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DELAWARE
STATE MEDICAL JOURNAL
– Feb. 1944 -
[Delaware State Medical Journal Vol. 16 Jan, 1944]
THE MARIHUANA
PROBLEM- JOHN H. FOULGER, M.D.
(Director, Haskell Laboratory of Industrial
Toxicology. E. I. du Pont de Nemours
and Company.)
Wilmington, Del.
An
editorial in the January, 1944, issue of this Journal, brings to attention the
recurrent controversy over the harmfulness of marihuana.
The issue has recently been raised an editorial entitled "The
Marihuana Bugaboo,” in The Military Surgeon, which in turn was quoted in
Philadelphia Medicine for January 8, 1944.
Since the possibility of widespread, uncontrolled use of drugs is always
a serious matters and particularly at the present moment when upheaval of social
conditions makes difficult the maintenance of law and order and the control of
public health, it seems pertinent to review briefly the history of the marihuana
problem. Such a review can have
additional value, for the history is, itself, very interesting.
Marihuana
is hemp, cannabis radical or as it is termed in this country, cannabis
Americana. Its use in the orient is
as old as time and has led to such romantic literature as "A Thousand and
One Nights." Marihuana is the
hashish of the Assassins, about whom Collier's New
Encyclopedia says:
"Assassins,
or Ismaili, a sect of religious fanatics who existed in the 11th and 12th
centuries. They derived their name
of assassins originally from their immoderate use of hasheesh, which produces an
intense cerebral excitement often amounting to fury. Their founder and law-giver was Hassan-ben-Sabah, to whom the
orientals gave the name of Sheikh-el-Jobelz, but who was better known in Europe
as the "Old -Man of the Mountain"; he was a wily imposter, who made
fanatical and implicit slaves of his devotees, by imbuing them with a religion
compounded of that of the Christians, the Jews, the Magi, and the Mohammedans.
The principal article of their belief was that the Holy Ghost was
embodied in their chief, and that his orders proceeded from the Deity, and were
declarations of the divine will. They
believed assassinations to be meritorious when sanctioned by his command, and
courted danger and death in the execution of his orders.
In the time of the crusades, they mustered to the number of 50,000. So great was the power of the Sheikh, that the soverigns of
every quarter of the globe secretly pensioned him.
For a long time this fearful sect reigned in Persia, and on Mt. Lebanon.
Holagoo, or Julaka, a Mogul Tartar, in 1254, dispossessed them of several
of their strongholds; but it was not till some years after that they were
extirpated partially by the Egyptian forces sent against them by the great
Sultan Bibars. A feeble residue of the Ismaili has survived in Persia and
Syria. The Syrian Ismaili dwell
around Mesiode, west of Homar, and on Lebanon; they are under Turkish domain,
with a sheikh of their own, and formerly enjoyed a productive and flourishing
agriculture and commerce.”
In
the Malayan language the terms, “hasheesh” and “amuck” are synonymous.
It
was for some time believed that only the Indian variety of hemp, cannabis indica,
was potent. This belief led to an
extremely interesting account by Horatio C. Wood [1] of his own experiences
following the taking of a rather large dose of an extract made from the American
hemp:
”About
half-past four P. M., September 23, I took most of the extract.
No immediate symptoms were produced.
About seven P. M. a professional call was requested, and forgetting all
about the hemp, I went out and saw my patient.
Whilst writing the prescription, I became perfectly oblivious to
surrounding objects, but went on writing, without any check to or deviation from
the ordinary series of mental acts connected with the process, at least that I
am aware of. When the recipe was
finished, I suddenly recollected where I was, and, looking up, saw my patient
sitting quietly before me. The conviction was irresistible that I had sat thus many
minutes, perhaps hours, and directly the idea fastened itself that the hemp had
commenced to act, and had thrown me into a trance-like state of considerable
duration, during which I had been stolidly sitting before my wondering patient.
