Toxic Shock: A Social History by Sharra L. Vostral (review)

Nearly 40 years after Toxic Shock Syndrome was first connected with tampon usage – in an era when women of menstruating age are bombarded with advertisements for organic tampons on their social media feeds (I certainly am), and when even Tampax is selling a reusable cup in drugstores – it is past time for a new critical history of menstrual products. Sharra Vostral has answered the call, following up on her wide-ranging Under Wraps with Toxic Shock, a meticulously researched and highly readable study of the early 1980s health crisis of the same name.

Can I get away with a regular instead of a super? Are the fancy 100% cotton ones worth the extra money? Should I just use a pad today instead? Anyone who has ever used a tampon has probably asked herself these questions, or some variation on them, at some point. They, along with the warning labels accompanying insertion instructions in her box of tampons, are a legacy of the Toxic Shock Syndrome scandal at the center of this book. A certain sense of unease lingers for many women, knowing that the risk of TSS still remains even today, and that the disease can be painful and even fatal. Women are encouraged by manufacturers to be on the lookout for potential TSS symptoms and to be proactive in its prevention by using the minimum absorbency level required, changing tampons frequently, and perhaps avoiding them altogether. It should be no surprise that many still seem skeptical of the product, seeking out purportedly healthier alternatives such as the cup.

The thematic organization of the book resulted in a nice even flow. Vostral strings together a number of different approaches to unravel the story of TSS and tampons. One of the first pieces of the puzzle is that for too long, people have viewed the tampon as fundamentally inert. Rather than being just a blank canvas of cotton simply sitting there, ready to absorb menstrual fluids helpfully and innocuously, Vostral argues instead that the tampon can be a "biocatalytic technology." By introducing this term, she emphasizes in chapter 1 that the relationship between the Staphylococcus aureus bacterium and the technology is one of active co-agency. "Individually," she writes, "both the tampon and bacterium were neutral, but due to ecological circumstances they triggered a harmful consequence." This combination "served as a catalyst, prompting a bacterium that was at best in stasis to begin producing toxins." (10) Tampons never introduced any new disease vector into the body; rather, in some women, their breakdown in the vagina created a dangerous reaction with already present, otherwise harmless bacteria.

Chapter 2 presents a fascinating case study of the construction of a new disease. Though it has largely been overshadowed by the epidemic that followed shortly on its heels, TSS was also an example of physicians, epidemiologists, and the public negotiating the meaning of a confusing set of symptoms. This chapter in particular made this reader eager for a renewed focus on the history of disease in the late twentieth century, beyond the AIDS epidemic. TSS was not an epidemic, as Vostral points out, but still a significant health crisis. Looking back on it, we find the 1980s medical community befuddled, again slowly working out the cause and effects of a potentially devastating public health emergency. To this day, researchers still puzzle over the exact biological mechanism that leads to TSS, though the syndrome itself is well defined.

The next two chapters focus on the media and the courts, respectively. In 1980, Vostral reports, via the Washington Post, TSS was the third top news story in the country. Only the standoff between Reagan and Carter in the election and the Iran hostage crisis garnered more attention. Just a few short years after the National Association of Broadcasters began allowing advertisements for feminine hygiene products, the airwaves were abuzz with reports of tampons, TSS, and a public health crisis. Newspapers and reports from the CDC added to...