Report of the Ohio State Medical Committee on Cannabis Indica, BY R.R. McMEENS, M.D.

Submitted by Norm Roulet on Sun, 06/27/2010 - 22:24.

Report of the Ohio State Medical Committee on cannabis Indica, BY R.R. McMEENS, M.D.

As chairman of the committee, appointed at the last session of the Ohio State Medical Society, to report upon Cannabis Indica, I have to say that no extended or adequate efforts have been made, either by myself or the other members of the committee, in soliciting the concurrence of the profession at large, with the view of ascertaining and collaborating the opinions entertained, or practical results observed, from the use of this remarkable and renowned exotic, and accordingly can offer but a partial and imperfect report at this time.

However, as the medicinal properties and therapeutical value of this abnegated and nearly obsolete agent has engaged much of my attention and inquiry for several years, and been somewhat frequently administered and attested by me, I feel too great an interest in the subject to allow so favorable an opportunity to pass without endeavoring to enlist a more general interest and co-operation in the further investigation of this peculiar, potent and misapprehended article.

I shall therefore only attempt to submit a brief historical sketch of the plant, with an abstract of its physiological effects, modes of preparation, therapeutical applications,
reports of cases, and personal experience, derived from the very limited sources of information placed at my command, with the object of fulfilling my obligations to the Society, and adding whatever of consequence or certainty I can to the progress and perfection of the medical armamentarium.

Reprinted from the Transactions of the Fifteenth Annual Meeting of the Ohio State Medical Societ
Ohio White Sulphur Springs, June 12 to 14, 1860 - Pages 75-100.

History.

   The Cannabis Indica, or Indian Hemp, is alleged to be one
of the most ancient medicinal substances and Oriental luxu-
ries on record, and was resorted to by the voluptuary for the
production of pleasure, and by the valetudinarian for the
palliation of pain. “Herodotus mentions the hemp plant, and
states that the Scythians, who cultivated it, made themselves
garments of it. He also adds, that they threw the seeds on
red-hot stones, and used the perfumed vapor thereby ob-
tained as a bath, which excited them to excess of exaltation.
This is supposed to be produced by the intoxicating proper-
ties of its smoke.” (Pereira on Cannabis Zndica.) Dr. Royle
mentions that the hemp might have been used as the assuager
of grief, of which Homer speaks. Dr. Simpson says the
anodyne, ecstatic and anaesthetic effects of Indian hemp, and
the various preparations made from it, have long been known
in Africa and Asia. He states that “Sir Joseph Banks says it is
always taken in Barbary, when it can be procured, by
criminals condemned to suffer amputation; and it is said to
enable those wretches to bear the rough operations of an
unfeeling executioner better than we Europeans can the keen
knife of our most skillful surgeons.” M. Julien lately pointed
out to the French Academy an old Chinese work, proving
that, 1500 years ago, a preparation of hemp was employed
medicinally in China to annul the pain attendant upon
cauterization and surgical operations. The wonderful power
of endurance of the Hindu devotees, appears to have been
sometimes produced by the influence of this powerful drug.
Some high Biblical commentators maintain that the gall and
vinegar, or myrrhed wine, offered to our Saviour immediately
before his crucifixion, was in all probability a preparation of
hemp, and even speak of its earlier use. (Obstetric works.) It
is also alleged that during the Crusades it was frequently used
by the Saracen warriors to stimulate them to the work of
slaughter.

The botanical relations of the plant appear to have been
somewhat involved in a confusion of the several varieties of
its class; but it is at present conceded by most, if not all,
distinguished    botanists, to be identical with the Cannabis
Sativa of Linnaeus. Pereira believes the differences to depend
upon locality and cultivation, and cannot be considered
specific. Dr. Wood remarks, in his work on Pharmacology,
that the plant is a native of the interior of Asia, but
cultivated in many parts of the world, and to a considerable
extent in our own Western States, but that it is only the
product of the plant grown in the East Indies that is used
medicinally; while Dr. Dunglison states that the use of
Cannabis Indica is unknown in Western Europe, and it is
questionable whether the hemp of that region, or of this
country, be possessed of the same properties. Dr. O’Shaugh-
nessy, who has had the most ample opportunities of observa-
tion, from a long residence in this Indies, asserts that the
extraordinary symptoms produced by the Oriental plant,
depend upon a resinous secretion with which it abounds, and
which seems to be wholly absent in the European plant. This
absence of the resinous secretion, and consequent want of
narcotic power, is ascribed to difference of climate. Messrs.
Smith, of Edinburgh, satisfied themselves that the resin
contained in itself the whole properties of the plant. Dr.
Fronmueller says, the external appearances of Indian and
European hemp are the same, as are their botanical charac-
ters. The differences described by many authors, are proba-
bly due to local causes only. The only real difference is the
quantity of narcotic resin which is secreted by particular
glands, like the lupulin in the hop plant. This resin is called in
India, churrus. Its quantity increases with the southern
direction.

Mr. Donovan made numerous experiments with hemp
cultivated by himself, and was satisfied that the domestic
hemp is quite destitute of the principle which renders the
Indian plant so desirable to the voluptuous people of the
East. To the impurity of the hemp, is to be attributed the
diversity of opinion as to its operation and benefit in disease.
An English author remarks that very little, if any, genuine
hemp can be found in Europe; and the same fact will
undoubtedly apply to this country. The active principles,
according to Dr. Wood, consist in a volatile oil, and a peculiar
resin called cannabin. “That the former has narcotic proper-
ties, is to be inferred from the effects of the odor of the
plant. The latter is a neuter substance, having a somewhat
fragrant odor, especially when heated, and a warm, bitterish
subacrid and balsamic taste. It is insoluble in water, but
soluble in alcohol and ether, and from its alcoholic solution is
precipitated white by water.”
                                                    

Physiological Effects.

