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Thread: Cannabis Treatments In Obstetrics And Gynecology: A Historical Review

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    Cannabis Treatments In Obstetrics And Gynecology: A Historical Review

    Ethan Russo

    SUMMARY. Cannabis has an ancient tradition of usage as a medicine in
    obstetrics and gynecology. This study presents that history in the literature
    to the present era, compares it to current ethnobotanical, clinical and epidemiological
    reports, and examines it in light of modern developments in
    cannabinoid research.
    The author believes that cannabis extracts may represent an efficacious
    and safe alternative for treatment of a wide range of conditions in women
    including dysmenorrhea, dysuria, hyperemesis gravidarum, and menopausal
    symptoms. [Article copies available for a fee from The Haworth Document
    Delivery Service: 1-800-HAWORTH. E-mail address: <getinfo@
    haworthpressinc.com> Website: <http://www.HaworthPress.com> 2002 by
    The Haworth Press, Inc. All rights reserved.]

    Ethan Russo, MD, is Clinical Assistant Professor of Medicine, University of Washington,
    Adjunct Associate Professor of Pharmacy, University of Montana, and Clinical Child
    and Adult Neurologist, Montana Neurobehavioral Specialists, 900 North Orange Street,
    Missoula, MT 58902 USA (E-mail: erusso@blackfoot.net).
    The author would like to thank the dedicated women of the Interlibrary Loan office at
    the Mansfield Library of the University of Montana, whose continued assistance has
    helped to revitalize lost medical knowledge. Dr. John Riddle provided valuable guidance,
    while Drs. Indalecio Lozano, David Deakle and Daniel Westberg translated key passages.
    [Haworth co-indexing entry note]: “Cannabis Treatments in Obstetrics and Gynecology: A Historical Review.”
    Russo, Ethan. Co-published simultaneously in Journal of Cannabis Therapeutics (The Haworth Integrative
    Healing Press, an imprint of The Haworth Press, Inc.) Vol. 2, No. 3/4, 2002, pp. 5-35; and: Women and
    Cannabis: Medicine, Science, and Sociology (ed: Ethan Russo, Melanie Dreher, and Mary Lynn Mathre) The
    Haworth Integrative Healing Press, an imprint of The Haworth Press, Inc., 2002, pp. 5-35. Single or multiple copies
    of this article are available for a fee from The Haworth Document Delivery Service [1-800-HAWORTH, 9:00
    a.m. - 5:00 p.m. (EST). E-mail address: getinfo@haworthpressinc.com].

    KEYWORDS. Cannabis, cannabinoids, medical marijuana, THC, obstetrics,
    gynecology, dysmenorrhea, miscarriage, childbirth, fertility, history
    of medicine
    INTRODUCTION
    For much of history the herbal lore of women has been secret. As pointed out
    in John Riddle’s book, Eve’s Herbs (Riddle 1997), botanical agents for control of
    reproduction have been known for millennia, but have often been forgotten over
    time or lost utterly, as in the case of the Greek contraceptive, sylphion. The same
    is true for other agents instrumental in women’s health, frequently due to religious
    constraints. One botanical agent that exemplifies this lost knowledge is
    cannabis. As will be discussed, its role as an herbal remedy in obstetric and
    gynecological conditions is ancient, but will surprise most by its breadth and
    prevalence. Cannabis appears in this role across many cultures, Old World and
    New, classical and modern, among young and old, in a sort of herbal vanishing
    act. This study will attempt to bring some of that history to light, and place it in a
    modern scientific context.
    THE ANCIENT WORLD
    AND MEDIEVAL MIDDLE AND FAR EAST
    The earliest references to cannabis in female medical conditions probably
    originate in Ancient Mesopotamia. In the 7th century BCE, the Assyrian King
    Ashurbanipal assembled a library of manuscripts of vast scale, including Sumerian
    and Akkadian medical stone tablets dating to 2000 BCE. Specifically according
    to Thompson, azallû, as hemp seeds were mixed with other agents in beer for
    an unspecified female ailment (Thompson 1924). Azallû was also employed for
    difficult childbirth, and staying the menses when mixed with saffron and mint in
    beer (Thompson 1949). Usage of cannabis rectally and by fumigation was described
    for other indications.
    Cannabis has remained in the Egyptian pharmacopoeia since pharaonic times
    (Mannische 1989), administered orally, rectally, vaginally, on the skin, in the
    eyes, and by fumigation. The Ebers Papyrus has been dated to the reign of
    Amenhotep I, circa 1534 BCE, while some hints suggest an origin closer to the
    1st Dynasty in 3000 BCE (Ghalioungui 1987). One passage (Ebers Papyrus 821)
    describes use of cannabis as an aid to childbirth (p. 209): “Another: smsm-t
    [shemshemet]; ground in honey; introduced into her vagina (iwf). This is a contraction.”
    The Zend-Avesta, the holy book of Zoroastrianism, survives only in fragments
    dating from around 600 BCE in Persia. Some passages clearly point to psychoactive effects of Banga, which is identified as hempseed by the translator
    (Darmesteter 1895). Its possible role as an abortifacient is noted as follows
    (Fargard XV, IIb., 14 (43), p. 179):
    And the damsel goes to the old woman and applies to her for one of her
    drugs, that she may procure her miscarriage; and the old woman brings her
    some Banga, or Shaêta [“another sort of narcotic”], a drug that kills in
    womb or one that expels out of the womb, or some other of the drugs that
    produce miscarriage . . .
    Physical evidence to support the presence of medicinal cannabis use in Israel/
    Palestine was found by Zias et al. (1993) in a burial tomb, where the skeleton
    of a 14 year-old girl was found along with 4th century bronze coins. She apparently
    had failed to deliver a term fetus due to cephalopelvic disproportion. Gray
    carbonized material was noted in the abdominal area (Figure 1). Analysis revealed
    phytocannabinoid metabolites. The authors stated (p. 363), “We assume
    Ethan Russo 7
    FIGURE 1. Carbonized residue from 4th century Judea, containing phytocannabinoid
    elements, as a presumed obstetrical aid. (Permission Courtesy of the Israel
    Antiquities Authority.)
    The right and permission to reproduce Figure 1 is unavailable for the online
    version of this paper. To obtain a print copy of this paper, including Figure 1,
    please contact our Document Delivery Service at: 1-800-HAWORTH. E-mail address:
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    that the ashes found in the tomb were cannabis, burned in a vessel and administered
    to the young girl as an inhalant to facilitate the birth process.”
    Budge (1913) noted Syriac use of cannabis to treat anal fissures, as might occur
    postpartum.
    Dwarakanath (1965) described a series of Ayurvedic and Arabic tradition
    preparations containing cannabis indicated as aphrodisiacs and treatments for
    pain. It was noted that cannabis was employed in Indian folk medicine onwards
    from the 4th-3rd centuries BCE.
