558
tioner, and has been working in Sylhet for some
seventeen years, so that I place reliance on his
statements. I did believe that the cure was due
to this, and therefore put it down. I did not
enquire what the dropsy was due to. I have
heard that effusion into cavities does undergo
spontaneous absorption, but I have no experience.
Question 46.—I have seen dysentery in patients
who said that the ailment had followed upon ex-
cessive use of ganja. This information was given in
answer to my enquiries whether they had eaten bad
food or got chills. They said no, but they had in-
dulged more largely than usual in ganja in com-
pany with other people. I did not make further
enquiry regarding the exceptional dissipation in-
dicated in their replies. The cases were rapidly
cured by a little astringent and regulation of diet
without ipecacuanha. I would call these cases of
dysentery of a mild type, I have seen two cases
of hœmoptysis which, in my opinion, were due to
ganja. One case I saw three times within a fort-
night, after which he was all right, and I did not see
him again. I think I saw the other case twice, and
then the man never returned. They were both
out-patients. Hœmoptysis is, strictly speaking,
a symptom and not a disease, but it is entered as
a disease in the "Nomenclature of Diseases" of
the Royal College of Physicians, London, so I
regard it as a disease. Hœmoptysis is a common
symptom in phthisis. It is generally a late symp-
tom. It may be laid down in text-books as one of
the early symptoms, but that is not my experience.
In the two cases I have mentioned symptoms of
phthisis were absent. The lung symptoms were
dullness and moist rales. I made only a rough
examination as they were out-door patients, and
prescribed rest and astringents and low diet. I
have only heard from some native practitioners
about asthma, bronchitis, and hœmatemisis, not
seen any cases. I ascribed the cases of hœmopty-
sis to ganja-smoking, because the patients said
they were ganja-smokers. They were fairly
young men, without, as far as I could make out,
any lung disease, and I could discover no other
cause. The dullness might have been due to
effusion of blood, but could not have been due to
physical consolidation, because in one case at least
it was completely cured. In both cases the dull-
ness was at the base of the lung. I made a fairly
searching enquiry in these cases. I asked if there
had been any fall or blow or exposure, and could
not ascertain that there had been any.
My experience of insanity is connected largely
with cases which have come under my observation
as Civil Surgeon. On the average 30 or 35 such
cases come before me during the year—some are
sent to the asylum and some are made over to
their friends. I do not treat them; I merely pre-
vent their doing harm, and sometimes give them
a sedative when they are violent. My duty is to
ascertain their state of mind, and to forward them
to the Deputy Commissioner.
I should say about 20 per cent. of these cases
are due to pure ganja, and of the rest some are
due to ganja with country liquor. The police
send a report with the man. This always gives
information about cause. Pretty often the man's
friends come to jail to enquire about him and get
his release. This occurs in about half the cases.
I see the friends myself in the majority of the
cases in which they do come when I am in the
station, and I always ask them about cause.
They come to ask me about treatment, and what
is to be done with the man, and whether the
disease is temporary or likely to be cured. I ask
the friends because I do not regard the police
reports as good enough. I ask the friends with-
out regard to the fact that the statement of cause
is contained in the police report. If it is given in
the police report, I ask so as to have it confirmed.
If the police reports showed ganja as the cause,
I should ask what kind of ganja he smoked
and how much, and whether he was in the
habit of taking other intoxicants, such as
country liquor or opium. In fact, I should go
mainly for ganja and not make any detailed
enquiry into other causes. That is what I do
if they put down ganja. If they do not, I
try to find out other causes of insanity, such as
grief, shock, etc. If no cause is shown, still I
make special enquiries about ganja, country
liquor, and opium, as well as other causes, includ-
ing heredity. The information is better and
more satisfactory than that given by the police,
because it is more full and I know how to ques-
tion them. I think that the conclusion thus
arrived at as to cause is in many cases different
from that reported by the police, that is to say,
in nearly half the number of cases. The police
make mistakes in about half the cases. When I
speak of what I receive from the police I include
what I receive from sub-divisional officers. The
people from whom I get my information are the
same ignorant class with whom the police have to
deal, but I can get more out of them owing to my
professional knowledge. I prefer my diagnosis
to that of the police, and I am fairly satisfied
with it because it is assisted by personal observ-
ation of the case. There is no special different-
ial diagnosis between insanity caused by ganja
and other insanity, but I see that the symptoms
do not conflict with the history. As, for example,
if I get a history of excessive ganja-smoking and
the man is raving mad, I put the case down as
"excessive ganja-smoking." If I found the same
symptoms without a ganja history, I should try
to discover another cause. There must be a
history of excess of ganja-smoking to justify this
diagnosis; the mere mention of ganja would not
be enough. I have always discriminated between
moderate and excessive use of ganja, at least ever
since I was transferred to the Civil Department.
In the regiment I did not. It took me about a
year to learn what was to be regarded as excess
and what not. I should say that in Assam one
to two chittacks a day of the Bengal ganja was
excessive use. If the friends admitted the use of
half a chittack, I should put the cause down to
ganja, but not for less. Many people admit that
amount of use, and generally the quantity in
chittacks is mentioned, but some say only "bahut
pita." In my written answers to question 28 I
have entered nine chittacks per mensem as the
average allowance of the habitual excessive con-
sumer. This was done after enquiry and is right.
I have now stated only what I thought, and I
am prepared to alter the quantity to one-third of a
chittack. Notwithstanding the discrepancy which
has been pointed out to me, I still maintain that in
diagnosing the cause, I enquire as to the probable
amount in chittacks which the man has been in
the habit of consuming and form my opinion ac-
cordingly. If the police report mentioned ganja
without stating the amount used, and no friend
came of whom I could make enquiries, I should
reject the police entry and send up the case with
cause of insanity unknown. If the police report
said "bahut" I should accept ganja as the cause.
Then it is the information gathered from the police
or the man's friends that I send to the Deputy
Commissioner. Having taken such pains to as-
certain that the consumption in a ganja case wa