“A purgative clears the bowels — and for 2,000 years, clearing the bowels was medicine's answer to almost everything, from fever to melancholy.”
Latin purgare meant to cleanse, purify, or purge — from purus (pure) and agere (to do, to drive). Purgativus described anything that produced purging or cleansing. In Galenic medicine, the four humors needed to be kept in balance, and excessive black bile — associated with melancholy — was removed by purgative herbs and medicines. The logic was internally consistent: imbalance causes disease; remove the excess; restore balance.
The medieval pharmacopoeia was thick with purgatives: senna, castor oil, rhubarb, calomel (mercury chloride), and dozens of herbal preparations. Physicians prescribed them for nearly every condition. Charles II of England was treated with repeated purgatives during his final illness in 1685 — along with bloodletting, enemas, and other humoral remedies. He died after several days of this treatment.
The Romantic poet John Keats, trained as a surgeon before turning to poetry, was treated with mercury purgatives for tuberculosis in 1820-1821. The mercury likely accelerated his death by destroying his gut flora and making it impossible to absorb nutrition. He died in Rome in 1821 at age 25. The purgative prescribed to cleanse the disease killed the patient.
Modern medicine retains purgatives in specific roles: bowel preparation before colonoscopy, treatment of certain poisonings, and management of severe constipation. The humoral theory is gone; the functional use for bowel preparation remains. The word has also become a metaphor: a purgative experience that clears the mind, a culturally purgative moment.
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Today
The purgative is medical history's most prescribed treatment for the least evidence. For 2,000 years, physicians cleansed bowels on the theory that excessive humors were causing illness. They were wrong about the theory and often harmful in practice.
The word's metaphorical life is more accurate than its medical one: emotional purgation, political purges, purgative reading — all describe the same genuine psychological process of clearing accumulated pressure. Aristotle may have been more right about catharsis than Galen was about humors.
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