Dr. John Bell, of New Hampshire, published an able and
somewhat elaborate article in the Boston Medical and Surgi-
cal Journal, of the effects of the drug, experimentally
produced upon himself, by taking a moderately large dose of
Tilden & Co.‘s extract, and can consequently be cited as a
reliable exposition of personal and professional experience.*

Dr. Fronmueller states that physiological experiments on
healthy persons, instituted by Lanslerer, Beron, Rech, Wolff,
Indee, Schroff, and himself and others, show more or less a
disturbance in the digestive tract, affection of the nervous
system, with convulsive movements and sudden shocks,
congestions of the brain, confused ideas, excited imagination,
with frequently changing pictures, torpor and sleep, the
cerebral symptoms being more constant, while the others
vary to a great extent, sometimes nothing being mentioned
but a few confused ideas, followed by sleep.

Bayard Taylor, the ubiquitous traveler and popular writer,
in a work entitled “The Lands of the Saracen,” gives a highly
ornate and exquisite delineation of the physical sensations
and mental phantasmagoria produced by an extreme dose of
the Oriental preparation of the drug. The experiment was
made by himself and two friends, while sojourning at Damas-
cus. He had, on a previous occasion, in Egypt, subjected
himself to a very moderate influence of the same article,
which, he states, after “provoking a wonderfully keen percep-
tion of the ludicrous in the most simple and familiar
objects,” as gradually subsided as it came, overcoming the
senses with a soft and pleasant drowsiness, eventuating in
deep and refreshing sleep. The description of his second trial
is too poetically and elaborately depicted to be introduced in
a report of this character, but a summary of the prominent
phenomena will serve to show the striking analogy, as
portrayed in the account given by Drs. Bell and Fronmueller,
already referred to. The same rapid scintillations of thought,
brilliant coruscations of light, shifting adumbrations of
scenery, and transient flashes of lucid intervals, eddying
through the brain in inextricable confusion, are observed and
illustrated in both cases. He states, they commenced by
taking a teaspoonful each of the mixture, procured by a
servant. As this was about the quantity taken in Egypt, and
the effect then had been so slight, they had no fears of its
being an overdose. He says, “The strength of the drug,
 however, must have been far greater in this instance, for
 whereas I could in the former case distinguish no flavor but
 that of sugar and rose-leaves, I now found the taste intensely
 bitter and repulsive to the palate. We allowed the paste to
 dissolve slowly on our tongues, and sat sometime quietly
 waiting the result. But, having been taken on a full stomach,
 its operation was hindered, and after the lapse of nearly an
 hour, we could not detect the least change in our feelings. My
 friends loudly expressed their conviction of the humbug of
 hasheesh, but I, unwilling to give up the experiment at this
 point, proposed that we should take an additional half
 spoonful, and follow it with a cup of hot tea, which, if there
were really any virtue in the preparation, could not fail to
call it into action. This was done, though not without some
misgivings, as we were all ignorant of the precise quantity
which constituted a dose, and the limits within which the
drug could be taken with safety.” This last portion was taken
at ten o’clock at night. Soon after he became sensible of its
operation by experiencing a nervous thrill suddenly shooting
through the system, accompanied with a burning sensation at
the pit of the stomach. Among the many and remarkable
illusions and sensations he so vividly and minutely describes,
the following striking condition of the perceptive faculties is
worthy of notice and consideration: He says, “I was con-
scious of two distinct conditions of being in the same
moment; yet, singular as it may seem, neither conflicted with
the other. My enjoyment of the visions was complete and
absolute-undisturbed by the faintest doubt of their reality;
while in some other chamber of my brain, Reason sat coolly
watching them, and heaping the liveliest ridicule on their
fantastic features-one set of nerves was thrilled with the bliss
of the gods, while another was convulsed with unquenchable
laughter at that very bliss.” About midnight, the influence of
the drug had reached the acme of its power; and about three
o’clock in the morning, he sank into stupor-rather more
than five hours after the hasheesh began to take effect. He
lay thus all the following day and night, only once arousing
sufficiently to drink two cups of coffee and making an
attempt to dress himself, of which he did not retain the least
knowledge. On the morning of the second day, after a sleep
of thirty hours, he awoke, as he remarks, “with a system
utterly prostrate and unstrung, and a brain clouded with the
lingering images of my visions.” He states that he subse-
quently learned that he had taken a sufficient quantity for
six men. One of his companions, as soon as the drug took
effect, was suddenly metamorphosed into a locomotive;
which impression continued, and kept him in a violent state
of imitative exertion, until overcome by the somniferic or
stupefactive influences of the narcotic. This circumstance and
singular vagary, I shall have cause to refer to hereafter, when
treating of its therapeutical application. The other individual,
an Englishman, retired, on the first intimation of its action,
immediately to his room, where he remained, in company
with his wife, during its operation, and refused ever after to
make any disclosure of his conduct; in consequence of which
it might be inferred, from the reputed properties of the drug,
to have been of an aphrodisiacal character.

Dr. O’Shaughnessy, to whom is entitled the honor of
having first brought the article before the notice of the
profession as a remedy, in the various experiments made
upon himself and upon animals, observes that the general
effects on man are, usually, alleviation of pain, remarkable
augmentation of appetite, aphrodisia, and great mental cheer-
fulness.

Modes of Preparation.

