Two Cases of Poisoning by Cannabis Indica

BY JAMES FOULIS, M.D., F.R.C.P.Ed.

Edinburgh Medical Journal v. 8, 1900

One night at the beginning of this year, about 11:30 P.M. a young gentleman rang me up, and asked me to go as quickly as possible to see his two brothers, who, he said, were both suffering from some poison. I at once asked, what kind of poison -- was it opium! My young friend could only remember that his brothers had spoken of a drug which had a name like "Hash." I at once suspected "cannabis indica," or "Hashish," so I hurriedly looked at one or two medical books to refresh my memory as to symptoms and treatment in such a case of poisoning. On the way to the house I met a medical friend (Dr. C.), who had been sent for as the nearest medical man, and he was now on his way to bring me as quickly as possible to the patients. He had just left the patients, and he said to me he did not think there was any danger to life, though they were greatly excited, and were evidently suffering from the effects of a large dose of cannabis indica, or Indian hemp. These facts he had gathered from what he heard from one of the patients a few minutes before our meeting.

As I was well acquainted with both patients, I had great hopes I should soon find out all about the drug they had taken; and if the drug was Indian hemp, it would be comforting to tell them there was little or no danger from it. I requested Dr. C. to accompany me to the house of the patients, in case help would be needed.

The patients were brothers, A. and B. A. was twenty-two years of age, a medical student in his third year; B. was twenty years of age, an art student, quite a philosopher in his way, and of a highly strung and sensitive nature. Both were tall, powerful fellows, nearly six feet in height. On entering the dining-room, where our patients were, we saw an extra-ordinary sight. A. and B. were only partially dressed. A. was hanging tightly on to B., who was rushing round the dining-room table in a very excited state, wildly throwing about his arms and singing in a most jovial manner. They were alone in the room when we entered. A. was evidently doing his best to control B., both were panting for breath, while B. was singing out loudly in a most excited manner. A. looked pale and depressed, as if overweighted by some sense of heavy responsibility. Both in mind and body B. was in a state of extra-ordinary excitement. He appeared as if he could not talk fast enough, and as if his arms and legs were acting automatically, while A. hung like a dead-weight on the back of his brother, doing his best to control the awful restlessness. As Dr. C. and I entered the dining-room, B. was rushing wildly round the room, and A., in an almost exhausted condition, was hanging as a dead-weight on the back of his brother with his arms clasped tightly round his body. Dr. C. went quietly to an arm-chair and sat down, while I went up towards the brothers, who at once recognised me, and seemed to be wild with joy at my appearance on the scene.

The younger brother, B., threw his arms round me in a loving embrace, and spoke most kindly and even tenderly to me; and then all of a sudden he began to quote poetry, and in an excited manner asked me which poet I liked best, naming several, one after another -- the brother A. calmly looking on, and regaining his breath after the recent struggles. A perfect torrent of words and poetic sentences was showered on to my face in this moment of excitement, and then B. rushed off again round the table, with his brother after him, endeavouring to control him, as before.

I also did my best to control A., making the mistake of trying to argue with him as to such foolish conduct. This seemed to excite B. very much, and he made a rush at Dr. C. as if to strike him, and it required all my own power and that of A. to calm B. I then went upon the opposite plan, and agreed with A. in everything, and gradually B. became less excited. I then gave Dr. C. the hint to slip quietly out of the room, and told him to get the young brother to go off at once for a cab, as I had made up my mind that both patients would be better for a night in the Infirmary.

It is necessary here to state that the parents of our patients were at this time in the country, after an attack of influenza, for a change of air, and that the only relative in the house besides the youngest boy was a sister, who at this particular hour was fast asleep, and happily unconscious, in a room at the very top of the house.