I hastily arose and apologized for remaining so long, but was assured I
had only been a very few minutes. About
seven and a half P. M. I returned
home. I was by this time quite excited, and the feeling of hilarity
now rapidly increased. It was not a
sensuous feeling in the ordinary sense of the term; it was not merely an
intellectual excitation, it was a sort of bien-etre---the very opposite to
malaise. It did not come from
without; it was not connected with any passion or sense. It was simply a feeling of inner joyousness; the heart seemed
buoyant beyond all trouble; the whole system felt as though all sense of fatigue
were forever banished; the mind gladly run riot, free constantly to leap from
one side to another, apparently unbound from its ordinary laws.
I was disposed to laugh; to make comic gestures; one very frequently
recurrent fancy was to imitate with the arms the motions of a fiddler, and with
the lips the tune he was supposed to be playing.
"There
was nothing like wild delirium, nor any hallucinations
that I remember. At no time had I
any visions, or at least any that I can now call to mind; but a person
who was with me at that time states that once I raised my head and exclaimed,
'Oh, the mountains! the mountains!' Whilst
I was performing the various antics already alluded to, I knew very well I was
acting exceedingly foolishly, but could not control myself. I think it was about eight o'clock when I began to have a
feeling of numbness in my limbs, also a sense of 'general uneasiness and unrest,
and a fear lest I had taken an overdose. I
now constantly walked about the house; my skin to myself was warm, in fact my
whole surface felt flushed; my mouth and throat were very dry; my legs put on a
strange, foreign feeling, as though they were not a part of my body.
I counted my pulse and found it one hundred and twenty, quite full and
strong. A foreboding, an undefined,
horrible fear, as of impending death, now commenced to creep over me; in haste I
sent for medical aid. The curious sensations in my limbs increased.
My legs felt as though they were waxen pillars beneath me.
I remember feeling them with my hand and finding them, as I thought at
least, very firm, the muscles all in a state of tonic contraction.
"About
eight o'clock I began to have marked 'spells'---periods when all connection
seemed to be severed between the external world and myself.
I might be said to have been unconscious during these times, in so far
that I was oblivious to all external objects, but on coming out of one, it was
not a blank, dreamless void upon which I looked back, a mere empty space, but
rather it period of active but aimless life. I do not think there there was any
connected thought in them; they seemed simply wild reveries, without any binding
cord---each a mere chaos of disjointed ideas.
The, mind seemed freed from all its ordinary laws of association, so that
it passed from idea to idea, as it were perfectly at random.
The duration of these spells to me was very great, although they really
lasted but from a few seconds to a minute or two.
Indeed, I now entirely lost my power of measuring time. Seconds seemed hours; minutes seemed
days; hours seemed infinite. Still
I was perfectly conscious during the intermissions between the paroxysms.
I would look at my watch, and then after an hour or two, as I thought,
would look again and find that scarcely five minutes had elapsed.
I would gaze at its face in deep disgust, the minute-hand seemingly
motionless, as though graven in the face itself; the laggard second-hand moving
slowly, so slowly. It appeared a
hopeless task to watch during its whole infinite round of a minute, and always
would I give up in despair before the sixty seconds had elapsed.
"Occasionally,
when my mind was lucid, there was in it a sort of duplex action in regard to the
duration of time. I would think to
myself, It has been so long since a certain event, an hour, for example, since
the doctor came; and then would say, No, it has been only a few minutes; your
thoughts or feeling are caused by the hemp.
Nevertheless, I was not able to shake off this sense of the almost
indefinite prolongation of time, even for a minute. The paroxysms already alluded to were not accompanied with
muscular relaxation. About a
quarter before nine o'clock, I was standing at the door, anxiously watching for
the doctor, and when the spells would come on I would remain standing, leaning
slightly, perhaps, against the doorway. After
awhile I saw a man approaching whom I took to be the doctor.
