administered the tincture of hemp in several cases of that disease,
and cures were daily reported by its alleged efficacy. Dr. Goodeve was
thus led to try it in several cases, and his report was in the highest
degree favorable. The diarrhœa was in every instance checked, and the
stimulating effects of the drug clearly manifested. The durwan of the
college, an athletic Rajpoot, was attacked, and came under my treatment
after he had been ill seven hours; he was pulseless, cold, and in a
state of imminent danger, the characteristic evacuations streaming from
him without effort. Half a grain of the hemp resin was given, and in
twenty minutes the pulse returned, the skin became warm, the purging
ceased, and he fell asleep. In an hour he was cataleptic, and continued
so for several hours. In the morning he was perfectly well and at his
duty as usual.
It is but fair to state, however, that the character of the epidemic
was not at the time malignant. I admit the cases to be inconclusive,
but I conceive them to be promising, and that they deserve the due
attention of the practitioner.
Since this passage was written in 1838, the tincture of hemp has been
used in a great number of cases, both European and native, in the
hospital of the Medical College. I know no remedy equal to it as a
general and steady stimulant when given to _Europeans_ in half drachm
doses during the tractable stage of this disease. I have known the
pulse and heat return and the purging checked by a single dose. It
allays vomiting much more certainly than the opium preparations, and
is not more likely than these to lead to cerebral congestion on the
cessation of cholera symptoms. The cheering effect on the patient’s
spirits is not the least benefit this remedy confers.
In _native_ cases much less advantage was obtained; nearly all this
class of patients were old gunjah smokers.
_Use in Tetanus._
I now proceed to notice a class of most important cases, in which the
results obtained are of the character which warrants me in regarding
the powers of the remedy as satisfactorily and incontrovertibly
established. I allude to its use in the treatment of traumatic
_tetanus_, or lock-jaw, next to hydrophobia, perhaps the most
intractable and agonising of the whole catalogue of human maladies.
The first case of this disease treated by hemp was that of Ramjan
Khan, aged thirty, admitted to the College Hospital, on the 13th of
December, 1838, for a sloughing ulcer on the back of the left hand.
Five days previously a native empiric had applied a red hot _gool_
(the mixture of charcoal and tobacco used in the hookah) to the back
of the left wrist, as a remedy for chronic dysentery and spleen. The
patient’s brother was similarly cauterised on the same day. In both
sloughing took place down to the tendons. Symptoms of tetanus occurred
on the 24th of December. The brother, who had refused to avail himself
of European aid, had been seized with tetanus at his own home four
days previously, and died after three days’ illness. On the 26th
December spasms set in, and recurred at intervals of a few minutes; the
muscles of the abdomen, neck, and jaws became firmly and permanently
contracted. Large doses of opium with calomel having been administered
for some hours, without the least alleviation of symptoms, and his
case having on consultation been pronounced completely hopeless, I
obtained Mr. Egerton’s permission to subject the poor man to the trial
of the hemp resin. Two grains were first given at half past two, p.m.,
dissolved in a little spirit. In half an hour the patient felt giddy;
at five, p.m., his eyes were closed, he felt sleepy, and expressed
himself much intoxicated.
He slept at intervals during the night, but on waking had convulsive
attacks.
On the 27th, two grains were given every third hour (a purgative enema
was also administered, which operated three times); the stiffness of
the muscles became much less towards evening, but the spasms returned
at intervals as before; pulse and skin natural.
28. Improved; is lethargic but intelligent; spasms occasionally occur,
but at much longer intervals, and in less severity.
29. Dose of hemp increased to three grains every second hour. Symptoms
moderating.
30. Much intoxicated; continues to improve.
January 1, 1839. A hemp cataplasm applied to the ulcer, and internal
use of remedy continued. Towards evening was much improved; spasms
trivial; no permanent rigidity; had passed two _dysenteric stools_.
2. Morning report: Had passed a good night, and seems much better.
Evening report: Doing remarkably well.
3, 4, and 5. Continues to improve. Hemp resin in two grain doses every
fifth hour.
6. Five, p.m.--Feverish; skin hot; pulse quick; all tetanic symptoms
gone; passing mucous and bloody stools. Leeches to abdomen; a starch
and opium enema with three grains of acetate of lead every second hour;
tepid sponging to the body; hemp omitted.
