Elaterium.—Elaterium.
Related entry: Elaterinum (U. S. P.)—Elaterin
The feculence of the juice of the fruit of Ecballium Elaterium (Linné), A. Richard. (Ecballium officinale, Nees; Ecballium agreste, Reichenbach; Momordica Elaterium, Linné; Elaterium cordifolium, Moench).
Nat. Ord.—Cucurbitaceae.
COMMON NAMES AND SYNONYMS (of plant producing it): Squirting cucumber, Wild cucumber, Wild balsam-apple, Cucumis agrestis, Cucumis asininus.
ILLUSTRATION: Bentley and Trimen, Med. Plants, 115.
Botanical Source.—The wild, or squirting cucumber, sometimes called wild balsam-apple, is a hispid, scabrous, and glaucous plant. The stems number several from the same root, and are cylindrical, prostrate, and without tendrils. The leaves are cordate, somewhat lobed, crenate-toothed, very rugose, supported on 1ong stalks. The flowers are monoecious and yellow. Male flowers: corolla 5-parted; calyx 5-cleft, with a short tube; stamens triadelphous, with yellow, connate anthers. Female flowers: filaments 3, sterile; style trifid; ovary 3-celled. The fruit is oblong, obtuse at each end, hispid, disarticulating from its stalk with violence, expelling its seeds and mucus with considerable force, in consequence of the sudden contraction of the sides. The seeds are black, compressed, and reticulated (L.).
History and Preparation.—The wild cucumber produces the Ecballii Fructus of the British Pharmacopoeia. It is indigenous to the south of Europe, growing on poor soils, in waste places, and flowering in July. It has been extensively cultivated in England for medicinal purposes, where, however, it dies in the winter. It could be cultivated in our country, as it thrives well, requiring but little attention. The medicinal part is obtained by sedimentation from the juice of the pulp, and forms the Elaterium of commerce. The process of the British pharmacopoeia for preparing it is essentially as follows: Slice nearly ripe wild cucumbers, sieve; then set it aside for some hours until the thicker part has subsided. Reject the thinner, supernatant liquid, transfer the greenish sediment to a linen strainer, allow it to drain, and then, by means of a gentle heat, dry it on a porous brick. Elaterium exists in the juice of the fruit in a soluble condition, but rapidly becomes insoluble when the juice is exposed to the air. Elaterium is seldom adulterated, its variation in strength being due both to the difference in the time of its collection, and to faulty modes of preparation. Sometimes it is obtained by subjecting the pulp to too strong pressure, and in other instances, perhaps, by evaporating the juice to an extract. It is then called Elaterium nigrum, as against Elaterium album, which is made by the method herein described.
Description.—Good elaterium is in light, brittle, flat flakes, about ½ line or 1 line in thickness, of a pale-gray color, with a slight greenish or yellowish tinge, having a feeble animal odor (slightly tea-like—Pharmacographia), and an intensely bitter, somewhat acrid taste. It frequently carries the marks of the muslin or paper containing it during its desiccation. It floats upon water, forms a green tincture with alcohol, and does not effervesce in diluted hydrochloric acid. Rectified spirit dissolves about half its weight, and such a solution concentrated and added to a warm caustic potash solution should yield a deposit of at least 20 per cent of colorless, crystalline elaterin (Brit. Pharm.). Elaterium of inferior quality is more or less curled, much darker colored, less brittle, and has a glistening fracture. It yields about 6 per cent of elaterin, while good elaterium. yields from 15 to 25 per cent. When obtained from the fruit collected in summer, elaterium may contain from 40 to 50 per cent elaterin. The Maltese elaterium is in larger flakes than the best English, is paler, with hardly a trace of green, is soft and friable, or chalky to the touch, and frequently contains starch, chalk, and other impurities. It is inodorous, heavier than water, and effervesces with diluted hydrochloric acid.
Chemical Composition.—Mr. Hennel obtained from elaterium 44 parts of elaterin, 17 parts of green resin, 6 of starch, 7 of saline matters, and 26 of woody fiber (P.). Pectin, gummy substances, and albumen have also been found in it. Its watery solution should be wholly or nearly free from starch, as shown by its behavior to iodine solution. Its most important constituent is the drastic principle elaterin (C20H28O5. (see Elaterinum). From the whole plant, including the root, four principles, said to be found also in elaterium, were detected by Walz in 1859. They are the yellow, crystallizable glucosid, prophetin (found also in the fruit of Cucumis prophetarum, Linné); ecballin (ecballic acid), a bitter, acrid, amorphous, resin-like body; amorphous, non-bitter hydro-elaterin; and an extremely bitter, amorphous body, elaterid. For a more detailed account of these substances see Husemann and Hilger, Pflanzenstoffe, p. 1353.
