Physical, Mental, and Moral Effects of Marijuana: The Indian Hemp Drugs Commission Report
Tod H. Mikuriya, M.D.
San Francisco, California
The Indian Hemp Drugs Commission Report (1894), comprising some seven volumes and 3,281 pages, is by far the most complete and systematic study of marijuana undertaken to date. Because of the rarity and, perhaps, the formidable size of this document, the wealth of information contained in it has not found its way into contemporary writings on this subject. This is indeed unfortunate, as many of the issues concerning marijuana being argued in the United States today were dealt with in the Indian Hemp Drugs Commission Report.
It is both surprising and gratifying to note the timeless and lucid quality of the writings of these British colonial bureaucrats. It would be fortunate if studies undertaken by contemporary commissions, task force committees, and study groups could measure up to the standards of thoroughness and general objectivity embodied in this report. In the current context of violently polarized attitudes toward marijuana, the prospect of a study of similar stature is bleak.
The scope of this paper is necessarily limited to the issues of physical, mental, and moral effects of hemp drugs as discussed in the report, although the topics of cultivation, processing, and administrative control schemes make up significant portions of the work itself.
History of British Involvement
The British government in India had substantial knowledge of intoxicants other than alcohol because of active involvement in regulation, taxation, and actual trafficking in these substances for over a hundred years prior to the Hemp Drugs Commission investigation and report.
In 1790 duties on alcohol and other intoxicant drugs were first levied by the British on landlords in India. The regulation of cannabis preparations was further specified in 1793 in Regulation XXXIV of that year. "No person shall manufacture or vend any such drugs (bhang,2 ganja,3 charas,4 and other intoxicating drugs) without a license from the collector of the zillah5" (3:16).
This system of regulations was instituted "with a view to check immoderate consumption, and at the same time to augment the public revenue" (3:16).
In 1800 in a further modification of regulation, the manufacture and sale of charas was prohibited as "being of a most noxious quality" (3:16), while daily rates of duty were declared as the basis for taxing procedures. Curiously, in 1824 the restriction on charas was rescinded "as this drug was found on examination to be not more prejudicial to health than ganja or other intoxicating drugs" (3:16).
In 1849 limits on retail sale of cannabis drugs were fixed "for better securing the abkari6 revenue of Calcutta," and later extended to the whole of Bengal (3:16). Four years later the daily tax method was abandoned and a fee charged on a per weight basis, and in 1860 an additional set of dealers fees' imposed (3:16).
It should be noted, however, that the system of the state of Bengal was only one of several schemes among the many provinces. Variations on this approach existed in the other states, a function of the differing local administrations, reflecting the degree of administrative and fiscal controls exerted by the Imperial government.
There had apparently been controversies as to the possible noxious effects of cannabis drugs at least from the time of the inception of British controls on these products, unless we assume that the initial stated reasons for regulation were merely cynical rationalizations for obtaining additional sources of revenue. Within a country of several hundred millions of inhabitants, divided into hundreds of regions, and with only rudimentary "homogenizing" forces of effective transportation and mass media, it is perhaps reasonable to infer that wide variations in opinions and beliefs would be encountered.
1 Report of the Indian Hemp Drugs Commission, 1893-94. Simla, India: Government Central Printing House, 1894, 7 vols. All references in this paper are to volumes of the Report.
Received for publication December 1967
2 Leaves and flowers of wild growing or inferior cultivated cannabis plants.
3 Flowering tops of the cannabis plant.
4 Resin from the mature cannabis plant.
5 A county-sized district or administrative division.
6 Manufacture or sale of intoxicating liquors or drugs: hence, an excise or internal revenue tax on such manufacture or sale (Ankara: A wine seller; distiller. Also, one whose trade is subject to abkari tax).
FORMATION OF THE COMMISSION
On 2 March 1893 (1:1,n) a question was raised in the British House of Commons concerning the effects of the production and consumption of hemp drugs in the province of Bengal, India. In response, the Government of India convened a seven-member commission to look into these questions on 3 July 1893 (1:1). Upon the suggestion of Lord Kimberley the scope of the investigation was expanded to include all of India.
The Commission actually met for the first time in Calcutta on 3 August 1893 (1:4). Between this date and 6 August of the following year, when the study was finished (1:361), the Commission received evidence from 1,193 witnesses (1:12). Field trips were made to thirty cities in eight provinces and Burma from the end of October 1893 through the latter part of April 1894 (1:9-10). Eighty-six meetings for examination of witnesses transpired during the inquiry. Actual participation of the members of the Commission was duly noted and reported - a custom that it might be worthwhile to revive.
The statement on the previous page shows the attendance of the members of the Commission during the period occupied in inquiry (3rd August 1893 to 25th April 1894).
Witnesses whose evidence was received by the Commission were divided into three categories:
(1) Official witnesses able to give information regarding hemp drugs, based on their official and local experience.
