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The Online Reefer Madness Teaching Museum
The British Journal of Inebriety
-
1929-30 - Vol. 27
CANNABIS INDICA:
AN HISTORICAL
AND
PHARMACOLOGICAL STUDY
OF THE DRUG.
By PAUL B. WILKINSON, Senior
House Physician, National Hospital, Queen's Square, London. THE present paper has been prepared at the suggestion of the Editor of this Journal. It aims at presenting in a condensed form the essential facts known regarding cannabis indica, which under such names as bhang, hashish, and ganja, is used as a drug of addiction. Historical Review. The medicinal properties of cannabis indica have been known from time immemorial. One of the earliest references to it in a Chinese herbal compiled about 500 years B.C. It has also been shown recently that the Assyrians were aware of its uses as early as the seventh or eighth century B.C. They used it as incense, and apparently obtained its narcotic effect by inhalation. This fact throws light on a curious passage in Herodotus (486-406 B.C.) which runs thus: "When the Scythians obtain the seed of this kannabis, they throw it on to red-hot stones in the fire. It burns like incense, sending up more smoke than any Greek vapour bath. This they then inhale and begin to rave." Diodorus Siculus also refers to the drug in this passage: "Homer says that Helen obtained the drug nepenthes from the Egyptians through Polydama, the wife of Thon." Speculation has been rife as to the exact pharmacological identify of nepenthes, but it was possibly either cannabis indica or a compound containing cannabis indica. Galen, writing, in the second Century A.D., mentions the plant under the heading "De cannabis semine": "Its fluid extract is poisonous. Yet mixed with other drugs, it is eaten after meals by some people to induce pleasurable sensations. Shortly after taking it they experience a feeling of warmth and finally lose consciousness." Exactly how the knowledge of the drug spread is not known, but it seems probable that it was used in Assyria, Arabia, and the districts south of the Caspian Sea before it reached India. It was certainly known and used in India by the first century A.D. Marco Polo in his "Travels" tells the story of how the drug, was used by Hasan, son of Ali, one of the descendants of the prophet. He had set up an independent sovereignty in Alamout, an isolated fortress in Syria, where he ruled as "the old man of the mountains." To maintain his power he had recourse to the drug with which he used to stupefy his servants. Some of their crimes were doubtless committed under the influence of the drug, but Hasan relied mainly on the psychological impression produced by the visions which followed its use. Silvestre de Saey showed in 1809 how the word assassin is derived from the various names given to these followers of Hasan---Assassini, Assissini, Heissessini. Arnold of Lubeck, writing in the twelfth century, also quotes this story in the "Chronicit Slavorum, in which it is mentioned twice. References to the drug and its uses become more frequent in the middle ages. Garcias ab Horto, writing in 1563, describes the effects of eating bangue, which he calls "a plant not very different from hemp." He found its use widespread among, the Indians, and gives an admirable account of the gaiety induced in the early stages of the intoxication and of the final stupor. Prosper Alpinus, in his "De Medicina Aegyptorum," also gives a picture of the effects which follow the taking of cannabis indica. Like Garcias ab Horto, he compares the early stages to those of alcoholic intoxication, but he stresses the fact that the visions obtained are dependent largely on the mental level and on the mental background of the patient. He also describes the furious anger shown by some cases in the later stages of poisoning, and the subsequent intense depression. Coming to modern times, we find the drug once more came into notice during the Napoleonic campaign in Egypt. The first description of it and its action by a physician was that given by O'Shaghnessy in 1840 in India, where he had an extensive experience of its use and prepared a potent alcoholic extract. He also ascertained that the active preparation was not an alkaloid. From thence onwards accounts have been fairly numerous, some of the best being those given by non-medical observers. Of these, Theophile Gautier's description of the effect of the drug on himself is one of the most notable. Its effects have also been described by Bandelaire, whose account we shall examine in dealing with the action of the drug. The name KarraBiz given to the plant in Herodotus is presumably cognate with the term Qonnoubon or Qunnuabon; and this in its turn comes from the Iran Konaba. KarraViz is probably another form of the Greek word Ko'vaBos---noise. Possibly there is some reference here to the "shouts " uttered by Herodotu's Seythians when under the influence of the drug. From KovaBoz the modern French chanve and chanvre come through the Latin cannabis; and probably the old German Hanapas and the modern German Hanf have the same origin. Pharmacology of Cannabis Indica. Cannabis indica, or Indian hemp, is outwardly the same plant as Cannabis sativa. The plant grows widely throughout Asia, Africa, and Asia Minor. The botanical characteristics of Cannabis sativa, which can be cultivated readily in temperate climates such as that of France, are identical with those of cannabis indica. The resinous substance elaborated