Action, Medical Uses, and Dosage.—Elaterium is an energetic hydragogue cathartic, operating with great violence in doses of a few grains, causing diffuse inflammation of the stomach and bowels, characterized by vomiting, griping pain, and profuse diarrhoea. It is the most powerful of our hydragogue purgatives, and for this purpose should be used only in plethoric states. In ordinary medicinal doses it produces copious watery evacuations, attended with considerable depression of the circulation and nervous system, and most generally nausea and vomiting. Hence, it is often used in dropsy, especially pulmonary oedema and ascites, to aid in removing the effused fluid, as a revulsive in cerebral affections, and wherever a hydragogue or revellent effect is indicated. It has been used in this manner in narcotic poisoning. It causes an enormous flow of watery serum from the blood and mucous structures, and it has been aptly said that one may be "bled through the tissues" with a full dose of elaterium. It also augments the urinary discharge. The dose of the common commercial article, as a cathartic, is from ¼ to ½ grain, administered every 1 or 2 hours until it operates; of Clutterbuck's elaterium, considered the best, and so named because it is prepared after the process recommended by Clutterbuck, from ⅛ to 1/10 of a grain every 3 or 4 hours; of elaterin, from 1/40 to 1/12 of a grain, best given in form of tincture. A few grains of capsicum added to each dose of elaterium will prevent its nauseating effects. Morris recommends a tincture of elaterin made by dissolving 1 grain in 1 fluid ounce of alcohol, to which 4 drops of nitric acid aye been added; the dose is from 20 to 40 drops diluted with cinnamon water. Great care should be exercised in administering elaterium to the debilitated, or to old and infirm individuals, and it is always contraindicated by gastro-intestinal inflammation. Prof. Locke recommends the following: In dropsy with liver complications, Rx Elaterium, gr. j; podophyllin, grs. ij; powd. ext. colocynth comp., grs. xvj; ext. hyoscyamus, q. s. to make a pill mass. Mix. Divide into 8 pills. Give 1 pill every 3 hours until the bowels are freely moved. In dropsy with heart complications, Rx Elaterium, gr. j; powd. digitalis, ʒss; powd. squill, ʒss; ext. hyoscyamus, q. s. to make a pill mass. Mix. Divide into 20 pills. Give 1 or 2 pills every 3 hours until the bowels move freely; after that 1 or 2 pills each day. For uraemic convulsions with ascites, particularly that following scarlatina, Rx Elaterium, gr. j; powd. ext. colocynth comp., grs. xv. Mix. Divide into 8 pills. Administer 1 pill every hour until free evacuations are produced (Syllabus of Ec. Mat. Med.). In the latter condition, gelsemium, jaborandi, or apocynum may be associated with the elaterium treatment if indicated. "For the first time, I now introduce this article to the profession as a specific in chronic inflammation of the neck of the bladder, in which disease I have successfully used it for many years. I am not aware of its ever having been named heretofore for this purpose. It is more especially useful in cases in which there is a constant, more or less painful sensation in the region of the neck of the bladder, where the urine passes in a torrent as if poured through the urethra, and where, after micturition, there is a violent, cramp-like aching in the parts, often extending over the whole lower pelvic region and thighs. The saturated tincture (elaterium gr. j, alcohol fl℥j), is employed in doses varying from 5 to 30 minims; I usually mix it with simple sarsaparilla or other syrup, so that a teaspoonful of the mixture may be taken at a dose, and be repeated 3 or 4 times a day. It must be used carefully, so that it does not purge, although occasionally cases will be met with in which, if its purgative effect is produced by the first doses, its subsequent influence will be more decided. The dose should be small at first, and be gradually increased, as it can be borne. I have also found some good effects from it in chronic gastritis and chronic inflammation of other mucous membranes" (John King). It must be remembered that it is the minute dose that allays gastric irritation. Sore, tender, and heavy, or dragging sensations in the region of the bladder, or in the whole pelvic or perineal region, and accompanied with tenesmic passage of urine containing an abundance of mucus or muco-pus, are relieved by small doses of elaterium more readily than by any other drug. It should also be remembered that in the administration of elaterium only the smallest dose that will accomplish results should be used, for even small doses are apt to occasion emesis and other unpleasant results that may interfere with a successful treatment.
For irritable and painful states of the bladder, the small dose is now preferred: Rx Specific elaterium gtt. v to x to aqua fl℥iv. Dose, a teaspoonful every 2 or 3 hours. The ordinary dose of elaterium is from 1/20 to ⅛ grain; of elaterin 1/40 to 1/12 grain. It must be remembered that both elaterium and elaterin greatly vary in strength.
Specific Indications and Uses.—Chronic cystitis with "constant, more or less painful sensation in the region of the neck of the bladder, where the urine passes in a torrent as if poured through the urethra, and where, after micturition, there is a violent, cramp-like aching in the parts, often extending over the whole lower pelvic region and thighs" (King); deep soreness or tenderness in bladder, pelvis, or perineum, with tenesmic passage of urine loaded with mucus or muco-pus; constipation. In cathartic doses: Dropsy of plethora; ascites and pulmonary oedema; cerebral congestion.
Related Species.—Momordica buchu (Couldn't find any hints to such a species. -Henriette). Nat. Ord.—Cucurbitaceae. Brazil. Resembles squirting cucumber in its properties, though its drastic qualities are said to be harsher (Brit. Med. Jour., 1887).