(2) Non-official witnesses of all ranks able to give information regarding the drugs generally or in connection with certain classes of the people.
(3) Other persons or associations having facts or holding opinions which they desired to communicate to the Commission (1:11).
Categories and numbers of the witnesses were (1:12):
Civil Officers 467
Medical Officers 214
Private Practitioners (European methods) 34
Private Practitioners (Native methods) 87
Professional Men 55
Persons engaged in Trade 75
To facilitate collection of information, seventy questions framed by the Commission were given to the witnesses. The written answers to these questions constituted the bulk of the evidence before the Commission (1:13). Where appropriate, witnesses were examined orally for further clarification or explanation. In addition, witnesses who had not submitted written statements were examined orally. It was duly noted in the record which forms of testimony had been provided by the individual witnesses. The following were the questions dealing with effects of hemp drugs with regard to adverse physical consequences, insanity, and the causation of crime (4:iii):
45. (a) Does the habitual moderate use of any of these drugs produce any noxious effects - physical, mental, or moral?
(b) Does it impair the constitution in any way?
(c) Does it injure the digestion or cause loss of appetite?
(d) Does it cause dysentery, bronchitis, or asthma?
(e) Does it impair the moral sense or induce laziness or habits of immortality or debauchery?
(f) Does it deaden the intellect or produce insanity?
If it produces insanity, then of what type, and is it temporary or permanent?
If temporary, may the symptoms be re-induced by use of the drug after liberation from restraint?
Are there any typical symptoms?
Do insanes, who have no recorded ganja history, confess to the use of the drug?
(g) In such cases of the alleged connection between insanity and the use of hemp as are known to you, are you of opinion that the use of the drug by persons suffering from mental anxiety or brain disease to obtain relief his been sufficiently considered in explaining that connection?
And do you think there is any evidence to indicate that insanity may often tend to indulgence in the use of hemp drugs by a person who is deficient in self-control through weakened intellect?
Give an account under each of these points of any cased with which you are acquainted.
46. Discuss the same questions in regard to the habitual excessive use of any of these drugs.
51. (a) Are any large proportion of bad characters habitual moderate consumers of any of these drugs?
(b) What connection, if any, has the moderate use with crime in general or with crime of any special character?
52. Discuss the same question in regard to the excessive use of any of these drugs.
53. Does excessive indulgence in any of these drugs incite to unpremeditated crime, violent or otherwise? Do you know of any case in which it has led to temporary homicidal frenzy?
- Are these drugs used by criminals to fortify themselves to commit a premeditated act of violence or other crime?
Physical Effects of Chronic Cannabis Use
The Commission sought to evaluate alleged connections of hemp drug use with disorders other than mental. Popular opinion held that the use of hemp drugs led to the physical disorders of dysentery, bronchitis, and asthma:
In regard to these definite physical results, the only evidence to which much weight can be attached is the evidence of the medical witnesses. From their training and opportunities of observation they are the only witnesses qualified to give reliable evidence. It is proposed to examine this medical evidence in detail (1:205).
The Commission reviewed and discussed medical evidence given by 335 physicians7 throughout India from Bengal, Assam, North-Western Provinces, Punjab, Central Provinces, Madras, Bombay, Sind, Burma, and Berar. The testimony from the array of medical witnesses from Bengal illustrates the confusion and the lack of knowledge among the members of our profession:
In Bengal eight commissioned medical officers were examined on the effect of the moderate use of the drugs. Surgeon-Lieutenant-Colonel Russell (witness No. 105), 20 years in civil employ in Bengal and Assam, a witness whose evidence has frequently been quoted by the Commission, stated that the use of the drug does not cause bronchitis, dysentery, or asthma, and that scarcely any other noxious effects are induced. Surgeon-Lieutenant-Colonel Russiel Lall Dutt (witness No. 107) an officer of over 20 years' experience, stated "Very moderate smoking of Ganja or charas or moderate drinking of siddhi in infusion do not produce any appreciable effects. . . but these moderate cases are seldom long-lived. There is in them a slow and insidious undermining process going on in their digestive, respiratory, and nervous system, which predispose them to acute diseases and cut their lives short." Surgeon-Lieutenant-Colonel Price (witness No. 108), of 21 years' service, who had frequently come across consumers of hemp drugs, was unable to answer the question regarding effects. Surgeon-Captain Prain (witness No. 113) stated: "I do not believe that the habitual moderate use of any of these drugs produces any noxious effects - physical, mental, or moral. I think that perhaps the use of bhang does injure the digestion and impair appetite even when used moderately, but I am convinced that it neither causes dysentery, bronchitis, or asthma." Surgeon-Major Cobb (witness No. 110) stated that the drugs did not cause asthma, bronchitis, or dysentery; and in cross-examination he stated: "I have no experience that the excessive use of the drug produces dysentery and bowel complaints." Surgeon-Lieutenant-Colonel Flood Murray (witness No. 102),
five years in military service and nineteen years in civil employ, quoted the opinion of a pandit8 whom he consulted regarding the ill effects of the drugs. In cross-examination he stated: "The general statement as contained in my written answer is a statement made to me by this hakim9 and others to whom I applied for information. My own experience in no way corroborates it." Surgeon-Lieutenant-Colonel Bovill (witness No. 109), of 21 years' service, stated that the habitual moderate use of bhang does not produce any ill effects, and in many cases that of ganja is equally harmless. He added; "I know of no case where it has caused bronchitis, dysentery, or asthma, but I have noted hoarseness of the voice probably due to some laryngeal irritation among ganja smokers." Surgeon-Lieutenant-Colonel Crombie (witness No. 104), of over 20 years' service, is not aware of any ill effects being produced by the moderate use of the drugs; but he added: "If any were produced, the use would no longer be moderate, but excessive." In cross-examination Dr. Crombie stated: "I have had no experience of any diseases attributable to ganja. My experience has been chiefly in Eastern Bengal, where ganja is largely consumed."