The defective pharmaceutic processes employed by the
inhabitants of its native countries, render its preparations of
very different strength, and admixtures of various foreign
substances make its effects uncertain. A specimen obtained
from Damascus, contained about twenty-five percent of
opium, a considerable quantity of camphor and spices, and
nearly half was a mixture of rancid butter and extract of
hemp. The substance widely known in in this country under
the Arabic name of Hasheesh, is obtained by boiling the
leaves and flowers of the plant with butter, and when pure
and carefully prepared, is said to be a very active preparation.
The extracts prepared in this country from the Indian plant,
contain all the properties of the hasheesh, and are every way
preferable to it. The U.S. Pharmacopeia recognizes only an
alcoholic extract, under the name of Extract of Hemp, or
Extractum Cannabis. The Tincture of Hemp may be made by
dissolving six drachms of the extract in a pint of officinal
alcohol (sp. gr. 0.835). The dose equivalent to one grain of
extract is about 20 minims, or 40 drops. Dr. O’Shaughnessy
gave 10 drops of the tincture every half hour in cholera, and
a fl. drachm as often in tetanus, until effects were produced
(Wood). Tilden & Co.‘s Fluid Extract is probably most
frequently used in this country at the present time, but so far
as my experience extends, it has proved ineffective, if not
entirely inutile, in almost any quantity. I have ever preferred,
in my own practice, the alcoholic extract (Herring’s), and
have never been disappointed in obtaining its peculiar effects.
The best forms of preparation or combination I consider to
be that of the tincture, or pills of the extract, rolled in a
powder of the hemp. Sometimes I have dissolved it in ether
and water, or chloroform. In cases of children, I have
incorporated it in simple syrup, or the aromatic Syrup Rhei,
or Syrup Aurantii. In this affection, three grains of the
extract, dissolved in one ounce of proof spirits, one drachm
of which is to be given every half hour, until the patient be
brought under its influence. For its beneficial effects upon
this direful disease, he refers to fourteen cases, nine of which
recovered.

Professor Miller, of Edinburgh, says, “My own experience
speaks loudly in favor of the hemp in tetanus.” He believes it
valueless as an anodyne, as well as hypnotic, in ordinary
circumstances, but thinks its virtues consist in a power of
controlling inordinate muscular spasm.

Dr. Duncan says he used the hemp in 1846, in the Royal
Infirmary in Edinburgh, as a calmative and hypnotic. The
object was in general obtained, and no evil results followed.
Hemp was given in other wards of the Infirmary for a like
purpose, and with like results.

Mr. Donovan was convinced of the beneficial effects of
hemp, particularly in neuralgia, in his own case as well as in
that of others.

Dr. Christison has administered hemp in many instances,
and has observed that it produces sleep, and that its power
over uterine contraction is very marked and powerful in
many instances.

Dr. Simpson states that he had been induced to try hemp,
in consequence of Dr. Churchill stating that it possessed
powers similar to those of ergot of rye, in arresting hemor-
rhage from the uterus. In the few cases of labor in which he
tried it, parturient action seemed to be very marked and
distinctly increased.

Dr. Gregor gave the hemp in sixteen cases of labor, in
seven of which it succeeded well.

Dr. West says the hemp is extremely serviceable in con-
trolling neuralgic pain, and recommends it, combined with
camphor, in dysmenorrhoea and in flexions of the uterus,
when there is excessive menstruation, in connection with
pain. Its power in checking uterine hemorrhage is favorably
spoken of by many, and in some cases in which it would not
do to give the ergot of rye.

Dr. J. P. Willis, of Royalston, from whose communication,
in the Boston Medical and Surgical Journal, the foregoing
therapeutical facts are chiefly abstracted, says, “I have used
the Indian hemp for some time and in many diseases,
especially in those connected with the womb, in neuralgic
dysmenorrhoea, in menorrhagia, in cessation of menstrua-
tion, where the red discharge alternates with uterine leucor-
rhoea of long continuance, in repeated attacks of uterine
hemorrhage, in all cases of nervous excitability, and in
tedious labor, where there is restlessness of the patient, with
ineffectual   propulsive action of the uterus.” He further
remarks, “Authors generally attribute puerperal convulsions
to some irritation caused by the uterus, coming on during
gestation or after delivery. From these statements, I was led
to the use of hemp in puerperal convulsions, having also seen
its beneficial effects in convulsions in general, after all the
common remedies had been tried without relief. I made use
of it in chorea, more particularly in that form connected with
hysteria, or partaking of the character of both; in delirium
tremens, both in the period of excitement and after the
delirium subsides, and where long-continued watchfulness
and great mental excitement continue; in mania, where there
is watchfulness and excitement; in shaking palsy; in whoop-
ing-cough, and all coughs of a spasmodic character. In
phthisis, and other lung diseases, it may be given, especially
where opium has ceased to procure sleep.”

The late Dr. E. Dresbach, of Tiffin, made use of the article
as early as 1847, and was the first to administer it in practice,
so far as I am able to ascertain, in this region of country; and
as I remember from familiar converse with him, was favor-
ably impressed with its curative powers, especially in diseases
of a nervous character. My first experience with the remedy
was its recommendation by him in an inveterate case of
infantile convulsions, in which he was consulted, and where it
acted most promptly and effectively, after everything else
had failed to afford any relief. This interesting case, together
with three others of a similar nature, in which it had proved
equally successful, were communicated by me and published
in the June number of the Western Lancet (Vol. xvii., 1856).
Dr. Dresbach, at this time, expressed an undoubted confi-
dence in its efficacy in general nervous disorders, particularly
of a persistent or paroxysmal character. However, Dr. J. A.
McFarland, of the same place, and for many years his
immediate confrere and intimate friend, in reply to inquiries
made by me in February last, says, “My experience with the
article is confined to a single case (nervous irritability), in
which it was suggested by our old friend, Dr. Dresbach, but
in which its effects were not very decided. It was for a time
frequently employed by Dr. Dresbach, especially in derange-
ments of the nervous system, and I am not sure that his
confidence in the remedy was increased in proportion to his
experience. My impression is that the contrary is true.”

