Report of the Superintendent, Nagpur Asylum, on the hemp drug cases of 1892.

IN reply to your No. 2236 of 9th instant asking me for an expression of my own views with regard to the history of the cases of insanty admitted into the Asylum during the year 1892, and in which cases the alleged cause of the insanity was the immoderate use of ganja or other preparation of Indian hemp, I may be permitted to draw your attention to the concluding paragraph of my letter No. 21 of 27th January 1894, in which I express-ly stated that I had not been able at the time of writing to formulate any decided opinion as to the mental condition and causation of the insanity of the cases admitted during i892-93.

2. Since writing the above I have endeavoured to study the mental condition of the six insanes admitted during 1892 and still in the Asylum, in which the cause of the insani-ty is alleged to have been the excessive use of ganja taken in some form or other. I beg to submit a few brief notes and comments on these cases.

3. I may note that, although acute ganja intoxication and its detection, symptoms, &c., &c., are abundantly treated of in various medical works, I am not myself acquainted with any recent medical work which specifically treats of types of insanity which are espe-cially attributable to the habitual use of ganja or atly of the various preparations of Cannabis indica or sativa and the differentiation of the symptoms of these cases from other cases of toxic insanity (alcoholic, opium, &c.), and, therefore, when discussing the causation of the mental aberration in any given case in which a history, which may be true or may be ex-aggerated, of having taken some preparation of Cannabis at some previous period of their lives is obtainable or suspected, it is necessary to avoid being led away by the post hoc ergo proper hoc fallacy—I mean that, although it is, no doubt, exceedingly common to meet with cases of chronic insanity associated with the frequent or habitual use of ganja, it is not therefore sufficient to assume from this alone without the very clearest proof (which proof must exclude every other probable cause) that the man or woman is insane because he or she has taken ganja or bhang at some time in his life.

As a writer has pointed out, a list of the number of cases in an Asylum in which a history of ganja-smoking is alleged as a cause of the insanity in the papers sent with the lunatics often simply shows the number of lunatics in the Asylum who have used ganja at some period of their lives, moderately or immoderately, as the case may be, and the causal connection between the use of the intoxicant and the insanity is not readily demonstrable.

1. Atmaram, Soonetr.—This man tells me that he has taken ganja since his father died, that is, about 9 or to years ago. He says that his father occasionally took ganja. His mother did not take ganja, but both his parents were in the habit of drinking " darn " or country spirit freely and habitually. An uncle (mother's brother) also was a heavy drinker. He himself cannot say why he commenced the habit of ganja-smoking, but his usual allow-ance was 2 chillums daily. In addition to the ganja-smoking he used to drink bottle of "dobara " (or the 2nd distillation) daily. 1 he average cost was 16 pice, and he says he drank it because he felt tired after his day's work. In the hot months he also used to drink bhang mixed with sugar, pice worth of each, and by his own account he drank this concoction 3 times in 6 months. He has been in Jail for theft.

The papers that were sent with him when he was admitted into _Asylum state that his insanity dates from the time he went to Jail, and the supposed cause is " perhaps the use of ganja."

Dajiba, a distant relative (cousin) of Atmaram, told the Magistrate who was deputed to make a special enquiry into the antecedents of these cases, that from an early age Atmaram was " given up to vicious habits" and that " he used to smoke ganja."

As a rule his behaviour in the Asylum has been good. Once (in August 1892) he was excited and destroyed a coat, and once again (in August 1893) he is said to have become very excited and abusive. Excepting on these two occasions he has not shown any violent or maniacal excitement.

His main delusion throughout has been that he is a successful Railway Engineer and has performed wonderful engineering feats (building railways and digging tunnels, &c.). Makes his own silver from " gitti" by heating it. Says that his pay was Rs. r,006 per mensem and that he now has over Rs. 18,000 saved up. Calculates 32 days to the month and 15 months in the year. His physical health is fairly good ; he usually is contented and cheerful. Patellar reflexy completely absent. Pupils somewhat contracted, and respond sluggishly to the stimulus of light and for purposes of accommodation ; no marked tremor of tongue on protrusion ; no distinct paralysis, but he is inclined to totter when he stands with his eyes shut and walks backwards very slowly.

His left hand shows a central thickening and discoloration of the palmar surface, somewhat towards the inner side, but no corn or callosity.

Here we have an instance of a condition of mental unsoundness owning, in my opinion, a very complex causality. Assuming that the facts of the family history and personal history obtained are trustworthy, we note first a history of alcoholic indulgence in both parents and in one uncle and a further history of ganja indulgence on the part of the father : and taking into consideration these facts, we are not surprised that his relative Dajiba states that Atmaram was given up to vicious habits from an early age.