The sounds of his steps told me he was walking very rapidly, and he was
under a gas-lamp, not more than one-fourth of a square distant, yet he appeared
a vast distance away, and a corresponding time approaching.
This was the only occasion in which I noticed an
exaggeration of distance; in the room it was not perceptible.
My extremities now began to grow cold, and I went into the house.
I do not remember further until I was aroused by the doctor shaking or
calling me. Then intellection
seemed pretty good. I narrated what
I had done and suffered, and told the doctor my opinion was that an emetic was
indicated, both to remove any of the extract still remaining in my stomach, and
also to arouse the nervous system. I
further suggested our going into the office, as more suitable than the parlor,
where we then were. There was at
this time a very marked sense of numbness in my limbs, and what the doctor said
was a hard pinch produced no pain. When
I attempted to walk upstairs, my legs seemed as though their lower halves were
made of lead.
“After
this there were no new symptoms, only an intensifying of those already
mentioned. The periods of
unconsciousness became at once longer and more frequent, and during their
absence intellection was more imperfect, although when thoroughly roused I
thought I reasoned and judged clearly. The
oppressive feeling of impending death became more intense.
It. was horrible. Each
paroxysm would seem to have been the longest I had suffered; as I came out of
it, a voice seemed constantly saying, 'You are getting worse; your paroxysms are
growing longer and deeper; they will overmaster you; you will die.'
A sense of personal antagonism between my will-power and myself, is
affected by the drug, grew very strong. I
felt as though my only chance was to struggle against these paroxysms---that I
must constantly arouse myself by an effort of will; and that effort was made
with infinite toil and pain. I felt
as if some evil spirit had control of the whole of me except the will-power and
was in determined conflict with that, the last citadel of my being.
I have never experienced anything like the fearful sense of almost
hopeless anguish and utter weariness which was upon me.
Once or twice during a paroxysm I had what might be called nightmare
sensations; I felt myself mounting upwards, expanding, dilating, dissolving into
wide confines of space, overwhelmed by a horrible, rending, unutterable despair.
Then, with tremendous effort, I seemed to shake this off, and to start up
with the shuddering thought, Next time you will not be able to throw this off,
and what then? Under
the influence of an emetic I vomited freely, without nausea, and without
much relief.
"About
midnight, at the suggestion of the doctors, I went up-stairs to bed.
My legs and feet seemed so heavy I could scarcely move them, and it was
as much as I could do to walk with help. I
have no recollections whatever of being undressed, but am told I went
immediately to sleep. When I awoke, early in the morning, my mind was at first
clear, but in a few minutes the paroxysms, similar to those of the evening, came
on again, and recurred until late in the afternoon. All of the day there was marked anesthesia of the skin.
At no time were there any aphrodisiac feelings
produced. There was a marked increase of the urinary secretion.
There were no after-effects, such as nausea, headache, or constipation of
the bowels."
It
is seen from Wood's account that American cannabis can be very potent and, in
fact, is sometimes more potent than the standard Indian products.
Munch [2] lists the physiological activity of cannabis grown in various
parts of the world. Of forty varieties of cannabis compared with the average
Indian product, eighteen originated from United States. Of these, nine were of equal strength to the Indian product;
three reached 75 to 80% of its strength; two attained 60 to 65%, and only three
were classified as "weaker." It
is apparent, therefore, that the plant as grown in this country can have
qualitatively and quantitatively the physiological effects of the standard
cannabis indica.
The
growing of hemp for its fiber is an old industry in United States.
Some states, such as Kentucky, have specialized on its growth.
But the profitable cultivation of hemp for its fiber requires
considerable care, whereas the growing of hemp for its Physiological properties,
particularly if it is to be sold illicity, as a drug, without any need for
standardization, needs little care. In
fact, during campaigns of the last few years, to suppress the selling of
marihuana, hemp his been found growing in vacant lots all over the country, and
hemp seed sold ostensibly as bird seed could at one time be bought by anyone and
used to grow the young plants. Incidentally,
while we were investigating this problem some years ago, we
were told that hemp seed is not good food for birds, but were unable to
confirm this opinion by more than scant literary data.
