purging Purgatives (or laxatives) are substances that encourage the bowels to move. They have probably always been some of the commonest drugs prescribed. They have been used as a form of medical treatment since at least the time of the ancient Egyptians. Galen (c. ad 129–216), whose works were the basis of medical knowledge for the next 1500 years, was a strong advocate of purging and bleeding. The distinguished Thomas Sydenham (1624–89) said that the physician possessed two resources: to bleed and to purge.

The French philosopher Michel de Montaigne (1533–92) was sceptical. What was the evidence, he asked, that purgation did anyone any good? ‘The violent struggles between the drug and the disease are always at our expense, since the combat is fought out within us.’ He also noted how quickly doctors claimed success when the patient improved. There have been many such critics since and during the twentieth century: orthodox medicine has come to doubt the wisdom of giving purgatives to all patients. In the 1950s a successful physician used to tell his students that the healthiest community he had ever looked after was a convent where the nuns opened their bowels once a week and the reverend mother once a month. True or not, he hoped to wean his students from the myth on which many of them had been raised, that failure to open the bowels at least once a day was likely to lead to serious illness and should be immediately remedied with purgatives.

Another famous critic was Molière (1622–73). In Le Malade Imaginaire all the patients, regardless of what is wrong with them, are treated with enemas, bleeding, and purging. The physician of the time had little else in his repertoire that could produce a visible effect. William Buchan, addressing the general public in his Domestic Medicine (1800 edition), wrote, ‘Persons who have regular recourse to medicines for preventing constiveness, seldom fail to ruin their constitution’ — and he advised against the use of drugs.

Nevertheless, a century later many Victorians were taking a nightly dose of blue pill, aloes, colocynth, and castor and croton oils to purge their bowels. Enlightened doctors disapproved, but the practice continued into the twentieth century. It was still believed that constipation was to be feared and avoided as the poisoner of the blood and the cause of many diseases. Many parents dosed their children regularly with purgatives, despite criticism of different kinds. ‘Syrup of figs’ diminished many English children's enjoyment of life. The Nobel Prize winner, Élie Metchnikoff, believed that toxic action in the bowel was the cause of ageing and death. He advocated sour milk and colectomy as purgatives instead of the usual stronger ones. Sir Arthur Hurst, a distinguished gastroenterologist, pointed out that regular use of purgatives caused them to be inactive. He wrote, ‘If the fortunes made from purgative pills had been devoted to the hospitals which treat the victims of their abuse, the financial problems of the voluntary hospitals would have been solved.’ He pointed out that bowel investigations were done with the patient not taking purgatives: ‘It is interesting to observe how large a proportion of patients, who are supposed to be the victims of toxaemia from intestinal stasis, feel better whilst these examinations are being carried out. The fact is that symptoms result far more frequently from the artificial diarrhoea produced by purgatives than from intestinal stasis.’

Current thinking is that few people need laxatives unless they suffer from neurological disease such as multiple sclerosis, are old and very inactive, or need to avoid all strenuous activity, perhaps after a heart attack or stroke. On the other hand the value of a high fibre diet for healthy bowel function is widely recognized and advocated. Still, many people, obsessed with their bowels, continue to swell the profits of pharmacists and pharmaceutical companies by consuming purgatives regularly, usually unknown to their doctor, often simply in the attempt to lose weight.

Ann Dally

See also colonic irrigation; constipation.