266
It causes chronic bronchitis and emphysema
of the lungs, resulting in an asthmatic condition.
It causes at first hyperœmia of the conjunc-
tivæ, which later assume a dusky or yellowish hue,
and lividity of the lips and complexion.
I believe that it impairs the moral sense,
and induces laziness and immorality.
It produces insanity, which is at first of a
maniacal type and temporary, but may become
permanent and end in dementia.
The symptoms may certainly be reinduced on
resumption of the drug.
I think that the mania differs from the
ordinary non-toxic type—
(a) in the absence of fixed delusions;
(b) the occasional presence of cataleptic
symptoms.
(c) or of automatic cerebrospinal action;
( d) in the great frequency or early appearance
of mental and moral degradation.
The mania due to hemp resembles, I think,
that of general paralysis of the insane—
(a) in the absence of fixed delusions;
(b) the exaltation of ideas.
But differs from it to the best of my belief
—
(a) in the occasional occurrence of cataleptic
symptoms;
(b) in the occurrence of automatic cerebrospinal
action;
(c) in the absence of paralysis or epilepsy.
That the insanity is not due to alcohol is, I
think, proved—
( a ) by the extreme rarity of delirium tremens
among the insanes of this country or the
general population, or of tremors or
other symptoms of chronic alcoholism;
(b) the infrequency among the insanes of
visceral lesions attributable to alcohol;
( c ) the rarity of a history among them of alco-
holic intoxication;
(d) the frequency of rapid recovery in confine-
ment without ill-effects from deprivation
of all intoxicants;
( e) the absence of craving for alcohol;
( f) by the character of the mania which dis-
plays either greater aggressiveness or
greater moral and mental degradation. It
is never of a good-humoured form.
The theory that the insanity of India is
mainly due to hemp drugs is supported by—
(a) the known prevalence of their use;
(b) the statements of patients themselves;
(c) or of their relatives or friends;
(d) the absence of other adequate causes;
(e) the correspondence between some of the
symptoms and the known effects of acute
intoxication by the drug.
The emaciation and debility, chronic bronch-
itis and pulmonary emphysema are commonly
observed in persons known to have used the drugs
habitually. I state tins from frequent clinical
observation.
As instances of automatic action under the
influence of hemp drugs, I mention the following,
which I believe were cases of hemp intoxication :
—
(a) Some years ago when in Bombay my
coachman drove me daily to and from
the hospital by the direct road. On one
occasion without any reason, he went by
a circuitous route. He was quite unaware
of his mistake until it was pointed out to
him, yet had made no other errors in
driving. He had a vacant, stupid appear-
ance, but no symptoms of alcoholic intoxi-
cation.
(b) Two years ago in Karachi when leaving
my house one evening in a hired carriage,
the coachman began driving round the
compound in a circle. He was quiet, but
evidently intoxicated, though apparently
not with alcohol. I suggest this also as
a case of hemp intoxication.
(c) Extreme intoxication with a cataleptic
condition.
Sobha Choitra, mendicant, aged 24; certificate
of lunacy, dated 3rd June 1892. When
admitted into hospital on the 23rd May
1892, appeared quite insensible, and when
his arm was raised, kept it rigidly fixed
in that position. He struggled and resist-
ed on the use of the stomach pump and
attempts to give emetics.
Moderate intoxication. I have observed
t wo ' P a r d e s i ' g a r d e n e r s i n my e mp l o y me n t
when they were clearly in a state of intoxication
which was not alcoholic and, in my opinion, was
due to hemp drugs. The most notable signs were:
noisy excitement, loquacity, volubility and boast-
fulness, with elated appearance and insolent
manner; great accession of exaggerated and mis-
directed energy in work, absence of the signs of
alcoholic intoxication, such as inco-ordination of
gait and speech and spirituous odour.
I attach a statement showing the causes
assigned for the insanity in the cases of 83 luna-
tics sent to the Hyderabad or Colaba Lunatic Asy-
lums from the Civil Hospital, Karachi, during the
past ten years.
In only 17 of these was the mental alienation
formally ascribed to the use of hemp drugs.
In only 5 out of these 17 cases, did the
patient or his relatives acknowledge to indulgence
in the drugs. In one other (Sobha Choitra above
mentioned) there was what I consider good symp-
tomatic evidence of hemp intoxication.
In four of the five instances above named, it
was stated that the patient also used opium or
alcohol, or both.
It is, I think, significant that in only 3 of
these 83 cases was the insanity attributed to alcohol
alone, and in only 3 others to alcohol, opium
and hemp combined.
I consider it fair to assume that a considerable
number of the 39 cases under the head "cause
unknown" were due to hemp drugs. But in all
cases good proof of the indulgence is very difficult
to obtain; and the cause can often only be
guessed at from the known habits of the classes
chiefly affected, the absence of other causes and
the general history and symptoms of the mental
malady.
47 to 50. I do not know.
56 and 57. I do not know.
In conclusion, I think that it is generally ac-
knowledged that Indian hemp is a very baneful
drug; but that there is a want of exact
i n f o r m a - t i o n r e g a r d i n g t h e e x t e n t a n d m e t h o d s o f i t s u s e
and as to its effects.