The
marihuana problem has been rife in South American states and in Mexico for many
years. We
are informed by officers of General Pershing’s Mexican Border Expedition that
the use of marihuana created some difficulties among our own troops (see
article by Fossier quoted below). However,
since in South American states and in Mexico there may be a simultaneous use of
mescal, an entirely different drug but with similar properties, or of tequila
and other products of fermentation of cacti, stories of homicidal mania produced
among South Americans and Mexicans are not sound evidence of the effects of
marihuana addiction per se.
The
illicit sale of cigarettes containing hemp became widespread in this country in
the late twenties and early thirties, coinciding to some extent with the
financial and industrial depression. Because,
partly as a result of the failure of prohibition, and partly as a result of
widespread unemployment, police departments were faced with an almost impossible
task in suppressing not only minor, but also major crimes, the possibility that
a new drug habit might contribute to juvenile delinquency caused great alarm.
Apparently the matter was first mentioned in a newspaper article
entitled, "Mystery
of the Strange American Weed, " in the Baltimore Sun, August 24,
1924. Perhaps the greatest
impetus to medical and public interest was an article by Fossier [3].
This coincided with a rapidly increased use of marihuana in this country.
Fossier gave an interesting history of cannabis and quoted records from
the coroner of the parish of Orleans which stated ". . . four hundred and
fifty prisoners show one hundred and twenty-five confirmed marihuana addicts,
from 18 to 31 years of age. Addiction
was not found in any one beyond that age. It
is twice more frequent in the whites than in the negroes.
"The
records of the district attorney during the past year reveal that 17 out of 37
murderers, 13 out of 145 forgers, 36 out of 195 imprisoned for grand larceny,
and 21 out of 115 detained for assault and robbery were addicts of muggles', and
that 68 arrests were made for the sale and possession of marihuana."
At
first, there was little knowledge of the actual nature of marihuana.
In the underworld it was given a number of names, such as "muggles,"
"reefers," "loco weed," and at
least one scientific writer to a midwestem newspaper of some standing
demonstrated at length, to his own satisfaction, that this was identical with
the drug which caused poisoning of cattle in Montana and Wyoming.
Unfortunately, the loco weed of the west is a plant of the lupine family
and, both botanically and pharmacologically, is entirely unlike cannabis.
The
real facts concerning the action of cannabis are stated very clearly in a
comprehensive article by Bromberg.[4] According
to this author, addiction to the drug is relatively uncommon.
On page 309, he states:
"
The chief effect of the drug in the smoked form (when inhaled) is an
intoxication of transitory nature and relatively uniform symptomatology.
The intoxication is initiated by a period of anxiety within 10 to 30
minutes after smoking in which the user sometimes becomes panicky, develops
fears of death and anxieties; of vague nature associated with restlessness and
hyperactivity. Within a few minutes, he begins to feel more calm and soon
develops definite euphoria; he becomes talkative, feels more at ease, is elated,
exhilarated and filled with a vivid sense of happiness.
He begins to have a sensation of lightness in his limbs.
Walking becomes effortless. The
paresthesias and changes in bodily sensations help to give an astounding feelin,,
of lightness to the limbs and body. Elation
continues: he laughs uncontrollably and explosively for brief periods of time
without at times the slightest provocation: if there is a reason it quickly
fades, the point of the joke is lost immediately. Speech is rapid, flighty, the subject has the impression that
his conversation is witty, brilliant; ideas flow quickly.
"Conclusions
to questions seem to appear, ready-formed and surprising in their clarity.
The feeling of clarity is, of course, spurious: it is merely a subjective
feeling. When the user wishes to
explain what he has thought, there is only confusion.
