On
May 15, 2010, a pregnant woman in Rapid City, South Dakota, took a can of soda
to the police for analytical testing after months of allegedly receiving odd-tasting
drinks from her former boyfriend, Alfredo Vargas. Mr. Vargas, who supposedly
made it known that he did not want a child with the woman, is said to have
become angry when she commented on the strange taste and appearance of the
beverages she attests that he served her. “She
noticed a minty taste and kind of a greasy-looking film,” said Deputy State’s
Attorney Scott Roetzel, who is bringing allegations of attempted fetal homicide
against Mr. Vargas for the second time (and charges of unauthorized abortion for the first time), more than one year after his
client delivered a healthy boy (oral communication, October 26, 2012). If he is
found guilty of attempted fetal homicide, Mr. Vargas could face a 25-year prison sentence.1
South Dakota law defines fetal homicide, a Class B felony, as follows:
Homicide
is fetal homicide if the person knew, or reasonably should have known, that a
woman bearing an unborn child was pregnant and caused the death of the unborn
child without lawful justification and if the person:
(1)
Intended to cause the death of or do serious bodily injury to the pregnant
woman or the unborn child; or
(2)
Knew that the acts taken would cause death or serious bodily injury to the
pregnant woman or her unborn child; or
(3)
If perpetrated without any design to effect death by a person engaged in the
commission of any felony.
This
section does not apply to acts which cause the death of an unborn child if
those acts were committed during any abortion, lawful or unlawful, to which the
pregnant woman consented.1 “Any
person who performs, procures, or advises” an abortion that is not authorized by
South Dakota law is guilty of unauthorized abortion, a Class 6 Felony carrying
a 2-year sentence.1
Through
undisclosed methods of testing, the state health department determined that the
soda had been tainted with 141 mg/L pulegone, a compound found in pennyroyal (Mentha pulegium) and other mint species.
During an initial pre-trial hearing earlier this year, the judge dismissed the
prosecution’s expert witnesses — a local chemist and herbalist — for lacking what
she deemed adequate training or background, according to Mr. Roetzel. He has
since enlisted a toxicologist from Denver, Colorado.
Pennyroyal’s
potential as an abortifacient has been recognized for thousands of years. Aristophanes’
plays Peace and Lysistrata (of the early 400s BCE) contain references to its use for
this purpose.2 Pennyroyal numbered among the herbs Persian physician
Avicenna (aka Ibn Sinna; ca. 980-1037 CE) prescribed for contraception, and was
mentioned in the surgeon William of Saliceto’s (ca. 1210-1280 CE) list of
abortifacient drugs.2 In the 12th century, Nicholaus of
Salerno’s Antidotarium — well known
in Europe’s apothecaries by the later medieval period — included an antidotum for “passions of the womb”
that contained 31 ingredients, pennyroyal among them.2 In a 1554
edition of German botanist Otto Brunfels’ herbal, pennyroyal is cataloged under
ducentia foetum and matrici convenientia (“cutting off the
fetus” and “comforts the womb,” respectively).2
In
more recent history, recipes for emmenagogues (agents that incite menstruation)
and menstrual regulators in early-to-mid 19th century medical
publications called for pennyroyal.2 Advertisements for medicines
such as “Colchester’s Pennyroyal and Tansy Pills” and “Chichester’s Pennyroyal
Pills” appeared in newspapers by the late 1800s; the ad copy frequently left
little doubt as to what “condition” the pills were intended to treat.2
In The Essential Guide to Herbal Safety*,
authors Simon Mills and Kerry Bone explain that pennyroyal “is contraindicated
in pregnancy and lactation. The oil should not be taken internally.”3
“Although
traditionally used as an abortifacient, there are no studies elaborating on the
nature of the effect on the womb, nor any teratogenic or other related toxicity
data,” they write. “Nevertheless, the risk of harm to mother or foetus if
pennyroyal or its oil is used is at least as high as any systemic
abortifacient, with the additional risks of damage to organ development and
central nervous system in the foetus.”3
Mr.
Mills and Mr. Bone go on to review 22 cases in the literature in which patients
who ingested a minimum of 10mL (0.34 fl. oz.) of pennyroyal oil experienced
“moderate to severe toxicity” — and at least two of them died.3
“In
one case of ingestion of 30mL (1 fl. oz.) of pennyroyal oil by a pregnant
woman, symptoms included abdominal spasm, nausea, vomiting, alternating
lethargy and agitated behavior,” wrote Mr. Bone and Mills. “Later, a kidney
failure and a solid liver necrosis developed; death occurred seven days later.”3†
However,
according to physician, herbalist, and midwife Aviva Romm, MD, “[Pennyroyal] is
a fairly gentle mint and frankly, it is really difficult to induce a
miscarriage even with known abortifacient herbs” (email, November 2, 2012).