7. Six, a.m.--Still feverish; stools frequent, mucous; abdomen tender
on pressure; no appetite; the ulcer sloughy, ragged, and offensive.
Opium and acetate of lead continued; abdomen leeched; sore dressed with
water. At noon there was slight rigidity of abdominal muscles. Hemp
resumed. At three, p.m., became intoxicated and hungry; ulcer extremely
dry, foul, and abominably fœtid; towards evening rigidity ceased. Hemp
discontinued.
From this day the tetanus may be considered to have ceased altogether,
but the dysenteric symptoms continued, despite of the use of opium
and acetate of lead; the ulcer, too, proved utterly intractable. Some
improvement in the dysenteric symptoms occurred from the 10th to the
15th, when natural stools were passed. He seemed gaining strength,
but the wound was in no wise improved; the slough, on the contrary,
threatened to spread, and two metacarpal bones lay loose in the centre
of the sore; on consultation it was agreed to amputate the arm, but to
this the patient peremptorily objected. The mortification now spread
rapidly, and, to our infinite regret, he died of exhaustion on the
night of the 23rd of January.
An unprejudiced review of the preceding details exhibits the sedative
powers of the remedy in the most favorable light; and, although the
patient died, it must be remembered that it was of a different disease,
over which it is not presumed that the hemp possesses the least power.
The _second_ case was that of Chunoo Syce (treated by Mr. O’Brien,
at the Native Hospital), in whom tetanus supervened on the 11th
of December, after an injury from the kick of a horse. After an
ineffectual trial of turpentine and castor oil in large doses, two
grain doses of hemp resin were given on the 16th of December. He
consumed in all 134 grains of the resin, and left the hospital cured on
the 28th of December.
_Third case._--Huroo, a female, aged twenty-five, admitted to the
Native Hospital on the 16th of December; had tetanus for the three
previous days, the sequel of a cut on the left elbow received a
fortnight before. Symptoms violent on admission. Turpentine and castor
oil given repeatedly without effect; on the 16th and 17th, three grains
of hemp resin were given at bed-time. On the morning of the 18th she
was found in a state of complete catalepsy, and remained so until
evening, when she became sensible, and a tetanic paroxysm recurred.
Hemp resumed, and continued in two grain doses every fourth hour. She
subsequently took a grain twice daily till the 8th of February, when
she left the hospital apparently quite well.
Mr. O’Brien has since used the hemp resin in five cases, of which four
were admitted in a perfectly hopeless state. He employed the remedy
in _ten grain doses_ dissolved in spirit. The effect he describes as
almost immediate relaxation of the muscles and interruption of the
convulsive tendency. Of Mr. O’Brien’s seven cases four have recovered.
In the Police Hospital of Calcutta, the late Dr. Bain has used the
remedy in three cases of traumatic tetanus, of these one has died and
two recovered.
A very remarkable case has recently occurred in the practice of my
cousin, Mr. Richard O’Shaughnessy. The patient was a Jew, aged thirty,
attacked with tetanus during the progress of a sloughing sore of the
scrotum, the sequel of a neglected hydrocele. Three grain doses were
used every second hour with the effect of inducing intoxication and
suspending the symptoms. The patient has recovered perfectly, and now
enjoys excellent health.
Beside the preceding cases I have heard of two of puerperal trismus
treated in native females. Both terminated fatally, an event which
cannot discredit the remedy, when it is remembered that the Hindoo
native females of all ranks are placed, during and subsequent to their
confinement, in a cell, within which large logs of wood are kept
constantly ignited. The temperature of these dens I have found to
exceed 120° of Fahrenheit’s scale.
A curious coincidental proof of the value of hemp in these cases has
very recently come to my notice. In the appendix to Sir James Murray’s
“Medical Essays,” p. 16, dated Dublin 1837, occurs the following
passage:--“Having written the substance of these pages (Sir James’s
work) to my brother, then assistant-surgeon of the 60th Rifles, at
the Cape of Good Hope, he mentioned that a plant called _dyka_, or
wild hemp, which grows on the eastern coast of Africa, is used by the
natives for this purpose (the relief of puerperal convulsions), and
that they all, male and female, smoke it to bring on perfect relaxation
and relief from pain and spasm of any kind during its relaxing
influence.”
