This section is from the book "Materia Medica And Therapeutics - Vegetable Kingdom", by Charles D. F. Phillips. Also available from Amazon: Materia Medica And Therapeutics: Vegetable Kingdom.
Active Ingredients. - According to the earlier of the modern writers upon elaterium, every portion of the plant is cathartic; and it is expressly stated by some, that the root may be employed in substance, and that an infusion of it is equally efficacious. It appears, however, from the experiments of Dr. Clutterbuck, that the properties of the herbaceous portions are very trifling, and that the pericarp of the fruit is itself of scarcely more importance, the only part really valuable as a medicine being the juicy pulp which invests the seeds. This juice, as it issues from the natural orifice in the fruit, without pressure from the fingers, is perfectly limpid and colorless. After standing for a short time, it becomes turbid; and in the course of a few hours deposits a sediment, which, being dried without much exposure to light, becomes a yellowish-white powder, slightly tinged with green, very light and pulverulent, and constituting the pure and genuine "elaterium" of the Materia Medica. Much of the elaterium of commerce is not pure, being prepared by strong pressure of the fruit, and consequently contains the deposit of the ordinary juices, as well as the absolute principle. This compound elaterium is dark green, approaching black, and is in substance compact and heavy, breaking with a resinous and shining fracture. The best British elaterium contains 26 per cent. of the active principle; the worst about 15 per cent. The French elaterium is considerably inferior, the proportion being only 5 or 6 per cent.
1 Edin. New Phil. Journal (new series), i. 300.
2 A beautiful dye for silk.
3 Indian Ann. Med. Sciences, i. p. 286.
The active principle is Elaterine (C20H18O5), a crystalline substance, which forms colorless, shining, hexagonal tables; it has a pungent, bitter taste, and a neutral reaction; it melts at 200° C. into a yellow fluid, which on cooling forms amorphous yellow masses. It is neither soluble in water nor in glycerine, but is easily dissolved by boiling (not by cold) alcohol, and by chloroform. Concentrated sulphuric acid dissolves elaterine dark red: the addition of water gives a brown precipitate.
Physiological Action. - The active properties of elaterium are fully represented by elaterine, which has been made the subject of numerous experiments, the earliest being those undertaken by Morris (the discoverer) and Golding Bird. Given even in very small doses, either to animals or man, it produces the violent drastic purging characteristics of the action of the drug; and in larger quantity proves speedily fatal. It is remarkable that the drastic action only takes place when the drug comes in direct contact with the bile. Kohler experimented on animals by placing powdered elaterine in a portion of intestine, which was included between two ligatures (the contents having first been squeezed out of this part of the bowel), and found no effects, whether local or remote. He also tied the ductus choledochus, and then found that the aqueous solution of elaterium administered by the stomach, produced no purging, but only some remote poisonous effects.
Investigation of its action upon man has been made by Schroff:1 he observed the effects of very considerable doses upon two of his pupils, as much as 3/4 grain, an amount somewhat dangerous, being given. In one of these young men the earliest phenomenon was marked salivation; followed (45 minutes after administration) by nausea, retching, and vomiting, which was repeated four times in the course of two hours, and was eventually quite bilious: the salivation ceased when the vomiting began. Simultaneously with the sickness, the patient suffered from flatulent belchings, griping, abdominal pains, irritation in the throat, and cerebral torpor. Six hours after swallowing the elaterium, there occurred a very copious watery evacuation, soon followed by two similar ones, leaving the patient in a state of anorexia and depression. In the second case, a similar dose was given, and this quickly produced nausea and retching, which was a good deal relieved by a fit of sneezing: a stool occurred 6 1/2 hours after the administration, and a second two hours later. Eleven hours after the administration there occurred epistaxis, and a single violent vomiting, which last did not recur, although there was constant nausea and a smell (subjective?) of rotten eggs. On the second day there were nine fluid stools, and on the third day there were three; the nausea and retching, with great feeling of weakness and languor, continued till the fifth day.