in the flowering tops of the female plant possesses very much feebler narcotic properties when obtained from Cannabis sativa. They are not, ver, completely lost, but much large doses must be given to produce any effect at all. The three most used preparations in India are bhang, charras, and ganja. Bhang consists of the coarsely powdered leaves of the female plant mixed with some resin. It is used mainly in preparing narcotic draughts. Charras is the resin extracted from the flowering tops of the female plants, and ganja, which consists of the Lowering tops of the non-fertilized female plants coated with resin, is used chiefly for smoking. Haschisch is it collective term applied to almost any preparation of the plant which can be eaten or drunk. The active principle resides in the resin from which it can be extracted with petroleum spirit. Wood, Spivey, and Easter-field working in this way obtained an extract which, when evaporated to dryness and fractionally distilled, yielded a reddish oil. This oil they called cannabinol. It appears to have a constant composition and to produce the effects of the crude drug when given in small doses. Cannabinol is obtained in that part of the distillate which comes over between 210° and 240°C. Cannabinol oxidizes readily on exposure to air and at the same time loses its toxicity. Frankel considers it to be a phenolaldehyde of the formula CH.C2OH28.CHO. Professor Marshall of Aberdeen working with this oil a year after its isolation found that it produced a typical cannabis indica effect on himself, and also gave rise to the usual symptoms induced by cannabis indica in dogs. Enormous variations in the action of the drug have been noted by different workers. These are due to the fact that resin of different seasons and from different places contains different amounts of cannabinol. The amount of resin is no guide to the toxicity of the drug. Again, resin which is brought from the Orient to Europe may undergo slow oxidation in transport. These facts account for the numerous cases on record where symptoms of acute intoxication have followed the ingestion of such small doses as 7 or 10 minims of the fluid extract. All specimens needed for pharmacological work have, therefore, to be packed in air-tight containers. Another point which has to be taken into consideration is the temperament of the person taking the drug. While one man may get a marked effect by taking a certain specimen of resin, another, after taking the same resin, may experience nothing at all. THE
USE OF CANNABIS INDICA. As we have pointed out earlier the use of the drug appears to have spread through India, Servia, and Arabia in the early middle ages. Thence it spread to Africa and Asia Minor. In the thirteenth century Napoleon found its use so widespread and so deleterious in Egypt that in 1800 he issued ordinances absolutely prohibiting the smoking or drinking of hemp preparations. Indeed, such ordinances had been issued intermittently with but little effect since 1378. The Napoleonic edicts were equally inefficacious, as have been still more recent prohibitions. Today the drug is used habitually in India, Asia Minor, Turkey, Egypt, and in many other parts of Africa. Its use appears to be especially prevalent in Egypt and along the North African coast from Tripoli to Morocco. The drug is preferred to opium because its effects when it is smoked are more rapid. All the efforts of the French have failed to stamp out the addiction in their North African colonies where the drug is smoked under various names. In the Rif the drug is used by the Senussi in certain religious ceremonies. This connection between the drug and religion is even more marked in the Congo district. There the Kassai and the Baluba have gone so far as to destroy their ancient fetishes, setting up in their place "riamba" or. hemp. They regard the drug as a means of protection against all the ills the flesh is heir to, and as a symbol of peace. They have organized themselves into a sect called Bena Riamba, and greet each other with the word "Moio" (life). The smoking of hemp is, of course, an integral part of the ceremonial of this sect, though the use of alcohol is forbidden. The Baluba also have as part of their ritual nocturnal orgies at which hemp is smoked. At the "feasts of Riamba" treaties and alliances are concluded, and the drug is smoked in a large calabash which goes round the company. Criminals among these tribes are condemned to smoke hemp until they lose consciousness. So great is the importance of the drug among these peoples that the pipe accompanies them on all campaigns and journeys. In the more northern parts of the West African littoral the use of the drug is confined to certain isolated districts. In East Africa and Madagascar hemp-smoking is prevalent, the only districts free from it being those in the vicinity of the Great Lakes. It is, however, grown and used around Lake Victoria Nyanza. There are various methods used in smoking the drug, each tribe having its own name for it and as a rule its own method of smoking it. Water pipes are used in the Loango district; other tribes use ordinary tobacco-pipes. The Zulus bury a handful of the prepared drug beneath a heap of burning dung, cover the whole mass with earth, and then inhale the smoke through small holes made in the earth with their fingers. In India, especially in the North-West, bhang is largely used to make various drinks. Ganja smoking is forbidden by law in these provinces. In Kashmir: Bengal and Nepal hemp is abundantly cultivated and smoked. Farther north in Afghanistan and Baluchistan the addiction is widespread. Hemp is also imported into the Pamirs, where it is used by the Kopeks and the Tartars. In Turkey, the use of the drug has been forbidden since the end of the nineteenth century. Needless to say it is still smoked and eaten under various forms, one of the most popular (Gania) being known as Esrar or "secret." The plant is still grown in Syria, and is smoked both in Palestine and Persia. THE
