Until the end of the nineteenth century, there were very few medicines physicians actually prescribed that actually cured diseases or ailments. Medicine consisted of extensive blood letting and various emetics and enemas to induce vomiting and diarrhoea, respectively to "purge" the body of toxins. Unwitting laxative abuse to cure chronic constipation in the 18th and early 19th century was rife.A side effect of plentiful living, particularly in the upper classes of soceity who would indulge in meals rich in meat and drink but low fibre intake. With the benefit of colonoscopy we can now visualize the insidious effects of chronic laxative abuse. Pic (bottom): Chronic laxative causes melanosis coli. As the laxative travels down the intestinal tract, it remains inactive until it reaches the large intestine. Once in the large intestine, the molecules transform into an active form leading to cell damage in the lining of the intestine and death (apoptosis). As these cells die they create a dark pigment, lipofuscin, which lines the large bowel giving a characteristic leopard skin pattern. Pic(top) : Normal large intestine for comparison