The preceding facts are offered to the professional reader with
unfeigned diffidence as to the inferences I feel disposed to derive
from their consideration. To me they seem unequivocally to show that
when given boldly and in large doses the resin of hemp is capable of
arresting effectually the progress of this formidable disease, and in a
large proportion of cases of effecting a perfect cure.
The facts are such at least as justify the hope that the virtues of
the drug may be widely and severely tested in the multitudes of these
appalling cases which present themselves in all Indian hospitals.
Messrs. Hughes and Templar, eminent veterinary surgeons of Calcutta,
have used the hemp resin in five cases of horses suffering from
tetanus; of these three have recovered. Dr. Sawyers, of the medical
board, has cured a pony similarly affected.
Drs. Esdaile and Macrae have used the hemp with success; the former
in a case of tetanus; the latter in one of convulsions from neuralgia
of the testis, which had resisted every other remedy, and for which
the removal of the organ had been decided on. In the “London Medical
Gazette” Mr. Lewis gives a case of tetanus in which the hemp was used
with great relief to the symptoms, although it did not effect a cure.
_Case of Infantile Convulsions._
A very interesting case of this disease has recently occurred in my
private practice, the particulars of which I have the permission of the
family to insert in this paper.
A female infant, forty days old, the child of Mr. and Mrs. J. L., of
Calcutta, on the 10th of September had a slight attack of convulsions,
which recurred chiefly at night for about a fortnight, and for which
the usual purgatives--warm baths and a few doses of calomel and
chalk--were given without effect. On the 23rd the convulsive paroxysms
became very severe, and the bowels being but little deranged two
leeches were applied to the head. Leeches, purgatives, and opiates,
were alternately resorted to, and without the slightest benefit, up to
the 30th of September.
On that day the attacks were almost unceasing, and amounted to regular
tetanic paroxysms. The child had, moreover, completely lost appetite
and was emaciating rapidly.[5]
I had by this time exhausted all the usual methods of treatment, and
the child was apparently in a sinking state.
Under these circumstances I stated to the parents the results of the
experiments I had made with the hemp, and my conviction that it would
relieve their infant if relief could possibly be obtained.
They gladly consented to the trial, and a single drop of the spirituous
tincture, equal to the one-twentieth part of a grain of extract, was
placed on the child’s tongue at ten, p.m. No immediate effect was
perceptible, and in an hour and a half two drops more were given. The
infant fell asleep in a few minutes, and slept soundly till four, p.m.,
when she awoke, screamed for food, _took the breast freely_, and fell
asleep again. At nine, a.m., 1st of October, I found the child fast
asleep, but easily roused; the pulse, countenance, and skin perfectly
natural. In this drowsy state she continued for four days totally free
from convulsive symptoms in any form. During this time the bowels were
frequently spontaneously relieved, and the appetite returned to the
natural degree.
October 4. At one, a.m., convulsions returned and continued at
intervals during the day; five drop doses of the tincture were given
hourly. Up to midnight there were thirty fits, and forty-four drops of
the tincture of hemp were ineffectually given.
5. Paroxysms continued during the night. At eleven, a.m., it was found
that the tincture in use during the preceding days had been kept by the
servant in a small bottle with a paper stopper; that the spirit had
evaporated and the whole of the resin had settled on the sides of the
phial. The infant had in fact been taking drops of mere water during
the preceding day.
A new preparation was given in three drop doses during the 5th and
6th, and increased to eight drops with the effect of diminishing the
violence, though not of preventing the return of the paroxysm.
On the 7th I met Dr. Nicholson in consultation, and despairing of a
cure from the hemp, it was agreed to intermit its use, to apply a
mustard poultice to the epigastrium, and to give a dose of castor oil
and turpentine. The child, however, rapidly became worse, and at two,
p.m., a tetanic spasm set in, which lasted without intermission till
half-past six, p.m. A cold bath was tried without solution of the
spasm; the hemp was, therefore, again resorted to, and a dose of thirty
drops, equal to one and a half grains of the resin, given at once.
Immediately after this dose was given the limbs relaxed, the little
patient fell fast asleep, and so continued for thirteen hours. While
asleep, she was evidently under the peculiar influence of the drug.