As soon as Dr. C. left the house and the young boy had gone for a cab, I thought of an emetic for my patients. I could not find mustard; but I had in my pocket a bottle of ipecacuanha wine, a large dessert-spoonful of which I persuaded B. to swallow. As it was nearly two hours since the drug had been swallowed, I had little hopes that an emetic would do good, and it was not possible for me to give an antidote to cannabis indica. I therefore decided to stay with my patients until I could safely get them to bed, either in their own house or in the Infirmary. For a full quarter of an hour after this our time was spent in rushing round the room, accompanying B. as he dashed about his arms and legs, and as he talked and sang and quoted poetry incessantly. A. looked quite tired out. He was quite conscious, and able to talk sensibly regarding the situation; but it was impossible to get B. to do anything else than dance and sing and talk. I saw an open penknife on the dining-room table when I entered the room at first; this I took possession of. At last we heard the cab drive up to the front door. It was now snowing hard, and the air was very cold. A. put on his coat and cap, and after some trouble we managed to get B. to put on his coat and hat, and then with a rush we all bundled into the cab, and I told the cabman to drive rapidly to the Infirmary. A. and I got B. into a corner of the cab, where we partly held him down, for fits of excitement came upon him at simple suggestions, and it was most difficult to prevent him from becoming violent. Fortunately B. and I were great friends, and my plan of humouring and agreeing with him had a soothing effect upon him.

After what seemed a terribly long journey, we at last reached the Infirmary at about 1 A.M., in the midst of a heavy snow-storm, and we at once went into the medical waiting-room and rang up the resident medical officer.

During our journey to the Infirmary, A. was very depressed. His head hung down, and I saw him continually feeling his pulse; and he frequently asked me if he was going to die. On the other hand, B. was very lively during the journey -- songs and poetic quotations would come out, in spite of a tendency to yawn occasionally. I rather thought the dessert-spoonful of ipecacuanha wine was now nauseating him slightly, but he did not vomit. The medical officer was greatly puzzled by B.'s symptoms, and began questioning him. This greatly excited B., who went at the doctor. The latter quickly retreated to a corner of the room, while A. and I took possession of B. once more.

The doctor told us there were no private wards to be had, and that the only beds vacant for such a case were in the D.T. Ward. This was rather trying to my patients, especially to A. but B. was still quite jovial, and did not seem to care about anything as long as he could sing and talk.

Up to this time I had a difficulty in seeing into B.'s eyes. I now saw that his pupils were widely dilated, and I found that his pulse was rapid and small.

I left my patients in the care of a strong male nurse in the D.T. Ward. Next morning at 10:30 I called at the Inirmary, but found that my patients had left that excellent institution, the D.T. Ward, at 9:30 A.M., and had reached home in time for breakfast with their astonished and wondering sister, who had so peacefully slept through the previous night, in blissful ignorance of all that had occurred in the dining-room between the hours of 10 P.M. and 1 A.M.

The elder of the two patients, A. -- the medical student -- has written a description of his experiences, which I now append.

An Experience under Haschish, or "A Night Out." -- With a view to experiencing the wonderful dreams said to be produced by haschish, or cannabis indica, my brother and I on three successive occasions took doses of that drug. On the first occasion we took twenty-five minims of the tincture. This produced no effect on my brother, but, on the other hand, I began to feel somewhat hysterical. Hoping that it would produce the desired effect, I went to bed. After about half an hour's sleep, I awoke trembling all over. I soon, however, went to sleep again, and there was no further result.

On the second occasion (a week later), we took over forty minims. My brother chose as a fitting subject to excite the dreamy, imaginative state of which we were in quest, De Quincey's famous "Confessions," from which he read aloud. I soon found myself totally unable to follow him, and was seized with uncontrollable convulsions of laughter, in which my brother joined, although he seemed to have more control over himself than I had. I soon went to bed. My brother followed two hours later in an extremely nervous condition, and frightened like a child in the dark. We neither of us experienced the dreams we had anticipated.

After a three weeks' interval, we tried a third time, taking on this occasion over ninety minims. My brother, taking the dose after me, drank in all probability a considerable amount of sediment, although there was still some of the drug left in the bottle when he had finished.

In about twenty minutes we both began to feel exhilarated, the dose, as before, having a greater effect upon me. I felt decidedly pleased with myself, and versatile. My brother failed to follow my erratic criticisms on some of Beardsley's weird drawings, at which we were looking. Then one of the figures before me began to nod and whirl round. Suddenly I felt myself carried away as it were by a whirlwind, and finally lose consciousness. Here I must quote my brother's account of what happened at this moment.

