The feculence of the juice of the fruit of Ecballium Elaterium (Linné), A. Richard. (Nat. Ord. Cucurbitaceae.) A trailing vine of southern Europe.
Common Names (of fruit): Squirting Cucumber, Wild Cucumber, Wild Balsam Apple.
Description.—Light, brittle, flat flakes, pale-gray with a greenish or yellowish tinge, a tea-like odor, and an intensely bitter taste.
Principal Constituent.—The neutral purgative principle elaterin (C20H28O5. present to the extent of 20 to 25 per cent.
Preparation.—Specific Medicine Elaterium. Dose, 1 to 20 drops.
Derivative.—Elaterinum, Elaterin. (Odorless, very bitter, and slightly acrid, white scales or crystals; permanent in the air. Very soluble in chloroform; sparingly in alcohol, and almost insoluble in water.) Dose, 1/40 to 1/8 grain. Of the Trituratio Elaterini (elaterin, 1; sugar of milk, 9), 1/4 to 1/2 grain.
Specific Indications.—Chronic cystitis with pain in the neck of bladder, the urine passes in a torrent, and after micturition there is violent cramp-like aching extending from the bladder into the pelvis and thighs; deep soreness or tenderness in the bladder, perineum, or throughout the pelvis, with tenesmic voiding of mucus or muco-pus-laden urine; dropsies of plethora; cerebral congestion; pulmonary edema.
Action and Therapy.—Elaterium is the most powerful and the best of the hydragogue cathartics. As such it is indicated only in individuals strong enough to stand depletion, and is always contraindicated in the weak and feeble. Overdoses-even a few grains-may produce a diffuse gastro-enteritis, with violent vomiting, cramps, and watery purgation. In medium doses only copious watery stools are produced, but with considerable depression. The treatment for excessive action of elaterium is that for gastro-enteritis in general.
In medium doses elaterium has been, and is still to a lesser extent, used as a dehydrating cathartic in chronic dropsies of hepatic or abdominal origin, and in chronic nephritis. When the liver is involved, with congestion or torpor, it may be given with podophyllin; if there are heart complications, with digitalis. It is quite certain to reduce the ascites; but when the latter is dependent on destruction of tissue, it does not, of course, cure the disease, of which the dropsy is but a symptom. It is often useful in dropsy after scarlet fever, if the patient is not greatly exhausted; and it is more especially indicated when uremic convulsions threaten or are present. Elaterium is a useful purgative when a revulsive is needed in cerebral congestion.
The small dose of elaterium is preferred for other specific purposes. Elaterium is the remedy for chronic inflammation of the bladder, as first announced by King. When indicated the urine rushes from the urethra as in a torrent and is accompanied by constant pain radiating from the neck of the bladder to the surrounding tissues, and micturition is followed by violent pelvic and femoral cramps. This condition is frequently associated with general pelvic dragging and tenderness, and the urine is characteristic of chronic subacute inflammation-ropy with mucus or mucopus. The dose should be small enough not to provoke emesis or catharsis. The usual prescription is: Rx Specific Medicine Elaterium, 10-20 drops; Water, enough to make 4 fluidounces. Mix. Sig.: One teaspoonful 3 or 4 times a day.
For hydragogue purposes Elaterin is preferred by some physicians, though elaterium, notwithstanding its impurities, seems to be more generally efficient than its derivative.
The Eclectic Materia Medica, Pharmacology and Therapeutics, 1922, was written by Harvey Wickes Felter, M.D.