many chose to trust their taste buds rather than scientists’ data pointing to saccharin’s danger. In fact, the New York Times reporting on the recall of Rely in 1980 referred to the similarities between the two. An unnamed advertising executive noted to a reporter that “the reaction could be like saccharin. There’s such a strong preference for tampons that it might outweigh the degree of risk.”81 There was some truth in this since the risk was low for most women. This attitude, however, pushed the burden of the illness onto women, citing their “preference” and choice to use tampons knowing that they were dangerous, rather than holding the companies responsible for the manufacture, design, and distribution of synthetic superabsorbent tampons.
There were plenty of mixed feelings and mixed messages about tampons. Before the recall during the 1970s, tampons, including Rely, enjoyed widespread support. For many women tampons were their only choice, and there was no going back to sanitary pads with cellulose wadding and elastic belts. For most young women who suffered through pads chafing the inner thighs, the discomfort of a bulky pad worn between their legs, and the awkward gait of walking around a pad, wearing a tampon, whatever its composition, eliminated these problems. In light of the superabsorbents that were readily available to manufacturers, and consumers’ willingness to try more technologically sophisticated products, it is no wonder that more and more tampons incorporated synthetics and that women would like them.
In addition, tampon technology was particularly linked with women’s liberation. Advertisers equated bodily freedom to political freedom, a claim that was hard to contradict and was reinforced in advertisements with women in white outfits undertaking all sorts of desirable activities. After using tampons, most women had no intention of returning to pads. Many women incorporated tampon technology into their daily lives, and this object became an important item in what I refer to as the “feminist toolbox.” Like other tools such as birth control, trousers, and the right to enter a contract, tampons offered a unique vehicle to support personal independence and agency, and to absorb bodily fluid while remaining unencumbered. Because of this very personal and intimate relationship of the tampon to women’s sense of freedom and well-being, the emergence of TSS seemed both impossible and particularly destabilizing. How could this object, so normalized and domesticated, suddenly become deadly? Some women, like the saccharin users, refused to believe that products might cause harm and continued on as before, their faith in Rely clouding facts and adding to denial. Others acquiesced to warnings and limited their tampon usage or switched back to pads. Others got angry and boycotted, and some sued manufacturers for product liability.
Many scientists continue to be divided about what exactly triggered the outbreak; with a strong history of scientific method and inconclusive results, it was and continues to be difficult to make scientifically informed recommendations in the face of contradictory evidence. Even in 2012, researchers publishing in the Australasian Journal of Dermatology asked as part of their article title “Is Menstrual Toxic Shock Syndrome Really Caused by Tampons?,” raising the same decades-old and misleading question that researchers in the early 1980s did.82 The title indicates doubt about the role of tampons due to the assumption that they are inert. If, as Langdon Winner argues, artifacts have politics, and if, as Bruno Latour and Jane Bennett suggest, things exert agency, then it is high time to recognize the social and political meanings of menstrual hygiene technologies as well as the multiple outcomes related to their technological use. Because tampon technology has historically been disparaged, is hidden from sight, is worn internally within the body, and is primarily used by women, this changes the scope of injury compared to a faulty automobile airbag or a dresser drawer that tips over onto a person. No contemporary woman in the United States has benefited from unearned privileges derived from purposely or accidentally exposing menstrual fluid for others to see. Tampons powerfully conceal a disparaged bodily fluid, and thus the social disregard for menstruation casts a shadow on related illnesses such as TSS. Because of these social roadblocks, the imagination must be stretched to consider bacterium that reside on bodies and in vaginal spaces as technological users of tampons, even though they were not the primary target audience. By examining TSS as the result of a biocatalytic technology, we can gain a better understanding of how we need to think very carefully and deeply about technologies for biological use, not just for humans but for nonhumans as well.
2
Mystery
People get sick all the time. It is easy enough to minimize symptoms such as fever, chills, or sweats. Imagine then, that a person’s fever keeps rising, diarrhea and vomiting are unremittent, and fatigue and muscle weakness make it a Herculean effort to get out of bed. Deciding to seek professional, allopathic medical help carries an economic cost in the United States, so the decision to stay home and wait for the symptoms to subside is not unusual. In the late 1970s when a woman possessing these symptoms finally decided it was time to see her doctor, or a family member insisted she needed more immediate care at an emergency room, she would likely get an IV drip to replenish fluids and electrolytes, with further orders to rest at home. The sudden illness might take a turn for the worse, with her getting rushed into acute care and then suffering the onset of kidney failure. Still no one knew what was wrong. This all seemed very unusual for a healthy, young person, and it was likely that the attending physician would diagnose a severe viral infection.
Toxic shock syndrome (TSS) became this mystery illness in the late 1970s. What made it unique was that it challenged traditional forms of knowledge production about sickness. A direct causal model was insufficient to identify TSS. A paradigmatic shift to include a medical device as a cofactor was necessary for scientists and researchers to effectively associate tampons with TSS. Without a biocatalytic model as part of the usual scope of medical inquiry, recognizing this alternative pathway was not obvious. The politics of whether or not this should be “obvious” falls within the context of long-standing and systematic practices dismissing women’s reproductive health. However, with numbers on the rise, the life-and-death emergency-room cases could not so easily be ignored because the sufferers were mostly white teenagers and young mothers. This unknown malady needed to be framed in new ways, recognizing tampon technology in the illness process and challenging the long-held view that tampons were inert. It also required public health officials to argue for an unusual etiology, and one that manufacturers of tampons initially disputed.
This chapter examines how TSS gained traction as an illness and also how medical practitioners and epidemiologists further associated it with superabsorbent tampons. Within the milieu of the time period, it was neither intuitive nor “common sense” and took a good deal of research, contested at multiple levels, to conclude that TSS was a real illness with the potential of becoming an epidemiological event. In addition, the Centers for Disease Control (CDC) was under a good deal of pressure after some less-than-ideal outcomes with the 1976 swine flu pandemic that never arrived, and Legionnaires’ disease, which took nearly a year to analyze and identify. It could not afford to be the agency responsible for the deaths of thousands of young, mostly white, women, so it mobilized to thwart this emerging illness before it could unleash untold damage.
As researchers pondered what this set of symptoms might indicate, some possibilities emerged as potential culprits. Christian Schrock, an infectious disease specialist writing in the Journal of the American Medical Association (JAMA) in 1980 wondered whether it was a manifestation of herpes.1 Bruce Dan, an epidemiologist at the CDC, hypothesized it may be a variant of scarlet fever.2 Though it is the job of the epidemiologist to track outbreaks, both known and unknown, positively identifying an emergent and novel illness carries implications. Though sometimes medical-device technologies carry the risk of injury, postoperative infection, or even simply wearing out, they had not been assumed to catalyze illness in healthy individuals via bacteriological toxins. The very assumption of the safety of all tampons was called into question, which held both serious financial costs for corporations and also major adjustments to daily menstrual management practices for millions of women. How to identify an unknown syndrome, and the methodology used to do so, carried political consequences for federal agencies, corporate scientists, and women users, with ramifications still resonating today. In order to understand the scope of research and the marshaling
