Abortifacient Substances

ABORTIFACIENT SUBSTANCES, or emmenagogues, are medicinal agents used to interrupt pregnancy during its first 28 weeks. A. S. in scientific medicine have not yet received full recognition, because their action does not appear justified from a theoretical standpoint, and in practical terms they prove to be unreliable. Hoffman speaks of emmenagogues: 'If we evaluate the action of substances considered emmenagogues, we will see that among them there is not one that could be called emmenagogous in the strict sense of the word. If as a result of their use miscarriage does sometimes occur, it is rarely due to a specific and primary action on the motor centers of the uterus or on the fetus itself; usually, miscarriage constitutes only a secondary phenomenon and occurs as a consequence of various functional changes produced by A. S. in the mother's organism, i.e., as a consequence of poisoning in the broad sense of the word. It follows that, properly speaking, all poisons under certain conditions can also produce miscarriage, and that sometimes they may be taken with the aim of expelling the fetus.' Indeed, in some localities even phosphorus and arsenic are used by the population as A. S. To such unreliable but dangerous A. S. belong, for example, so-called purgatives (drastics); when administered in large doses, they can cause dangerous bleeding in pregnant women, reflex irritation of the uterus caused by vigorous peristaltic contractions of the intestine, and as a subsequent phenomenon—abortion. Severe circulatory disorders, especially in the kidneys and pelvic organs, are caused by the Don juniper (Juniperus sabina) and turpentine oil (Ol. Terebinthinae), the vessel walls of which become easily permeable and bleed profusely, which may cause miscarriage; however, even here these substances are administered in such large doses that they primarily threaten the mother's death rather than abortion. Containing essential oils—tansy or wild chamomile (Tanacetum vulgare), especially a popular A. S. in France, thuja (Thuja occidentalis et orientalis), rue (Ruta graveolens), readily used as an A. S. in America—they complete the list of vegetable A. S. that act on the uterus secondarily, through severe circulatory disorders in the intestine. The Spanish fly (Cantharides) can also be included here, where irritation of the kidneys and intestine reaches maximum intensity and usually ends in the mother's death with large doses. To A. S. also belong Mentha pulegium, Hedeoma pulegioides, Salvia officinalis, Semen Myristicae, Ledum palustre, Crocus sativus, Gossypium herbaceum, Senecio vulgaris, Senecio jacobaeus, aureus, maritimus, Erodium cicutarium; regarding them it can be said that all of them, when used, are also not specific A. S., and the abortive action they produce is only a secondary phenomenon. Somewhat apart are other medicinal agents also used as A. S.—ergot of rye (Secale cornutum), golden seal rhizome (Rhizoma Hydrastis canadensis), cotarnine, pituitrin, adrenaline, pilocarpine, muscarine, physostigmine, nicotine, quinine, and morphine; for these preparations we must recognize the primary action on the uterus, but nevertheless their emmenagogue properties cannot be considered certain: small doses usually do not give the desired effect, while large administrations, although sometimes leading to miscarriage, at the same time lead to the same phenomena of poisoning. Experimental study of the named substances reveals different action on the uterus in different animals, as well as the dependence of the nature of the action of these substances on the state of the uterus—pregnant or non-pregnant. This concerns, for example, adrenaline, pilocarpine, physostigmine, and nicotine. The mechanism of their action on the uterus is connected with their influence on the peripheral nerve apparatus of the parasympathetic system. Otherwise, the action of pituitrin must be explained, whose effect on the uterus is not eliminated by atropine. Adrenaline in very high dilutions (1:20 million) still causes the strongest contractions of the rabbit's uterus. Quinine acts on the uterus through its peripheral apparatus, but miscarriage occurs only from such enormous doses that quinine completely disrupts the circulation and nutrition of both mother and fetus. Movements of the uterus are intensified by small doses of morphine, but these doses do not cause miscarriage, while large doses, acting on the uterus rather soothingly, may be the cause of severe poisoning of the fetus or its death, which ends in abortion. As for ergot of rye, in mass poisonings from ergot there are cases of miscarriage; however, even here abortion occurs in the pregnant woman either as a result of very severe poisoning that quickly ends in her death, or after the death of the fetus and expulsion after some time, the mother's death also occurs. Regarding the means of the last group, it can be said that if they are of great therapeutic value, as A. S. they are still unreliable, and when administered in large doses are dangerous to the life of both mother and fetus. Of mineral salts, those containing predominantly potassium are used as A. S., and of these potassium permanganate is most frequently used. The essence of the action of potassium salts lies in the influence of potassium on the muscles, sometimes causing miscarriage, but only if the salts are administered in large poisonous doses that cause irreparable harm to the mother.