There may be some truth in what Baudelaire says in "Les paradis artificiels", namely, that the reaction of different individuals varies according to their degree intellectual refinement, thus distinguishing merely- material, even brute intoxicatio from the "spiritual" form. To this one can add Carstairs' witty remark that. the quality of the intoxication may be influenced by the expectations with which the subject enters into it.

The hallucinations being influenced by the mental make-up of the individual, by his inclinations, his personal and even professional interests, the effect of the resin will take a different form in a cultured as compared with a primitive person.

According to Abdullais observations, there are three periods which can be distinguished:

(1) transitory intoxication with increased cerebral activity, decrease of normal inhibitions, euphoria, loquacity, hilarity without motivation and which cannot be kept under control. Characteristic is the incoherency of ideas, of Which the cannabis consumer is not aware. After ten to twenty minutes this euphoria is replaced by hallucinations. On the whole it is a polymorphous picture which changes according to individual factors;

(2) the visional period (of hallucinations) is the most important phase of the acute cannabis intoxication; it is accompanied by varied pictures which recall varicus kinds of psychosis. The personis sometimes aware of this state and sometimes not, entering a stage of mental dullness. Abdulla refers furthermore to the well-known visions which can arise, the slowing dawn of the reaction time, the erotic dreams, etc.;

(3) with a consumption of up to 4 g of hashish daily - which is usual - chronic cannabium and likewise the above-mentioned symptoms and psychotic changea develop. The mental dullness increases.

An extensive study on the "Psychophysiology of hashish intoxication" is at present being undertaken in the Sudan; but as its author wishes to check his observations in the light of further experience before drawing final conclusions, we have not referred here to the preliminary results of this promising investigation.(14)

An important paper which was not mentioned in the earlier study 'is one entitled "Insanity from Hasheesh", by J. Warnock, who was for many years Medical Director of the Egyptian Hospital for the Insane in Cairo. During temporary intoxication, the smoker becomes dull and drowsy, and has pleasant half-waking dreams. The active excitement of alcoholic inebriety is uncommon, but if the smoker is annoyed or interfered with during his dreams, he is liable to become irritable and excited and to show loss of self-control. A staggering gait makes the condition not unlike that of alcoholic intoxication, while the pleasant, dreamy state approaches that of the opium smoker.

Warnock then describes the "delirium from hasheesh" with the well-known hallucinations of different kinds, the delusions of persecution which often occur, the great exaltation and the smoker's belief that he is a sultan or prophet. The "mania from hasheesh" varies in degree, up to a prolonged attack of furious mania ending in exhaustion or even death; exaltation delusions of grandeur or persecution are frequently observed and provoke violence towards others, further restlessness, destructiveness, indecency, loss of moral feelings and affections, etc.    "Chronic Mania from hasheesh" is often not distinguishable from ordinary chronic mania, but the patient is less worried than the alcoholic chronic maniac. "Chronic dementia from hasheesh" is the final stage of the precedinig forms.

' The chronic hashish user is a good-for-nothing, often even assaulting his relatives when he is without money to buy cannabis. Moral degradation is the most salient feature; loss of social position, shamelessness, addiction to lying and theft and a loose, irregular life are also characteristic.

Warnock concludes that hin Egypt it fresuentiy* causes insanity" and he insists on cannabis as a cause of crime. "Again, in my experience, I find that persons insar from hasheesh have a proneness te commit crimes, especially those of violence, and have a strong suspicion that much disorderly conduct results from hasheesh smoking

There are quite a few other papers, from the same period or somewhat earlier, which come to the same conclusions, but which are nowadays more or less forgotten. In the Report of the Indian Hemp Drugs Commission of 1893 also, many valuable observations can be found, although Warnock remarks: "Unfortunately, it appears that no lunacy expert sat on the Commission".

