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The Therapeutic Value of Cannabis Indica
The following is a good example of an article written just before the turn of the (19th into the 20th Century) about the medical uses of Cannabis. Note that not all of the patients mentioned in the article faired well (which is to be expected in a medical setting) and that some of the information (as stated) sounds like it could have come right out of the Reefer Madness era. But overall, it presents a very good discussion on the uses of Medical Cannabis during that time period.
The TEXAS MEDICAL NEWS Vol. 8, Aug. 1899
The Therapeutic Value of Cannabis Indica. (Read before the Central Texas Medical Association in June, 1899.) By BY JOHN V. Shoemaker, MD., LL.D., of Philadelphia.
Cannabis indica is a very interesting drug on account of the peculiarity of its physiological action and the excesses which, in Oriental countries, have been committed under its influence. In the East its more remarkable properties have been known for many centuries. It was employed medicinally in the early Middle Ages by the Arabian school of medicine and became known wherever the culture of that people prevailed. Its introduction into modern medicine is principally due to the clinical investigations of Dr. O'Shaugnessy of Calcutta, about sixty years ago. Although, since that time it has always been employed in practice to a certain extent, yet it has not obtained such general recognition as its powerful properties might lead us to expect. One reason for this Comparative neglect is that until recently there has been much variation in the quality and strength of the preparations obtainable and, consequently, much want of uniformity in its medicinal action. As a neurotic remedy, also, it has been overshadowed by opium. Cannabis, however, though its sphere is confessedly more restricted, possesses virtues, which in some cases render it superior to opium. The preparations of cannabis indica available in this country are a solid extract, of which the average dose is half a grain; a fluid, extract, of which from one to twenty minims may be given; and a tincture, the dose of which is from ten to twenty minims.
PHYSIOLOGICAL ACTION.
Cannabis indica is destitute of local action. According to German Sec, it has a special sedative effect upon the pneumogastric nerve and that author terms the drug "a true sedative of the stomach." From the recent researches of Dr. C. R. Marshall, of Cambridge, England, it appears that the drug is probably absorbed only from the intestines. "The condition of the stomach, however," writes Dr. Marshall, "plays an important part in the time of appearance of the symptoms, probably by hastening or retarding the course of the drug to the intestines. Thus in one case, when the drug was taken on an almost empty stomach, four hours passed before the onset of the symptoms, whereas, if taken just before a meal, the first symptoms invariably occurred within one and a half hours. Taken after meals the appearance of the first symptoms is variable. * * * The small solubility of The drug, even in alkalies, prolonged accounts for the insidious onset of the symptoms and its prolonged effect. The main action of Cannabinol, however, is on the nervous system and probably upon the cerebral cells." Indian hemp has but little direct influence upon the digestive processes but possesses an advantage over opium in not producing constipation. Neither does it interfere with the secretion of the bronchial mucous membrane. It has but little effect upon the circulation. The primary action of cannabis indica upon the nervous system is stimulation and the secondary effect is depression. This drug relieves spasm and pain. It also possesses hypnotic virtues. The most striking peculiarity of cannabis indica upon the brain is the appalling extension of the ideas of space and time. When the full physiological effect of the drug has been secured an hour will seem stretched out to an interminable period and a city street or a country road will project indefinitely into space. A room of ordinary size will expand to the dimensions of a vast hall. A sense of double consciousness is also sometimes produced. "A most interesting condition, after large doses," writes Dr. lvlarshall, "is the occurrence, alternately, of loss of control and lucid intervals. During the latter, all the elements of complete sanity are present, but the physical state is below the normal level. In it the processes on which consciousness depend are readily exhausted and the condition of irresponsibleness develops. Slight mental strain during the lucid periods seem to hasten the occurrence of a state of irresponsibility. A more complete rest from thought brings back the rational intervals."
A toxic dose of cannabis indica may cause coma and epilepsy, but seldom results in death. In eastern countries, where an impure preparation is used to excess, a furious intoxication is often produced. The wild Malays experience an insane impulse to slay, rushing along a crowded street, knife in hand, slashing without discrimination every one whom they meet. The abuse of cannabis indica is it frequent, source of insanity in the Orient.
These extreme effects of Indian hemp, however interesting they may be from certain standpoints, do not closely relate to the object of this paper and to our purposes as practitioners of the healing art. Our principal concern is with the application of the drug to therapeutics.
