This section is from the book "A Treatise On Therapeutics, And Pharmacology Or Materia Medica Vol2", by George B. Wood. Also available from Amazon: Part 1 and Part 2.
Elaterium is a substance deposited by the juice of the fruit of Momordica Elalerium (Ecbalium officinarum, Ecbalium agresle, Ec-balium Elaterium), the wild or squirting cucumber, a trailing, herbaceous perennial plant, bearing some resemblance to the common cucumber vine, though without tendrils, growing wild in the South of Europe, and cultivated in England, where the medicine is prepared. The fruit is oval, about an inch and a half long, and like a small cucumber. When quite ripe, it separates from the stem, and, through the former place of junction, throws out its juice and seeds with great force, and sometimes, according to Mr. Jacob Bell, to a distance of twenty yards. (Pharm. J. and Trans., Oct. 1850.) To procure the elaterium, the fruits are picked before perfect maturity, sliced, and expressed; and the juice thus obtained is set aside for deposition, which takes place in about four hours. The clear liquor is poured off from the deposited matter, which, after being well drained, is spread out upon cloths and dried. This is the ordinary mode of proceeding. The method first employed by Dr. Clutterbuck, which yields the finest product, is to slice the fruits, allow the free juice about the seeds to drain upon a sieve; then to scrape out the interior pulp and seeds, and, having washed these with water upon the sieve, to permit the united liquids to stand until deposition takes place. The deposited matter is then dried. Procured in this way, it is called Clutterbuck's elaterium.
Good elaterium is in thin, irregular, flat or somewhat curled, wafer-like pieces, often having upon one side the marks of the cloth upon which it was dried, very light, friable, and opaque, of a greenish or grayish-green colour, inodorous, and of a bitter somewhat acrid taste. inferior kinds are very dark, hard, and of difficult fracture, probably prepared by the evaporation of the juice after deposition; or light-coloured, friable, and soft, from adulteration, as the drug formerly sold under the name of Maltese elaterium. Both of these should be rejected. Elaterium yields its active matter to alcohol, but not to water.
Active Principle. The purgative properties of elaterium have been found to reside in a peculiar neuter principle, called elaterin, which is white, crystallizable, inodorous, of an acrid and extremely bitter taste, insoluble in water, and in alkaline solutions, but dissolved by alcohol, ether, heated olive oil, and the diluted acids. it is most conveniently obtained by treating elaterium with boiling alcohol, which dissolves the elaterin with a green resinous matter, evaporating the tincture until separation begins to take place, and then pouring it into a boiling solution of potassa. The alkaline solution dissolves the green resin, and the elaterin crystallizes on cooling. According to Dr. Morries, English elaterium yields from 15 to 26 per cent of elaterin; but Mr. Hennel obtained from one specimen as much as 44 per cent. The discovery of the principle was made by these chemists about the same time.
The purgative properties of elaterium were known to the ancients. in its local action, it is irritant, producing severe ophthalmia when brought into contact with the eyes, and causing inflammation and ulceration of the fingers of the persons engaged in its preparation. it is a powerful drastic, hydragogue purgative, prompt in its action, often in its full dose causing nausea and vomiting, severe griping pains in the bowels, and much prostration of the general strength; though it produces, at the same time, a stimulant effect upon the circulatory system, as evinced by increased frequency of pulse, dryness of the tongue, and thirst. No cathartic equals it in hydragogue effect, or in general power and violence of action. in over-doses it produces the effects of an acrid poison, and has repeatedly caused death, with all the symptoms of gastro-intestinal inflammation. This harshness of operation led at one time to its entire abandonment; but its extraordinary powers in dropsy have brought it again into use, and, properly regulated, it may be employed safely, and sometimes with great effect. it is thought also to operate as a diuretic, and thus to be additionally useful in the disease.
It should not be employed indiscriminately in all cases of dropsy, and never when there is any evidence of gastro-enteric irritation or inflammation. But in obstinate cases, with a tendency to constipation of the bowels, and without febrile complication, which have resisted all other treatment, it should be tried. it has appeared to me best adapted to ascites; and I have seen it promptly successful in that form of the disease, after failure with all other measures. it should be given every second or third day, and may be continued a week or two, if the patient be not too much exhausted, and no evidence of inflammation of the alimentary canal is exhibited. its stimulant influence on the circulation has a tendency to counteract the depressing effects of the copious evacuation, which might otherwise occasion syncope. Though prudence requires its suspension after the time specified, it may be resumed again subsequently if deemed advisable.
It may be used also in other affections requiring extreme energy of purgative action, but always with caution; and there are few cases, in which all that can be accomplished by cathartics may not be effected by means of others less violent and dangerous.
The dose of elaterium varies extremely, in consequence of the variable strength of the drug. The purest, prepared according to the method of Clutterbuck, will operate energetically in the dose of one-eighth of a grain, while sometimes two grains of commercial elaterium are required. Unless when the strength of the drug is known, the practitioner should always begin with small doses, and increase, if necessary, until he has ascertained the amount required to act. Perhaps the best plan would be to commence with one-sixth or one-quarter of a grain, repeated every hour or two till it operates, or till found inefficient in that quantity, and then to increase. it may be given in pill or alcoholic solution. The pill is conveniently made with extract of gentian. As elaterin is of uniform strength, and readily prepared, it would be well to substitute it for elaterium; as a definite dose could thus always be obtained. This principle acts in the dose of one-sixteenth or one-twelfth of a grain. One grain of it may be dissolved in a fluidounce of alcohol with four drops of nitric acid, and from thirty to forty minims given for a dose, diluted with water. The acid aids in holding it in solution in water, when the tincture is diluted.