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to excess, and there was no other cause. One was
before and one was after I began the special in-
quiry in relation to this Commission. They were
both within the last few months. Dysentery is
the commonest cause of abscess of the liver among
natives ; secondly, malarial effects. In both these
cases there was an absence of history of dysentery
and malaria as absolute as I could get. I think
both men belonged to the town. They were not
spirit drinkers.
As regards malaria, it is almost impossible to
find a native who had not suffered ; but as far as
I could gather from the history, these were cases.
Of course these men may have been exposed to
malaria. I had never heard abscess of the liver
attributed to hemp drugs before, but in both
these cases the men themselves ascribed their ill-
ness to the excessive use of the drugs, and one said
that he had somewhat similar symptoms once
before, and on stopping the charas smoking for a
while he thought he had been better, but took to
the habit again. This was the earlier case. As
far as I know, there is nothing in the physiologi-
cal action of the drug that would cause abscess of
the liver.
I have no information as to insanity being
caused by these drugs apart from my asylum ex-
perience except the temporary case above recited.
In my practice I have had several cases brought
to me in my dispensary practice of men tempora-
rily insane whose insanity was ascribed by their
friends to these drugs after a big bout perhaps ;
but the histories were so unsatisfactory that I
could not attribute their insanity to hemp drugs
with anything like confidence.
I have experience of cases sent to me for ob-
servation as Civil Surgeon, and also of cases ad-
mitted to the asylums of which I have held
charge.
In cases sent to me as Civil Surgeon, the Ma-
gistrate sends me as much information as he can ;
but it is very meagre. It is sent on a printed
form. The information is sent filled up on a printed
form, giving the man's history as far as they can
get it from the police, and a blank space is left on
the back for my certificate. This is the practice
both at Benares and Bareilly. There is a space
for cause, but as a rule it is unknown. I moke
inquiry as to cause from friends who may be sent
with the man, or from the police who accompany
him (or in cases discharged cured without admis-
sion to the asylum from the man himself), or
from the papers above referred to. The friends
very rarely attend. As a rule then I am left en-
tirely to the statement or form received and to
the police. The former is filled up in the Magis-
trate's office, not in his band-writing, and signed
by him. I do not know who fills it up. As
Civil Surgeon, I would certify as to cause if I
could get at the cause. Of course, there are num-
bers of cases where you cannot. If the Magis-
trate's statement showed hemp drugs as the cause
and I could get no further information myself,
I would certify that as the cause, as having been
obtained from some source which he considered
reliable. I would say " this insanity is pro-
bably due to such and such a drug from the his-
tory of the case." I consider that I have as Civil
Surgeon to consider the cause as well as the fact
of the insanity. This has always been my habit.
When a case comes into the asylum under the
orders of the Magistrate on the Civil Surgeon's
certificate, the magisterial statement and Civil
Surgeon's certificate are sent with the order. I
enter the cause in the proper place in the asylum
register as soon as the man comes in, i.e., at my
next visit. I enter this from the papers I receive
with the man, i. e., from the magisterial statement
or from the Civil Surgeon's certificate if he certi-
fies as to cause. Many Civil Surgeons do not.
It is extremely rarely that I have a chance of
meeting friends; they very rarely come. But
both I myself and my subordinates enquire from
the patient as to the cause when at any time he is
fit to answer. If I were satisfied that he was
giving a reliable answer, I should alter the entry
as to cause, If I got at a history of heredity, I
would enter that. If I got a history of ganja, I
should put that down. If the cause were " un-
known," I should put down ganja if the man said
he smoked, if he acknowledged the use of the
drug. At Bareilly the Deputy Superintendent is
an old soldier. He has no medical training He
very frequently makes enquiries. I wish to know
the cause for my own satisfaction. It might
affect the treatment. The Benares and Agra
Asylums have Deputy Superintendents who are
not medical men. If such a Deputy Superintend-
ent were to state the results of his enquiries, I
should not accept them without myself asking the
patient or his friends, as the case might be.
There is a Hospital Assistant also attached to the
asylum. I would accept his statement as to en-
quiries made. It is from such enquiries and from
the papers that I enter cause. These are the only
source of my information on this point. The
Hospital Assistant in conducting such enquiries is
left to his own discretion. He asks his own ques-
tions. Of course, if I could verify his statement
myself, I should do go. I would not take it
without verifying it if I could.
Diagnosis comes in after this. There are no
typical symptoms, except perhaps that the person
is much emaciated, combined with laughing im-
moderately. At the same time I could not say
that these symptoms were not due to another cause
without a history of the use of these drugs. The
history is absolutely essential for diagnosis. All
the symptoms may be due to other cause? than
hemp drugs.
As a rule the histories given by friends of
patients are so vague that I cannot say that they
are reliable either when given before or after
the admission of the patient. It practically re-
solves itself into this, that the mere fact of the
use of hemp drugs is a sufficient cause. I have
no bias in reference to hemp drugs as compared
with alcohol. If I had a history of both, I should
put the case down to liquor. I did not write the
report for 1892.
In case of such further enquiries as I have de-
scribed above, no entry is made except the mere
correction.
I was not in charge of the asylum in 1892, and
have not seen (discharged) nine out of the eleven
hemp drug cases, but I studied the histories and
submitted notes on them. Dr. Anderson was in
charge. He has returned to duty.
In the eleven cases ascribed in Statement VII
of the last Annual Report to hemp drugs, I should
be inclined to put the cases of Nathu, Fackeray,
and Debi rather down to drink, because there is
in these three cases a history of liquor, and those
who have both habits as a rule prefer the spirit
drinking. In the cases of Davi Singh and Balak
Ram the true cause is (I think from the history)
heredity. The case of Malyun Singh is a doubt-
ful case, for the circumstances of the man's sur-
roundings as described in the history may have
led to the bhang drinking or may themselves have