Dr. C. E. Buckingham reports, in the Boston Medical and Reports of Cases.
Surgical Journal (Vol. Iviii. March number, lSSS>, a case of
acute rheumatism, in which he had experimentally used the
medicine. In the discussion that ensued before the Boston
Society for Medical Observation, the following facts were
elicited: Dr. B. stated that he had been making numerous
experiments of late with this drug, as to its powers of
relieving pain, and it had answered so well in other cases that
he wished to use it in this. He thought that opium might
perhaps have relieved the pain more quickly, but having bad
results in other cases with opium, he felt disinclined to use it.
As to Cannabis Indica, Dr. Buckingham said that he thought
the activity of the medicine depended very much upon the
parcel from which it was taken. When used in five-grain
doses, he thought it a good substitute for opium. He was first
led to use it from results obtained by Dr. Jno. C. Dalton, Jr.,
who took it ,in doses, commencing at 20 drops of the
tincture, three times daily, increasing the amount to 100
drops three times daily. The use of it in the latter dose
induced a peculiar, prolonged and agreeable sleep.

Dr. Cabot said that he had employed it, and never saw any
result obtained from less than three-grain doses.

Dr. Clarke asked if any peculiar mental effect was pro-
duced. Dr. Buckingham had not seen any; he had never given
the medicine in over five-grain doses at a time. He commonly
orders one or two grains every hour, till the pain is relieved.
The apothecaries commonly consider three grains as the
maximum dose. He had not found it to produce any peculiar
effect on the skin, nor to act as a diuretic.

Dr. Clarke said that of late the Cannabis Indica was much
used in the treatment of the insane, and that it had been
found to be exceedingly variable in its effects.

Dr. Buckingham remarked, that as prepared by one or two
London chemists, the drug was very even and powerful;
generally it was not so. The best of it only dissolves in
chloroform, ether, or the strongest alcohol. The best way of
making a mixture, was to dissolve the drug in chloroform,
and then add to its simple syrup. In about twenty-four hours
it will settle to the bottom, but it may readily be shaken up
again.

Dr. H. J. Donahoo, of Sandusky, Ohio, read a paper on the
use of Cannabis Indica before the Eric County Medical
Society, in August, 1857, in which he details a full history of
two interesting cases, where he had used the medicine with
decided effect and complete success. The following is a copy
of his paper, as read:

   “B.O., a bookbinder, says he has been troubled with
    an obscure affection of the stomach for the past year,
    and had submitted to almost every kind of treatment,
   without any marked improvement in his general health.
   Morphine had given him more relief than anything else,
   and he was fast getting into the habit of,keeping himself
   under its influence. The case seemed to me to be one of
   gastrodynia. I accordingly ordered anodynes and anti-
   spasmodics, with very little relief. Finally this attack
   subsided, and he enjoyed a respite of some ten days
   from the attack of his enemy. He usually had warning of
   an attack some hours before it became fully developed.
   Damp, rainy weather scarcely ever failed to bring with it
    an attack of his disease. Being conscious of an approach-
    ing attack, he sent for me. I advised him to abandon the
    use of morphia; for, as I stated before, he was not only
    contracting the habit of using it constantly, but it was
   deranging the entire economy, by locking up the secre-
   tions of the liver and producing a jaundiced condition,
   with constipation. I prescribed a laxative, combined
   with extract of cicuta and hyosciamus, and instructed
   him to procure some charcoal, and take a dessert-
   spoonful, in case he should have an attack, and to repeat
   it, if necessary.

    “As anticipated, he was seized with a most terrible
   attack. I was sent for in the night, and found my patient
   suffering as much, one would think, as mortal flesh
   could bear. His friends said they would much rather see
   him die than be compelled to witness a continuance of
   such agony. I administered chloroform by inhalation,
  until he was brought fully under its influence, but he
   soon came out of its anaesthetic influence. It was
   repeated, but the effect soon subsided. I instructed his
   nurse how to administer it, and left the patient. Next
   morning, much to my surprise, I found he had suffered
   so much that he had been kept almost constantly under
   the influence of the chloroform. His countenance
   looked care-worn and haggard, his pulse was feeble, and
   the heat of the body was below the normal standard. As
   a kind of dernier resort, I prescribed the ‘Tincture of
   Cannabis Indica;’ dose twenty drops every three hours.
   In one hour after the first dose was taken, his pains grew
   easy, and before the time arrived for him to take the
   second dose, he was almost entirely free from pain. He
   took the second dose, however, but did not find it
   necessary to take any more. I instructed him to take a
   dose of the Cannabis, in case he should have any
   premonitions of a return of his trouble. He remained
   here some six weeks after his last attack, and had
   succeeded in preventing a recurrence of his disease by
   following the above course. The action of his bowels
   became regular, and his general health improved as
   rapidly as himself, his friends, or his physician could
   have desired.

   “On Sept. 24th, 1857, I was requested to visit Col.
   McK., in consultation with Dr. Austin, the attending
   physician. He was suffering very severely from an attack
   of spasmodic asthma. We prescribed the smoking of
   stramonium, but this, contrary to our expectations, gave
   no relief. We then ordered equal quantities of Hoffman’s
   anodyne and camp. tinct. opii, dose one teaspoonful
   every hour. This gave him much relief, but it soon lost
   its magic power; and we found that something else must
   be tried. I advised the use of the Cannabis Indica; the
   doctor acquiesced, and we accordingly gave one grain of
   the extract every three hours. Its effects were almost
   magical; the patient became quiet, breathed easily, and
   assured us, next morning, that he had never been so
   happy, the same length of time, as while under the
   influence of the Cannabis; to use his own words, ‘he was
   in Heaven all night.’ With a view to excite expectoration
   and correct existing hepatic derangement, we ordered a
   pill composed of submur-hydrarg, Doveri and ipecac.
   This prescription relieved him somewhat, produced
   nausea and vomiting, and finally acted upon the bowels.
   Towards evening he grew restless, and was ordered to
   resume the use of the Cannabis, in connection with the
   above pills. With these instructions, we left the patient
   for the night. About one o’clock in the morning, I was
   sent for in great haste. I found the patient suffering
   from a most terrible spasm. His features wore a sharp,
   pinched and cadaverous appearance. The inquiry was
   made, wirh much alarm, if I could relieve him. I
   responded in the affirmative, and immediately pro-
   ceeded to administer a pill of the extract Cannabis
   Indica (one grain to the pill); repeated the pill in one
   hour. This relieved the spasms, and by giving one of the
   pills every two hours, I succeeded in keeping up the
   effect, so that he not only breathed well, but slept
   tranquilly until morning. He afterwards occasionally
   took a pill of the Cannabis, but, with the exception of a
   little camp. tinct. opii, to relieve some pain of the
   bowels, caused by a slight bilious diarrhoea, he required
   no further treatment. I am not aware of the Cannabis
   having before been used in asthma, having in vain
   searched for authority for using it in his disease. If the
   Cannabis proves as useful in other hands as it has in
   mine, asthmatics will bless the hand that administered
   it. I have likewise frequently prescribed the hemp in
   cases of hysteria, and have always been pleased with its
   effects.