"Scarcely had my brother," he writes, "recovered from his hysterics when he sprang up with appalling suddenness, upsetting everything, and shouting exultingly, 'Hurrah! I'm off!' Almost instantaneously he became unnaturally serious, and began muttering, 'We've done a damned foolish thing, a damned foolish thing!' all the while stamping up and down the room, striking and kicking out with his arms and legs as if struggling with some invisible antagonist."

The next thing I remember after regaining consciousness was the room heaving up and down. I was standing, trembling from head to foot, clutching my brother. First it seemed I was towering above him; then he in his turn overtopped me. With each upheaval of the room I felt we were growing worse and worse. It was a nightmare in its most horrible phase -- a feeling that we were drifting into an irrevocable madness. I felt as if I was at the mercy of some supernatural force, which was sweeping through my brain, keeping me in a breathless state of suspension. Everything -- time, objects -- seemed to be rushing past me. I was nerved to the extremest limit of excitement. Would this force suddenly break itself up and play havoc with my brain, urging me to the very verge of insanity? It was as if a mesmerist was compelling his unhappy victim to perform some act of hopeless madness. What was going to happen next! Should we indeed commit some senseless deed, which we were powerless to prevent! This growing sense of responsibility made me think of putting ourselves into the hands of a policeman; but before I could formulate such an idea into words, everything again became blank. When I again recovered consciousness, it gradually dawned upon me that possibly I alone was mad. It took some time to convince myself that this was really the case. My brother assured me that he was sane, and this gave me an immense relief. There was now somebody to look after me. I was in safe hands, in case I should attempt anything foolish. I now realised in a forcible yet dim sort of way the necessity of controlling myself. The importance of not arousing the inmates of the house was the predominant idea throughout my subsequent actions that night. I took an exultant pleasure in grinding my teeth, clenching my hands, striding up and down the room, in the endeavour to prevent the fit which every moment I was anticipating. Sometimes I would stand still, quivering from head to foot. Presently I heard my brother mention "mustard," which I must have unknowingly suggested to him, with the idea that a vomit would help matters. We failed to discover any. Then I remembered some morphine tabloids which I had upstairs with my hypodermic. This my brother went to fetch; but, feeling that I should be unable to control myself in his absence, I followed behind. I found the tabloids, and took them in my hand, and then again all was a blank. The next thing I remember was swallowing spoonfuls of salt, in the hope that this would make me vomit. Meanwhile my brother had awakened my youngest brother, and, on emerging from the pantry, I heard him giving him orders to fetch a doctor. In the middle of his directions he broke into an insane fit of laughter. This completely mystified my youngest brother, who had previously witnessed my own strange behaviour, and thought than in any case his other brother would be in his right senses.

At this juncture we returned to the dining-room. The sudden outburst of insane laughter on my brother's part somewhat sobered me. Was he also going mad? I realised now the increased horror of the situation. Every now and then he would burst out into laughter. It seemed to me an absolute necessity that, if he was going to abandon himself to the wiles of the drug, I should keep control over my actions. About this time I felt my limbs contracting. In my excitement I pictured myself assuming that posture of opisthotonos.

I rubbed my calves, stamped up and down the room, opened my pen-knife and dug it into my hand. My brother, however, in one of his intervals of sanity, not approving of my possessing a knife, endeavoured to take it from me; but before he could do so all again became a blank -- this time for both of us. Strange and absurdly silly ideas now began to pass through our minds, one after the other. We related stories to each other, never failing to laugh at the conclusion of each, however much they might be lacking in wit. In fact we were immensely pleased with ourselves. There was a general feeling of cleverness in the air, exhilaration. Subsequently I noticed my brother getting more noisy, even pugnacious. I had to laugh now at his jokes, fearing there might be an unfriendly rupture between us if I did not. It was all-important that there should be no outbreak of hostilities between us. He now developed an insane desire to peep out of the windows, and see if people were watching us from the street. Then, imagining he heard whispers outside the room, he would rush off to the kitchen banisters and peer downstairs to see if the servants were listening to us. This irritated me intensely; I thought it quite unnecessary. Then he would begin marching round the dining-room table, waving his arms, striking absurd attitudes, and singing in a low voice.