Twenty-three assistant surgeons were examined. Assistant Surgeon Devendranath Roy (witness No. 123), of over 20 years' service, and who has had service in Rajputana, the North-Western Provinces, Behar, and Bengal, where hemp drugs are used by a large portion of the people, is of opinion that those who smoke ganja not more than twice or thrice a day do not suffer in general health; bhang does not impair the digestion, whereas ganja does. "Those of my patients," he remarks "who admitted having been habitual ganja smokers suffered from dysentery or diarrhoea, but they have been exposed to conditions which produce these ailments. Hence I do not draw any conclusion as to ganja being a primary cause of those diseases." Assistant Surgeon Preonath Bose (witness No. 122), Teacher of Materia Medica and Pharmacy in the Dacca Medical School, clearly has no personal knowledge of the effects, as he remarked: "Evidence on these points is conflicting. Some of the consumers maintain, others deny, that evil effects are produced." Another teacher at the same school (witness No. 121 ) stated: "Evidence on these points is conflicting. The general consensus of opinion is that the habitual moderate use of bhang and ganja does not impair the constitution." Assistant Surgeon Soorjee Narain Singh, of 28 years' service, now Teacher of Materia Medica, Patna Medical School (witness No. 125), stated that "habitual moderate consumers of bhang, ganja or charas do not apparently suffer from any injurious effects." Assistant Surgeon Narendra Nath Gupta (witness No. 120), as Deputy Superintendent of Vaccination and as Deputy Sanitary Commissioner and as Civil Medical Officer has had considerable opportunities for noting the effects of the drugs. His opinion is that the moderate use of ganja and bhang does not produce any noxious effects. Durga Dass Lahiri, L.M.S. (witness No. 132), a private medical practitioner, said: "I have not seen any evil results mentioned when taken moderately, but it is very difficult to keep to moderation." Assistant Surgeon Taraprosanna Roy (witness No. 116) is Chemical Examiner to the Government of Bengal. He stated that the habitual moderate use of the three drugs is not known to produce any noxious effects. Assistant Surgeon Bosonto Kumar Sen (witness No. 119) has had service in ganja producing districts. He stated that the use of ganja and bhang products noxious effects, and "generally produce dysentery, asthma, and bronchitis." The cross-examination of this witness is of interest. "I have seen more than one person, about half a dozen, in my village. . . suffering from dysentery, bronchitis, and asthma who were also ganja smokers. They were all excessive smokers. These effects do not follow the moderate, but the excessive, use. It is a mistake to have put them under the moderate use. . . . The fact that they were ganja smokers led me to believe that these effects were due to ganja . . . I have no recollection of ever treating any case of dysentery, bronchitis, or asthma caused by ganja. These cases are the basis of my remarks. I do not remember any case of dysentery, bronchitis, or asthma in a ganja smoker which I attributed to any other cause. In other words, when I saw ganja smokers suffering from these diseases, I attributed them to ganja. This was twenty years ago, before I was a medical student." Pyari Sankar Dass Gupta, L.M.S. (witness No. 134), is a private medical practitioner, Secretary to the Bogra Medical Society of ten members, and a member of a temperance association founded by the late Keshub Chunder Sen. The witness is pledged against the use of all intoxicants. The witness submitted three papers to the Commission which seem to illustrate the development of tradition into opinion. In one paper the witness states: "The smokers of ganja often suffer from hoarseness of voice produced by the continual inhalation of its fumes, giving rise to sore-throat, bronchitis, and carbonaceous phthisis. It has long been a tradition in our country that the ganja-khors always die of dysentery, their intestines gradually sloughing away." In his second paper the witness states "Ganja smokers generally die of bloody dysentery, asthma and phthisis, and haemoptysis." And in his last paper he says: "It produces bloody dysentery and chest diseases, blood spitting, bronchitis, asthma, and phthisis." Kailas Chundra Bose, L.M.S. (witness No. 135), is a private medical practitioner in Calcutta with an extensive practice. He states that no ill effects are produced by the moderate use, and that, instead of causing bronchitis, dysentery, or asthma, it relieves these afflictions. The witness, however, states in his oral examination: "My experience is not to any large extent what I have gathered in my practice, but rather what I have learnt from smokers." Assistant Surgeon Akbar Khan (witness No. 124) is another Teacher in the Patna Medical School. He states the habitual moderate use of any of the drugs does not produce noxious effects, but that charas and ganja cause dysentery, bronchitis, and asthma if the consumers are not well fed. Witnesses Nos. 126 and 138 consider that no ill effects are produced. Assistant Surgeon Upendra Nath Sen (witness No. 118) states that bronchitis, and asthma are common complaints of ganja smokers. Madhab Krishna Dass, L.M.S. (witness No. 158) a private practitioner in Calcutta, considers that smoking may cause dysentery, bronchitis, or asthma. Assistant Surgeon Durga
Nath Chakravarti (witness No. 150) considers that "ganja causes dysentery after a long run." Annoda Prasanna Ghatak, M.B. (witness No. 149), a private medical practitioner, considers that digestive complaints are caused when good food is not procurable. Rakhal Das Ghosh, L.M.S., (witness No. 149) a private practitioner in Calcutta, had apparently seen no ill effects caused by the drug. The remaining witnesses in this class clearly failed to discriminate between the moderate and excessive use and their evidence has not been considered.