Dr. Robert Andrews, of North New Salem, communicates
the history of an interesting case to Dr. J. P. Willis, in which
the latter had recommended the use of the hemp, with
evident success, and was published by him in the Boston
Medical and Surgical Journal of Sept., 1859. The case was
one of placenta praevia, and after a great loss of blood by
hemorrhage, was delivered by a resort to podalic version, and
the hemorrhage subsequently controlled by the use of a
swathe and compress, cold applications, rest, etc. On the
third day after delivery, he found her doing well, and
dismissed her. Ten days afterwards, he remarks as follows:

    I was again called, July 28th, and found her with
   headache and nervous excitement, which I thought were
   caused by her having taken cold, and permitting her
   milk to dry up too soon. I gave her a cathartic and some
   powders of camphor, nitre and valerian. I heard no more
   from her till August 2d, when I was called to visit her in
   the night, and found her delirious, crying ‘fire,’ ‘murd-
   er,’ etc. From this time to August 19th, I saw her every
   second or third day, and used the ordinary remedies in
   such cases, with little if any mitigation of her symp-
   toms. August 20th she was moved from Freysville to her
   father’s, in Orange. I there saw her almost every day till
   August 27th, when you were called in consultation. You
   undoubtedly recollect the peculiar, restless condition in
   which you and D. C. found her at that time. She had
   actually worn the flesh from her elbows and hips by the
   constant rubbing of them together. She had gnawed her
   finger nails and the ends of her fingers till they bled. She
   refused to take anything which she suspected was
   medicine, or from any one whom she thought was a
   doctor. Her bowels were torpid. Under these circum-
   stances, the ‘hemp’ which you prescribed, had a wonder-
   ful effect in quieting the nervous system, and the dose
   was so small that we succeeded in getting it down in her
   food. The torpid condition of the liver and bowels was
   removed by small doses of podophyllin, administered
   daily in the same manner as the hemp. The hemp was
   given in doses sufficient to keep her quiet. Some days
   one dose was sufficient; other days it would be neces-
   sary to repeat the dose once or twice. Under the above
    treatment she gradually improved till Sept. 12th, when
    she was dismissed permanently cured.

 Dr. M. D. Mooney, of Georgia, reports that he has used the
 following prescription in four cases of gonorrhoea, and was
 successful in every case in from five to seven days:
               R Sugar of milk, . . . . .3ss.
                 Extr. Cannabis Indica, . . . . . xx grs.
                 Mix well and divide in 60 powders.
                 One to be taken every three or four hours.
    This prescription, he says, will relieve the most obstinate
cases in a short time.

    Dr. 0. C. Kendricks, Superintendent of the Northern
Lunatic Asylum, in the fifth annual report of that institution,
says: “We have made brief trial of the Cannabis Indica
(Herring’s Extract), in the cases to which it seemed ap-
plicable, but as yet with indifferent success.”

    The following case of hysterical insanity, which came
under my care in February, 1859, I introduce as being one in
which the patient was under no medical influences whatever,
and on which the hemp acted with almost magical power,
and with complete success.

    D a n i e l V a n F - - - , an unsophisticated and eccentric
nondescript of the genus “homo,” became infatuated, at a
rather mature age, with the idea that he possessed extraordi-
nary talents and ingenuity as a mechanician. He accordingly
abandoned his trade of carpenter and joiner, and concen-
trated all the energies of his mind in designing the model of
an invention of his, to supersede the popular patterns in use
at the time, as planning-machines. After long and arduous
labor, and repeated failures, to satisfactorily consummate his
project, he subsequently irretrievably involved his property
and impoverished his family, by the expenses incurred in
obtaining a patent-right for what he conceived to be the most
important discovery of the day, while the golden dreams that
filled his imagination knew no bounds. But, after many sore
and heart-sickening disappointments and overwhelming mis-
fortunes, together with the upbraidings and bitter taunts of
an unsympathizing family and unfeeling public, his already
overtaxed intellect began to stagger, and his spirits to sink
under the weight of his heavy sorrows. At this time he was
seized with symptoms of pneumonic inflammation, which his
wife had treated with considerable skill and success. But
becoming alarmed from the debility that ensued, and an
unusual display of irascibility of temper and incoherency of
language, I was requested to visit him.