In Spanish Morocco the cannabis resin is' mostly smoked; less frequently it is taken as an infusion with tea or as a sweetmeat or in the form of pressed green leave! mixed with raisins or figs. In some parts of the Spanish Protectorate there are clandestine smoking clubs, whose members assemble in spots distant from the city cent7 Surprisingly enough, the authors Fern'S.ndez A.ichez and Goneilez Mâs, psychiatrists in Ceuta, state that the members of such clubs are generally Europeans. The six to twelve persons who meet together smoke either cannabis cigarettes or a special pipe, one for each person, or a narghile for common use. So as to overcome its harsh and acrid taste, the cannabis is mixed with "taba", that is green tobacco fermented in dung. The lighting of the pipes is a special ceremony, proceeding from neighbour to neighbour. After a few quiet minutes of smokin(, excitation and loquacity set in, as well as incessant laurhing, all of which symptoms have been described by other observers.    One participant ("el rollista") takes the lead and recounts, sometimes for six hours or more, in a loud voice, personal adventures, mixed with imagination and the most loose fantasies, whilst the others keep quiet but on the basis of what thqy hear make mentally their awn associations of ideas in a curious fantastical and semi—hallucinatory state of delirium, realizing their dreams and aspirations. Sometimes another participant starts to speak in a loud voice, stimulated by his fantasies, and then the first one becomes silent and the second becomes the "rollista". Alhough they are sitting on the floor, uncomfortably, with crossed legs, for several hours, they do not show signs of fatigue. After finishing, they reach a normal state very rapidly, for instance, by drinking only a glass of fresh water, without passing through intermediate stages of disintoxication; they show no fatigue, but much hunger. The "novice", however, passes in his first experience through an acute state of nausea, dizziness, painful intestinal crises, headache and a light somnolence; but he quickly becomes addicted.

Unfortunately, nothing is said as to the ouantity of cannabis used during these meetings, nor is there a more detailed analysis of the facts observed.

It is also stated(16)(22) that the consumption of alcohol is generally avoided, because in combination with cannabis it frequently unchains impulsive acts of terrible violence.    This remark might also interest observers in other regions of the world. A. Foret (Algiers), however, states, that alcohol is regarded in some countries as an antidote to cannabis drunkenness.

The observations made by J. D. Fraser of nine cases "of an acute psychosis associated with the withdrawal of cannabis indica from addicts" seem to be significant. They were made on Indian troops, in a campaign in the Far East; all of these men came under observation in the first four weeks after departure from India, giving a similar history and presenting similar signs. They had been ganja smokers for some years and soon after departure began to notice signs of deprivation. On the sea voyage, two of them became extremely irritable but got over this when they procured some more ganja from their comrades. On arrival they all suffered from deprivation. Their comrades knew them as ranja adeicts and regarded them with some fear, and as untrustworthy.    Irritability increased, culminating "in a sudden outburst of violence, such as stabbing another man, striking out, or shooting at someone". On guard duty they shot at an imaginary enemy. The strange, and often dangerous fact was that these men had become quiet again by the time they were brought to a medical unit, were apparently rational, mildly depressed, taking their food and enjoying a smoke. "Patients have been returned to their units during this quiet phase with disastrous results." The deceptive nature of the "quiet phase" was revealed when after 48-72 hours there was another outburst of impulsive violence, followed by an acute psychotic episode lasting three to six weeks and Characterized by acute excitement; their habits became filthy, etc.; they would crawl abjectly along the floor begging for some ganja. Apparently they had terrifying visual and aural hallucinations. To Fraserls surprise, none of them died; all emerged from the psychotic phase, became quiet, co-operative and weIl-conducted, though weak and emaciated.

Fraser concludes that only a comparatively small proportion of cannabis addicts cannot manage without the drug.

These observations confirm the opinions - backed up by facts! - expressed on earlier occasions concerning the danger of crime resulting from abuse of the cannabis resin. (56)

Drewry has described in detail a case of psychosis, observed in the United States of America, where the person concerned smoked marihuana cigarettes for a year, two or three per day at the beginning, but more later on. Although the patient was of unstable make-ups he was not considered to have a true psychopathic personality. He had mild delusions, lost the sense of time and size (including his own size), had visual hallucinations and illusions of colour, and other symptoms which, according to the author, made it evident that the illness was due to marihuana intoxication. The diagnosis of schizophrenia, which at the height of the illnese seemed possible, was ruled out. After five months, he was discharged from the hospital as recovered; after ten months he was still well and had not returned to the drug,

It is known that the psychiatric symptoms of chronic cannabis abuse are extremely variable. Lucena et al. have added four new cases to those they previously described, namely four inveterate maconha smokers of 17, 19, 22 and 26 years of age. These subjects had been thoroughly studied for several months in the Psychiatric Clinic of the Medical Faculty at Recife (Brazil). Briefly, two of them had delusions of grandeur or persecution and rather frequent hallucinations; the third had schizophrenic symptoms which appeared immediately after meconha smoking, with a tendency to persist and become aggravated, and the fourth showed a complicated psychiatric picture, in addition to certain organic symptoms, character disturbances and emotional instability (he attacked his mother when searching for money, and threatened to kill the whole family).

In the case of other patients seen by Lucena, the problem was to decide how fax-it was maconha that was responsible for their disorderly conduct and anti-social behaviour. According to present psychiatric views, exogenous factors and endogenous symptoms are inter-related and it may be assumed that there was some pre-existent endogenous pathological disposition which had been activated when endogenous aymptoms appeared after an exogenous aggresgion.