    In the 9th century, Sabur ibn Sahl in Persia cited use of cannabis in the
    Al-Aqrabadhin Al-Saghir, the first materia medica in Arabic (Kahl 1994). According
    to the translation of Indalecio Lozano of the Universidad de Granada,
    Spain (personal communication, Feb. 4, 2002), an intranasal base preparation of
    juice from cannabis seeds was mixed with a variety of other herbs to treat migraine,
    calm uterine pains, prevent miscarriage, and preserve fetuses in their
    mothers’ abdomens.
    In the 11th century, the Andalusian physician, Ibn Wafid al-Lajmi indicated
    that drying qualities of hemp seeds would inhibit maternal milk production. Tabit
    ibn Qurra claimed that they would reduce female genital lubrication when mixed
    in a potion with lentils and vinegar (Lozano 1993).
    In the 13th century, the famous Persian physician, Avicenna (ibn Sina) recommended
    seeds and leaves of cannabis to resolve and expel uterine gases (Lozano
    1998).
    According to Lozano (2001), Ibn al-Baytar prescribed hemp seed oil for treatment
    of hardening and contraction of the uterus (al-Baytar 1291).
    In the Makhzan-ul-Adwiya, a 17th century Persian medical text, it was
    claimed that cannabis leaf juice (Dymock 1884, p. 606) “checks the discharge in
    diarrhoea and gonorrhoea, and is diuretic.”
    Farid Alakbarov has recently brought to light the amazing richness of cannabis
    therapeutics of medieval Azerbaijan (Alakbarov 2001). Four citations are
    pertinent. Muhammad Riza Shirwani employed hempseed oil in the 17th century
    to treat uterine tumors. Contemporaneously, another author advised likewise
    (Mu’min 1669). Tibbnama recommended a poultice of cannabis stems and
    leaves to treat hemorrhoids, and the leaves mixed with asafetida for “hysteria”
    (Tibbnama 1712).
    In China, the Pen T’sao Kang Mu, or Bencao Gang Mu was compiled by Li
    Shih-Chen in 1596 based on ancient traditions. This was later translated as Chinese
    Materia Medica (Stuart 1928). In it, cannabis flowers were recommended
    for menstrual disorders. Seed kernels were employed for postpartum difficulties.
    It was also observed (p. 91), “The juice of the root is . . . thought to have a beneficial
    action in retained placenta and post-partum hemorrhage.”
    The earliest European references to the use of cannabis in women’s medicine
    may derive from Anglo-Saxon sources. In the 11th century Old English Herbarium
    (Vriend 1984, CXVI, p.148), haenep, or hemp is recommended for sore
    breasts. This was translated as follows (Crawford 2002, p. 74): “Rub [the herb]
    with fat, lay it to the breast, it will disperse the swelling; if there is a gathering of
    diseased matter it will purge it.”
    The Österreichische Nationalbibliothek in Vienna, Austria displays a manuscript
    of the Codex Vindobonensis 93, said to be a 13th century southern Italian
    copy of a work produced in previous centuries, or even earlier Roman sources
    (Zotter 1996). Plate 108 depicts a clearly recognizable cannabis plant above the
    figure of a bare-breasted woman (Figure 2). According to a translation of Drs.
    David Deakle and Daniel Westberg (personal communication 2002), the Latin
    inscription describes the use of cannabis mixed into an ointment and rubbed on
    the breasts to reduce swelling and pain.
    A translation in Old Catalan of Ibn Wafid’s work above, interpreted it differently,
    indicating that hemp seeds, when eaten in great quantity, liberate maternal
    milk and treat pain of amenorrhea (Lozano 1993; personal communication,
    2002).
    Citing the Kräuterbuch of Tabernaemontanus in 1564, it was noted (Kabelik,
    Krejei, and Santavy 1960, p. 7), “Women stooping due to a disease of the uterus
    were said to stand up straight again after having inhaled the smoke of burning
    cannabis.”
    In England, in the Theatrum Botanicum (Parkinson, Bonham, and L’Obel
    1640), John Parkinson noted (p. 598) “Hempe is cold and dry . . . the Emulsion or
    decoction of the seede, stayeth laskes and fluxes that are continuall, . . .”
    In 1696, Georg Eberhard Rumpf (Rumphius), a German physician in the service
    of the Dutch crown, reported on the use of cannabis root in Indonesia to treat
    gonorrhea (Rumpf and Beekman 1981, p. 197): “the green leaves of the female
    plant, cooked in water with Nutmeg, to drink to folks who felt a great oppression
    in their breasts, along with stabs, as if they had Pleuritis too.”
    According to Hamilton (1852), Valentini recommended hemp seed emulsion
    in the previous century to treat furor uterinus, a loosely defined malady of the era,
    frequently associated with nymphomania, melancholia or other ills, more fully
    discussed by Dixon (1994).
    In his book, Medicina Britannica, Short (1751) employed cannabis for treatment
    of obstruction of the menses, even of chronic duration. In one case, he stated
    (p. 137-138), “I once ordered only the Hemp alone, where they [menses] had
    been obstructed not only Months, but some Years, with Success; and, when it
    could not break the Uterine or Vaginal Vessels, the Woman threw up Blood from
    the Lungs, but had them naturally the next Time.”
    FIGURE 2. Plate from the Codex Vindobonensis 93 from the 13th century or earlier,
    depicting use of cannabis to allay breast swelling and pain. (From Bildarchiv
    d., with permission of the Österreichishe Nationalbibliothek, Vienna, Austria.)
    The right and permission to reproduce Figure 2 is unavailable for the online
    version of this paper. To obtain a print copy of this paper, including Figure 2,
    please contact our Document Delivery Service at: 1-800-HAWORTH. E-mail address:
    <getinfo@haworthpressinc.com> Website: <420 MAGAZINE. com>
    Short (1751) also described a combination of hemp in “New-wort” (steeped
    crushed grain used in brewing beer) with feverfew (Tanacetum parthenium) and
    pennyroyal (Mentha pulegium) employed on three successive nights to (p. 137)
    “bring down the Menses minime fallax.” Feverfew has anti-inflammatory effects,
    while pennyroyal is a known abortifacient (Riddle 1997). Thus, this treatment
    may well have induced miscarriage.
    Finally, Short (1751, p. 138) noted this of a complex herbal mixture with
    hemp: “Some pretend the following a great Secret against Pissing the Bed . . .”
    In 1794, the Edinburgh New Dispensatory noted use of a hemp seed oil emulsion
    in milk, useful for “heat of urine,” “incontinence of urine,” and “restraining
    venereal appetites” (Lewis 1794, p. 126).
    After the reintroduction of cannabis to Western medicine in the form of solid
    oral extracts and tinctures by O’Shaughnessy (1842), its spectrum of activity
    quickly extended to many conditions. The first citation of its use for uterine hemorrhage
    in modern medicine is probably from Churchill (1849), and its discovery
    for this indication was apparently serendipitous (p. 512):
    We possess two remedies for these excessive discharges, at the time of the
    menses going off, which were not in use in Dr. Fothergill’s time [18th century].