On the 8th October, at four, a.m., there was a severe fit, and from
this hour to ten at night twenty-five fits occurred, and 130 drops of
the tincture were given in thirty drop doses. It was now manifestly a
struggle between the disease and the remedy; but at ten, p.m., she was
again narcotised, and from that hour no fit returned.
On the three following days there was considerable griping, and on
administering large doses of almond oil several small dark green lumps
of hemp resin were voided, which gave effectual relief. The child is
now (December 17) in the enjoyment of robust health, and has regained
her natural plump and happy appearance.
In reviewing this case several very remarkable circumstances present
themselves. At first we find three drops, or three-twentieths of a
grain, causing profound narcotism, subsequently we find 130 drops daily
required to produce the same effect. The severity of the symptoms
doubtless must be taken chiefly into account in endeavouring to explain
this circumstance. It was too soon for habit to gain ascendency over
the narcotic powers of the drug. Should the disease ever recur, it will
be a matter of much interest to notice the quantity of the tincture
requisite to afford relief. The reader will remember that this infant
was but sixty days old when 130 drops were given in one day, of the
same preparation of which ten drops had intoxicated the student
Dinonath Dhur, who took the drug for experiment.
_Use in Delirium Tremens._
I have given the tincture of hemp an extensive trial in this disease,
and have had much reason to be gratified with its effects. In
action it resembles opium and wine, but is much more certain than
these remedies. I have no hesitation in saying, that in the cases in
which the opium treatment is applicable, hemp will be found far more
effectual. The changed state of mind it produces is truly wonderful.
From the appalling terror which generally predominates, the patient
soon passes into a state of cheerfulness, often of boisterous mirth,
and soon sinks into a happy sleep. Of course there are many cases in
which this, or any other, narcotic should not be employed.
_Delirium occasioned by continued Hemp Inebriation._
Before quitting this subject, it is desirable to notice the singular
form of delirium which the incautious use of the hemp preparations
often occasions, especially among young men who try it for the first
time. Several such cases have presented themselves to my notice. They
are as peculiar as the “delirium tremens” which succeeds the prolonged
abuse of spirituous liquors, but are quite distinct from any other
species of delirium with which I am acquainted.
This state is at once recognised by the strange balancing gait of the
patient, a constant rubbing of the hands, perpetual giggling, and a
propensity to caress and chafe the feet of all bystanders of whatever
rank. The eye wears an expression of cunning and merriment which
can scarcely be mistaken. In a few cases, the patients are violent;
in many, highly aphrodisiac; in all that I have seen, voraciously
hungry. There is no increased heat or frequency of circulation, or any
appearance of inflammation or congestion, and the skin and general
functions are in a natural state.
A blister to the nape of the neck, leeches to the temples, and
nauseating doses of tartar emetic with saline purgatives have rapidly
dispelled the symptoms in all the cases I have met with, and have
restored the patient to perfect health.
_Conclusion._
The preceding cases constitute an abstract of my experience on this
subject, and constitute the grounds of my belief that in hemp the
profession has gained an anti-convulsive remedy of the greatest value.
Entertaining this conviction, be it true or false, I deem it my duty
to publish it without any avoidable delay, in order that the most
extensive and the speediest trial may be given to the proposed remedy.
I repeat what I have already stated in a previous paper--that were
mere reputation my object, I would let years pass by, and hundreds of
cases accumulate before publication; and in publishing I would enter
into every kind of elaborate detail. But the object I have proposed
to myself in these inquiries is of a very different kind. To gather
together a few strong facts, to ascertain the limits which cannot be
passed without danger, and then pointing out these to the profession,
to leave them to prosecute and decide on the subject of discussion,
such seems to me the fittest mode of attempting to explore the
medicinal resources which an untried remedy may afford.
It may be useful to add a formula for making the preparations which I
have employed.
The _resinous extract_ is prepared by boiling the rich, adhesive tops
of the dried _gunjah_, in spirit (sp. gr. 835), until all the resin
is dissolved. The tincture thus obtained is evaporated to dryness by
distillation, or in a vessel placed over a pot of boiling water. The
extract softens at a gentle heat, and can be made into pills without
any addition.
The _tincture_ is prepared by dissolving the extract in spirit of 835°
density.