As with other narcotic substances, a considerable variation is observed in the readiness with which different individuals respond to the influence of this drug. Differing from opium in one important particular, cannabis indica has rather less proportionate influence upon children than upon adults.
THERAPY.
Cannabis indica renders efficient service in allaying the pain of functional and organic diseases. From its marked sedative effect upon the stomach, it is a valuable remedy in that distressing, malady, gastraigia. I have, in frequent instance witnessed marked relief from its use in this malady. It assuages the paroxysms of pain, and, in association with other remedies, together with regulation of the diet and observance of hygienic rules, it aids in effecting a permanent cure. A case which pointedly illustrates the benefit of cannabis indica in this affection may he here briefly narrated.
Case 1. Gastralgia.
A man, 35 years of age, had for two years been subject to frequent and severe attacks of pain, referred to the epigastrium. There was habitual constipation but no vomiting. The quantity or nature of his food had little, if any, relation to the occurrence of pain. There was some tenderness upon pressure and the pain would sometimes radiate to other portions of the abdomen. There was no evidence of gastro-intestinal catarrh or malignant disease.
We sometimes encounter affections apparently of a similar character involving principally the intestine. Neuralgia of the intestine, or enteralgia, is distinguished by paroxysms of intense abdominal pain. A case of the kind in which cannabis indica was used with happy effect was the following:
Case 2 Exteralgia.
A man, 55 years of age, who had long been of a constipated habit, had been affected for two or three years, by violent pain in the lower abdominal regions. The distress was aggravated when had been for some time unrelieved. The attacks had gradually become more frequent and were of almost daily occurrence. The paroxysms lasted for several hours. They did not seem to be excited by the food taken. There was no abdominal growth and inflammation of the bowel could be eliminated.
In this case cannabis indica produced a very satisfactory improvement. It was given in the form of extract and in the dose of one-fourth of a grain three times a day for a while, when it was cautiously increased to one-half grain. An occasional laxative was ordered as required, but the cannabis indica so far overcame the tendency to constipation that not much medicine of this kind was needed.
The pain of gastric ulcer is materially mitigated by the administration of cannabis indica, and this remedy is also serviceable in checking the hemorrhage. In this disease a combination of Indian hemp with silver nitrate is very effective. This combination was of marked efficacy in the following case which may be briefly cited as an example of the value of the remedies employed:
Case 3 Gastric Ulcer.
A woman, aged 30 years, suffered from the usual symptoms of gastric ulcer. The trouble had been in existence for two months. There was indigestion, pain in the epigastrium radiating into the back, and hemorrhages. There was some loss of flesh, but no cachexia or tumor. Malignant disease was excluded by these facts and also by the age of the patient. The woman, in fact, made a satisfactory recovery under the treatment adopted. The power of the Indian hemp in assuaging the sharp pain was undoubted. It likewise lessened hemorrhage.
In nervous dyspepsia associated with constipation this remedy is beneficial by relieving the disorder of the nervous system, which causes or which attends the case. Its freedom from constipating effect renders it additionally serviceable in affections of this nature. On the other hand, it has often been given with advantage in diarrhea attended by indigestion.
This remedy possesses a well marked sphere of usefulness in disorders of the female sexual apparatus. It assuages suffering and restrains hemorrhage. In chronic endometritis and uterine subinvolution Indian hemp, in conjunction with other agents and the proper local measures, is of distinct service. it relieves the pain of ovaralgia, ovaritis and dysmenorrhuea. It alleviates dysuria in either sex. In menorrhagia and metrorrhagia cannabis indica is an excellent adjuvant to the more radical methods which it may be necessary to adopt. The frequent interdependence of several of these afflicting conditions render the drug of peculiar efficacy. For example I may allude to a case in which it was used with signal benefit.
Case 4 Endometritis with metrorrhagia.
A married woman, 30 years of age, had borne two children and had had the same number of abortions. The womb was enlarged and anteflexed. There was a moderate degree of teucorrhoeal discharge. She suffered considerable pain at the menstrual periods, which were by no means regular as to time. There was considerable backache, especially during her periods, and there was often pain in passing urine. At uncertain intervals there was free hemorrhage from the womb, lasting several days, sometimes coinciding, or nearly so, with a menstrual-epock and at other times being independent of that event. This was mainly a surgical case. Marked relief of symptoms was afforded, however, by the administration of Indian hemp. It relieved pain and diminished hemorrhage, and was highly valued by the patient. surgical treatment was also instituted, and eventually the patient, who had lost flesh, weight and spirits, was restored approximately to the normal condition. Cannabis indica has been used with good results in the headaches and other nervous manifestations which attend the menopause. In these troubles it is a good practice to combine cannabis indica with potassium bromide. Indian hemp will often also reduce chordee.
