A treatise of vapours or hysterick fits
John Purcell
1707 AD

1. In 1707 AD, John Purcell, a doctor of medicine, and unlike his contemporary church ministers, was confused and clueless about the causes and cures of mental illness. He viewed epilepsy and hysteria ("Fits of the Mother") as two different degrees of the same disease. He describes epileptic fits in great detail and gives great warnings about burying living epileptics alive. To make sure they are dead he advises: "hold a very little fine Carded Wool, a Feather, or burnt Paper before their Mouths". He also believes that Fits of the Mother (hysteria) are caused by the uterus sending vapors up to the head and making one sick. He also viewed hysteria as being transmitted from mother to daughter: "Another Question to be ask'd, is, if she were Born of Parents subject to Hystericks ; for Vapours as well as other Diseases, are transmitted to us from our Fathers and Mothers." John Purcell was a quack who could have learned much from his local church minister for they were way ahead of him. (A treatise of vapours or hysterick fits, John Purcell, 1707 AD)
2. "The concept of 'Vapours' or 'Hysterick Fits' which was popular in the later seventeenth and eighteenth centuries illustrates one of the pitfalls of tracing the history of mental illness down the centuries by terminology. At the present time the diagnosis hysteria implies a psychological disturbance and is made when patients complain of nervous symptoms but have no organic disease. This is in contrast to the sense in which Purcell used the term as the extract shows. He took `Epilepsies and this Distemper to be the same Disease', the difference being only quantitative as it were, not qualitative: 'an Epilepsy, is Vapours arriv'd to a more violent degree'. In this sense he applied it to all episodic disturbances of consciousness short only of cases showing the classical tonic-clonic stages of grand mal. His list of differential diagnoses of conditions characterised by `Trance' or 'Syncope' including such very organic conditions as apoplexy and even death shows how difficult the stuporose, unconscious or catatonic patient was to diagnose at that time. Purcell's thesis that the cause of 'Vapours' lay not in the nervous system but `in the Stomach and Guts; whereof the Grumbling of the one and the Heaviness and uneasiness of the other generally preceding the Paroxysm, are no small Proofs' was a variant of the ancient theory of `Vitious and corrupted humors .. . engendered in the Womb' rising 'up to the Head' — hence 'Vapours'. This uterine etiology also led him to allow in a general way for the operation of psychological factors, particularly ungratified desire which came to play so important a part in the psychological theories of hysteria in the nineteenth and twentieth centuries. It seems legitimate from present day knowledge of the epilepsies to speculate to what extent observation of phenomena associated with temporal lobe disturbances such as visceral and olfactory auras and autonomic upsets helped to shape etiological theories which physicians like Purcell built on what they called 'Hysterick Fits'. The first and for long the only book on epilepsy proper was by John Andree ( ?1699-1785), M D Rheims, L R C P, founder of and physician to the London Infirmary (which became the London Hospital), entitled Cases of the epilepsy, hysteric fits, and St. Vitus dance, with the process of cure, 1746. From the `numbers of diseased Objects' who resorted to his London Infirmary he decided `to turn this great Opportunity to the Advantage of the Public, by making proper Observations upon the Operation of Medicines . . . And as Epilepsies and Hysteric Fits are of late become very frequent, and reduce the unhappy Person labouring under them to the most deplorable Condition; I therefore publish here, by Way of Essay, divers Cases, by whose Example the Reader will see the Method I treated them with, and its Success'. His cases included `Epilepsia Cursiva', 'Epileptic Fits from a Fright', `. . . after a Fever', `. . . from Pregnancy', `. . . from a Blow on the Head', `. . . from Worms', `. . . from Grief and Trouble', `. .. from Fright', 'Hereditary Syncope' and 'Palsy and Convulsions'." (300 years of Psychiatry, Richard Hunter, 1963, p288)

A treatise of vapours or hysterick fits, John Purcell, 1707 AD

John Purcell (1674-1730) M D Montpellier, L R C P, physician of London

A treatise of vapours, or, hysterick fits, 1702 London, Newman & Cox (pp. viii +158 +x) pp 1-9, 120-3

A second edition 1707

THE SYMPTOMS AND DIAGNOSTICKS OF VAPOURS

Vapours, otherwise called Hysterick Fits, or Fits of the Mother, is a Disease which more generally afflicts Humane Kind, than any other whatsoever; and Proteus-like, transforms it self into the shape and representation of almost all Distempers . . . My design is, first, to number up all or most of the Symptoms and Accidents of this Disease : Next to seek out the Causes that are capable of producing them; and having Established them, to proceed to explain Mechanically the manner how they produce them: Then to speak a word or two of the Distempers which this Prognosticates, and Leads to : And lastly, to treat of its Cure.

Those who are troubled with Vapours, generally perceive them approach in the following manner; first, they feel a Heaviness upon their Breast; a Grumbling in their Belly; they Belch up, and sometimes Vomit, Sower, Sharp, Insipid, or Bitter Humours : They have a Difficulty in breathing; and think they feel something that comes up into their Throat, which is ready to Choak them; they Struggle; Cry out; make odd and inarticulate sounds, or mutterings; they perceive a Swimming in their heads; a Dimness comes over their Eyes; they turn pale; are scarce able to stand; their Pulse is weak, they shut their Eyes; Fall down; and remain senseless for some time; afterwards by little and little, their Pulse returns; their Face regains its natural colour; their Body grows hot as before; they Open their Eyes, Sigh, and by degrees come to themselves.