Although these psychotic changes were quite different from each other in symptomatic exteriorization, and atypical, they belong according to Luconals opinion, to the wide range of schizophrenic forms in their most general sense. The frequency of the appearance of such psychotic behaviour is much greater with maconha smokers than among the population in general, so that possibly there is'a certain link between chronic cannabis consumption and the atypical schizophrenic picture.

Giulia has described six cases of maconha smokers in the psychiatric clinic of Porto Alegre (Rio Grande do Sul), in the southern part of Brazil, where, contrary to the northenrarazilian states, this vice is rarely observed. One of them, twenty years of age, was confined in the clinic because ho was found to be in a state of turbulent "drunkennessn after smoking maconha.    He said he had smoked thesp cigarettes for six months because they were exciting, made him venturesome, and caused euphoria for a period of two hours. In the hospital, he was restless, irritated and loquacious.

The most interesting of the cases was the second one, which showed the correctness of characterizing cannabis rosin as a criminogenic drug. This young man, twenty years old, of Porto'Llegre origin, said he had never before smoked a maconha cigarette.    He got one by chance from sailors at the port. He stated. that after three or four whiffs he had disagreeable sensations, the outer world became strange and he had a sensation of levitation. His mind became crepuscular, so that he could only vaguely remember what happened. He had an imperious desire to do things which in a normal state of mind he would never have permitted himself to do. Without any justification he attacked a man and took his coat away by force; ho attacked another man because he identified him apparently with himself, and finally fought violently with the policemen who tried to overpower him. Several hours later, he became quiet. Three days later he was dismissed from the hospital.

It is worthy of notice that this violent reaction appeared after one maconha cigarette - at least according to the patient's statement.

The other four, sailors from the north of the country, did not show traits worth while mentioning here. They ere described as men of degraded morals, without family ties, adventuring from port to port in search of new stimuli; maconha gave the satisfaction, namely the euphoria typical of it, with a certain mental obnubilation, and frequently, sexual erethism.

From the point of view of social repercussions, it is interesting to note that these few cases created alarm in Porto Alegre, so that the four northerners were immediately sent back by the police to their own region before they could infect vagrants in the south.

Parreiras refers to a man who smoked the enormous quantity of fifteen cigarettes per day, had delusions, fell into the water, which ho thought was sand, and when walking alone during the night in the forest heard voices which called him and accused him.

According to the observations of two psychiatrists, A..Reales Orozco and E. Martinez Gomez, in Barranquilla (Colombia), where marihuana abuse is very prevalent, in the acute stage of intoxication the psychological manifestations appear before the physical ones. They are so manifold that any effort to systematize them would fail. Likewise, as has been done on earlier occasions, these authors also relate the psychological symptoms in each case to the individual "psychological formula", temperament (as in acute alcoholic drunkenness), education, cultural level, social standing and environment of the person concerned. The mood at the moment whei marihuana is taken has a great influence, so that experimental observation is "distant from reality" because the reactions of the subject are subordinated to influences which impair spontaneity, and thus diverge from the form they normally tako For instance, experimental trials, employing marihuana smokers in psychiatric institutions or prisons, led to contradictory conclusions because the marihuana acted differently and its influence was diminished. This important statement confirms the criticism expressed by the writer in 1948, of certain other experiments of this nature. Thus, it ws pointed out, inter alia, that the experimental conditions are not correct when prisoners are given marihuana to smoke in surroundings of rigid discipline, instead of in the bad (but free) environment to which they are accustomed, and that marihuana smokers only react freely when they are in their own "susurroundings", safeguarded from alien observation and vicilance.(55)

The authors give a vivid picture of the acute stage of cannabism which confirms statements by earlier observers. Thr say that during the first periods of the acute stage there is a notable sexual excitation, an opinion with which not all investigators agree, but which is in any case, whether true or not, an important factor inducing many cannabis users to take the drug, e.g. in Arab countries. As far as behaviour is concerned, cannabis weakens inhibitions and sets free previously repressed antisocial tendencies.

The chronic abuser becomes thin, he shows diminished motility, a stupid expression and, very frequently, anaphrodisie and impotence.

Frequently maniac episodes of confusional character in individuals of cyclothymie type, psychoses of a definite toxi-confusional kind and reactions cf a schizophrenic type were found.

Six cases of varying psychotic character are described which show the seriousness of the symptoms, although they disappeared in hospital after from one to six weeks:

*in italics in the original text.

**recently extensively aLstracted by H. C. Mookerjee.04)