PHARMACOLOGICAL ACTION OF CANNABIS INDICA. The action of the drug differs slightly according to the mode of administration. All the effects of intoxication come on more rapidly when it is taken by inhalation. When taken by mouth the same effects are seen and are more easy to study owing to their more gradual onset. There are, broadly speaking, three stages in the action of the drug: the first stage is that of excitation and loss of self-control; the second the stage of hallucinations; the third the stage of coma. Like all narcotic drugs it obeys the principle of dissolution in its action on the nervous system. The highest centres are those first affected, the result being loss of self-control and judgment. Usually a short phase of temporary anxiety precedes the onset of loss of self-control. The subject then experiences a feeling of intense well-being which may manifest itself in emotional overreaction. Attacks of convulsive laughter are common, and he will laugh for minutes on end for no apparent reason. These paroxysms of laughter may alternate with attacks of uncontrollable weeping. There is often a desire for motor activity of some sort at this stage; the patient wants to throw books about the room, to run up and down stairs and so on, and unless he be restrained he may indulge in the most fantastic actions. Giddiness is frequently complained of and some motor inco-ordination now becomes obvious. The subject is usually flushed at this stage and may complain of palpitation. The pulse rate may be increased up to 80 or 90 per minutes and the pupils may dilate. They remain active, however, up to the onset of coma. As the action of the drug progresses the hallucinatory stage begins. And here it is necessary to point out that the hallucinations are very largely dependent on the intellectual level and on the usual mental background of the subject. Some Occidentals take the drug and obtain no hallucinations at all; on the other hand, decadents, like Baudelaire, have the most absurd hallucinations while under the influence of the poison. The first hallucinations are usually comparatively simple. Visual and auditory acuity, and general sensibility become much heightened at this stage. Gautier describes vividly how his body seemed to him to become transparent, thus enabling him to see the mass of haschisch he had eaten glowing like an emerald in his belly. At the same time his auditory acuity was enormously increased. If he spoke the sound reverberated in his head like thunder. The least whisper sounded like a cataract. Another curious phenomenon connected with hearing, described both by Gautier and Baudelaire also says that musical notes appeared to be numbers, and that one could work out prodigious calculations in a few seconds. Gautier's own description is as follows: "My bearing was enormously increased ; I heard the noise of colours. Green, red, blue and yellow sounds reached me quite distinctly in waves. A glass knocked over, the creaking of an armchair, a whispered word vibrated and re-echoed in me like a peal of thunder; in own voice seemed to me so loud that I dared not speak for fear of knocking the walls down or making myself explode like a bomb. More than five hundred clocks sang the time to me in silvery flute-like voices. Everything, I touched gave forth the note of a lyre or an /Eolian harp. I was swimming in a sea of sound in which certain motifs from Lucia or the Barber of Seville floated like islands of light . . . . Sounds, scents, and light all came to me through innumerable pipes, thin as hairs, in which I could hear magnetic currents whistling. As far as I could make out, this state lasted about three hundred years. When the attack was over I saw that it had lasted a quarter of all hour." Gautier also gives till account of his astonishing visual hallucinations; in the first attack the air seemed to be filled with a myriad butterflies, whose wings produced faint rustling, as the fluttered round him. In his last attack he was surrounded by a hideous and continually changing collection of mythological birds and beasts---wyverns, griffins, unicorns. He stresses, as do most other observers, the occurrence of lucid intervals during the period of intoxication. The disturbances of general sensibility are always more or less unpleasant in their character. The commonest are paraesthesiae in the hands, arms, and feet, though subjective sensations of numbness involving the whole body have been described. The hallucinations concerning time and space appear to be of almost constant occurrence. It is probable that the mere press of images tends to produce the time hallucination. One lives the lives of several men in one hour. Hallucinations of being levitated do occur, but rarely. It is common for the subject to imagine himself to be some inanimate thing, like a locomotive, a violin, a tree, or a tobacco pipe, and to do his best to enact the part. In contrast