In neuralgia this agent is frequently of decided service. As is well known, neuralgia depends upon various causes and the aching nerve points us to an impoverished or contaminated state of the blood, to infection or auto-intoxication, to the impression of cold and to many other deleterious influences. We cannot, therefore, cure neuralgia by one drug or any specific and universal method of treatment. In, any disease attended by severe pain it is a matter of importance to afford relief as rapidly as possible. To remove the cause of neuralgia may be difficult and may require prolonged treatment. In acute attacks the timely and intelligent administration of cannabis indica rapidly relieves the pain. I have made frequent of this drug in all forms of the disease, but it is particularly beneficial in facial neuralgia. An example of one case out of many in which this medicine was advantageously given is the following:
CASE 5.-DENTAL NEURALGIA.
A man, 40 years of age, was a victim of anterior dental and infra-orbital neuralgia. For several years he had suffered from sharp attacks of pain, principally in the incisor teeth of the right upper jaw. During an attack he was scarcely able to obtain any sleep. The pain shot upward to the infra-orbital foramen. The teeth were all sound, except one of the molars of the lower jaw.
Headache depends upon a great variety of causes. It may be due to functional or organic influences. In a large proportion of cases, even of the latter class, cannabis indica is an efficient remedy. One or the most excruciating and unpromising forms of pain ill the head is that caused by the presence of a cerebral tumor. In several cases of the kind I have witnessed marked relief follow the administration of cannabis indica. A short account of one case will serve as an illustration.
CASE 6 Cerebral Tumor.
A man, 50 years of age, had suffered for several months from the most intense agony constantly located upon the right side of the head. The torment was at times almost unbearable. Other symptoms were vertigo, vomiting and paralysis. The complexus of symptoms could be due only to a tumor of the brain. The disease did not seem to be of syphilitic origin. The beneficial influence of the cannabis indica was striking in the extreme. The remedy was given in the form of the fluid extract in the full dose of twenty minims and toward bedtime. The man had been scarcely able to obtain any sleep. He would sit up in bed, moaning and pressing his head with his hands, declaring, that the pain would drive him crazy. The effect of the medicine entirely changed the scene. The pain vanished, and the unfortunate man fell asleep and rested quietly for three hours. A -similar dose was given him in the early morning, and he again slept. From this time he was kept sufficiently under the influence of the drug to escape the torture to which he had formerly been subject. Of course, the general progress of the malady was unchecked, convulsions came on and the patient expired after he had been three month under observation. To have been saved so much suffering during the latter part of his illness was, nevertheless, esteemed a great blessing by every one concerned.
By Dr. Stephen Mackenzie cannabis indica is esteemed in the management of the headache of chronic uraemia. This writer describes the drug as almost a specific in a class of headaches of a continuous or subeutqneous type, the exact nature of which is uncertain, but which does not depend upon anemia. He was accustomed to employ the extract in pill form, beginning with doses of one fourth of a grain, increasing to one-half a grain night and morning, and if no decided improvement resulted in two week he raised the amount to one grain at night and one-half a grain in the morning. In particularly obstinate case he pushed the drug until toxic symptoms appeared. D. Mackenzie adds that the remedy acts best in the worst cases.
I have often made use of cannabis indica in neuritis and in this malady, often so distressing, have witnessed very excellent results from its use. As an example of a group of cases in which this agent may quell pain, I may adduce the following
Case 7 --- Ulnar Neuritis.
A young man, 22 years of age, had long been subject to pain in the forearm in the course of the ulnar nerve. Sometimes the pain was of an aching and again of a lancinating character. There was tenderness upon pressure over the tract of the nerve. There was no regularity or periodieify as regards the occurrence of the pain, nor did it seem to be influenced by fluctuations of the weather.