1 Lehrb. d. Pharmakologie.
It is certain that over and above the action upon the alimentary canal, elaterine can produce a train of poisonous effects upon the nervous system; and, according to the way in which it is given, the irritative or the nervous phenomena may respectively predominate. Marked toxic effects upon the nervous system have been produced in cats, by direct injection into the veins: here, again, a marked symptom was salivation, followed in one instance by restlessness, stertorous breathing, and death in twenty-two minutes. In a second experiment (half the former dose being employed) there were salivation, dyspnoea, and death from passive hyperaemia and oedema of the lungs in an hour and a half. In rabbits to which elaterine was given by subcutaneous injection, Kohler observed salivation, oedema of the lungs, coma, tetanus, and death.
Therapeutic Action. - Elaterium, though only occasionally available, is one of the most powerful and valuable remedies in existence when employed in appropriate cases.
In Passive Dropsy, the remedial effect of elaterium consists in the abstraction of a large quantity of fluid by the channel of the intestines; and hence it is applied to the removal of passive dropsical accumulations which by their mechanical pressure are causing mischief that requires to be promptly stopped. It was much employed by Sydenham and his contemporaries; but, for a time, owing to its violent effects, it fell into disrepute. Dr. Ferriar, of Manchester, restored its credit by employing it in cases of hydrothorax; and Dr. Hope showed it to possess equal efficacy in other forms of cardiac dropsy. Since then elaterium has held its ground, at least in these respects, though many practitioners are very much afraid of it.
In Obstinate Constipation, elaterium has been proved, by Golding Bird and others, to act very effectively; but it is certain that there are numerous cases in which a happy result could not be looked for, and some in which such a drug as elaterium would do great harm: while, so far as I know, there are not any sufficiently accurate indications to allow of its being employed with confidence for obstruction of the bowels.
Gout. - A combination of elaterium and opium has been employed with good results in the treatment of gout.
In Apoplexy. - In those cases of sudden brain-mischief where it is thought that the action of a decided purgative may produce beneficial revulsion, elaterium has been strongly recommended. It is important to remember, however, that if any good is to be produced in this way, the action must be speedy: it is therefore not desirable to give elaterium for this purpose in ordinary doses by the mouth, as its action would probably be far slower than that of calomel and croton oil placed on the tongue with a little sugar. Elaterium should be given in suppository, a large dose (2 grains) being rubbed up with hard soap; or, still better, in injection, a solution of elaterine being thrown up well into the large bowel.
As an Errhine. - Elaterium was formerly valued as a member of the now almost disused class of remedies intended to provoke sneezing; but it is clearly very inferior to many familiar agents.
Preparations And Dose. - Usually given in the form of pills, upon a basis of extract of gentian.
Dr. Hope, to whom we owe very much of our accurate knowledge of the efficacy of elaterium in cardiac dropsy, was in the habit of combining elaterium with capsicum in these cases; and this is, very probably, a useful plan, as tending to avoid the extreme depression which is sometimes produced by the powerful action of the drug. Each dose might be accompanied by a draught containing 20 minims of the tinct. capsici.
Another combination of elaterium is that with hyoscyamus, which is said by G. Harley to be especially necessary when the drug is resorted to in the treatment of renal dropsy. Without this safeguard it is apt to set up a persistent diarrhoea, seriously dangerous to the patient, especially if uraemic symptoms have already appeared.
It is unquestionably very desirable that elaterine should be employed rather than a drug which is subject to such serious fluctuations as elaterium. Even in this case, however, it will be necessary to exercise care in choosing a manufacturer, and to make sure that the drug corresponds to the physical and ehemical characteristics given above; for whatever may be the state of things now, it is certain that formerly there was great difference in the purity of different specimens: this is obvious from the varying results, as to intensity of effect, recorded by different experimenters.
As regards dose, it must be reckoned that elaterine is four to five times as strong as good elaterium: on this basis, the proper dose of the former, for drastic purposes, will be 1/32 to 1/8 gr. (according to the age and strength of the patient), repeated every four hours till decided action is produced, which will usually occur after the second dose. It is in some cases necessary to maintain the action for some time; in that case the elaterium should be combined with 5-grain doses of extract of gentian, and the doses be repeated every two or three days; and then an interval allowed, after Dr. Darwell's plan.
Smaller quantities (1/64 gr. elaterine, 1/16th elaterium) are proper to be given in such maladies as gout, unless in the exceptional instances where it is desirable to relieve not only the joint affection, but a coincident dropsy.