Three hospital assistants were examined. One gave no reply regarding moderate use. The other stated: "The habitual moderate use of ganja or charas does not produce any noxious effects - physical, mental, or moral, but the use of ganja impairs the constitution in some way or other . . . and has a tendency toward bronchitis and asthma." Witness No. 145 is a vernacular class hospital assistant, but not now in Government employ. According to this witness, moderate use of ganja leads to excessive use. "The habitual moderate consumers, as well as the excessive consumers, suffer in their lungs and become insane . . . No intoxicant can be taken in moderation except when administered medicinally."
Fifteen native practitioners were examined. Bijoya Ratna Son (witness No. 151), a kabiraj10 practising in Calcutta, considers that the habitual moderate use of ganja or charas, but not siddhi, may in some cases cause bronchitis, dysentery or asthma. Witness No. 152, also of Calcutta, gives the same reply couched in the same language. Witness No. 126, of Nattore, in the Rajsha-hi district, and witness No. 153, of Calcutta, both consider the moderate use harmless. Piyari Mohan (witness No. 154), a kabiraj states: "I know it causesdysentery and I believe owing to its healing power it can cause bronchitis and asthma." Kedareswar Acharjya (Witness No. 137) remarks: "Those ganja smokers who cannot command abundant wholesome food suffer from dysentery, but it is difficult to determine how far it is due to ganja or to improper food. As to asthma, I have not seen any typical case originating from ganja smoking. I know that a chronic catarrhal condition of the air passages with a certain amount of spasm is the misfortune of many old ganja smokers. I know a friend who suffered from chronic bronchitis, and in whom asthmatic fits were induced by attempts to smoke ganja." The witness refers also to another case in which a habitual ganja smoker had an asthmatic attack which subsided on breaking off the habit and reappeared on resuming it." This witness lays stress in personal idiosyncrasy as modifying the effects of the drugs, and on the importance of a diet rich in fat. Witness No. 155, another kabiraj, states that, while no ill effects are produced, occasionally it entices dysentery, bronchitis, and asthma. Witness No. 128, also a kabiraj, states that, according to the Aurveda Shastra, smoking these drugs causes bronchitis and asthma, and in his opinion "even the moderate use of any of these drugs, not according to the rules of Shastra, is injurious in its effects." This witness does not appear to have any personal knowledge of ill effects, but to base his views on the teachings of the Shastras. Witness No. 139 states: "Certainly they produce effects on the moral and physical constitution," but as the witness is silent as to the effects of excessive use, probably he has not discriminated between the two uses of the drugs. Witness No. 157, a valid11, considers that even the habitual moderate use of these drugs produces noxious effects. This is the pandit who was consulted by Dr. Flood Murray (witness No. 102), and who produced two cases of hemp drug asthma and weakened heart for Dr. Murray's inspection. These seem to have been the only cases in any way connected with hemp drug that he had. Witness No. 146 is a zamindar12 and medical practitioner, and does not reply as to effects. Witness No. 147 studied two and half years at the Calcutta Medical College, but took no degree. He states that no noxious effects are produced without giving details (1:205-8).
