mackay needed the help of someone deft in historical narration, especially on the scale of a book. Frequently we argued over what should be included and what left out. Mackay usually contended that we needed to write more about technical aspects of immunology, and about recent developments, such as ideas about the influence of the gut microbiome. Anderson found the necessary incursions into the past thirty years discomforting. He wanted to write more about concepts like “self,” “tolerance,” and “surveillance”—and, predictably, to discourse on Derrida. But Mackay, with Rosenberg’s “collusion,” beseeched him to omit a few of the redundant Deriddean paragraphs, and to label the philosophical “conclusion” an Afterword. More than our friends and families could ever imagine, we compromised. (Some claimed to be amused that two such intolerant people—intolerable even—could be writing about immunological tolerance.) When our disagreements proved unresolvable, one of us would spin off an article on the inassimilable material. The resulting book is not perfect, but it’s as comprehensive, informative, coherent, and appealing as we could make it.

Ultimately, our collaboration depended on mutual respect and trust. Though both of us had mellowed over the years, it was not always easy. Senior immunologists, recalling the severity of Mackay in his earlier days, often wondered how the two of us could ever write a book together —others speculated on Anderson’s historian “lone wolf” tendencies. Sometimes Anderson regarded Mackay—when he persisted more than six months in rejecting one cherished phrase or another—as stubborn. Mackay complained that Anderson could be unyielding on even the most trivial aspects of literary style. We persevered. Our friendship remained intact. And through our labors we both learned a lot—about immunology, history, and ourselves.

Warwick Anderson is an Australian Research Council Laureate Fellow and Professor at the University of Sydney; and Ian R. Mackay is an honorary Professor at Monash University in Melbourne. It should be noted that Mackay disputes the accuracy of Anderson’s memories of him and the CRU; while Anderson cannot believe he was so insignificant a medical resident.