Herpes zoster is comparable to neuralgia and neuritis in respect to pain, and to the latter in regard to pathology. One should, therefore, expect to find cannabis indica as effective in relieving the sharp pain of shingles as in the affections which I have already mentioned. According to my experience this expectation is not usually disappointed. In many cases of herpes zoster the pain is atrocious. A case in which this symptom was successfully controlled by cannabis indica was as follows:
CASE 8 -- Herpes Zoster.
A vigorous man, 22 years of age, displayed the characteristic eruption of herpes zoster upon the right side. It had been in existence for three days. The eruption was the seat of sharp, darting pain. This was frequently so severe as to stamp a look of suffering upon his countenance. Signal alleviation was produced by the exhibition of cannabis indica in combination with quinine.
The lightning girdle-pains of locomotor ataxia are notably diminished by the use of Indian hemp, as are also those in the limbs and the paraesthesia.
CASE - -- LocoMotor Ataxia.
A dissipate man, 44 years of age, had for about two months unmistakable signs of posterior spinal sclerosis. There had been severe gastric disturbance, numbness and tingling with deficient tactile sensibility in the hands, forearm and arms. The same manifestations occurred somewhat later in the lower limbs. Pain also darted along the limbs and around the waist. co-ordination was defective. He could not walk well in the dark. cannabis indica accomplished good in this case. It relieved pain and paraesthesia. It abolished the gastric distress and improved digestion. The patients comfort was enhanced.
In migraine, hemierania, or sick headache the use of this remedy is often productive of excellent results. Osler regards it as the most satisfactory remedy in this distressing malady, and adds that Seguin recommends a prolong course of the drug. Russell Reynolds, whose experience of the virtue of cannabis indica covered a space of thirty years, writes that when pure and administered carefully it is one of the most valuable medicines we possess. Referring to migraine, he states that by the use of Indian hemp many patients have for years aborted threatened attacks.
Case 10 Migraine.
A young man, 26 years of age, or rather frail physique, had from boyhood been subject of periodical paroxysms of severe pain in the right side of the head, accompanied by vertigo, nausea and vomiting. The attack lasted for forty-eight hours and produced much exhaustion. His distress was aggravated by the slightest noise, by light and by movements of the body. He was compelled to keep to his bed in a darkened room until the paroxysms had ceased. Many remedies had been tried at different times, but none had been of much avail. Cannabis indica brought him more relief than he had obtained from any other substance. Convinced by experience, he had recourse to this remedy as soon as he felt the slightest promonition of an attack. He would sometimes succeed in aborting a par-oxysm and upon other occasions the severity of an attack would be much mitigated.
In another case, which might be instanced in this connection, a young woman, 24 years of age, was subject to migraine coincident with dysmenorrhoea. In this, by no means uncommon complication, the properties of cannabis indica render it doubly valuable as it effectual relieves both the hemicrania and the menstrual difficulty.
I may, in this place, appropriately refer to the value of cannabis indica in asthma, which exhibits a certain analogy to the former affection in being of a paroxysmal nature, in often depending upon lithaemia or occurring in persons of neurotic type, and in being accompanied by spasm. Both diseases also exhibit a tendency to run in families. In many asthmatic patients when, for one reason or another, morphine is admissible, I have witnessed much improvement attend the use of cannabis indica. Much the same may be said of hay fever, hay asthma, or autumnal catarrh.
The remedy has likewise a place in the management of the par-oxysmal stage of whooping cough. Cannabis indica has a field of usefulness in bronchial and pulmonary affections. It allays pain and cough without suppressing secretion. For these reasons it is serviceable conjoined with other agents in the treatment of bronchitis and pulmonary tuberculosis. It has a beneficial influence also upon reflex coughs.
Indian hemp possesses marked power in overcoming muscular spasm. It may be used with advantage in most diseases accompanied by this manifestation. One of the commonest of these is chorea. In this disease the remedy co-operates with arsenic in diminishing the nervous instability and the spasmodic movements.
CASE 11 - CHOREA.
An interesting case in which the above combination had a very happy effect was that of a little girl, 10 years of age, who, for about a month, had been afflicted at times with night terrors; who was exceedingly nervous in many ways; whose disposition and temper had seriously changed, and whose mind appeared to be weakened. At length genuine choreic movements occurred in the face and limbs. After persistent treatment, chiefly by means of the remedies specified, the child was completely restored to health. The spasmodic jerks completely subsided, and the child was eventually restored to perfect health.
