Toxic Shock. Sharra L. Vostral
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cellular level while also being mindful of the culture in which the science is situated, analyzing it with a feminist eye. While at the University of Illinois, my colleague Cris Mayo joked that I was the only person left in the department studying actual women’s bodies, the field had so moved into other areas. It is in this tension that research on biology about menstruation and the engineering of menstrual management technologies fall. It is the case of “both/and.” TSS is both technobiological and socially constructed, and it must be read back and forth and across.
Discussions about menstruation on the whole need more thoughtful attention to meanings and their implications. There has been an unquestioning link between menstruation and identities of womanhood, which falls back on an essentialist understanding of “woman,” and that conveniently sustains the man/woman binary. This reified notion, however, does not capture the whole picture of women or men or of the interplay of gender. The growing attention to transgender individuals has made it clear that biological body parts and processes do not define a woman. Yet menstruation has most definitely been a sign of being a woman, and as the feminist philosopher Denise Riley comments in Am I That Name?, menstruation summons a woman back to her body, often read as inferior to men, despite all the ways she may try to transcend prejudice with her mind, actions, and efforts.26 Thus menstruation has been a fraught subject of study, and in my book Under Wraps I traced how pro-woman physicians worked to break menstrual stigmas and conceptualize menstruation as normal rather than a sign of weakness and infirmity.
Menstruation remains a strong signifier of woman, yet this is not entirely accurate. When I refer to “women” and “woman” in this book, I fall into the trap of signifying those humans who menstruate, did menstruate, or could menstruate. Yet this is shortsighted, for there are many kinds of women among us who do not menstruate. Though this list is not exhaustive, menopause, hysterectomy, pharmaceuticals, pregnancy, lactation, endocrine issues, excessive exercise, and other causes, as well as being transgender, are all reasons why women might not menstruate. I used the term “menstruant” and referred to women using menstrual hygiene technologies who temporarily pass as “nonmenstruants” in Under Wraps, but perhaps it would be better to refer not to women, but to “menstruators” as Chris Bobel explores in her book New Blood: Third-Wave Feminism and the Politics of Menstruation, since all women, however that category is understood, do not menstruate.27 This would also allow space for those transgender men, along the various spectrum of transitioning, who do have periods. They are menstruators, too. It is not the intention of the book to write a queer history of menstruation, but one needs to be written, and I want to acknowledge the shortcomings of terms in writing about women and menstruation. Because I cannot escape the trap of language, in the book I employ the more historically bound usage of “women,” in large part because that is what the archival sources mean and what stakeholders understood within contemporary popular debates. In an effort to disaggregate essentialist terms, “menstruator” is far more accurate and I also utilize that term throughout the book.
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“[W]hat if you died from toxic shock syndrome and they put that in your obituary letting everyone know you died from a tampon[?]”28 This question from a Twitter feed captures the common knowledge that tampons cause TSS, and that death from a tampon would be embarrassing and shameful. It also implies it would be a stupid way to die, in that such a death is both unnecessary and preventable. This sentiment—that it should not happen and it is avoidable—haunts those who contract TSS, and it circulates as an urban/suburban myth, blaming women for their tragic illness. If only they followed the warning signs. This is quite unfair and displaces responsibility. Corporations must be more forthcoming with ingredient labeling, and medicine can and should offer preventative tests.
For menstruators who have used and do use tampons, the nagging warning about TSS is pervasive. I untangle the history of tampon-related TSS by examining scientific discovery and lack thereof, policy and lack thereof, as well as women’s reactions and the ways that many women paid the ultimate price by contracting a horrible illness and even dying due to the biocatalytic reaction that the tampon set into motion. Only extreme conditions prompted actions about tampon-related TSS, and this should be heeded as a warning for other similar kinds of unexpected and unintended techno-bacteriological illnesses. How tampon-related TSS was understood, reported on, and managed affects us to this very day and reveals the tensions inherent to relationships among feminism, medical science, technological developments, and bacterial agents of the human body.
1
Unexpected Consequences
A tampon is a thing. A bacterium is a life form. These assertions, however, are shortsighted. As it turns out, and as toxic shock syndrome (TSS) came to attest, both are quite more dynamic together than anyone ever imagined. This was difficult to envision because of the overwhelming assumption that tampons were inert, disposable objects. They sometimes caused irritation, an allergic reaction from embedded perfumes, or lacerations from an applicator, but they were not conceptualized as dynamic. That a bacterium typically associated with food poisoning or boils might possibly develop into a strain that could produce septic shock seemed like a stretch, but it became accepted knowledge. Agreeing on a new ailment of TSS and further specifying it as tampon-related TSS became part of a repertoire of illnesses predominantly affecting women.
What is not well conceptualized, and an idea that I propose here, is that during this process a bacterium became the overlooked and unintended user of tampons, thus changing the relationship of user/technology. The bacterium advantageously capitalized on the technological innovation to reproduce and multiply. Though tampons were intended for menstruating women to be the dominant users of the technology, it is constructive to think of bacteria as users, too. This changes subject/object orientation, thus shifting the conditions of agency. It is here that the relational activity of technology and bacterium must be far better conceptualized and understood as co-agents of unintended illness.
This chapter focuses on this relational activity. There are many conceptual underpinnings that need to be addressed to better understand this techno-bacteriological relationship. First, tampons are a technology, with a history of design and development during the twentieth century. Second, they share in common the ability to cause gendered injury, like many other technologies used to manage and regulate women’s reproductive bodies. As such, and third, they fall into a loosely woven safety net of the Medical Device Amendments (MDA), which in theory provide a process by which therapeutic technology undergoes testing to assess its compatibility with the human body and its proclivity to do harm. Fourth, what these tests do not predict is how other organisms in and of the human body will interact with medical devices, because technology is not neutral or inert. This has a direct effect on the next important concept: that bacteria possess the ability to become technological users, and, as users, create unintended consequences for humans with which they share an ecological space. Finally, this techno-bacteriological interface has been poorly anticipated in terms of design and risk, so that resultant injury appears unexpectedly, as a surprise. The indecorous subject of tampons and menstruation made it difficult for many to willingly concede the game-changing scope of this technobiological illness.1
Tampons as Technologies
Tampons were neither regulated nor particularly trusted technologies when they first commercially appeared in the form of Tampax in 1936. They required a good degree of domestication as emergent technologies, accompanied by educational advertising teaching women about the benefits of the technology.2 Because tampons were phallic-like in shape and a perceived threat to the virginal hymen, some educators, nurses, and parents felt convinced to leave well enough alone. They promoted the use of disposable sanitary napkins instead for adolescent girls.3 Yet, by the 1940s, many young women were early adopters, because they recognized how tampons relieved them of the physical encumbrance of elastic belts, long tabs, and uncomfortably thick pads worn between the thighs.4 Advertising, menstrual hygiene education films, and word of mouth shifted many women’s opinions about tampons from dubious to acceptable; under certain circumstances such as dancing, swimming, or working long shifts, many embraced them as a useful tool of physical liberation.5 Still, there was much cloaking, double entendre, and indirect language about how and when to use a tampon. To the uninitiated, the cryptic language of advertising made tampons seem like magic in a box; I have anecdotally