to this is the drug's curious power of doubling one's personality, of enabling one to see one's self seated in it room, lying in bed, talking, laughing, and so on. During the stage of hallucinations it is by no means uncommon for the patient to have sudden attacks of intense fear, in which he is in terror of dying on the spot. As the intoxication deepens the hallucinations cease, and the final stage is generally ushered in by a state of indescribable calm and happiness---the state called "kief" by Orientals. In this state the patient feels that every philosophic doubt he ever had has been resolved, that he holds the key to the eternal mysteries, that he has overtopped God. Very naturally coma ensues rapidly upon this condition---coma which may deepen into profound unconsciousness. This account gives the points usually observed in acute intoxication with cannabis indica. But there are many variations, especially among the inveterate smokers of the drug. In many of these cases three or four inhalations of the smoke are enough to induce complete loss of awareness to the surroundings. Villard gives a vivid picture of the chronic smokers, pallid, emaciated, and hollow-eyed, sitting for hours staring fixedly in front of them. Other smokers become excited even to the point of mania, and convulsions have been recorded. The older observers, like O'Shaughnessy and Villard, describe catalepsy as one of the conditions which may be brought on by the drug. Chronic cannabinism undoubtedly produces both bodily and mental changes. The addicts are recognizable at sight in hemp districts by their pallor, emaciation, and ataxic gait. There is also a slow but sure intellectual and moral deterioration. The drug taken in small doses over a long period of time gives rise to these changes. An occasional massive dose, among Orientals at least, seems more likely to give rise to an attack of mania or to make the patient violent as well as hallucinated. In India and other countries where the addiction is widespread, statistics tend to show that a definite percentage of mental disorders is directly attributable to an abuse of cannabis indica. Peebles and Mann in 1914 estimated that in the Punjab ganjah smoking appeared to be responsible for 27 per cent of the total admissions to mental hospitals; and further that 25 per cent of the total number of criminal lunatics were addicts to the drug. They stress the difficulty, however, of obtaining correct histories from such people, and point out that many mentally irresponsible people in India never receive treatment. The same general conclusions may be drawn from the figures in other countries where hemp is habitually used. These mental cases are to be classified in three groups. It is noteworthy that the percentage of women among them is very small---not exceeding 1-2 per cent. The first group shows a condition of general well-being with the usual hallucinations. Violent delirium may occur but is not common. Ataxic symptoms are always absent and here can be brought about rapidly. The second group comprises the maniacal cases. In these cases the sensory hallucinations are usually of a terrifying nature, and may lead to extreme violence on the patient's part. Such cases usually show insomnia and may last months. Cure is by no means certain. The third and largest group contains those mentally enfeebled by the drug who live a peaceful life until an overdose causes them to become maniacal again. While in hospital they are essentially children of the moment, caring nothing for the future or anything beyond their immediate surroundings. Once out of hospital they invariably relapse into a manic and aggressive state after their next excess. They usually end as chronic dements. It is possible that in some cases the mental changes are helped on if not induced by other drugs mixed with the hemp-datura, for example. There has recently been a movement against the growing of hemp in European countries. A suggestion that more cannabinol might be produced in this way in Germany was rejected in 1925. Cannabis indica was recently added to the list of drugs controlled by the Dangerous Drugs Act, and "haschisch" has just been brought under the surveillance of the Customs. BIBLIOGRAPHY. Homer: " Odyssey," L. IV., 11. 219-230. HERODOTUS : L. IV., c. 74, 75. DIODORUS SICCLUS: L. I., 287 GALEN : "De aliment. fac.," Lib.I., cap. XXXIV,. MARCO POLO: "Travels," c. xxvi. ARNOLDUS (Abbot of St. John's, Lubeck) : "Chronica Slavorum," 1659, L. Ill., c. xxxvii. WIERUS, J. : "De Priestigiis daemonum, " L. 11., c. xxxv., 1566). GARCIAS AB HORTO : "Due libri del I'historia del Semplici," 1576, I,. VII.,c.x.; "Del Bangue," c. xxv. P. PETITUS: "Nepenthes Homeri," 1689. PROSPER ALPINUS: "De Medicina Aegyptorum," L. IV., c. ii., 1638-1640. THEOPHILE GAUTIER: " L'Orient," vol. ii., c. ii., 1843. MOREAU J. J.: " Du haschisch et de L'Alienation Mentale," 1845. WOOD, SPIVEY, and EASTERFIELD: Pharm. Jour., vol xv., p. 575. MARSHALL, Lancet, 1897. ROCHE, Lancet, 1897. FOULIS, Edin, Med. Jour., 1900. EWENS, Ind. Med. Gaz., 1904. VILLARD, F.: "Du haschish, Etude clinique" (These de Paris), 1872. FRANKEL, F. ; Arch.f. exp. Path, und Pharm., 1898. TAYLOR, BAYARD: "Travels in Palestine." RAUDELAIRE, CHARLES: "Los Paradis Artificiels." PEEBLES AND MANN: Ind. Med. Gaz., 1914 LEWIN, L. : "Die Gifte in der Weltgeschichte," 1920: "Phantastica," 1924. Royal Commission on Hemp 1894-1896.
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