T There are no typical symptoms that I am aware
of to enable you to diagnose hemp drug insanity.
Ganja cases generally recover rapidly. Cases
arising from mental shock are of longer duration.
To diagnose by this symptom, therefore, the
patient must be under continuous observation. It
is nevertheless the practice to enter the cause im-
mediately on the admission of a case to the
asylum. But it is supposed that the Civil Surgeon
bas had the man under observation for a week or
ten days more or less, and has diagnosed the cause.
Insanes are rarely cured by the time they reach
the asylum. The Civil Surgeon only keeps the
man long enough to satisfy himself that he is
insane. As a rule the Civil Surgeon's diagnosis
is accepted, but if the Superintendent has reason
to think the diagnosis is wrong, he ought to
change it. As a fact, I have not known of any
case of such change since I have been at Poona.
The symptoms are of short duration in the
majority of cases, about a week or ten dys. If it
is a second attack, or the indulgence has gone to
great excess, the insanity would last longer. I
know the insanity of the kind called transient
mania. I believe it to be caused by mental shock
or nervous shock, or a debauch of wine, bhang, or
other intoxicants, especially by a. person of weak
temperament. I have known fever to produce it
in the latter case. It is most often due to moral
causes, and not to toxic physical causes, though
these may produce it. I think that transient
mania caused by ganja would be difficult or
almost impossible to distinguish from the same
form of insanity due to any other case if history
were wanting. I think I have noticed that
persons insane from bhang have red and watery
eyes. This symptom may be produced by fever, but
is generally present in bhang cases. The use of
hemp is likely to produce contraction of the pupil,
but in great excess to the point of intoxication or
insensibility it might cause dilatation. I do not
think short duration, redness of eyes, and dilated
pupils would be sufficient to diagnose a case upon.
These symptoms would point to hemp insanity
rather than any other cause, but they are recognised
as symptoms of transient mania due to other causes
than hemp drugs. But I think redness of eyes
is more marked in hemp insanity than in other
cases. I think an accurate history is essential
to diagnose the cause of insanity. Hemp drugs
m may predispose, but I should rather regard them
as exciting cause of insanity. I think the hemp
drugs have slightly cumulative effects, but not
more so than alcohol. They are not to be classed
with digitalis or arsenic in this respect. For
diagnosis, duration of the habit, the amount of
drug used, and hereditary history are necessary.
I think that if the information regarding a man
suffering from acute mania were nothing more
than that he was ganja smoker, the ganja should
be regarded as the existing cause in eighteen cases
out of twenty. The mere statement of the ganja
habit would be sufficient if there were no reason to
disbelieve it.
The man whose case is reported by Mr. Fox
was brought to me occasionally as an out-door
patient a year ago. I have endeavoured to get
further information about him, but Mr. Fox is at
present in Bombay, and he has not mentioned the
man's name. My recollection is that I was
informed that his attack was due in great
measure to the persecution he had suffered on
account of his conversion to Christianity, and that
he had taken to smoking ganja in consequence. I
only saw the man two or three times as an out-
patient, and am unable to exclude other possible
causes to account for his mental condition. I
remember telling Mr. Fox that if he allowed the
man to go on smoking, he would certainly get an
attack of acute mania. I formed this impression
from the man's looks, which appeared to me to
show that he was verging on insanity. The
information about the cause of the man's distress
came from his friends, who either told me or the
house surgeon.
I have been observing eases of hemp drug
insanity for seven or eight years. I have not
observed the effects of the hemp drugs apart from
insanity. I have spoken to many people who
have told me they were moderate smokers, but
seen no effects among such persons. I do not
know any excessive consumer, nor have I had to
do with any such persons, except in the way of
treatment for mental disease. My impression of
the connection between hemp drugs and insanity
is therefore not based on any knowledge of the
general consumption and effects of the drug
among the people.
144
70. Evidence of SURGEON-MAJOR H. McCALMAN, Civil Surgeon, and Superintendent,
Dharwar Lunatic Asylum .
Oral evidence.
Question 1.—I am Superintendent of the
Dharwar Lunatic Asylum. I came out in 1877
in the Indian Medical Service. The greater part
of my time I have passed in civil employ. I was
in military employ the first two or three years of
my service. I was in charge of the Ratnagiri
Asylum, but have had no English experience of
insanity. I have been in charge of the Ratnagiri
and Dharwar Asylums for a total period of seven
years. I was not in charge of the Dharwar
Asylum during the whole of 1892. I was absent
from May to September. Since September 1892
I have been in charge at Dharwar. I did not
gain much experience of hemp drug insanity at
Dharwar.
Question 45 .—When a lunatic is sent to me as
Civil Surgeon for observation, he is locked up in
a room, set apart for the purpose, under a proper
guard, and kept under observation with a view
to report to the Magistrate. At the same time I
make enquiries of the police or relations, if any,
as to the cause of insanity, not because I have to
certify to cause, but to throw light upon the case.
The Magistrate sends me a paper containing in-
formation as to cause. As Civil Surgeon, I think
I should accept that information without further
enquiry, if it contained a statement of cause suffi-
ciently clear and definite. I should make enquiry
to confirm the information ; but I should not make
any with the view of refuting it. The Magis-
trate's information is usually sent in a printed
form (Form C). That form is passed on to the
asylum, and the information it contains is treated
by the Superintendent in the same way in which
the Civil Surgeon had treated it. If the Form
C contained a clear statement as to cause, I should