248 REPORT OF THE INDIAN HEMP DRUGS COMMISSION, 1893-94. [CH. XII.

of toxic insanity by which it can be recognized just, or nearly as readily, as those
of delirium tremens distinguish alcoholic intoxication. To enable me to do so
clearly, it is necessary to distinguish between acute ganja intoxication due to a
single debauch or to continuous excessive use of it in what might be called a bout
of ganja drunkenness, and the effects of its continued immoderate use over
a lengthened period of time. Acute ganja intoxication is marked by the extreme
vehemence of the mania. In its mental, moral, and muscular manifestations, it
bears no resemblance to alcoholic intoxication whatever. The maniac is excited
in every fibre. His aspect is infuriated, his eye glares and is tense and glistening,
while at the same time the conjunctiva is red and injected. He shouts, vocifer-
ates, sings, walks quickly up and down or round his cell, and shakes the door out
of its fastenings. If at liberty, he is violent and aggressive, and may run amok. In
other cases the mental disturbance is less marked, but the demeanour is excited,
and he suddenly seizes some weapon, and slays one or more of the people in his
neighbourhood without apparent reason. The attack is of short duration, being
limited to a few days. Then there is perfect recovery, and the patient is oblivious
of things which took place during the period of intoxication............The insanity
produced by the long-continued immoderate use of ganja has also features of its
own. The patients are hilarious, attitudinise, and are full of the sense of well-
being; they are as a rule good-natured and trustworthy, and recover in a large
proportion of cases under confinement and deprivation of the drug. These cases
characterize Indian asylums by the large number of happy amusing lunatics
they contain. They are, however, very subject to relapses even after lengthened
periods of freedom from symptoms."

The alleged shorter duration of hemp drug cases is to some extent borne
out by the statistics obtained by comparing the accepted and rejected cases for
1892. In the accepted cases (98), after deducting the ten patients who were
not insane on admission, the percentage of recoveries has amounted to 56.8 per
cent. of the total admissions, while of the rejected cases only 32.4 per cent. of
the admissions have recovered. The Commission consider, however, that too
much stress should not be placed upon rapidity of recovery as a diagnostic sign
in attempting to differentiate between hemp drug and ordinary mania. It is
well recognized that as a rule ordinary uncomplicated cases of mania rapidly
recover. Moreover, bearing in mind that hitherto hemp drug cases have been
accepted as such as a rule on untrustworthy evidence, and that consequently
many of the cases on which Superintendents of Asylums have based an opinion
as to the relative rapidity of cure of hemp drug and ordinary mania were not
actually toxic cases, "rapidity of recovery" can only be accepted tentatively
as a means of discrimination. It is scarcely necessary to observe that this so
called "diagnostic mark" has not been used in diagnosing hemp drug insanity in
the asylums, as it has been shown that diagnosis was made on the admission of
the patient and not after his recovery.

In connection with the alleged greater recoverability of cases of hemp drug
mania, it may be of interest to quote statistics of cases in an English asylum.
In the West Riding Asylum the percentage of recoveries in acute and simple
mania were respectively 65.5 and 61 per cent., while 8.4 and 11.9 per cent.
were relieved and 11.9 and 16 per cent. formed a chronic residue. Taking all
maniacal forms in the same asylum (including the simple, acute, hysteric, chronic,