    I mean ergot of rye, and tincture of Indian hemp. . . .
    The property of Indian hemp, of restraining uterine hemorrhage, has
    only been known to the profession a year or two. It was accidentally discovered
    by my friend, Dr Maguire of Castleknock, and since then it has
    been extensively tried by different medical men in Dublin, and by myself,
    with considerable success. The tincture of the resin is the most efficacious
    preparation, and it may be given in doses of from five to fifteen or twenty
    drops three times a day, in water. Its effects, in many cases, are very
    marked, often instantaneous, but generally complete after three or four
    doses. In some few cases of ulceration in which I have tried it on account of
    the hemorrhage, it seemed to be equally beneficial.
    Alexander Christison extended the work of Churchill and applied Indian
    hemp to the problem of childbirth (Christison 1851), offering the following (pp.
    117-118):
    Indian hemp appears to possess a remarkable power of increasing the force
    of uterine contraction during labour . . .
    One woman, in her first confinement, had forty minims of the tincture of
    cannabis one hour before the birth of the child. The os uteri was then of the
    size of a shilling, the parts very tender, with induration around the os uteri.
    The pains quickly became very strong, so much so as to burst the membranes,
    and project the liquor amnii to some distance, and soon the head
    was born. The uterus subsequently contracted well.
    Another, in her first confinement, had one drachm of the tincture, when
    the os uteri was rigid, and the size of a half-crown ; from this the labour became
    very rapid.
    Another, in her first confinement, had also one drachm of the tincture,
    when the os uteri was the size of a half-crown. Labour advanced very rapidly,
    and the child was born in an hour and a-half. There were severe after-
    pains.
    Subsequently, Christison studied the oxytocic effects of cannabis tincture systematically
    in seven cases. He made several conclusions (pp. 120-121):
    Shortening of the [pain] interval was in general a more conspicuous phenomenon
    than prolongation of the pain.–
    It is worthy of remark, that in none of these cases were the ordinary
    physiological effects produced ; there was no excitement or intoxicating
    action, and there did not seem to be the least tendency to sleep in any of
    them.
    . . . While the effect of ergot does not come on for some considerable
    time, that of hemp, if it is to appear, is observed within two or three minutes.
    Secondly,-The action of ergot is of a lasting character, that of hemp is
    confined to a few pain shortly after its administration. Thirdly,-The action
    of hemp is more energetic, and perhaps more certainly induced, than that of
    ergot.
    There appears little doubt, then, that the Indian hemp may often prove of
    essential service in promoting uterine contraction in tedious labours.
    Grigor (1852) also examined the role of tincture of Cannabis indica in facilitation
    of childbirth. In 9 cases, little was noticeable, but in 7, including 5
    primiparous women (p. 125):
    I have noticed the contractions acquire great increase of strength and frequency
    immediately on swallowing the drug, and have seen four or five
    minutes ere the effect ensued ; . . . when effectual it is capable of bringing
    the labour to a happy conclusion considerably within a half of the time that
    would other have been required . . .
    I have not observed it to possess any anaesthetic effects . . .
    I consider the expulsive action of the cannabis to be stronger than that of
    ergot, but less certain in its effect . . .
    . . . nor have unpleasant consequences, so far as I have seen, appeared afterwards.
    By 1854, the first uses of therapeutic cannabis were acknowledged in the
    Dispensatory of the United States (Wood and Bache 1854), and these effects of
    cannabis to hasten childbirth without anesthesia were noted (p. 339).
    Willis (1859) reviewed past literature on therapeutic cannabis, and then described
    his own experience, which was frequently cited subsequently (p. 176):
    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 menstruation where the red discharge alternates
    with uterine leucorrhoea 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.
    . . . 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.
    Willis opined that based on literature and experience (p. 178), “It is a safe conclusion,
    from the many facts which have been published, that Indian hemp deserves
    further trial; in all cases making sure that the preparation used is good.”
    McMeens (1860) headed an Ohio State Commission that examined medical
    effects of cannabis. In addition to many references cited above, he reported on a
    Dr. M.D. Mooney of Georgia, who noted that a mixture of milk sugar and Cannabis
    indica extract (20 mg) taken every 3-4 h to treat gonorrhea was (p. 90) “successful
    in every case in from five to seven days.”
    That same year, a popular text (Stillé 1860) cited many contemporary authorities,
    noted irregular effects, and opined (vol. 2, p. 88), “From some experiments,
    cannabis would appear to excite contractions of the uterus.”
    Wright (1862) specifically noted the benefit of cannabis in relieving vomiting
    of pregnancy. In an initial letter, he discussed the case of a woman where all other
    available remedies had failed (pp. 246-247): “In a patient of mine, who was suffering
    to an extent that threatened death, with vomiting, I found the vomiting
    completely arrested by cannabis indica, given in repeated doses of three grains
    every four hours, until several doses were taken.” He later revisited the issue in a
    subsequent article (Wright 1863), and explained (p. 75), “Cannabis indica does
    not paralyze the nerves, but strengthens them directly. It does not constipate by
    paralysis–it cures by beneficent virtues.”
    Silver (1870) devoted an entire article to the use of cannabis to treat
    menorrhagia and dysmenorrhea, reporting 5 cases in detail, all relieved nicely
    with cannabis within a few doses. He also referred to a colleague, who had never
    failed in over a hundred cases to control pain and discomfort in these disorders
    within 3 doses. When flow was not checked after early treatment, Silver felt this diagnostic of “organic mischief” (p. 60) due to uterine fibroids, cervical carcinoma
    or other cause.
    Grailey Hewitt authored a comprehensive textbook of obstetrics and gynecology.
    Cannabis was endorsed as a hemostatic treatment for menorrhagia, analgesic
    in dysmenorrhea and uterine cancer (Hewitt 1872). He compared it to other
    available remedies for the latter, including belladonna, hyoscyamus, opium and
    chloroform, remarking (p. 416), “The Indian hemp is, however, better entitled to
    consideration, and in many cases undoubtedly exercises a marked influence in allaying
    or preventing pain.”
    In another contemporary text (Scudder 1875), the author observed (p. 100), “I
    have employed the Cannabis specially to relieve irritation of the kidneys, bladder
    and urethra. It will be found especially beneficial in vesical and urethral irritation,
    and is an excellent remedy in the treatment of gonorrhoea.”
    Cannabis was also popular in France for Ob-Gyn indications. Racime (1876)
    described medical usage of hashish and Indian hemp (p. 443, [translation EBR]):
    “In women, hemp has a most manifest action on the uterus; this action translates
    itself into a contraction of the uterine muscular fibers.”