    I found him a good deal prostrated, pulse soft and excited,
 expectoration free and favorable, tongue somewhat coated,
 surface moist and pliable, respiration as full, easy and
unobstructed as would be anticipated. His mind was mor-
bidly active, occasionally inconsistent, and evidently, from
his manner and expressions that escaped him, impressed with
suspicions of nefarious designs on the part of his family. He
had been, for several nights, unable to sleep and extremely
restless. I prescribed Dover’s powder and hyosciamus in
combination, to meet the above indications, and decoction of
senega to facilitate expectoration. I was then formally dis-
missed, and assured that I would be duly notified if further
assistance should be required. I did not again hear from him
for ten days, when his wife waited upon me, and informed
me that his cough had about disappeared, but that his mental
disquietude had constantly increased, and at present he
appeared to be wholly insane. He remained resolutely in bed,
persisted in covering his head and face with the bedclothes,
and obstinately refused to see me or any other physician,
asserting that we were all in league with the rest of commun-
ity to encompass his death-that the Lord had visited him in
person, and warned him of the conspiracy. He refused to take
any nourishment, and but rarely a drink of water. He had
sent for a Methodist exhorter, of about his own calibre and
character, to read the Bible; while they both sang hymns and
prayed without ceasing. I accompanied her home. He re-
ceived me coolly but not unkindly, and watched me closely
but furtively. All my efforts at flattery and familiarity failed
to secure his confidence, to persuade him to partake of food,
or to convince him of the fallacy of his fears. The influence
of his spiritual adviser and the importunities of his wife had
no avail. I then attempted a variety of subterfuges, to secure
the introduction of a saline cathartic, as he had become very
constipated, but without success; and, as a dernier resort,
assumed a determined and dictatorial manner, threatened and
even exercised some force; but he maintained the same
stoical, silent and imperturbable indifference. After the lapse
of near forty-eight hours, he became so exhausted and feeble
that some fluids were forced down him, together with a
mixture of senna and salts, after the operation of which, I
succeeded in administering a drachm of laudanum, with an
equal quantity of tinct. valerian in brandy. This failed to
procure sleep or have any other beneficial effect, but only
produced a dull unnatural expression of the countenance. I
then attempted to bring him under the influence of chloro-
form; but he so stoutly resisted its application, and avoided
its inhalation, that no decided impression could be obtained.
His features began to assume a haggard, contracted, and
sallow hue, his hands affected with tremor, his eyes injected
and their nictation spasmodic, and his whole frame greatly
emaciated. He now imagined himself to be a steam-engine,
and began to work both his upper and lower extremities
alternately and constantly, in imitation of his fancied con-
gener. This he continued almost without a moment’s cessa-
tion for one whole night, and without a particle of suste-
nance. We then resorted to a concerted deception, by all
present feeling his pulse and declaring the water in his boiler
to be about exhausted, and expressing great fears of an
approaching explosion. This, to our gratification, had the
desired effect; and he blew off steam with loud and forcible
expirations, and came to a stand-still, his whole body bathed
in a profuse perspiration, while great drops of sweat’ beaded
and rolled from his brow. I was prepared with one drachm of
the tinct. of Cannabis Indica, which was administered in a
cup of diluted coffee. He then gradually let on steam, and
resumed his locomotive operations. I then left and returned
in about three hours, and found him perfectly quiescent,
with a relaxed and placid countenance, dilated pupils and a
fixed, dreamy expression of the eye. He was obviously in a
state of complete inebriation, and I remained to watch its
further developments. He made no movement whatever, but
would smile with his eyes fixed on vacancy, and subsequently
broke out in sudden exclamations of suprise, then laugh
loud and immoderately. After some hours, he sank into a
deep and sonorous slumber. He awoke from an interrupted
rest of six hours quite rational, but somewhat confused and
extremely exhausted. A milk and brandy punch was given,
and he again slept; afterwards chicken broth, some simple
tonic, and he recovered without any relapse or further
remedies.

   Upon reading the effects of hasheesh, as described by
Bayard Taylor, in which his friend was affected with a similar
hallucination, as heretofore stated, I was agreeably surprised
with the striking analogy of the two cases, produced by the
hemp in one, and induced by disease in the other.

   The modus operandi of the hemp in the above case, would
appear to be that of substitution, the existing disorders of the
cerebral and nervous centres being displaced or extinguished
by the powerful and persistent impression made by the
medicine upon the sentient economy of the same system. I
have also derived decided benefit from the use of the hemp in
a case of laryngismus stridulus, which was reported by me
and published in the Cincinnati Lancet and Observer (Vol. ii.
No. 8, August, 1859).

   In a variety of forms of nervous rheumatism, I have also
been very successful with the following combination of the
hemp, first recommended, I believe, by Dr. Atlee of Phila-
delphia, and find it preferable in many cases to the prepara-
tions of opium, especially where constipated habits contra-
indicated their use :
            s Etherial Tinct. Guiacum . . . . . . . . . . . fl 3j.
              Etherial Tinct. Colchicum . . . . . . . . . . fl ,Svj.
              Etherial Tinct. Cannab. Indica . _. . . . . fl 3ij.
              M-Dose 25 to 30 drops every 3 to 4 hours on
              sugar.

   In all forms of bronchitis, I have frequently found it one
of the best adjuvants, in combination with any of the
ordinary expectorant mixtures, used in that affection.

   Dr. A. P. Dutcher, of Enon Valley, Pa., reports an interest-
ing case in the Cincinnati Lancet and Observer (Vol. ii. No. 5,
May, 1859). The patient had been afflicted with bronchitis
for five years; had at this time but recovered from an
aggravation of the disease, complicated with a degree of
inflammation; after the subsidence of which, he
pneumonic states, “that the cough and expectoration were now about
the same as they had been for the last five years-
troublesome and unmanageable. As she had taken every
therapeutical agent known to have any power in the cure of
bronchitis, and been the rounds of quackdom, I concluded,
as a last resort, to try the following:
           Extr. Cannabis Indica . . . . . . . . . . . .         fl. 3 ss.
           Alcohol . . . . . . . . . . . . . . . . . . . . . . . fl. 3iv.