Cases of epilepsy have been observed in which this remedy was used with beneficial effect. Dr. Russell Reynolds is of the opinion that it is very useful in clonic spasm, whether epileptoid or choreic in type, and also in convulsions due to gross organic lesion of nerve centers. A favorable effect may be produced upon the tremor of paralysis agitans by the prolonged administration of cannabis indica. This influence was clearly displayed in the case of an old lady under my observation, who, for years, had been thus afflicted. Although they were not entirely banished yet the tremors were undoubtedly much less severe and frequent, and less influenced by bodily movements or mental emotion. I have also witnessed good results from the employment of this remedy in cases of reflex and tremor. Indian hemp is of special value in cases where pain as associated with spasm. This activity was admirably exhibited in the case f an old woman who was attacked by spasmodic contraction of muscles in various regions of the body. The contractions raised great knots upon the limbs. Consciousness was completely preserved and the patient writhed and cried from acute agony. The effect of tincture of cannabis indica in full doses was prompt and decided. The spasms were allayed, the limbs could be extended in an easy position and the patient after awhile fell into peaceful and refreshing sleep. The painful cramps were probably of litaemic origin. There was no evidence of lesions of the nerve centers.
In another form of faulty innervation cannabis indica is an excellent remedy. I speak of what is often termed pruritis, but which prefer to designate as paraesthesia, because the alterations of sensibility are of varied character and may assume any form of sensibility which the nerves are capable of conveying to the cerebrum. Thus, one patient may be tormented with the most abominable itching, while in others the sensations may be those of burning, prickling, creeping or tingling; again, several of these perversions may be present in the same individual. Paraesthesia is often a difficult condition to treat successfully, for it depends upon a variety, of causes, and no one remedy will suit all cases.. In many instances, however, cannabis indica will afford relief, and it should always be given a trial in refractory cases. I may briefly refer here to a case in which the most atrocious itching had tormented a neurotic woman day and night for months, and in which cannabis indica produced more comfort than had been given by any of the numerous substances which had been previously tried. In many body, and for that reason local measures, with the exception of baths and electricity, are scarcely available.
Cannabis indica is one of the medicines which should be thought of in treating insomnia. I always endeavor to cure insomnia with as little aid from drugs as possible, by means of physical exercise, regulation of diet, warm baths, avoidance of excitement, travel and other hygienic measures. Nevertheless, we must often order medicine, and in some cases cannabis indica answers an excellent purpose. In senile insomnia with mental wandering, probably due to softening, nothing compares, according to Russell Reynolds, to the extract of cannabis indica given at bedtime, in a quarter to a third of a grain doses. The same remedy is valuable in the insomnia, restlessness and delirium of acute febrile diseases. It often succeeds in quieting the typhoid fever patient. This power was abundantly evidenced in the summer and autumn of 1898 when we had under our care at the Medicao-Chirurgical Hospital a large number of soldiers from the camps and field suffering from typhoid fever. I frequently obtained the happiest results from the tincture of cannabis indica. I recall, moreover, a case of rheumatic fever in which its virtues were conspicuously exhibited. The patient was a woman, about 60 years of age, formerly vigorous, but who had become subject to rheumatic attacks with cardiac debility. In the illness to which I allude, there was not much involvement of the joints, but there was a continued high temperature accompanied by acid sweats, insomnia, restlessness, delirium and enfeebled action of the heart. As morphine disagreed with this patient. I had recourse to Indian hemp, which produced an excellent effect. Through its agency sleep was procured and delirium was lessened. The drug is of advantage also in subduing the pain of rheumatism and gout. In acute and subacute cases I have in many instances observed a very favorable impression follow the administration of the remedy in question. In gout it relieves the paraesthesia as well as the pain. Cannabis indica has been used with success in order to alleviate pain in a number of other affections which entail more or less suffering. it has found a place, for this reason, in the management of hepatic or renal colic and even of cancer. I call to mind one case in which the stomach, liver and pancreas were carcinomatous and in which cannabis indica decidedly lessened the excessive pain from which the patient suffered. A case of cancer of the liver might also be instanced win which notable relief was afforded by the administration of the same drug.
The insomnia and excitement of mental alienation are not infrequently much relieved by the use of cannabis indica. I have known it to accomplish good in melancholia and acute dementia. It is often serviceable in delirium tremens, and some have written favorable of its action in tetanus.
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