After reviewing similar conflicting testimony from the other states, the Commission concluded:
The medical evidence which has thus been analyzed very clearly indicates in the opinion of the Commission that when the basis of the opinions as to the alleged evil effects of the moderate use of the drugs is subjected to careful examination, the grounds on which the allegations are founded, prove to be in the highest degree defective. A large number of medical witnesses of all classes, ascribe dysentery, bronchitis, and asthma to the moderate use of the drugs. An equally representative number give a diametrically opposite opinion. The most, striking feature of the medical evidence is perhaps the large number of practitioners of long experience who have seen no evidence of any connection between hemp drugs and disease, and when witnesses who speak to these ill effects from the moderate use are cross-examined it is found that (a) their opinions are based on popular ideas on the subject; (b) they have not discriminated between the effects of moderate and excessive use of the drugs; (c) they have accepted the disease as being induced by hemp drugs because the patients confessed to the habit; and (d) the fact has been overlooked that the smoking of hemp drugs is recognized as a remedial agent in asthma and bronchitis. A few witnesses incidentally refer to personal idiosyncrasy as perhaps being a factor in rendering some consumers of the drugs less tolerant and more liable to be affected by them even when used in moderate quantity. This view the Commission are prepared to accept; but for the vast majority of consumers, the Commission consider that the evidence shows the moderate use of ganja or charas not to be appreciably harmful, while in the case of moderate bhang drinking the evidence shows the habit to be quite harmless. As in long continued and excessive cigarette smoking considerable bronchial irritation and chronic catarrhal laryngitis may he induced, so, too, may a similar condition be caused by excessive ganja or charas smoking; and to the oetiology of bronchial catarrh and asthma in ganja smokers the Commission have already referred. The direct connection alleged between dysentery and the use of hemp drugs the Commission consider to be wholly without any foundation. In the case of bhang there is nothing in the physiological action of the drug which could in any way set up an acute inflammation of the large intestine resulting in ulceration. On the contrary, it is well known that hemp resin is a valuable remedial agent in dysentery. As regards ganja or charas smoking inducing dysentery, even assuming that the products of the destructive distillation of the drugs directly reached the intestines, there is evidence that those products, when condensed and injected into a cat's stomach, failed to induce any inflammatory process. The connection, therefore, between hemp drug smoking and dysentery appears even remoter than in the case of bhang drinking and that disease and cannot be accepted by any stretch of the imagination as even a possible direct cause of dysentery ( 1: 223).
7 214 Medical Officers, 34 Practitioners of European medicine and 87 Practitioners of native methods.
8 Learned man, teacher; esp., a Brahman versed in Sanskrit, and in the science, laws, and religion of the Hindus; in Kashmir, any clerk or native official.
9 In Moslem countries, a ruler or a judge.
10 A member of a Unitarian reform sect of India based upon the teachings of Kabir (Hindu mystic and poet, c. 1450-1518).
11 A native practitioner.
12 A land owner; also: Formerly, under the Mohammedan administration, a collector of the land revenue of a specified district for the government. Now, usually a kind of feudatory recognized as an actual proprietor so long as he pays the government a fixed revenue averaging in different provinces less than one-half the net revenue (India).
Cannabis and Insanity
Because many people believed that the use of hemp drugs led to insanity, especially in the case of prolonged use of large amounts of charas and perhaps ganja, the Commission addressed a significant amount of effort to the study of this topic ( 1: 225 and all of Vol. 2). In addition to the testimony received from physicians, the Commission set about to evaluate all cases admitted to the Indian mental hospitals for the year 1892 that were listed as being caused by hemp drugs ( 1:227).
Initial inquiry into the Dullunda Asylum at Calcutta led the Commission to distrust the asylum statistics. Because of incomplete figures, frequent absence of supporting data and outright errors, the Commission decided to take up each of the cases of 1892 separately and to inquire as fully as possible into its history (1:227).
In the course of its inquiry into the 24 asylums in India and Burma, the Commission sharply criticized the testimony of the reporting superintendents:
They have known nothing of the effects of the drugs at all, though the consumption is so extensive, except that cases of insanity have been brought to them attributed with apparent authority to hemp drugs. They have generalized from this limited and one-sided experience. They have concluded that hemp drugs produce insanity in every case, or in the great majority of cases, of consumption. They have had no idea that in the vast majority of cases this result does not follow the use. They have accordingly without sufficient inquiry assisted, by the statistics they have supplied and by the opinions they have expressed, in stereotyping the popular opinion and giving it authority and permanence (1:226).
With such hindrances to the inquiry into the connection between hemp drugs and insanity, the Commission, after careful inquiry into the 222 cases allegedly attributed to hemp drugs, from among the total of 2,344 patients admitted during the year 1892 to asylums, concluded, with reservation, that some 61 cases might have been caused by hemp drugs alone:
Even in regard to the remaining 61 cases, it must be borne in mind that it is impossible to say that the use of hemp drugs was in all the sole cause of insanity, or indeed any part of the cause. The following considerations combine to demand caution and reserve in pronouncing an opinion on this point.