    A selection from a broad French review follows (Michel 1880, pp. 111-112
    [translation EBR]):
    Illnesses of the genito-urinary organs.-Indian hemp has been employed in a
    large number of uterine affections, but principally in the diverse disturbances
    of menstruation. The tendency of authors is to administer it while
    the pain element predominates. . . .
    We have ourselves administered it often and in diverse cases of uterine
    hemorrhage: we have always seen success as well in postpartum hemorrhages,
    cases in which we employ it today in preference to the ergot of rye .
    . .
    . . . The reader would well permit us to affirm that but one first spoonful
    of the potion against menorrhagia (see the formula) has almost always succeeded
    in sufficiently diminishing the flow of blood. Rarely, the patient has
    had to take 4 spoonfuls. What has certainly struck us in its proper action is
    that its influence seems to have an effect on the following cycles; the Indian
    hemp acts, according to our observation and the remarks of Churchill himself,
    like a regulator of the catamenial function. Administered, in effect,
    during one sole period, sometimes two, rarely three, the menses return
    henceforth to just proportions and all medication becomes unnecessary. I
    know not of a similar effect that has been reported with ergotine or ergot of
    rye.
    Michel also endorsed cannabis treatment for blennorrhagia, or bloody uterine
    mucous discharge.
    In 1883, two consecutive letters to the British Medical Journal attested to the
    benefits of extract of Cannabis indica in menorrhagia, treating both pain and
    bleeding successfully with a few doses. In the first, cannabis was termed “a valuable
    remedy” (Brown 1883, p. 1002):
    Indian hemp has such specific use in menorrhagia–there is no medicine
    which has given such good results . . . A few doses {commencing with 5
    minims of tincture} are sufficient . . . The failures are so few, that I venture
    to call it a specific in menorrhagia. The drug deserves a trial.
    The second letter also extolled the benefits of cannabis (Batho 1883, p. 1002):
    . . . considerable experience of its employment in menorrhagia, more especially
    in India, has convinced me that it is, in that country at all events, one
    of the most reliable means at our disposal. I feel inclined to go further, and
    state that it is par excellence the remedy for that condition, which, unfortunately,
    is very frequent in India.
    I have ordered it, not once, but repeatedly, in such cases and always with
    satisfactory results. The form used has been the tincture, and the dose ten to
    twenty minims, repeated once or twice in the twenty-four hours. It is so certain
    in its power of controlling menorrhagia, that it is a valuable aid to diagnosis
    in cases where it is uncertain whether an early abortion may or may
    not have occurred. Over the hemorrhage attending the latter condition, it
    appears to exercise but little force. I can recall one case in my practice in India,
    where my patient had lost profusely at each period for years, until the
    tincture was ordered; subsequently, by commencing its use, as a matter of
    routine, at the commencement of each flow, the amount was reduced to the
    ordinary limits, with corresponding benefit to the general health. Neither I
    this, nor in any other instance in which I prescribed the drug, were any disagreeable
    physiological effects observed.
    One dissenting voice of the era was that of Oliver (1883) who felt that cannabis
    was not useful in dysmenorrhea since (p. 905) “its action seems so variable
    and the preparation itself so unreliable, as to be hardly worthy of a place on our
    list of remedial agents at all.” Quality control problems with cannabis were a frequent
    concern throughout its reign in Western medicine.
    Sydney Ringer, the British pioneer of intravenous fluid therapy, observed the
    following of Cannabis indica extract (Ringer 1886, p. 563):
    It is said to relieve dysuria, and strangury, and to be useful in retention of
    urine, dependent on paralysis from spinal disease. It is used occasionally in
    gonorrhoea. It is very useful in menorrhagia, or dysmenorrhoea. Half a
    grain to a grain thrice daily, though a grain every two hours, or hourly, is
    sometime required in those who can tolerate so large a dose, often relieve
    the pain of dysmenorrhoea. It is said to increase the energy of the internal
    contractions.
    In India, it was reported of Cannabis indica (McConnell 1888, p. 95), “its
    powerful effect in controlling uterine hemorrhage (menorrhagia, &c.) has been
    repeatedly recorded by competent observers, and its employment for the relief of
    such affections is well understood and more or less extensively resorted to.”
    Farlow (1889) penned a treatise on the use of rectal preparations of cannabis
    describing its use in young women before marriage to alleviate premenstrual
    symptoms and subsequent dysmenorrhea (p. 508):
    If the excitement can be moderated, if the pelvic organs can be made less irritable,
    there will be less pain, less hemorrhage, less weakness, and consequently
    a much longer period of health between the catamenia. This, I feel
    sure, can often be very successfully done by the rectal use of belladonna
    and cannabis indica, beginning a few days before the menstrual symptoms
    or prodromes appear.
    Farlow continued by describing another setting in sexually active, but
    nulliparous women (p. 508):
    After marriage and before childbirth, the uterus and pelvis, especially the
    left ovary, are very liable to be tender and irritable, even when there is no
    evident organic disease. The backache, bearing down, pain in the side,
    groin and legs, the frequent micturition, painful coitus, constipation and
    headache are often much relieved by the suppositories.
    Finally, Farlow mentioned another cannabis indication (p. 580): “At the
    menopause the well-known symptoms, the various reflexes, the excitement, the
    irritability, and pain in the neck of the bladder, flashes of heat, and cold, according
    to my experience, can frequently be much mitigated, by the suppositories.”
    Farlow employed low doses of these agents, 1/4 grain each (15 mg) or extracts
    of belladonna and Cannabis indica, administered by rectal suppository at night,
    or bid. Apparently no intoxication was necessary for therapeutic benefit (p. 509):
    “I do not think there is anything to be gained by pushing the drugs to their physiological
    action.”
    Aulde (1890) recommended cannabis extract for dysmenorrhea, sometimes
    combined with gelsemium (pp. 525-526):
    The majority of these cases uncomplicated by displacements, such as seen
    in young girls and married women, will be promptly benefited, and the
    menstrual flow appears, when there is no further trouble until the next pe-
    riod.
    . . . Cannabis has been highly recommended for the relief of menorrhagia,
    but is not curative in the true sense of the term.
    Sir John Russell Reynolds was personal physician to Queen Victoria, and it
    has been widely acknowledged that she received monthly doses of Cannabis indica
    for menstrual discomfort throughout her adult life. In 1890, after more than
    thirty years’ experience with the agent, Reynolds reported (Reynolds 1890, p.
    38), “Indian hemp . . . is of great service in cases of simple spasmodic
    dysmenorrhoea.”
    Another textbook of the era noted the following therapeutic indications for
    Cannabis indica (Cowperthwaite 1891, p. 188): “Said to be especially useful in
    gonorrhoea when the chordee is well marked. Uterine colic.”
    J.B. Mattison wrote extensively on therapeutic cannabis. He noted the following
    among several gynecological conditions reviewed (Mattison 1891, p. 268):
    “In genito-urinary disorders it often acts kindly-the renal pain of Bright’s disease
    ; and it calms the pain of clap equal to sandal or copaiva, and is less unpleasant.”