It has been frequently observed that the offsprings of alcoholic parents show sooner or later some signs of mental instability, with not uncommonly some indications of a liking for narcotics and stimulants and the excitement they produce. We have evidence that . early in his life Atmaram was a ganja-smoker, a wine-bibber, and a thief. There is no history of sexual excess and he himself denies it ; but as ganja is a supposed aphrodisiac, his denial may be taken for what it is worth. With this history I think it not improbable that the habit of ganja-smoking was not only not the sole or chief cause of his mental aberration, but more probably one of its remoter consequences. In the same way his drinking propensities may probably be attributable to the same cause. Setting aside heredity for the moment and seeking for another cause, I can find nothing either in his mental condition and behaviour during his past life in the:Asylum or in his present symp-toms to justify the expression as to causation in the certificate—" perhaps the use of ganja." Why not "perhaps the use of alchohol" ?

His condition in some respects, mental and physical, resembles an early condition of general paralysis of the insane. As a rule there is general condition of bien e'tre. He has exaggerated ideas of grandeur, wealth, powers, and capabilities ; his patellar reflexes are absent ; pupil reflex is sluggish. In some cases excessive indulgence in stimulants and narcotics have been not uncommonly noticed as amongst the prodromata of general paralysis.

In this particular case the man freely admits to having used both ganja and bhang ; but I am not on this account prepared, for the reasons stated above, to conclude that his insanity is solely attributable either to ganja or to the bhang which he has taken.

I am, however, quite ready to admit that a mentally weak-fibred individual with an unstable brain will ab,vays be further mentally enfeebled, whatever the narcotic or stimu-lants he indulges in.

2. Tajodin.—This man admitted to me that he used to take ganja two or three times daily and described how he prepared it. He said he rubbed it to powder in the palm of his hand, and washed it 7 times in water and then smoked it. The intoxicating effect used to come on at once. Says that he also drank " daru " and other kinds of alcohol daily. (His conversation was very incoherent, and it was very difficult and scarcely possi-ble to keep him to the point.)

He says that he was discharged from the 8th Madras Native Infantry at Saugor.

The medical history states that " I am informed that he is a confirmed ganja-smoker." Nothing is given in support of this information, or whether the informant was a trust-worthy person and one whose testimony was worthy of credence.

The special enquiry reports that his wife's brother states that he has been made for five years, that he has never shown signs of violence, that he has never drunk liquor or has been addicted to any intoxicant.

The supposed cause of insanity was disappointment in some love affair. He was in love with some chamar woman, whose husband is supposed to have given Tajadin some drug to smoke, and after smoking this he became insane.

He has never been violent since his admission. Incoherence of speech has been constantly present. He often refuses his food, and is mostly in a melancholic state. He became excited in January 1893. Is of a very suspicious disposition.

Knee-jerks completely absent ; pupil reflex doubtful ; no marked tremor of tongue, er signs of parlaysis of any part ; is generally depressed and melancholic ; has no sense of decency or cleanliness ; rambles off incoherently when spoken to, and cannot keep to the point ; there is a thickening of the skin of the inner side of the left palm.

In this case the history is contradictory and gives us very little help in coming to a distinct conclusion as to the cause of the mental aberration.

There is a history of ganja-smoking.       
)) ) )) )) )) alcohol-drinking.       
) )) ) )) disappointment in love.

He says himself that he took both ganja and alcohol : his rela.tive says that he was not in the habit of taking either alcohol or any narcotic drug-. Obviously both statements cannot be true and in the absence of other confirmatory evidence, which is to be believed ? This raises the whole question as to how much is to be believed in accepting the statements of a supposed ganja-consumer and how much rejected. Some lunatics are exceedingly cunning and will readily respnnd to, and if the expression be excused " play up to ", any leading question. Others, on the contrary, are so suspicious that they will answer nothing, nor the simplest and most direct question, always suspecting a trap.

The absolute disregard for veracity shown by dipso-maniacs and morphino-maniacs is notorious, and I am inclined to believe that the same disregard for facts and reliance on imagination is also to be met with in the subjects of what Dr. Hutchinson, the late Superintendent of the Patna Asylum, calls " Cannabism. " Did his ganja-smoking propensities develope subsequent to the disappointment in love ? I should feel inclined to look upon the case as an ordinary case of melancholia, which will probably go on to dementia in the course of time, and although disappointment in love, alcoholism, and persistent ganja-smoking may each and all have helped to bring about his present condition, yet I cannot, with the doubtful history given, disassociate one exciting cause from' the other two, and say definitely that this is a case of insanity traceable to ganja.

3. Itwargir, Gosain.---Convicted on 14th October 1891 for theft in a building and sentenced to one year's rigorous imprisonment. The Superintendent of the Nagpur Central Jail in October 1891 reported that he was violent, noisy, filthy in his habits, abusive and incoherent, also that his history is that of a ganja-smoker, that he has torn his clothes repeatedly, and that he suffered from insomnia.