    “A teaspoonful of the above was to be taken, three times a
day, in a wine-glassful of simple syrup. From this time she
recovered rapidly, and in six weeks her cough disappeared
entirely, and up to the present time (Feb. 26th, 1859), a
period of nine months, there has been no return, and her
general health is better than it has been for six years.” He
concludes the article as follows: “The happy result, in this
case, by the use of Cannabis, I regard as a little remarkable;
for it is not often that bronchitis is cured after it has run so
long, particularly in a person as old as my patient (60 years).
From the trials that I have made with the article, in chronic
pulmonary      affections, I am favorably impressed with its
virtues. It may be given in all cases to allay cough and
produce sleep, as a substitute for opium, especially where this
latter is contraindicated by its effects upon the brain, and by
its property of checking mucous secretion.”

   Dr. Fronmueller, of Fuerth, makes the following remarks
as the sum of his experience with the hemp:

      I have used hemp many hundred times to relieve local
   pains of an inflammatory as well as neuralgic nature,
   and judging from these experiments, I have to assign to
   the Indian hemp a place among the so called hypnotic
   medicines next to opium; its effects are less intense, and
   the secretions are not so much suppressed by it. Diges-
   tion is not disturbed; the appetite rather increased;
   sickness of the stomach seldom induced; congestion
   never. Hemp may consequently be employed in inflam-
   matory conditions. It disturbs the expectoration far less
   than opium; the nervous system is also not so much
   affected. The whole effect of hemp being less violent,
   and producing a more natural sleep, without interfering
   with the actions of the internal organs, it is certainly
   often preferable to opium, although it is not equal to
   that drug in strength and reliability. An alternating
   course of opium and Indian hemp seems particularly
   adapted to those cases where opium alone fails in
   producing the desired effect. The best form is small
   pills, made from the spirituous extract, with a little of
    the powdered leaves. The smallest dose may be set down
    at eight grains; a rapid increase is frequently required.

    I would here introduce and direct attention to the interest-
ing report furnished me by Dr. W. P. Kincaid, of Neville,
associated with me on this subject, and whose experience
with the medicine has been of a most direct and practical
character. (See report of Dr. Kincaid.)

   In conclusion, I would state as the result of my own
experience and observation, in addition to the cases already
reported and referred to, that I am fully convinced of the
peculiar efficacy and pertinency of the remedy to certain
pathological conditions, occupying or involving the nervous
system. In those mixed and indefinable paroxysms of an
hysterical nature, I have found no remedy to control or
curtail them with equal promptness and permanency. In the
protean and painful conditions connected with uterine dis-
order, I have ever found it an admirable adjuvant in their
treatment, as an anodyne ingredient, in a variety of combina-
tions. In sleeplessness, where opium is contraindicated, it is
an excellent substitute. In two cases of nervous spasmodic
cough, it proved efficacious, where a number of anti-
spasmodics failed to afford any relief. In a violent case of
puerperal mania, it acted most happily and beneficially in
controlling the fury of the patient and in securing sleep. As a
calmative and hypnotic, in all forms of nervous inquietude
and cerebral excitement, it will be found an invaluable agent,
as it produces none of those functional derangements or
sequences that render many of the more customary remedies
objectionable.
                                    

Neville, Ohio, Feb. 21, 1860 Report of

W. P. Kincaid, M.1
R. R. McMeens, M.D., Chairman Committee on Can. Ind.:

Dear Sir:

   Yours of the 5th has just come to hand, and as you are
now engaged in making up your report, I will, without delay,
very briefly give you some of my observations upon the
action of Cannabis Indica.

   My attention was first directed to this medicinal agent by
yourself, at the meeting of the Ohio State Medical Society,
held at Sandusky, in June, 1857.

   Since that time, while engaged in the practice of medicine,
I have embraced every opportunity to test its virtues in such
cases as I thought it applicable.

    The diseases in which I have prescribed it, and to which
my observations have especially been directed, are, laryn-
gismus stridulus, epilepsy, tetanus, hysteria and mania-a-potu.

    By laryngismus stridulus, I mean spasm of the glottis,
recurring at irregular intervals of from a few minutes to any
period of time, either in children or adults.

    My design in the use of this article has been to test its
effects, separate and apart from any other medicine, given at
the same time, as far as it was consistent to rely only upon
one remedy.

    In several instances where the symptoms were imminent, I
used chloroform in conjunction with the hemp, and in those
cases am unable to say whether the effects produced were the
combined action of the two, or of one or the other sep-
arately, but am inclined to the opinion that they were the
result of the two acting in harmony.

    In one case of laryngismus stridulus, infant, aged seven and
a half months (case published in the Transactions of the Oh.
St. Med. Sot. of lSSS>, I gave the two combined for the first
twenty-four hours, with marked improvement; then discon-
tinued the chloroform, and increased the quantity of hemp,
with entire cessation of the spasms after the second dose. The
spasms in this case had recurred at intervals of 10 or 15
minutes for 95 days.

    On the 9th of the present month, I was called some
distance back into Kentucky, to see a Miss Conly, aged 18
years, of sanguine temperament, unmarried, a patient of Dr.
Boner’s of that State. Found her laboring under spasm of the
glottis, with slight spasm of fingers and toes. These par-
oxysms recurred at intervals of five or six minutes, and were,
in duration, from three quarters of a minute to a minute and
a half. There was entire suspension of respiration during the
spasm. Her pulse was very small, moderately frequent and
irregular, and, while in the paroxysm, imperceptible. Extrem-
ities cold, surface pallid, pupils dilated to double their normal
size, voice entirely extinct.

    Her friends had encircled her bed for the previous twelve
hours, momentarily expecting her exit.

    The physician assured me the symptoms now, and fre-
quency of the paroxysms, were about the same as they had
been for the past twelve hours.

    Her mother informed me, she had formerly enjoyed as
good health as other girls in the neighborhood, except that
she suffered rather more than usual at her catamenial periods,
and about that time was very nervous.

    She had taken nothing in the way of medicine or nourish-
ment during these twelve hours, owing perhaps to the fact
that all were of the impression that an effort to swallow
brought on the spasms.