    The Indian Hemp Drugs Commission of 1893-1894 exhaustively examined
    the uses and abuses of cannabis, noting its indication for prolonged labor and
    dysmenorrhea (Kaplan 1969; Commission 1894).
    In this era, patent medicines containing cannabis were very common. One
    preparation, named “Dysmenine,” contained cannabis with a variety of other
    herbal tinctures, “Indicated for Dysmenorrhea, Menstrual Colic, and Cramps”
    (Figure 3). Interestingly, one component was capsicum, raising the possibility of
    synergistic action on cannabinoid and vanilloid receptors.
    An 1898 text opined of the fluidextract of cannabis (Lilly 1898, p. 32), “Its anodyne
    power is marked in chronic metritis and dysmenorrhea.”
    Shoemaker (1899) reported a case of endometritis with metrorrhagia, that required
    surgery, but in which (p. 481) “Marked relief of symptom was afforded,
    however, by the administration of Indian hemp. It relieved pain and diminished
    hemorrhage, and was highly valued by the patient.”
    Lewis (1900) observed the following (p. 251):
    Dysmenorrhea, not due to anatomical of inflammatory causes, is, in my
    opinion, one of the principal indications for indian hemp. No other drug
    acts so promptly and with fewer after effects.
    From my own personal observation, I am convinced that cannabis indica
    does exert a powerful influence on muscular contraction, particularly
    of the uterus. It may not, as Bartholow says, have the power of initiating
    uterine contraction, but I have demonstrated time and time again to my own
    satisfaction that the presence of the merest contractile effort is enough to
    permit its fullest effects. It is therefore of some service in uterine hemor
    rhage, but since its action is much slower than that of ergot, it is not as useful
    in those sudden hemorrhages great enough to require immediate check.
    I have noticed, however, that ergot is considerably quicker and more prolonged
    in its action when combined with cannabis indica.
    The drug is very useful in profuse menstruation, decreasing the flow
    nicely without completely arresting it, as ergot very frequently and improperly
    does.
    Felter and Lloyd (1900) described numerous Ob-Gyn indications for cannabis
    (pp. 426-427):
    The pains of chronic rheumatism, sciatica, spinal meningitis, dysmenorrhea,
    endometritis, subinvolution, and the vague pains of amenorrhoea,
    with depression, call for cannabis. Owing to a special action upon the reproductive
    apparatus, it is accredited with averting threatened abortion. . . .
    Cannabis is said in many cases to increase the strength of the uterine
    contractions during parturition, in atonic conditions, without the unpleasant
    consequences of ergot, and for which purpose it should be used in the
    form of tincture (see below), 30 drops, or specific cannabis, 10 drops, in
    sweetened water or mucilage, as often as required. In menorrhagia, the
    tincture in doses of 5 or 10 drops, 3 or 4 times a day, has checked the discharge
    in 24 or 48 hours.
    The greatest reputation of cannabis has been acquired from its prompt
    results in certain disorders of the genito-urinary tract. In fact, its second
    great keynote or indication is irritation of the genito-urinary tract, and the
    indication is even of more value when associated with general nervous depression.
    It is therefore useful in gonorrhoeas, chronic irritation of the bladder, in
    chronic cystitis, with painful micturition, and in painful urinary affections
    generally. It makes no difference whether a urethritis be specific or not, or
    whether it is acute or chronic, the irritation is a sufficient guide to the selection
    of cannabis. Use it in gonorrhoea to relieve the ardor urinae, and to
    prevent urethral spasm and avert chordee, and in gleet, to relive the irritation
    and discharge; employ it also in spasm of the vesical sphincter, in
    dysuria and in strangury, when spasmodic. Burning and scalding in passing
    urine, with frequent desire to micturate, are always relieved by cannabis.
    The authors clearly understood that the potency of the preparation directly affected
    clinical results. While both Indian hemp and American hemp were said to
    be effective, much higher doses of the latter were said to be required.
    In a popular American text of the era, Bartholow (1903) noted (p. 557):
    It is well established that hemp has the power to promote uterine contractions.
    It can not initiate them, but increased their energy when action has
    begun. It may be given with ergot. In consequence of this power which it
    possesses to affect the muscular tissue of organic life, hemp is used successfully
    in the treatment of menorrhagia. It is said to be especially useful
    in that form of menorrhagia which occurs in the climacteric period (Churchill).
    It has, more recently, been show to possess the power to arrest hemorrhage
    from any point, but it is chiefly in menorrhagia that much good is
    accomplished. . . .
    This agent has also been used with success in the treatment of gonorrhoea.
    It diminishes the local inflammation, allays chordee, and lessens the
    pain and irritation, with accompanying restlessness.
    In Ceylon, Ratnam (1916) defended use of therapeutic cannabis against legislative
    challenges (p. 37): “I and other medical practitioners have used it extensively
    in the treatment of tetanus, asthma and uterine disorders, especially
    dysmenorrhea and menorrhagia.”
    In a text of the era, cannabis was deemed useful in menopausal headaches
    (Hare 1922), as well as the following (p. 182):
    In cases of uterine subinvolution, chronic inflammation, and irritation cannabis
    is of great value, and it has been found of service in metrorrhagia and
    nervous and spasmodic dysmenorrhea. Not only does it relieve pain, but it
    also seems to act favorably upon the muscular fibers of the uterus.
    Another popular text (Sajous and Sajous 1924) cited cannabis as an analgesic
    for menopause, uterine disturbances, dysmenorrhea, menorrhagia and impending
    abortion, and postpartum hemorrhage.
    In 1928, in Pharmacotherapeutics, materia medica and drug action, the authors
    remarked on the ability of cannabis to counteract “painful cramps” and its
    “particular influence over visceral pain” (Solis-Cohen and Githens 1928,
    p. 1702). More specifically, they noted (p. 1705):
    Cannabis acts favorably upon the uterine musculature and may be used as a
    synergist to ergot in sluggish labor. It is useful also in relieving the pain of
    chronic metritis and dysmenorrhea and reduces the flow in menorrhagia. It
    is employed as a symptomatic remedy in gonorrhea in doses of 1/4 grain
    (0.015 Gm.) of the extract four times a day, relieving the pain, dysuria, and
    chordee.
    An anonymous editor (probably Morris Fishbein) noted the ability of cannabis
    to achieve a labor with pain burden substantially reduced or eliminated, followed
    by a tranquil sleep (Anonymous 1930, p. 1165):
    Hence a woman in labor may have a more or less painless labor. If a sufficient
    amount of the drug is taken, the patient may fall into a tranquil sleep
    form which she will awaken refreshed. . . . As far as is known, a baby born
    of a mother intoxicated with cannabis will not be abnormal in any way.
    The British Pharmaceutical Codex retained an indication for cannabis in
    treatment of dysmenorrhea in 1934 (Pharmaceutical Society of Great Britain
    1934).