The man told the Ganja Commission that he was in the habit of taking ganja regularly. It was food to him and he could work on it. Never took opium or liquor.

In the Asylum he was frequently crying and was depressed, dull, and apathetic ; told me in January 1892 that he took ganja. Was destructive and noisy at night. At times was excitable, and assaulted a lunatic on the 3rd April 1892. Continued to be troublesome and chiefly of very destructive propensities until April 1893, when he showed signs of mental improvement.

The magisterial special enquiry states, on the testimony of one Herag-ir, a cultivator, who had known Itwargir for several years, that Itwargir was made a gosain when he was 10 or 12 years old, and that " from his youth he was wild." He used to smoke ganja and go about begging, was turned out of Hamadpur for being a bad character ; " he was a ter-rible smoker of ganja."

Another religious mendicant or gosain, by name Harigir, also testified to the fact that Itwargir was a habitual ganja-smoker and that his moral character was bad, &c., &c.

In this case there are no details of the family history to help us, and we are driven to frame an hypothesis as to the supposed sequence of events which led up to the insanity. We have not improbably an instance of wild, dissipated, and misspent youth, coupled with a highly excitable temperament, and an ill-balanced mind, rendered more so by religious excitement, and the life of a gosain. Assuming the probable tr'uth of this history, and the existence of this excitable temperament, it is not difficult to further conjecture that the free and habitual use of ganja completed the mental unrest, and was sufficient to over-throw the scanty remains of reason, and set up a condition of melancholia with excitement (the active melancholia of Dr. Savage). Although in the absence of any particulars about his family history I am not prepared to state positively that the insanity in this case is clearly traceable to ganja-smoking and nothing else, neverthless I think that ganja mate–rially aided, if it did not actually set up, the mental disease.

Subsequent to my return he became daily quieter and showed signs of mental improve-ment, and on the 2oth April 1894 was sufficiently recovered to be released by order of the official visitors of the Asylum.

If he returns to his ganja-smoking propensities it is not unlikely that we shall have him back in the Asylum before long.

4. Akbar Khan.—From the statement which accompanied him on admission to the Lunatic Asylum, it would appear that he has been a wandering lunatic for six or seven months. The supposed cause is " ganja-smoking, &c." His Asylum history shows that he was noisy, abusive, and incoherent, alos at times destructive.

He himself ascribed his insanity to an illness for which he was blistered behind the ear. Says he took ganja, also "daru. "

Told me that he had used ganja and majum and also alcohol, brandy, &c.

He was very incoherent and could not be kept to the point. He is always abusive and uses indecent language. Is quarrelsome and at times violent and given to assaulting the others.

The magisterial special enquiry gives the evidence of two of Akbar Khan's acquaint-ances, who testify that he was a confirmed ganja-smoker and spent all his money' in intoxi-cants, but both say that he also used to drink " tari" pretty considerably. One witness states positively that the ganja caused his insanity, and the other states that his madness was subsequent to an attack of " fever " (acute mania?).

In this case the man is a confirmed lunatic, but whether the insanity in the first instance was induced by excess either of ganja or alcohol I think it would be difficult, if not impossible, to positively determine.

Little is known of his family history, and although one of his acquaintances says that none of Akbar Khan's relatives were insane, I should like more convincing evidence of this before I could altogether exclude_heredity as a factor in the causation of his insanity.

5, Rudraya.—His papers say that he was a wandering lunatic and was found sitting by the police on the banks of the Andhari River, was very violent, and required three men to restrain him, &c. Was violent whilst in Jail, and then lapsed into silence.

Subsequent to his admission to the Asylum he was at first depressed, and then very violent with impulses to strike every other person near him, and then he became depressed.

He would not talk to the members of the Ganja Commission.

The special magisterial enquiry states that no relatives can be found. He told me that he had never taken any narcotic or stimulant (alcohol, ganja, or tobacco). He was disinclined to answer any questions, or to pay much attention to what was said to him.

Alleged cause of insanity ganja, but no definite or trustworthy evidence on this point.

N.B.—The Asylum clerk says that he recollects that when Rudraya was admitted to the Asylum he admitted to having taken ganja, but there is nothing recorded of .any admission of this nature. He also says that the police who brought him said that Rudraya had been some days on the river bank and that the malguzar and people of the vicinity, considering:him to be a sadhu, had brought him from time to time milk and ganja. This may account for his violence at Chanda and when first admitted into the Asylum.

In my opinion all that we are justified in conjecturing from the history and present mental state of Rudraya is that he is a weak-minded creature, given to wandering habits, suffering from melancholia, with occasional periods of excitement and vvith a craving at these times for stimulant narcotics as ganja, and further that the gratification of this craving probably aggravates the mental excitement.

