Mystery

How a set of symptoms was stabilized into a defined illness with correlative healthcare practices required a great degree of consensus. This chapter traces how medical professionals, including family physicians, pediatricians, nephrologists, and specialized epidemiologists at the state and national levels, encountered ill girls and women, and collaborated through their networks to create a definition of toxic shock syndrome (TSS) and identify emerging cases. It took careful epidemiology to link TSS with tampon use, in part due to the assumption that tampons were inert. Scientific evidence associating TSS with tampons was all the more crucial in order to create a convincing case that it was a threat to public health, and that women should be warned of their use. Challenges by corporations and corporate-sponsored scientists to the epidemiological data questioned the legitimacy and the conclusion that tampons were associated with TSS.

Unexpected Consequences

The grounding assumptions and conceptualizations of bacteria and gendered technology are the focus of chapter 1. The term “biocatalytic technology” provides a way to think through this relationship between bacterium and technology as active co-agents. The tampon, conceptualized as an inert plug to stop up the fluids of a mechanical body, instead served as a catalyst, prompting bacterium that were at best in stasis to begin producing toxins. Individually both the tampon and bacterium were neutral, but due to ecological circumstances they triggered a harmful consequence. Constituent bacteria, menstruating bodies, and a reactive rather than inert technology converged to create the ideal environment for the Staphylococcus aureus bacterium to live and flourish in some women. Opportunistic, the bacterium became the unintended user of the tampon technology.

Grounds for Liability

Though the majority of women did not suffer from toxic shock syndrome (TSS), others experienced a flu-like illness, hospitalization, and even death from using Rely and other superabsorbent tampons. Lawyers filed lawsuits against all the major companies for failing to adequately disclose risk and selling a faulty product. Chapter 4 explores the 1982 federal court case Kehm v. Procter & Gamble in which the plaintiff’s argument sought to prove that tampons were not inert, thereby exposing this particular corporate presumption as well as announcing it to the broader public. Leaders at Procter & Gamble insisted that TSS was an industrywide issue, tampons had a long record of safety, and Rely was singled out unfairly, despite the results garnered by the Centers for Disease Control indicating otherwise. Some of their points were credible, yet the case highlighted the need for better testing and product labeling to avert more TSS-related injuries and lawsuits.

The Media Sounds the Alarm

Following the medical identification of tampon-related toxic shock syndrome (TSS), there was an urgent need to alert the hundreds of thousands of women using tampons and superabsorbent tampons that the products were potentially dangerous and deadly. Disseminating a message of risk challenged status quo journalistic practices, and chapter 3 examines the media coverage of a health crisis centered upon women’s reproductive health and menstrual management practices. The press had to figure out a way to talk about TSS in overly simplistic terms, in an era when the Federal Communication Commission only recently allowed feminine hygiene sprays, and then sanitary napkins and pads, to be advertised on television. Journalistic reports helped to disseminate messages and warnings about TSS and tampons, and also announce the recall of Rely—the tampon with the highest incidence of TSS—produced by Procter & Gamble. This contributed to a sense that the problem had been solved, but other superabsorbent tampons remained on the market and TSS was not eliminated.

Introduction

Toxic Shock: A Social History is a multifaceted exploration of toxic shock syndrome (TSS) and its relationship to tampon technology. The politics of this illness, the legacy of tampon labeling, and how to warn women about the risk of TSS have ramifications for all contemporary tampon users. The history of the relationship between Staphylococcus aureus to tampons, and the consequence of TSS is presented through the distinct lenses of (1) technology and bacterium; (2) medicine and epidemiology; (3) communication and journalism; (4) law and litigation; and (5) policy and politics. Health practitioners, corporate scientists, federal policy makers, and feminist political advocates shaped and defined the terms of the emergent illness. They both articulated and challenged notions of risk, the results of which changed the conceptualization of tampons from benign to dangerous, affecting all tampon users.

Health Activism and the Limits of Labeling

Since the threat of toxic shock syndrome (TSS) subsided but remained, how to manage it became a politically contested issue. Chapter 5 addresses the political stakes of science-based policy used to warn women about the risk of tampon-related TSS. Advice to use the least absorbent tampon possible was not feasible because packages were not accurately labeled. To help women make informed decisions, the Food and Drug Administration called upon the creation of a Tampon Task Force to recommend absorbency ranges and to standardize descriptions such as “regular” and “super.” Different stakeholders on the task force, including corporations, consumer groups, and women's health activists, exerted pressure to control the terms of policy, product labeling, and the language of warnings printed on tampon boxes. In particular, Esther Rome of the Boston Women’s Health Book Collective participated on the Tampon Task Force and challenged methods and procedures that were not beneficial to women. She sought to include menstrual fluid, rather than saline, in the syngyna lab tests as a basis of tampon absorbency to more accurately reflect real-life conditions.

Conclusion

The results and consequences of the bacteriological, technological, medical, journalistic, legal, and political understandings of toxic shock syndrome (TSS) influence tampon users today. Most are aware of controversies regarding hormonal birth control or the questionable safety of breast implants. With 70 percent of women using tampons, the history of federal regulation of menstrual hygiene products, and activists' efforts to improve safety, arguably touches more women than these other issues. Significantly, labeling tampon boxes, providing information about material and chemical content, and offering more understandable warnings about TSS remain incomplete. Better labeling, a blood test for the TSS antibody, and an assumption that technology interacts with the microbiome would help to predict and prevent occurrences of TSS.