    Despite the fact that cannabis had been dropped from the National Formulary
    the previous year, Morris Fishbein, the editor of the Journal of the American
    Medical Association, continued to recommend cannabis in migraine associated
    with menstruation (Fishbein 1942, p. 326):
    In this instance the patient may be given either sodium bromide or
    fluidextract of cannabis three days before the onset of the menstrual period,
    continued daily until three days after the menstrual period. . . . The dose of
    fluidextract of cannabis is five drops three times daily, increased daily by
    one drop until eleven drops, three times daily, are taken. Then the dosage is
    reduced by one drop daily until 5 drops are taken three times daily and so
    on.
    Medical investigation of cannabis persisted in Czechoslovakia. One group
    noted success in use of a cannabis extract in alcohol and glycerine to treat
    rhagades, or fissures, on the nipples of nursing women to prevent staphylococcal
    mastitis (Kabelik, Krejei, and Santavy 1960).
    MODERN ETHNOBOTANY OF CANNABIS
    IN OBSTETRICS AND GYNECOLOGY
    In the folk medicine of Germany, in the late 19th century (Rätsch 1998,
    p. 122), a cannabis preparation was “laid on the painful breasts of women who
    have given birth; hemp oil is also rubbed onto these areas; hempseed milk is used
    to treat bladder pains and dropsy.”
    Although the carminative properties of cannabis seeds had been noted since
    the time of Galen, Lozano (2001) notes that al-Mayusi (1877) claimed similar
    properties for the leaves, and to treat uterine gases.
    In 19th century Persia, Schlimmer (1874) reported his observations on usage
    of Cannabis indica leaves as a treatment for urethritis associated with the practice
    of prostitution. In modern Iran, Zargari (1990) notes continued use of Cannabis
    sativa seed oil rubbed on the breasts to diminish or even completely prevent
    lactation.
    Cannabis or nasha was employed medicinally despite Soviet prohibition in
    Tashkent in the 1930s (Benet 1975, pp. 46-47): “A mixture of lamb’s fat with
    nasha is recommended for brides to use on their wedding night to reduce the pain
    of defloration.” In the same culture (p. 47), “An ointment made by mixing hashish
    with tobacco is used by some women to shrink the vagina and prevent fluor
    alvus [leukorrhea].” More fancifully, Benet noted that in German folk medicine
    (p. 46), “sprigs of hemp were placed over the stomach and ankles to prevent convulsions
    and difficult childbirth.”
    Nadkarni (1976) reported the use in India of a poultice of cannabis for hemorrhoids,
    and (p. 263) “The concentrated resin exudate (resinous matters) extracted
    from the leaves and flowering tops or agglutinated spikes of C. sativa, and known
    as nasha or charas . . . is valuable in preventing and curing . . . dysuria and in relieving
    pain in dysmenorrhea and menorrhagia . . .”
    In a book about medicinal plants of India (Dastur 1962), we see the following
    (p. 67): “Charas [hashish] . . . is of great value in-dysuria . . . it is also used as an
    anaesthetic in dysmenorrhea . . . . Charas is usually given in one-sixth to onefourth
    grain doses.” A seed infusion was also employed to treat gonorrhea.
    Aldrich (1977) has extensively documented the Tantric use of cannabis in India
    from the 7th century onward as an aid to sexual pleasure and enlightenment
    (p. 229):
    The Kama Sutra and Ananga Ranga eloquently detail Hindu sexual techniques,
    and the Tantras transform such sexual practices into a means of
    meditational yoga.
    . . . In Hindu Tantrism, the female energy (shakti) is dynamic and paramount:
    the male is passive and takes all his vitality from the shakti. . . . In
    Buddhist Tantra it is just the opposite: the male is active and assumes the
    dynamic role of compassion, while the female is the passive embodiment
    of wisdom.
    We have little modern research to document a biochemical basis to these claims,
    which persist, nonetheless. In his inimitable prose, Ott (2002, p. 29) has stated of
    cannabis, “many women I have known are effusively enthusiastic about its
    aphrodisiacal amatory tributes.”
    A treatise on cannabis usage in India includes the following citation (Chopra
    and Chopra 1957, p. 12): “It [cannabis resin] is considered a sovereign remedy
    for relieving pain in dysmenorrhea and menorrhagia, and against dysurea.”
    In Cambodia, mothers reportedly use hemp products extensively after birth
    (Martin 1975), making an infusion of ten flowering tops to a liter of water to provide
    a sense of well-being. When insufficient milk is present for nursing, female
    hemp flowers are combined with other herbs for ingestion. An alcoholic extract
    of cannabis and various barks is said to alleviate postpartum stiffness. Another
    hemp extract mixture is employed to cure hemorrhoids and polyps of the sex organs.
    In Vietnam (Martin 1975), cannabis seed kernels in a preparation called sac
    thuoc are said to cure dysmenorrhea, or provide a feeling of wellness after childbirth.
    Citing Martin’s work, Rubin noted the following usage in Vietnam (Rubin
    1976, p. 3): “21 kernels boiled in water may be given to the expectant mother to
    reset the neonate in normal position at birth.”
    Hemp is of ancient use in China, but it was noted (Shou-zhong 1997, p. 148):
    “In modern clinical practice, Hemp Seeds are still in wide use. They are able to . .
    . promote lactation, hasten delivery, and disinhibit urination and defecation.”
    Perry and Metzger (1980) noted continued folk use of cannabis in China and
    Southeast Asia, where the seeds were specially prepared for treatment of uterine
    prolapse and as a birthing aid.
    In South Africa, a Sotho herbalist used cannabis to facilitate childbirth (Hewat
    1906, p. 98), and was “in the habit of getting his patient stupified by much smoking
    of dagga.”
    In modern times, urban Africans have also employed cannabis medicinally for
    a number of purposes (Du Toit 1980), as one informant related (p. 209):
    “. . . pregnant women should always have some burnt for her so as to have a
    completely healthy child.” But is particularly during childbirth that “pregnant
    women were given dagga to make them brave,” and “so that they
    wouldn’t feel pain.”
    In Brazil, it was observed (Hutchinson 1975, p. 180), “Such an infusion [of
    marijuana leaves] is taken to relieve rheumatism, ‘female troubles,’ colic and
    other common complaints.”
    In a 20th century English herbal, Grieve (1971) noted the following uses of
    hemp (p. 397): “The tincture helps parturition, and is used in senile catarrh, gonorrhoea,
    menorrhagia, chronic cystitis and all painful urinary affections. An infusion
    of the seed is useful in after pains and prolapsus uteri.” Dosages were
    provided (p. 397): “Of tincture for menorrhagia, 5 to 10 minims. Three to four
    times a day (i.e., 24 grains of resinous extract in a fluid ounce of rectified spirit).”
