A Syndrome Shocks Medicine

Daily Observer

February 23, 1981

Just as we are recovering our composure from the swift lesson taught by Legionnaire’s disease – namely; that we do not know everything that is to be known about disease – along comes the Toxic Shock Syndrome (TSS). We are forced to admit that vast pockets of ignorance exist and nature is never reluctant to point that out.

As a matter of fact, discovery of Legionnaire’s disease was made not by a physician but by the observation of one of the members of the American Legion who noted an uncommon number of deaths of his conferees shortly after a convention in Philadelphia at the Bellevue Stratford Hotel.

I don’t know how Toxic Shock was discovered but it is strikingly a disease of females, particularly and almost solely of females who use the ubiquitous and much advertised tampons. The disease finally surfaced in sufficient numbers to be noticed; that is there were enough serious cases and catastrophic deaths in young women for the epidemiologists to piece together a story and identify the entity and its probable causative agent.

The causative agent is thought to be a variant strain of staphylococcus aureus, the bacterium found in pus. It is not normally found in the vagina. Having looked at literally thousands of vaginal secretions under the microscope I have seen staph aureus only once. As a matter of fact the normal vaginal; flora is populated by a lactobacillus which maintains an environment inimical to other germs. When non-infectious and harmless contamination occurs, vaginal secretions play host to a number of organisms commonly found in the bowel. They may cause low grade urinary infection, rarely serious and certainly not lethal to the average healthy woman.

The first mystery of the Toxic shock syndrome is its association with staph aureus. This organism is not normal to vaginal secretions, and if wound at all it is not dominant. Why then should it suddenly become lethal? Could it be that there is something in the tampons that suppressed the normal vaginal flora? Or even that the tampons are contaminated with Staph.

The relationship between staph, TSS and tampons is established. Thus the wise forewarned woman will not wear tampons continually during menses, but intermittently if at all. That TSS has manifested itself in an age of super-absorbent tampons is probably significant. A bacterium multiplies every twenty minutes under ideal conditions. Ideal conditions include body temperature, nourishment (menstrual flow is nutritionally enriched food for germs) and a surface on which multiplication can take place, this of course the blood soaked tampon. A tampon removed eliminates millions of bacteria. A tampon left in place for twelve hours multiplies the bacteria exponentially.

The fulminant TSS is lethal. Supposedly the staph elaborates a new toxin which destroys kidneys, liver and finally its victim. But make no mistake, kids coming to the office with staph throats are vary sick -- nauseous, aching all over and febrile. They are toxic. Before antibiotics some of these kids died. Maybe TSS is something similar except in a different location. Perhaps staph proliferates in the tampon and then migrates into the uterine cavity, the internal surface of which is raw during menstruation. A lot of toxin elaborated in this place would enter the blood stream and disseminate, rather than form an abscess with protective walls as staph usually do.

There seems to be no relationship between TSS and intra uterine devices (IUDs). TSS has been observed in males, and the first case description (before there were tampons) were written in 1926. So there is a lot of mystery to unravel but until it is prudent women shouldn’t tamper with tampons.