6. Kalekhan.—Supposed duration of disease, 9 months. The medical certificate says :—" The patient is a ganja-smoker." He had been in the 1st Regiment of Infantry, Hyderabad Contingent. Had been discharged for insanity, was found wandering at Anjangaon, and when in the regiment had a habit of straying away towards the hills. He is under the impression that he is a great man, and that others should pay him every respect. Remains motionless for half an hour at a time, and then begins to laugh, &c. &c. The Asylum history shows nothing special beyond that he was excited in July 1892, again in August 1892, and again in January 1893. Depressed since May 1893.

Nothing coherent could be got out of him by the members of the Ganja Commission.

The special magisterial enquiry notes the evidence of one Mahomed Khan, who says he is a distant relative of Kalekhan (though Kalekhan denies this) ; says he was steady in early life, but after employment showed vicious tendencies. It was suspected that he drank liquor privately, but not in public. He was attached to a prostitute and quarrelled with her, whereupon she left him and he became .insane. It is said that something was given him to smoke with tobacco, and from this he became insane, None of his relatives are insane.

I questioned him at some length as to his past history, habits, &c., but beiond the fact that the above Mahomed Khan was no relation of his, he refused to reply to any question. Is generally depressed and silent. Knee-jerks present.

In my mind this is another instance of a man of weak intellect with wandering ten-dencies. I can find no positive evidence to support the ganja hypothesis. He was suspected of secret drinking, and there is a history of disappointment in love. Weighing these three possible causes of his insanity, I cannot find any grounds for assuming that one cause was more active than either of the other two in causing the insanity.

7. Lachman, Gond.—This man was discharged from the Asylum previous to my assum-ing charge of it, and his whereabouts are unknown. As I did not see him or examine into his mental condition, I prefer not to offer any criticism on the supposed cause of his insanity being ganja.

In conclusion, I find that in many of the cases there Is a history of ganja-somking combined with alcoholism, and in two cases a further complication of disappo:ntment in connection with some love intrigue. How much, if any, of the insanity was produced by the ganja I cannot say. Only in the case of Rudraya does it appear to me that‘ ganja was probably the main cause of the insanity.

I regret the delay in submitting the report on these cases, but I did not thoroughly understand that a report was called from me after having had the cases such a short time under observation.

Extract from the evidence of Surgeon-Lieutenant-Colonel McKay (Superintendent, Nagpur Asylum, 1892).

(1) Atmaram.—This man states that he now and then smoked ganja. He has apparently been insane for 7 years. There is no history of violence or very unusual ex-citement, and I very much doubt if ganja-smoking has had anything to do with his present condition. It is very doubtful if he even ever smoked ganja, for it is utterly impossible to believe what he says.

He appears to have been sane until he went to Jail at the age of 2o and became insane in the Jail and has remained so ever since. Supposed cause " perhaps ganja." There is no history of the man ever having smoked ganja and his symptoms would not lead me to suspect it.

(2) Tajodin.—There was no history sent with this man, and very little that is reli-able can be obtained from him. The Magistrate says that the cause of insanity was un-known. The medical officer of the dispensary, Kamtpee, says that he is supposed to be a great ganja-smoker. The man has occasional fits of excitement followed by depression, and he has lately become very suspicious, shies at everything he passes. Here again the ganja-smoking is doubtful. He has apparently been known to have been insane for 5 years and during that time there is his history of violence. Here again the symptoms would not lead me to suspect ganja. There is not that sudden violent excitement which one associates with the use of the drug.

(3) Itzvargir.—No history was sent with this man. He is a beggar. He was admit-ted into the Asylum violent, noisy, and filthy, abusive and incoherent. Beyond the man's ovvn statement it is not certain that he ever smoked the drug. He admits having been a ganja-smoker and perhaps this case might be put-down to the drug, but it is not a charac-teristic case.

(4) Akbar Khan.—This man was also a beggar ; used to sit at a certain spot in the city and had been doing so for years. He is supposed to be a ganja-smoker, but there is no evidence beyond his own word that he ever smoked the deug. He is a great talker, very abusive, but is never violent. This man has been a lunatic for years and will admit anything, but I cannot include this case.

(5) Ruclraya.—This man is also a beggar and has no friends or relatives. The sup-posed cause is excessive ganja-smoking. He certainly when admitted showed signs of violent mania, which may have been caused by smoking-ganja, but there is little known about him before he was found sitting on the banks of the river. This man has apparent-ly been insane for years. I do not think his symptoms- would lead me to say that ganja was the cause.

(6) Kalekkan.—There is here a history of ganja-smoking ; but can we put down the ganja as the predisposing or the exciting cause ? He was very depressed with occasional fits of excitement the first few days of admission and these fits of excitement continue but with longer intervals.

He says he has smoked ganja, but the symptoms do not lead me to suspect that ganja has had anything do with the insanity.