Firstly, there are twelve cases in which it has been found impossible to obtain any further information by local inquiry. In these cases we are thrown back on the original papers and the asylum history. Besides these, there are ten more cases in which the patients are beggars and foreign laborers about whose past history no satisfactory information is obtainable. Thus there remain only 39 of these 61 cases about which anything like a satisfactory inquiry has been possible. Further, a great majority of these cases come from the lower orders of cultivators and laborers, from whom information of any value is very difficult to obtain as to other than the most apparent causes. The fact of the existence of the hemp habit is easy enough to ascertain, but that it is the cause, or one of the causes of the insanity, or that it even preceded the insanity, is much more difficult to establish.
Secondly, the method of inquiry has not been satisfactory in regard to all the cases referred for local inquiry. In regard to the great majority, the instructions issued by the Commission as to the agency by which this further inquiry should be conducted have been carried out. But in some, it will be observed, even this further inquiry has been left to the police. Then again there are cases, such as those of the Hyderabad (Sind) Asylum, in which the Superintendent has necessarily been the principal agent in the inquiry, and has, perhaps, not unnaturally, but certainly unfortunately, evinced a strong tendency to defend the old asylum entries regarding cause. The series of questions framed by the Civil Surgeon of Delhi for use in the further inquiry also illustrates a tendency to assume that the cases were hemp drug cases, and thus to limit the scope of the inquiry.
Thirdly, it may be noted that excess in the use of hemp drugs is very frequently only one of several vices in which a dissipated man indulges. Further inquiry has proved this in several cases. There is strong probability that had information been complete, it would have been established in many more cases. It is impossible in such cases to say definitely to what form of excess insanity may be mainly due. Further, it is an accepted and established fact that intemperance of any kind may sometimes be not the cause of insanity, but an early manifestation of mental instability. Dr. Conolly Norman (Hack Tuke's Dictionary of Psychological Medicine; article "Mania") says: "The patient also indulges in intoxicants with very undue or unwonted freedom, and thereby precipitates the course and aggravates the symptoms of his disease." One or two cases have been rejected by the Commission on the ground that the evidence merely showed that the habit of use of hemp began at the same time as the mental aberration, or even later. There may have been other cases in which this would have been shown had the information been complete. It is possible therefore that more complete information might have shown in some cases, not only that other causes contributed to the insanity, but also that hemp drugs had nothing whatever to do with inducing it.
These and similar considerations already indicated demand caution in the expression of any judgment as to the causation of insanity in this country. If in England opinion, based on inquiries such as are there possible, has to be stated with caution, this is much more necessary here. In many or the cases in which the hemp drug habit has been established, it is impossible to feel certain in view of the defective character of the information that the drugs have been the sole cause, or perhaps indeed a cause at all, of the insanity (1:241-2).
Summing up, the Commission indicates the difficulties that prevent conclusive answers to the question of causality between the use of hemp drugs and insanity:
In answering the question therefore, on what the evidence rests that hemp drugs may induce mental aberration, the Commission would offer the following remarks: The evidence may he considered under two heads - (a) popular; (b) scientific. The popular idea that the use of hemp drugs may induce insanity can be traced back for many centuries, and the present day views on the subject are no doubt the outcome of old popular ideas which have been handed down and become concrete. With non-medical wit the mere use of the drug along with the fact of insanity, as the evidence shows, has as a rule been accepted as cause and effect. Of the large number of medical witnesses who have given evidence before the Commission, probably not a single one has ever observed the inception of the habit and the use giving rise to mental aberration, and been in a position to gauge the value of other contributory causes if present. With practically no modern literature on the subject, with no special knowledge apart from the popular idea, with a very slight or no clinical experience of insanity in England, with the experience derived from perhaps having had half a dozen insanes in the course of two years under observation as Civil Surgeons, officers have been placed in charge of asylums, and have had to differentiate between cases of hemp drug insanity and ordinary mania. The careful inquiry which has been made by the Commission into all the alleged hemp drug cases admitted in one year into asylums in British India demonstrates conclusively that the usual mode of differentiating between hemp drug insanity and ordinary mania was in the highest degree uncertain, and therefore fallacious. Even after the inquiry which has been conducted, it cannot be denied that in some of the cases at least the connection between hemp drugs and insanity has not been conclusively established (1:250).
Thus, final answers to this pressing but complex question of the causal relation between hemp drugs use and insanity, as such, remain obscured.
With their usual thoroughness, the Commission sought to explore the possible structural changes to the brain caused by chronic hemp drugs use. Because data from neuropathologic studies based on postmortem examinations was wholly lacking, Brigade-Surgeon-Lieutenant-Colonel D.D. Cunningham, F.R.S.. C.I.E., undertook three experiments at the Biological Laboratory attached to the Zoological Garden in Calcutta to evaluate the effects following the continued administration of hemp drugs to monkeys (3:192-6).
The first study dealt with the chronic smoking of ganja in a 16 lb. male rhesus monkey. By means of a smoking chamber, the animal was administered 181 inhalations of ganja smoke over a period of about 8 1/3 months. The daily dose was supplied by a habitué, the amount administered being proportional by weight to that consumed daily by the chronic user. An autopsy performed after sacrificing the animal, including gross examination of the brain, revealed an absence of any pathology.