    I suggested to Dr. Boner that this was a choice case in
which to test the Can. Ind., but when I came to examine my
saddle-bags, to my great disappointment and chagrin, I had
none with me, and was at a distance of six or eight miles
from where it could be procured.

   It being a case of emergency, I could not, with prudence,
wait until a messenger could go that distance and return with
the hemp. I therefore put her upon chloroform and corn.
tinct. opii, aa gss, to be repeated every two hours until the
Can. Ind. was obtained. Directed sinapisms to the extrem-
ities, and epispastics to the cervical and dorsal spine.

    I am reliably informed there was slight improvement, the
spasms being rather less frequent before the medicine arrived.
On the return of the messenger, she took tinct. of the ext.
%s, to be repeated every three hours.

    After she had taken the third portion of hemp, and one
additional portion of chloroform (given through a misunder-
standing), the spasms ceased, and she slept well for nine
hours.

    When she roused up, she was again in possession of her
voice, and having, from joy, talked too much, the spasms
returned, but in a milder form, and soon yielded to the same
prescription.

    The spasms recurred, at two or three irregular periods,
within the next four or five days, but soon yielded under the
action of the Can. Ind., given as before.

    This lady is now convalescent, it being twelve days since I
first saw her, and owes, most likely, her present existence to
the action of Can. Ind., or the combined effects of it and
chloroform.

    I have treated four cases of epilepsy with the hemp; two
were permanently benefited (at least to the present time);
one temporarily, and one not at all.

   I will give one case in detail, and compare the others with
it, for the sake of brevity, being fully satisfied that your
report will be full and comprehensive within itself.

   Case 1. Mr. J. K., aged 40 years; unmarried; of lymphatic
temperament, and rather feeble constitution; had been sub-
ject to epilepsy for twenty years; called upon me in July,
 1858, to treat him for, as he said, those “falling spells’ he was
subject to. He informed me they came on him at irregular
intervals. Sometimes he would not have any for two or three
weeks; then he would have one or two a day, or every
alternate or third day, for a week or two. He was so much
afflicted with them he was unable to attend to ordinary
business, or go from home alone.

   I put him on the tinct. Can. Ind. 3ss twice a day for two
weeks, then three times a day for two weeks, when it was
suspended for one week.

   During the first week of treatment he had two fits, one in
the second, and none in the third or fourth.

   About the last of the fifth week, he had another fit, when
he was again put on the hemp twice a day for five weeks;
then reduced to once a day for five weeks. In these ten weeks
he had no “falling spell,” neither did he have any for a month
after that, although he was taking nothing the last four
weeks.

   In December, 1858, they returned on him; and as I was
not engaged in the practice of my profession that winter, I
lost sight of his case until May, 1859.

   He informed me, on my return to professional duties in
the spring of 18.59, that he had had a few of his “old spells”
during the winter, but nothing like so frequent as before he
took the hemp. He has only been taking the medicine
occasionally the past season, as he had become tired taking it,
and not having a fit more than once in three months, which
did not greatly interfere with his ordinary engagements, he
concluded to rest for a time, unless his “spells” got worse on
him.

   Case 2. Male; aged 46 years; of sanguine or bilious
temperament; rather plethoric habit; married; has been sub-
ject to epilepsy for five years, recurring at intervals of about
four weeks. Sometimes he had only one fit at the recurring
period, and at others from two to seven.

   He was put on the use of the Can. Ind. in September,
1858; given the same as in case 1, with even better results.

    He has had but one fit in the past nine months; has taken
no hemp for four or five months; considers himself cured.
Whether he permanently cured or not, the future only will
demonstrate.

    Case 3. Male; aged 35 years; married; of nervous tempera-
ment; subject to fits for 17 years.

    He has sometimes two or three fits a day; then will miss
three or four days, and again recur upon him.

    I am informed by his wife that for the past five years he
has had, on an average, about fifty per year.

    He took the hemp for three months without any marked
improvement, when it was discontinued.

    Case 4 Male; aged 38 years; married; of nervous tempera-
ment; subject to epilepsy for ten years, recurring at intervals
of four or five weeks.

    Treated as cases 1 and 2, with slight improvement. This
patient has been taking the hemp for two and a half months,
and is still under treatment.

    I have given the Can. Ind. in two cases of tetanus: one
idiopathic, the other traumatic. In the former I gave 3ss every
three hours for six hours; then every two hours, with
chloroform, for eight or ten hours, but could produce no
impression upon the disease. Patient died.

    In the traumatic case, its beneficial effects were very
visible. The frequency and force of the paroxysms were
lessened just in proportion to its constitutional effects upon
the patient.

    This lady took half a drachm (tinct.) every three hours,
until there was dilatation of the pupils, and that peculiar
expression of countenance attending the exhilarating effects
of stimulus, when the spasms ceased. They returned at two or
three irregular periods before convalescence, but were each
 time controlled by the hemp.

    This was a case in which the tetanic spasms continued after
the amputation of the diseased limb. The hemp was not given
 before the amputation. Tetanus was the result of mortifica-
 tion of the hand.

   I have given the Can. Ind. in a few cases of hysteria, and
 am much pleased with its action, especially in those cases of a
 spasmodic character.

    I have not had an opportunity of testing its effects in
delirium tremens to the extent I had desired, but so far as my
observations were carried, it did not meet my expectations. It
seemed to exalt the nervous excitement already present,
rather than calm it; but such is the case in many instances,
even with morphine.

   As to its action in chorea, I have had no good opportunity
of testing it, but should anticipate good results from the
persevering use of it in that disease.

   In conclusion, I would remark, that I regard the hemp as
an excellent nervous stimulant, applicable in all diseases of a
purely nervous character.

   Yours, very respectfully,
                                                  W. P. Kincaid

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