The rapid flow of ideas gives the impression of brilliance of thought and
observation. The flighty ideas are
not deep enough to form an engram that can be recollected-hence the confusion
that appears on trying to remember what was thought.
The smoker is seized with the desire to impart his experiences to others;
he wishes in some way to transmit the glory and the thrill.
Activities speed up tremendously and time is slow in passing: there is a
feeling of changed reality. Sex
excitement consists in the fact that the sexual objects in his environment
become extraordinarily desirable. At
this stage (about 20-30 minutes after starting) he may
begin to see visual hallucinations which may start as misinterpretations
and illusions. Characteristically
there are at first flashes of light or amorphous forms of vivid color which
evolve and develop into geometric figures, shapes, human faces, and pictures of
great complexity. The depth of the
color and its unusually arresting tone strike the subject. After a longer or shorter time, lasting up to two hours, the
smoker becomes drowsy, falls into a dreamless sleep and awakens with no
physiologic after effects and with a clear memory of what had happened during
the intoxication."
Bromberg's
description of the action or cannabis, based on the study of clinical cases
cited in his paper, agrees in general with that given by Wood, but places the
period or rear of impending death at a much earlier stage than is indicated by
Wood's personal experience. To
Wood's description Bromberg adds the influence of the drug on sexual excitement.
Bromberg,
having studied material in the Court of General Sessions, New York County, over
a period of a year (1932-1933), :found no significant evidence that crimes were
committed during or immediately after intoxication by marihuana.
His incidence of the use of marihuana by criminals does not agree with
Fossier's report from the parish of Orleans.
According to Bromberg, “The chief antisocial effect arise from the
release of aggressive and sexual drives. All
writers agree that when crime is associated with marihuana smoking it is because
of the marked weakening effect on social restraint." Quoting Peebles (Gaiija
is a Cause of Insanity and Crime in Bengal, Indian Medical Journal, 49: 395:
1914), he concludes: "It is all ideal drug to cut off inhibitions
especially in inadequate types....”
Our
immediate a problem reduces to the following: Marihuana seldom causes serious
addiction, but in some localities may be associated with major crime.
It produces disorientation, hallucinations, a loss of time sense, and may
be a sexual excitant. When crime is associated with marihuana smoking, it is due to
a marked weakening effect on social restraint.
In
spite of legislation to the contrary, marihuana is still apparently sold.
The potential purchasers and users now include thousands of young men who
are living an unusual life, isolated from the contacts and controls of the
family. So that they may be able to
fight efficiently and to defend themselves while fighting, they must be
maintained in an optimum state of health at all times, both during the training
period and during their life as combatant troops at the front.
Every available moment of their training period must be devoted to
instruction in the, use of their weapons and the art of self-defense.
Time lost during this training period because of unnecessary sickness or
inefficiency reduces their value as fighting troops and their ability to protect
themselves. It must not be
forgotten that adequate training for warfare demands
that there be developed in these men a "killer" instinct which, being
contrary to their American tradition and upbringing, must necessarily in
some cases lead to mental conflict. Finally,
their health, and public health in general, requires proper control of all
situations which might lead to the spread of venereal disease.
Is
there really a "Marihuana Menace," or only a "Marihuana
Bugaboo?" Under present circumstances, it might be wise to adhere to the
maxim, " abundans cautela non nocet.
BIBLIOGRAPHY
1.
Wood, Horatio C.: Therapeutics, Materia Medica and and Toxicology. pages
264-266, 6th Ed., J. B. Lippincott Co., Phila., 1886.
2.
Munch, James: Bioassays, Table II, page 70, Williams and Wilkins Company,
Baltimore, 1931.
3
.Fossier, A. E.: Marihuana Menace, New Orleans M. & S. J., 84:
247-252, Oct., 1931.
4.
Bromberg. Walter: Marihuana
Intoxication, Am. J. Psychiat., 91, 303-330, Sept., 1934.
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