_Doses, &c._--In _tetanus_ a drachm of the tincture every half hour
until the paroxysms cease, or catalepsy or narcotism is induced. In
_hydrophobia_ I recommend the resin in soft pills, to the extent of ten
to twenty grains to be chewed by the patient, and repeated according
to the effect. In _cholera_, thirty drops of the tincture every half
hour will be often found to check the vomiting and purging, and bring
back warmth to the surface. My experience would here lead me to prefer
_small_ doses of the remedy in order to excite rather than narcotise
the patient.
I have only further to add, that since the substance of the preceding
memoir was first published, numerous cases have come to my knowledge
in which the _churrus_, or resin prepared by the natives for smoking,
has been used with little effect. This was the case in some experiments
made by Dr. Pereira with _churrus_ which I sent him myself. Age and
adulteration have been probably both concerned in rendering this
substance inactive. But with the alcoholic extract made from the tops
in the way I recommend, the practitioner has only to feel his way, and
increase the dose till he produces intoxication as the test of the
remedy having taken effect.
Of all powerful narcotics it is the safest to use with boldness and
decision.
I have given Mr. Squire, of Oxford-street, a large supply of the
gunjah, and that gentleman has kindly promised me to place a sufficient
quantity of the extract at the disposal of any hospital physician or
surgeon who may desire to employ the remedy. My object is to have it
extensively and exactly tested without favor or prejudice, for the
experience of four years has established the conviction in my mind,
that we possess no remedy at all equal to this in anti-convulsive and
anti-neuralgic power.
(_Date of Reprint_) London, January, 1843.
FOOTNOTES:
[1] For very fine specimens of _churrus_, I have to express my thanks
to Dr. Campbell, late political resident at Nipal.
[2] By this term is probably meant the first of the Sassanian dynasty,
to whom the epithet of “Khusrow” or Cosroes, equivalent to Kȧiser,
Cæsar, or Czar, has been applied in many generations. This dynasty
endured from A.D. 202 to A.D. 636.--_Vide note 50 to Lane’s Translation
of the Arabian Nights_, _vol._ ii. p. 226.
[3] Handbuch der Medicin und Pharmac. Botanik, von F. Ness von Esenbeck
und Dr. Carl Ebermaier, vol. i, p. 338.
[4] Although I observed no effect from two drachms of hemp resin given
to a horse, Messrs. Hughes and Templar, of Calcutta, have since cured
four horses of traumatic tetanus by giving half-pint doses of the
tincture.--W. B. O’S.
[5] The nurse, I should have mentioned, was changed early in the
illness, and change of air resorted to on the river, but in vain.
INDIAN HEMP.
TO THE EDITORS OF THE PROVINCIAL MEDICAL JOURNAL.
GENTLEMEN,--With reference to my paper on the Indian Hemp, lately
inserted in your Journal, I trust I may be permitted to disclaim any
wish to advance these preparations as specifics in the treatment of
tetanus, or in spasmodic diseases generally. That hemp possesses great,
indeed extraordinary, anti-convulsive power, I feel assured from
numerous facts which I have myself observed, and which others have also
witnessed. The cases of the six horses affected by traumatic tetanus,
recorded in my paper, of which four recovered, are almost enough
by themselves to convince any unprejudiced person of the energy and
promise of this drug.
Many failures must be expected at first, from the salutary caution
all good practitioners must observe in the doses of a remedy with
which they are not practically familiar. On this point I have further
to remark that in a case of traumatic tetanus, now under treatment,
fifteen grain doses of the resin have been given every second or third
hour, and of these doses five taken before narcotism was induced.
In cases of tetanus, I consider no trial of the drug at all conclusive,
unless it has been pushed to the extent of inducing stupor and
insensibility.
Too much importance has been attached by commentators on my paper to
the occurrence of _catalepsy_ as an effect of this drug; catalepsy I
have witnessed unequivocally in many cases, but the effect is not an
universal one; I have seen it produced by ten drops of the tincture,
and by one grain of the resin. But, on the other hand, I have given
fifty grains in one day to a tetanic patient without any such effect
being observable.
It seems quite evident, from the experiments made by Mr. Ley and Dr.
Pereira, that much larger doses must be used in this country than
those we found sufficient in India. The cause of this is possibly
to be traced to molecular chemical changes taking place by age in
the constituents of the drug, and analogous to those familiar to the
profession in the case of hemlock and its active principle.