“Pennyroyal
oil,” she said, “is an abortifacient with some possible efficacy, [but] the
doses needed are actually toxic to the pregnant woman.” Dr. Romm is also author
of Botanical Medicine for Women’s Health.‡
Other Potential Herbal
Culprits?
Peppermint oil (M. x piperita) allegedly was discovered in Mr.
Vargas’s home, and though it does contain pulegone, Dr. Romm doubts that
spiking drinks with it would have been an effective method of inducing
miscarriage.
“It
is highly unlikely that peppermint oil given in an amount that was not overtly
obvious to the person consuming it would cause any problems at all. The dose
would have had to be miniscule,” said Dr. Romm. “It is very strong tasting and
could not be hidden in anything but toothpaste and schnapps… I do not believe
there is much pulegone in peppermint oil, but again, this is irrelevant as the
amount would have had to have been insignificant.”
Regarding
peppermint, The Essential Guide to Herbal
Safety notes that “No increase in frequency of malformation or other
harmful effects on the foetus from limited use in women. Animal studies are
largely lacking.”3
The
woman bringing charges against Mr. Vargas alleges that she found a “white
powdery substance” left in a drink container, consistent, Mr. Roetzel says,
with blue cohosh (Caulophyllum
thalictroides)§, a traditional Native American medicinal plant
that is considered a dietary supplement ingredient of safety concern by the US
Food and Drug Administration.4 A female witness in the case
testified that Mr. Vargas once instructed her to utilize blue cohosh to induce
labor when she was pregnant and overdue to deliver; she allegedly spit it out
because of its taste. Blue cohosh’s extreme bitterness is not consistent with
the minty taste of the tested soda and other beverages that made Mr. Vargas’s
former girlfriend suspicious.
“I
do not believe any alkaloids from blue cohosh would precipitate out as
described,” said Dr. Romm. “It is more likely that there was an excipient or
binder in the product [if, in fact, there was an added substance present at
all].”
The
American Herbal Pharmacopoeia (AHP) recently published a monograph of blue
cohosh — co-edited by Dr. Romm with AHP Executive Director Roy Upton — that
details its traditional use as a partus
preparator and abortifacient.5
“Due
to its action as an oxytocic agent and its potential for teratogenicity and
adverse neonatal effects (e.g., cardiac toxicity of the glycosides), blue
cohosh should not be used during pregnancy other than during labor or to induce
labor and only under the supervision of qualified maternity health care
providers,” according to the monograph.5
The
safety profile section of the monograph describes a case in which a woman who
was five-to-six weeks pregnant self-administered 10-to-20 doses of blue cohosh
tincture over the course of four days in order to terminate the unwanted
pregnancy.5 She was unsuccessful, however, and suffered from “two
days of abdominal pain and bilious vomiting.” Medical examinaters determined
that the 21-year-old non-smoker was experiencing acute nicotinic poisoning.‖ She was treated and
recovered.5
Attorney
Roetzel is set for an arraignment with a new judge this month; depending on the
outcome, a trial may be underway as early as February 2013.
—Ash Lindstrom
* Recipient of the 2006 ABC James
A. Duke Excellence in Botanical Literature Award.
† According to a 1979 article in the Journal
of the American Medical Association, the 18-year-old patient referenced
here claimed that she had ingested pennyroyal oil to terminate “a suspected
pregnancy.” However, it was documented that she showed signs of depression and
may have intended to commit suicide.6
‡ Recipient of the 2011 ABC James A. Duke Excellence in Botanical
Literature Award.
§ Blue cohosh has no botanical relationship to the much more popular herb
black cohosh (Actaea racemosa, syn. Cimicifuga racemosa), used frequently
for its reputed ability to help manage menopausal symptoms.
‖ Blue cohosh does not
contain nicotine, but it does contain the constituent N-methylcytisine, “which binds to acetylcholine receptors in a
manner similar to nicotine.”5
References
1.
South Dakota Codified Laws Chapters
22-16-1.1 and 22-17-5.
2. Riddle J. Eve’s Herbs: A History of Contraception and Abortion in the West. Cambridge,
MA and London, England: Harvard University Press; 1997. 3. Mills S, Bone K. The Essential Guide to Herbal Safety. St. Louis, MO: Churchill
Livingstone; 2004. 4. 2009 Foods Report. US Food and Drug
Administration. Available here.
Accessed November 6, 2012. 5. Romm A, Upton R (eds). Blue Cohosh Root and
Rhizome. Scotts Valley, CA: American Herbal Pharmacopoeia; 2012. 6. Sullivan J, Rumack B, Thomas H, Peterson R,
Bryson P. Pennyroyal oil poisoning and hepatotoxicity. JAMA. 1979;242(26):2873-2874.
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