Then perhaps there would be an interval of relative sanity. Thinking we heard steps outside, we would rush to the hall-door to see if the doctor had arrived; or else he would again go up to the window or peer down the kitchen stairs, returning eventually to the dining-room and resuming his march round the table. Now, instead of singing and preaching sotto voce, he would get louder and louder. In vain I imitated him in whispers, in the endeavour to make him follow my example, so as not to arouse the household. He could not control himself. At last the doctor arrived. I implored him to give us morphia; but, after deliberating for some time, he decided to fetch our medical attendant. I besought him not to leave us alone, dreading that we might go totally mad during his absence. However, he decided to leave us.

The doctor once gone, my brother again returned to his interminable march round the table. Sometimes he would get more boisterous and hit me about in a good-natured way. I meekly submitted to this, laughed, and pretended to enjoy it, knowing that it was best to humour him. Once or twice I was foolish enough not to fall in with his insane ideas, and then he would go for me in earnest. After that I disagreed with him no more, and he returned to his everlasting promenade. How many times we walked round that table I should not like to say. Of this period my brother writes: "I have an impression that throughout the evening we spoke to each other in husky whispers; and I can remember vividly how strangely our natural voices sounded when, on one or two occasions, we spoke aloud. The sound was as of voices coming from another and far-distant world."

The drug was now exerting a very different effect on me. I began to feel extremely depressed and weary. I felt as if some magnetic force was dragging me to the ground. My limbs were heavy and aching. I gazed in despair at my brother, who still, as idiotic as ever, was waving his arms, imagining himself at the head of some triumphal procession. How long this dreary comedy lasted I do not know -- it seemed to me hours. I dared not now go to the door and look out, fearing my brother might stampede upstairs or out into the street. At last our medical attendant, Dr. Foulis, arrived. He immediately took in the situation. My brother took to him at once, shook hands, and probed him with good-natured jokes, -- "Swinburne is the poet I like -- Rossetti: now what do you think of Tennyson, doctor?"

It now dawned upon me that perhaps this escapade was going to end in death, and a most vivid picture presented itself to my mind. It was a picture showing Virgil and Dante standing on a rocky ridge overhanging a deep abyss, whence are issuing multitudes of lost souls on their way to Hades. I imagined myself standing on that ridge watching the unending and evermoving throng passing out of sight. Above me there seemed to be an irresistible force, dragging me most unwillingly from that spot. I told the doctor that I felt in the presence of death -- that feeling described by patients who suffer from angina pectoris. The doctor assured that the drug seldom proved fatal. This annoyed me extremely. I felt a craving to linger over the scene of the picture, thinking that I might possibly participate in it. Eventually the doctor told me that he was going to take us off to the Hospital. While waiting for the cab, the doctor gave my brother a considerable dose of vin. ipecac., which, however, never acted. He subsequently examined his pupils and found them widely dilated; the pulse was rapid and full; mine was rapid, but weak. At last the cab arrived. My brother made but little difficulty about entering. "During the whole time," my brother says, "that I was under the influence of the drug, I felt nothing but merriment and elation. The only exception to this was on hearing that I was to be taken to the Infirmary, when I felt like a criminal being dragged off to prison, humiliated and fearful."

Once in the cab I experienced intense relief, the necessity for that rigid control having vanished, my brother could now give vent to his feelings without any disastrous consequences. In fact, he had somewhat quieted down. He seemed to have passed the most acute stage.

We entered the Hospital gates a little before one o'clock, i.e., two and a half hours after having taken the drug. It gave me rather a shock at first to know that I was to be an inmate of the famous D.T. Ward, but I soon entered into the novelty of the situation. I must say that I felt at first rather like a condemned criminal being conducted to his cell. Whilst waiting in the corridor outside the ward, my brother suddenly made a rush at me, and there we stood clasping each other's arms, gazing at each other half stupefied, and engaging in a half-hearted struggle -- an exact reproduction of that characteristic picture of two drunkards struggling together, neither of them being any the worse for the encounter.