    Finally, this passage was offered (p. 397): “The following is stated to be a certain
    cure for gonorrhoea. Take equal parts of tops of male and female hemp in
    blossom. Bruise in a mortar, express the juice, and add an equal portion of alcohol.
    Take 1 to 3 drops every two to three hours.”
    Merzouki et al. (Merzouki, Ed-derfoufi, and Molero Mesa 2000) have examined
    the usage of cannabis as part of herbal mixtures employed by Moroccan
    herbalists to induce therapeutic abortion, concluding that the cannabis component
    did not produce this effect, but rather other clearly toxic components were
    responsible. The herbal mixture is applied per vaginam, or alternatively, its
    smoke is fumigated in close proximity to the genitals (Merzouki 2001).
    By the late 1960s, cannabis cures entered the scene in modern America. A
    popular treatise on marijuana noted medicinal effects (Margolis and Clorfene
    1969, p. 26):
    You’ll also discover that grass is an analgesic, and will reduce pain considerably.
    As a matter of fact, many women use it for dysmenorrhea or
    menorrhagia when they’re out of Pamprin or Midol. So if you have an upset
    stomach, or suffer from pain of neuritis or neuralgia, smoke grass. If pains
    persist, smoke more grass.
    Popular cannabis folklore, thus, did not escape American consciousness. Another
    example was noted by Thompson (1972, p. 3): “In the Jack’s Creek area of
    Fayette County, Kentucky, poultices with hemp leaves are supposed to relieve
    hemorrhoidal pains and bleeding when applied in the appropriate area of the human
    body.”
    RECENT THEORY AND CLINICAL DATA
    Solomon Snyder, the discoverer of opiate receptors, examined cannabis’ pros
    and cons as an analgesic (Snyder 1971, p. 14):
    For there are many conditions, such as migraine headaches or menstrual
    cramps, where something as mild as aspirin gives insufficient relief and
    opiates are too powerful, not to mention their potential for addiction. Cannabis
    might conceivably fulfill a useful role in such conditions.
    In the mid-1970s, Noyes et al. wrote several articles on analgesic effects of
    cannabis. In case reports (Noyes and Baram 1974), one young woman successfully
    employed cannabis to treat the pain and anxiety after a tubal ligation, and
    another in dysmenorrhea (p. 533): “The relief she got from smoking was prompt,
    complete, and consistently superior to that from aspirin.”
    In 1993, Grinspoon and Bakalar published Marihuana, the forbidden medicine,
    and subsequently revised it (Grinspoon and Bakalar 1997). The book contains
    numerous “anecdotal” testimonials from patients and doctors documenting
    clinical efficacy of cannabis where other drugs were ineffective. An entire section
    with case studies was included on premenstrual syndrome (PMS), menstrual
    cramps, and labor pains, supporting excellent symptomatic relief at low doses
    without cognitive impairment.
    Numerous surveys cite cannabis usage for obstetric and gynecological complaints,
    but in one Australian example, 51% of the women indicated indications
    for PMS or dysmenorrhea (Helliwell 1999).
    Rätsch (1998) has observed (p. 162), “Several women who delivered their babies
    at home have told me that they smoked or ate hemp products to ease the painful
    contractions and the birth process in general.”
    Beyond direct effects mediated by the cannabinoid receptors, McPartland has
    proposed that therapeutic effects of cannabis in dysmenorrhea involve anti-inflammatory
    mechanisms (McPartland 1999, 2001).
    It has been observed that women with PMS exhibit a fault in fatty acid metabolism
    that impedes the conversion of linoleic acid (LA) to gamma-linolenic acid
    (GLA) and prostaglandins. A daily dose of 150-200 milligrams of GLA over a
    twelve-week period significantly improved PMS-related symptoms (Horrobin
    and Manku 1989). As pointed out by Leson and Pless (2002), this amount of
    GLA can be supplied by only 5 ml of hemp seed oil daily.
    Experimentally, Δ9-THC inhibited herpes virus replication (HSV-1 and
    HSV-2) in vitro, even at low concentrations (Blevins and Dumic 1980), and was
    suggested for trials of topical usage.
    An Italian group recently demonstrated the inhibition of proliferation of human
    breast cancer cells by anandamide in vitro (De Petrocellis et al. 1998);
    2-arachidonylglycerol and the synthetic cannabinoid HU-210 acted similarly,
    while this activity was blocked by the CB1 antagonist, SR 141716A. It was felt
    that these effects were mediated through inhibition of endogenous prolactin activity
    at its receptor. It is likely that THC acts similarly. Palmitylethanolamide
    has subsequently been demonstrated to inhibit expression of fatty acid
    amidohydrolase, thereby enhancing the antiproliferative effects of anandamide on
    human breast cancer cells (Di Marzo et al. 2001).
    Recent animal work has elucidated the role of endocannabinoids in mammalian
    fertility. Recently Das et al. (1995) detected CB1 receptor mRNA in mouse
    uterus, thus suggesting that this organ is capable of anandamide production.
    Anandamide (arachidonylethanolamide, AEA) and Δ9-THC inhibited
    forskolin-stimulated cyclic AMP production in mouse uterus, whereas cannabidiol
    did not, suggesting that the uterine site is active in endocannabinoid production.
    Schmid et al. (1997) demonstrated very high levels of anandamide in the
    peri-implantation mouse uterus. Data suggest that down-regulation of AEA levels
    promote uterine receptivity, while up-regulation may inhibit implantation. It
    was surmised that aberrant AEA synthesis or expression may be etiological in
    early pregnancy failure or infertility. The corresponding role that THC or cannabis may have in human females at the time of fertilization and implantation is
    open to conjecture, but deserves further investigation.
    Wenger et al. (1997) claimed similarity in effects of injected THC and AEA in
    pregnant rats, prolonging length of gestation, and increasing stillbirths, perhaps
    due to inhibition of prostaglandin synthesis. The same lead author posited
    cannabinoid influences on hypothalamic and pituitary endocrine functions in a
    subsequent paper (Wenger et al. 1999).
    Paria et al. (2001) suggested the need for tight regulation of endocannabinoid
    signaling during synchronization of embryonic development and uterine receptivity.
    They demonstrated inhibition of implantation in wild-type mice with sustained
    high-level exposure to “natural cannabinoid” while not in CB1 (2/2)/CB2
    (2/2) double knockout mutant mice.
    Issues of cannabis use in human pregnancy remain a great concern. The topic
    is reviewed in (Fried 2002; Murphy 2001; Zimmer and Morgan 1997). A variety
    of studies have demonstrated transient effects of cannabis on endocrine hormone
    levels, but no consistent effects seem to occur in chronic settings (Russo et al.
    2002). Certainly subtle changes at critical times of fertilization or implantation
    may be significant.Avalid assessment was provided (Murphy 1999, p. 379): “the
    hormone milieu at the time of exposure may dictate a woman’s hormonal response
    to marijuana smoking.”