Sometimes the Patients in this distemper fall into such violent Fits of struggling that they can hardly be held; they Mutter odd and inarticulate Sounds, Foam at their Mouths, and Knock their Breasts. Others suffer such violent and long continued contractions of the Diaphragm and Intercostal Muscles, that their Breast and Lower Belly remain elevated for a long time together, so that they cannot draw their breath all that while; nay, some have layn for three whole days without the least sign of breathing that could be perceived by those that were about them.

1. One complains of a violent Pain on the top of her Head, which Sydenham calls Clavus Hystericus, and it is frequently accompanied with Vomiting.
2. Another is troubled with a Pain under her Heart, and a Reaching to Vomit . . .
3. A third lyes with her Jaws press'd together with all the violence imaginable . . .
4. A Fourth, upon the Smell of Civit, Musk, Amber, or any such Sweet Scent, shall fall into Fits.
5. A Fifth, shall be molested with them, upon any Anger, Passion or disturbance of Mind .. .
6. A Sixth is very Thoughtful, Blushes, or grows pale on a sudden, has deprav'd Appetite, sometimes to Craveing, at other times Loathing all sorts of usual Meats...
7. A Seventh will on a sudden fall into extravagant Fits of Crying, or Laughing, without being provok'd by any External Cause . . .
8. Lastly, we observe that those who have labour'd long under this Distemper, are oppress'd with a Dreadful Anguish of Mind, and a deep Melancholly, always reslecting on what may perplex, terrify, and disorder them most; so that at last they think their recovery impossible, and are very angry with those who pretend there is any hopes of it : The least Contradiction to their will casts them into violent Passions; they are Fickle, Wavering, and Unconstant, now resolving on one thing and immediately changing to something else, which they presently quit; and indulging their Distemper, they decline all diversions.

Note that all these Accidents do not happen to every one that has Hysterick Fits, or the Vapours; but some to one, some to another: This Person shall be molested with a great many; That, with but a few: and it suffices that any two, or three of them return'd by Intervals, to have them term'd Vapours. It is also to be observed that this distemper comes by Fits, and has its Intervals like an Ague, tho' the return be not exactly Periodical, and that in every Paroxysme the same Accidents happen, as did in the precedent, provided the Patient committed no excess in the interval .. .

This Distemper being strangely Various, and Counterfeiting several other Diseases, chiefly the Syncope, Apoplexies, Epilepsies and Convulsions; I will give you the distinctive Signs by which you may know them from any one of these Distempers. You may distinguish the Trance, which happens in Hysterick Fits, from a Syncope; first, because the Syncope lasts but a little while, whereas this Trance lasts sometimes several Hours or Days. Secondly, because a Syncope seizes on a suddain, whereas here there are always some preceeding Symptoms to be observ'd, upon a nice Examination. Thirdly, the Pulse is almost, if not quite imperceptible, in the Syncope; and in Hysterick Trances, tho' it is weak and low, yet it is far more perceptible. Fourthly in a Syncope, a cold Sweat always comes over the whole Body, which does not happen in these Trances : The Face is always Pale in the Syncope, but sometimes very Red in these Fits : In Vapours there are generally Convulsions; in an Syncope always a Feebleness or Inability of all the Parts to perform any Motion, regular or irregular.

Tho' it be very difficult to distinguish some Symptoms of this Disease from an Apoplectick Fit, (since the Patient lies equally Senseless and Motionless in both) yet by nice and diligent Observation, you will always find in these Hysterick Fits, some small Convulsions in the Hands, Feet, under Jaw, or Lips, or a six'd Staring of the Eyes, which seldom happens in Apoplexies : tho' it be true that sometimes Convulsions do accompany Apoplexies too. Therefore the surest way, is to examine whether the Patient be subject to Hysterick Fits or no; if she be, you may judge it to be Vapours and no Apoplexy. Another Question to be ask'd, is, if she were Born of Parents subject to Hystericks ; for Vapours as well as other Diseases, are transmitted to us from our Fathers and Mothers.

I take Epilepsies and this Distemper to be the same Disease, and if there be any difference to be made between them, it only consists in this, that an Epilepsie, is Vapours arriv'd to a more violent degree; that the Convulsions are more general and more apparent over all the Body, and they Foam at the Mouth much more than in Hysterick Fits. And since Persons in this Distemper lie in Trances for whole Days, Motionless, and Senseless like Dead Bodies; (nay some have had the misfortune, as very Credible Authors assert, to have been Buried Alive in these Fits) it will not be amiss to give you some Signs whereby to know whether they be alive or not : First then, hold a very little fine Carded Wooll, a Feather, or burnt Paper before their Mouths; if they stir, it is a Sign they Breath. Secondly, put a Glass brim-full of Water upon their Breast, which will spill if the Ribs make the least Motion. Thirdly, take a Looking-Glass, wipe it clean, and put it to their Mouths, which if it sullies, 'tis a Sign they Breath; but what is most secure in this Case, and what I advise to be done to every one who is subject to Vapours, is, to keep them for three or four Days till they are sensibly perceiv'd to Corrupt.

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