The second experiment examined the effects of chronic oral ingestion of charas, with the daily dose again obtained from a chronic user on a comparative weight basis. The animals used this time were two smaller cynomolgus monkeys, weighing 5 lb. 7 oz. and 4 lb. 1oz. The study lasted 67 days, the animals receiving the drug mixed in milk on 62 days. Because either minimal or no effects were noted, the dose was increased from the usual 1/2 grain to 2 and then 3 grains about a week before termination of the study. Although no behavioral effects were noted with this higher dose schedule, the animals refused to eat the charas-treated milk after three days, bringing the study to a premature end. These animals were not sacrificed.
The third investigation evaluated the effects on a rhesus monkey of the smoking of dhatura daily, for six weeks. The same inhalation chamber was used as in the first experiment. Unfortunately the size of the dose is not specified. Post-mortem examination of the central nervous system revealed the following effects:
On opening the cranium the dura-mater was found to be somewhat thickened and, especially in the neighbourhood of the superior longitudinal sinus, very conspicuously congested. In this region, too, the membrane in the occipital region was fixed to the cranial walls by soft, very vascular adhesions. The piamater was thickened and so highly injected throughout that the cerebral surface had a generally diffused pink tint. The cerebral substance was everywhere abnormally soft and so friable as to render any immediate removal of the membranes impossible without the occurrence of much destruction of the nervous tissue. Like the surface, although in minor degree, it was of a pinkish tinge owing to abnormal accumulation of blood. Conditions or this kind appeared to be universally diffused throughout the whole of the cerebral centres, the texture of the hemispheres, of the cerebellum and of the basal ganglia being alike soft, and the evidence of abnormal congestion universally distributed. In spite of this, however, the spinal cord and its membranes were to all appearance perfectly healthy.
In so far as a single experiment goes the results in this case would, then, seem in show that the habitual inhalation of the smoke of dhatura, even when only practised for a relatively brief period, is sufficient to establish serious morbid changes in the cerebral nervous centres, and that it therein differs from the habitual inhalation of the smoke of ganja extending over a much more prolonged period. This clearly indicates the necessity of distinguishing between cases in which ganja alone is employed from those in which a mixture of ganja and dhatura is substituted for it, as otherwise certain prejudicial effects which are really due to the use of the latter drug may be erroneously credited to the former one" (3:195-6).
Comparisons made concerning organic brain pathology caused by alcohol (whose effects were well known from other studies) and dhatura left the Commission with the impression that these other Intoxicants were far more hazardous than hemp drugs:
So far as the information from all sources before the Commission is concerned there is no evidence of any brain lesions being directly caused by hemp drugs, as they have been found to be caused by alcohol and dhatura; and there is evidence that the coarse brain lesions produced by alcohol and dhatura are not produced by hemp drugs (1,251).
The complex phenomenon of intoxication, as such, was noted by the Commission:
The individual factor with its idiosyncrasies plays here, as everywhere, a very important part. There are other factors, too, which have to be considered, the degree of education, reason, locality, dosage, and mode of preparation of the drug, all of which may modify the symptoms. Thus the hallucinations of the Western people under the influence of hashish are not identical with the voluptuous dreams of the Orientals ( 1:253).
Of more functional import is the discussion of medico-legal questions involved in the confusion between intoxication and insanity:
A more serious result of this confusion is that there are cases in which men who have committed offenses, especially crimes of violence, under the influence of hemp drugs have been acquitted on the ground of insanity, although the circumstances have been such that had the intoxicant been alcohol, they would have been convicted. It is undoubtedly more difficult in the case of ganja than in the case of alcohol to recognize the line drawn for social and legal purposes between intoxication and insanity. But the difficulty is not insuperable. The main reason for the confusion that has existed is probably the ignorance that has prevailed regarding hemp drugs. When they are recognized as a common intoxicant, it is to be hoped that the practice of the Courts will be freed from the occasional blemishes above indicated. It is not expedient nor is it just that intoxication from hemp drugs should secure immunity from punishment which is not allowed to alcohol (1:254).
Cannabis and Crime
The use of hemp drugs had been implicated as a cause of crime:
In discussing the connection of hemp drugs with crime, it is necessary to discriminate between any effect which they may be supposed to produce of crime in general and the unpremeditated crimes of violence to which intoxication may give rise. Thus there are those who allege that the habitual use of alcohol, at all events if carried to excess, degrades the mind and character of the consumer and predisposes him to crime in general, or to crimes of particular character, especially to offenses against property. Drink is thus so down sometimes as one of the most efficient agencies for increasing the criminal classes. On the other hand, there are well known cases in which intoxication from alcohol has led to crimes of an occasional and exceptional character generally to unpremeditated crimes of violence or other unpremeditated offenses against the person. These two classes of cases should be carefully distinguished and treated separately (1:253-6).