    Studies are hampered by the obvious fact that laboratory animals are not human
    in their responses. Estrous cycles and behaviors in animals are not always
    analogous to menstrual cycles and other physiological effects in women. Nevertheless,
    animal data suggest that in female rats, at least, THC acts on the CB1 receptor
    to initiate signal transduction with membrane dopamine and intracellular
    progesterone receptors to initiate sexual responses (Mani, Mitchell, and O’Malley
    2001).
    One available approach to the issues is provided by examining factors in spontaneous
    abortions. In a study of 171 women, 25% of pregnancies ended spontaneously
    within 6 weeks of the last menses. Cannabis exposure seemed to have no
    observable effect in these cases (Wilcox, Weinberg, and Baird 1990).
    The population of Ottawa, Ontario, Canada has been extensively examined
    over the last two decades with respect to cannabis effects in pregnancy. In a small
    study of cannabis using mothers vs. abstainers (O’Connell and Fried 1984), ocular
    hypertelorism and “severe epicanthus” were only noted in children born to users.
    In 1987, the Ottawa group compared effects of cannabis, tobacco, alcohol and
    caffeine during gestation (Fried et al. 1987). Whereas tobacco negatively affected
    neonatal birth weight and head circumference, and alcohol was associated
    with lower birth weight and length, no effects on any growth parameters were ascribable
    to maternal cannabis usage In a subsequent study (Witter and Niebyl 1990), examination of 8350 birth records
    revealed that 417 mothers (5%) claimed cannabis-only usage in pregnancy,
    but no association was noted with prematurity or congenital anomalies. The authors
    suggested that previously ascribed links to cannabis were likely confounded
    by concomitant alcohol and tobacco abuse.
    A group in Boston noted a decrease in birth weight of 79 g in infants born to
    331 of 1226 surveyed mothers with positive using drug screen for cannabis (p =
    0.04) (Parker and Zuckerman 1999), but no changes in gestation, head circumference
    or congenital abnormalities were noted.
    The largest study of the issue to date evaluated 12,424 pregnancies (Linn et al.
    1983). Although low birth weight, shortened gestation and malformations
    seemed to be associated with maternal cannabis usage, when logistic regression
    analysis was employed to control for other demographic and exposure factors,
    this association fell out of statistical significance.
    Dreher has extensively examined prenatal cannabis usage in Jamaica (Dreher
    1997; Dreher, Nugent, and Hudgins 1994), wherein the population observations
    were not compounded by concomitant alcohol, tobacco, or polydrug abuse. This
    study is unique in that regard, no less due to the heavy intake of cannabis
    (“ganja”), often daily, in this cohort of Rastafarian women. No differences were
    seen between groups of cannabis-using and non-cannabis-using mothers in the
    weight, length, gestational age or Apgar scores of their infants (Dreher, Nugent,
    and Hudgins 1994). Deleterious effects on progeny of cannabis smokers were not
    apparent; in fact, developmental precocity was observed in some measures in infants
    born to women who smoked ganja daily. The author noted (Dreher 1997, p.
    168):
    The findings from Jamaica, however, suggest that prenatal cannabis exposure
    is considerably more complex than we might first have thought. Loss
    of appetite, nausea and fatigue compound the “bad feeling” that women in
    this study commonly reported. For many women, ganja was seen as an option
    that provided a solution to these problems, i.e., to increase their appetites,
    control and prevent the nausea of pregnancy, assist them to sleep, and
    give them the energy they needed to work. . . . The women with several
    pregnancies, in particular, reported that the feelings of depression and desperation
    attending motherhood in their impoverished communities were alleviated
    by both social and private smoking. In this respect, the role of
    cannabis in providing both physical comfort and a more optimistic outlook
    may need to be reconceptualized, not as a recreational vehicle of escapism,
    but as a serious attempt to deal with difficult physical, emotional, and financial
    circumstances This presentation supports the proposition that cannabis has been employed
    historically for legion complaints in obstetrics and gynecology. To list briefly,
    these include treatment of: menstrual irregularity, menorrhagia, dysmenorrhea,
    threatened abortion, hyperemesis gravidarum, childbirth, postpartum hemorrhage,
    toxemic seizures, dysuria, urinary frequency, urinary retention, gonorrhea,
    menopausal symptoms, decreased libido, and as a possible abortifacient.
    It is only recently that a physiological basis for these claims has been available
    with the discovery of the endocannabinoid system. Limited research to date supports
    these claims in terms of cannabinoid analgesia, antispasmodic and anti-inflammatory
    activities, but requires additional study to ascertain mechanisms and
    confounding variables.
    Recommendations for cannabis therapeutics have often supported only utilization
    for terminal, intractable, or chronic disorders (Joy, Watson, and Benson
    1999). However, simple logic would indicate that side effects of any medicine
    would be less evident when the agent is employed sporadically. Generally, that
    situation prevails for many of the listed Ob-Gyn indications for cannabis. Available
    historical and epidemiological data supports very low toxicity, even in pregnancy,
    to mother or child. Professor Philip Robson of Oxford has summarized the
    situation with cannabis in obstetrics nicely (Lords 1998, p. 123):
    If you could have an agent which both speeded labour up, prevented hemorrhage
    after labour and reduced pain, this would be very desirable. Cannabis
    is so disreputable that nobody would begin to think of that and yet that is
    really an obvious application that we should seriously consider with perhaps
    some basic research and pursue it.
    A few intriguing issues remain. Is cannabis truly an abortifacient? Our four
    specific references are equivocal, one ancient (Darmesteter 1895), one old (Short
    1751), and two modern (Merzouki, Ed-derfoufi, and Molero Mesa 2000;
    Merzouki 2001), but these and current epidemiological data would seem to indicate
    that cannabis does not produce this effect sui generis. Perhaps its actual role
    is one to mitigate side effects of the active components.
    Numerous citations historically support the notion that cannabis is quite potent
    in its obstetric and gynecological actions, with specific attestation that medical
    benefits are frequently obtained at doses that are sub-psychoactive. The
    therapeutic ratio of cannabis with respect to cognitive impairment seems generous.
    Another mystery worthy of additional study surrounds the very rapid activity
    claimed for cannabis extracts in promotion of labor (Grigor 1852; Christison
    1851). Certainly modern anecdotal claims of a similar nature are legion when
    cannabis is smoked. Pharmacodynamically, oral administration of extracts
    would be unlikely to provide benefits within minutes. Perhaps these tinctures
    were demonstrating a sublingual or mucosal absorption akin to those in modern
    trials of cannabis-based medical extracts (Whittle, Guy, and Robson 2001).
    In summary, the long history of cannabis in women’s medicine supports further
    therapeutic investigation and application to a large variety of difficult clinical
    conditions. Cannabis as a logical medical alternative in obstetrics and
    gynecology may yet prove to be, in the words of Robson (1998), a phoenix whose
    time it is to rise once more.
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