- Toxic Shock: A Social History by Sharra L. Vostral
By Sharra L. Vostral. New York: New York University Press, 2018. Pp. 227.
Sharra L. Vostral begins Toxic Shock: A Social History with a vivid description of her experience learning about this syndrome as an American teenager in 1982. The public health concerns about contracting a sudden illness from (and possibly dying from) tampon use were broadcast extensively on television, in newspapers and magazines, and on product labels. As a teenager in California in the early 1990s, this reviewer also remembers these widespread but vague warnings about sudden death due to toxic [End Page 1261] shock syndrome (TSS) from overlong tampon use. From so few documented cases nationwide, how did TSS rise to such prominence in the United States' public health and safety discourse? Vostral addresses that and many other questions in the first book-length history of the syndrome.
Vostral's central argument is that "TSS was a paradigm shift in the way that illness manifests because the supposedly inert tampon interacted with a common bacterium (Staphylococcus aureus) to cause sickness in otherwise healthy women" (p. 2). She explores this argument from five perspectives that comprise the book's five roughly chronological central chapters: the material, technological history of tampons and S. aureus; medicine and epidemiology; communication and journalism; law and lawsuits; and policy and politics.
The narrative begins with a history of tampons as material technologies. It focuses on how synthetic superabsorbent materials (like those in Rely, the Procter & Gamble tampon that became the focus of TSS investigations) provide an environment where they and the bacteria act together to produce conditions where TSS can occur. The next chapter describes how scientists, physicians, and policymakers identified, traced, and publicized TSS from the late 1970s onward (chapter 2). The book also traces media attention to TSS, Procter & Gamble's withdrawal of Rely tampons from the market, and U.S. Food & Drug Administration (FDA) efforts to require warning inserts in tampon boxes under a Ronald Reagan administration hostile to federal regulation. Chapter four centers on a lawsuit brought against Procter & Gamble by the family of a woman who died from TSS after using Rely tampons. Vostral then examines the efforts of an uneasily aligned task force made up of consumer advocates, feminist health activists from the Boston Women's Health Book Collective, Procter & Gamble representatives, and FDA Bureau of Medical Devices staff members. In early 1982, they were charged with developing standard guidelines for tampon absorbency, but they ultimately produced nothing. By 1990, the FDA Federal Register published standard absorbency ranges for different tampon sizes, though there is still no federal requirement to list tampon ingredients on the box or guidelines on how long tampons should be worn.
The book's primary theoretical contribution is in the first chapter, where Vostral introduces the concept of biocatalytic technology. Biocatalytic technologies "are not primarily dangerous to humans but have the potential to catalyze microbial activity that may result in harm because of their use" (p. 38). Intriguing and potentially useful as this analytic is, it largely disappears from the rest of the book until the conclusion, when the narrative turns to the policy-oriented, legal, and activist elements of TSS's history. There is consequently a disconnect between the first chapter of the book, which develops this analytic and its potential for identifying bacteria as "a nonhuman unintended user . . . able to exploit the technology," and the remaining four chapters (p. 22). The tampon users, activists, lawyers, [End Page 1262] litigants, scientists, and policymakers in the final four chapters focus on the tampons themselves and pay little attention to S. aureus as an actor.
Toxic Shock joins a wider literature of social and technological histories of menstruation and menstrual products. These include Vostral's own Under Wraps (Lexington Books, 2009); Lara Freidenfelds's The Modern Period (Johns Hopkins University Press, 2009); Janice Delaney, Mary Jane Lupton, and Emily Toth's The Curse (University of Illinois Press, 1976/ 1988); and Sara Read's Menstruation and the Female Body in Early Modern England (Palgrave Macmillan, 2013).
Vostral proves the argument that TSS changed scientific understandings of...