In addition to hearing testimony of numerous enforcement and county officials, the Commission examined the 81 case records of crimes of violence alleged to have been caused by cannabis drugs in the whole of India over the prior 20 years. The Commission immediately excluded 5 of these cases, ascertaining either that data included in abstracts of the court records did not support the assertion that hemp drugs were causative factor, or that the records were unavailable.
In each of the remaining 23 cases, the Commission reviewed the court transcripts and examined, where possible, individuals who were connected, with the case (1:259-60; 3:262-6). The Commission concluded:
Of these twenty-three cases, then, the records in not less than eighteen show that the crimes cannot be connected with hemp drugs. There is one case of which doubt is thrown by subsequent discoveries. The connection between drugs and crime is only established in the remaining four. It is astonishing to find how detective and misleading are the recollections which man witnesses retain even of cases with which they have had special opportunities of being well acquainted. It is instructive to see how preconceived notion based on rumour and tradition tend to preserve the impression of certain particulars, while the impressions of far more important features of the case are completely forgotten.
In some cases these preconceived notions seem to prevail to distort the incident altogether and to create a picture in the mind of the witness quite different from the recorded facts.Some of the witnesses whose me have thus failed them are men who might have been expected to be careful and accurate. Their failure must tend to increase the distrust with which similar evidence, which there has been no opportunity of testing must be received (1:263).
On the topic of crime, the Commission concluded:
In respect to his relations to society, however, even the excessive consumer of hemp drugs is ordinarily inoffensive. His excesses may indeed bring him to degraded poverty which may lead him to dishonest practices; and occasionally, but apparently very rarely indeed, excessive indulgence in hemp drugs may lead to violent crime. But for all practical purposes it may be laid down that there is little or no connection between the use of hemp drugs and crime (1:264).
The Commission have now examined all the evidence before them regarding the effects attributed to hemp drugs. It will be well to summarize briefly the conclusions to which they come. It has been clearly established that the occasional use or hemp in moderate doses may be beneficial; but this use may be regarded as medicinal in character. It is rather to the popular and common use of the drugs that the Commission will now confine their attention. It is convenient to consider the effects separately as affecting the physical, mental, or moral nature.
In regard to the physical effects, the Commission have come to the conclusion that the moderate use of hemp drugs is practically attended by no evil results at all. There may be exceptional cases in which, owing to idiosyncrasies of constitution, the drugs in even moderate use may be injurious. There is probably nothing the use of which may not possibly be injurious in cases of exceptional intolerance. There are also many cases where in tracts with a specially malarious climate, or in circumstances of hard work and exposure, the people attribute beneficial effects to the habitual moderate use of these drugs; and there is evidence to show that the popular impression may have some basis in fact. Speaking generally, the Commission are of opinion that the moderate use of hemp drugs appears to cause no appreciable physical injury of any kind. The excessive use does cause injury. As in the case of other intoxicants, excessive use tends to weaken the constitution and to render the consumer more susceptible to disease. In respect to the particular diseases which according to a considerable number of witnesses should be associated directly with hemp drugs, it appears to be reasonably established that the excessive use of these drugs does not cause asthma; that it may indirectly cause dysentery by weakening the constitution as above indicated; and that it may cause bronchitis mainly through the action of the inhaled smoke on the bronchial tubes (1:263-4).
In respect to the alleged mental effects of the drugs, the Commission have come to the conclusion that the moderate use of hemp drugs produces no injurious effects on the mind. It may indeed be accepted that in the case of specially marked neurotic diathesis, even the moderate use may produce mental injury. For the slightest mental stimulation or excitement may have that effect in such cases. But putting aside these quite exceptional cases, the moderate use of these drugs produces no mental injury. It is otherwise with the excessive use. Excessive use indicates and intensifies mental instability (1:264).
In regard to the moral effects of the drugs, the Commission are of opinion that their moderate use produces no moral injury whatever. There is no adequate ground for believing that it injuriously affects the character of the consumer. Excessive consumption, on the other hand, both indicates and intensifies moral weakness or depravity (1:264).
Viewing the subject generally, it may be added that the moderate use of these drugs is the rule, and that the excessive use is comparatively exceptional. The moderate use practically produces no ill effects. In all but the most exceptional cases, the injury from habitual moderate use is not appreciable. The excessive use may certainly be accepted as very injurious, though it must be admitted that in many excessive consumers the injury is not clearly marked. The injury done by the excessive use is, however, confined almost exclusively to the consumer himself; the effect on society is rarely appreciable. It has been the most striking feature in this inquiry to find how little the effects of hemp drugs have obtruded themselves on observation. The large number of witnesses of all classes who professed never to have seen these effects, the vague statements made by many who professed to have observed them, the very few witnesses who could so recall a case as to give any definite account of it, and the manner in which a large proportion of these cases broke down on the first attempt to examine them, are facts which combine to show most clearly how little injury society has hitherto sustained from hemp drugs (1:264).