My brother was soon after taken off by the keeper and given a bath. Finding that the water sustained its normal tint, the attendant remarked cheerily, "You don't want much of a bath, you don't!" at which my brother was duly flattered. I was not even offered a bath. We were then handed over to the nurse. I am afraid she did not look upon us in a very favourable light, although I tried to impress upon her that it was an extremely interesting experience. Indeed, it was with difficulty that I could persuade anyone that we had not been taking the common drink. Lastly, our names and addresses were taken. My brother was under the impression that we ought to give false ones, but gave himself away by telling me so at the top of his voice. "Matthew," he said in answer to the nurse. "Nonsense," she replied. "Matthew Prior -- Matthew, Mark, Luke, and John went"- In the end I had to answer for him.

Finally, thoroughly tired out, I sank into a doze. Sometimes I would hear my brother singing to himself, as pleased and contented as ever. I saw the resident pass round on his nightly round, and then succumbed to sleep.

The effect of the drug lasted for three or four days, during which time we were in an extremely unstable state of mind, and had to keep a constant guard over our actions. On the afternoon of the following day, my brother had another attack. "I became restless," he writes, "wandered about the house, and finally shut myself into the drawing-room, where I danced and sang for my own delectation in front of the looking-glass. Mixed with my merriment was a sinister vision of my brother coming back, raving mad, from a concert to which he had gone that afternoon. I pictured to myself the door being suddenly flung open, and my brother standing at the doorway with flaming eyes; and I knew if this happened I should rush at him with murderous intent."

The following is the account of his dreams, on falling to sleep at the Infirmary: -- "Upon falling to sleep I experienced the most exquisite dreams. The sky was scinrillating with delicate colours, rapidly succeeding one another. Then came shifting landscapes of unimaginable beauty, following fast upon each other, and all too quickly disappearing."

Such was the unexpected sequel brought about by a draught of that green liquid. I remember saying at the time how extremely suggestive it was -- suggestive perhaps of some magic potion. I compared it to the crimson wine with which Circe intoxicated and beguiled away her unwary guests. Certainly, it seemed to me that there was some definite yet unfamiliar force which had taken temporary possession of my body, and was expending itself on my nervous mechanism, producing a state of molecular unrest which at any moment might culminate in a nerve storm. So real and persistent was this presence, that I should like to believe the drug to have acted in the following manner, that it so altered the relation of the molecules to one another in the nerve cells, by the increased influx of the blood to the brain, that they became capable of receiving waves of vibrations (thus producing the feeling described), which normally pass through the brain without exerting any influence over it. It was a most ludicrous and, under different circumstances, might have been a most enjoyable experience. The imperative necessity that ever weighed most heavily upon us -- that of keeping ourselves under control -- and the trouble we entailed on those who attended us, prevented this.

I think the following points to be of some considerable interest: --

First, the different ways in which the drug expended itself on my brother and myself. Our ages are respectively twenty and twenty-two. In my brother's case the onset of his period of excitement was postponed for some little time and was gradual in character. Also his lysis, if I might so call it, was more prolonged than mine. Then the occurrence of his outbreak on the following day. Lastly, his pupils remained dilated for at least four days after the taking of the drug. I think that all the above facts may be accounted for by the fact that his dose contained much of the resinous material undissolved, forming a sediment at the bottom of the bottle. His dose, therefore, took some time in being absorbed by the stomach, and some of the resin may even have remained undissolved until the day following, thus accounting for his second outbreak.

In comparing my own case with his, the onset was much sooner, and was almost instantaneous, reaching its climax at once. Later, this stage of excitement gave way to one of extreme mental depression. This state of mental depression stands out in striking contrast to that of my brother's, which was one of levity throughout the evening. I was able to experience the numbing effect of the drug whilst digging the knife into my hand. There were no dreams in my case. And, secondly, in neither of us did the drug produce its reputed aphrodisiac action.