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A Case of Dysmenorrhcea in Which the Tincture of Cannabis Indica was Employed

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By BzNJAMJN BARROW, Follow of the Royal Medico-
Chirurgical Society, of London.
In offering the following observations to the perusal
of the profession, it must not be supposed that I consider
the usual effects of the hemp to be those whichcame
under my notice in the case in which I employed
it, but simply that they are some of those which mayoccur
and cause much alarm not only to the patient
and friends but also to the medical attendant. It is
my desire in giving these details to put those. practitioners
who may not have employed the cannabis
upon their guard as to its administration, for my own
part I shall not again give it in any case wherein the
uterus is at fault, knowing as I now do what may
happen, and as I shall presently show, how long the
uncomfortable and painful sensations about that organ
may continue after its exhibition.
The Cannabis Indica, being one of those ,lrugs,
the use of which has been. I believe, very limited, and
of which little is known, it may be interesting to some
and useful to others of our profession to have a few
-particulars of the plant and preparation laid before
them, as also a brief outline of the experience of those
who have employed it as a medicinal remedy. I find
that Dr. Pereira, to whose able work on Matcria
Medica I may refer for full information, represents
the Cannabis Indica as possessing no specific qdalities
different from the Cannabis sativa, which is, as
of course all know, the common hemp. Some
botanists have, however, stated that there are certain
slight differences in the growth and flowering of the
plants.* The ordinary dose of the tincture prepared
from these plants appears to be from ten to twenty
drops; in some cases even as much as a drachb has
been given, and without producing effects of any kind.
Dr. Pereira, as well as others, has experimented with
the drug, and witnessed various effects in different
individuals, but none exactly similar to those which
were present in the case I shall directly relate. The
Indian hemp is mentioned as causing a very agreeable
kind of deliriua, augmented appetite, venereal excitement,
and impaired volition, followed by insensibility,
during which the patient retains any position in
which he may be placed; its effects, tberefore, simu.
late catalepsy. Dr. W. B. O'Shaughnessy, of Calcutta,
has written upon this subject, and his observations
upon these preparations may be consulted with advan.
tage. He has described their effects on the animal System
in health, and their utility in the treatment of tetanus
and other convulsive disorders. Dr. J. Clendinning
givesi a favourable account of the drug, and says "s its
exhibition was followed with remarkably few excep.
tions by manifest effects as a soporific or hypnotic in
conciliating sleep, as an anodyne in lulling irritation,
as an antispasmodic in checking cough and cramp, and
ts a nervine stimulant in removing languor and
anxiety. These effects were observed in both acute and
chronic affections, and in patients of all ages and both
-sexes. It had also the advantage of not producing the
injurious effects of opium. The following is a faithful
record of the circumstances which att6nded the case
which came l,tely under my care
A married lady, twenty-six years of age, of a thin
spare habit, of a naturally feeble constitution, and who
had suffered for some years from dysmenorrhbea, the
pain at these periods being of a more than ordittsy
severe character, requested my attendance in Consquotmce
of the extreme suffering with which the last
piMod was ushered in. On previous ocoasions, I had
only been able in any way to alleviate her sufferings,
by administering very large quantities of - opium or
morphine, both of which remedies had been given in
every form, but had become so obnoxious to my patient,
inducing excessive nausea and vomiting, which frequently
lasted for many subsequent days, that I determined
to make trial in this instance of the tincture of the
Cannabis Indica, my attention having been directed to
this remedy and its use recommended, by a muclh valued
and professional friend. I therefore immediately gave
five drops for a first dose; in two hours the same quantity
was again given, and in three hours five additional;
so that in the course of five hours not more than
fifteen drops were taken. That this quantity was not
exceeded I am certain, since I took the precaution of
myself dropping the doses into separate glasses before
I quitted the patient. Some ease was experienced
after the last dose, and I found my patient tolerably
comfortable in the afternoon, but somewhat drowsy, of
which I took no particular notice, knowing -she had
passed but a restless night.
She rose at five o'clock, and went down stairs to
dinner at six, at which meal she ate about as usual,
and drank one glass of wine. A degree of incoherence
of manner and speech was observed by her family
during the meal, and almost immediately afterwards
she became violently sick and vomited, being at the
same time altogether unconscious; the extremities and
body became cold, and when I saw her she was perfectly
pulseless, the eyes wide open and staring, the pupils
somewhat contracted and quite insensible to the
strongest light, with strong convulsions of the whole
frame, and involuntary twitchings of the muscles, which
symptoms remained for a day or two whether awake or
asleep. This state of complete insensibility, I might
almost say of lifelessness, lasted for about a quarter of an
hour. Warm brandy and water, sal volatile, and warmth
to the extremities and abdomen had the effect of
recalling the circulation, and allaying the other formidable
symptoms, but there remained during the whole
night a partial state of unconsciousness, as also the
other symptoms in a milder degree. The pulse, which
varied from 100 to 140 or 150 was extremely feeble, and
intermitted from time to time during the following
two days.
It is unnecessary to say more of the case, than that
the recovery went on progressively under the careful
administration of stimulants, although the pains aud
uncomfortable sensations about the uterus and its
appendages continued for a fortnight or longer, which
I can only attribute to the medicine, as sbe had ntever
suffered in a similar way at the termination of any
former menstrual period. Warm baths and opium
plaster over the hypogastric region, with occasional
small doses of hyoscyamus with camphor mixture,
tended to relieve these last remaining ueImptoms.
There are a few observations which it may be useful
to make before conicluding, but which I shall say ia
as few words as possible.
The subject of the above case had never suffered at
any time of her life from any description of fit or
cerebral affection, and ber heart, so far as external
examination can prove, is free from all disease; so that
the failing of the circulation so completely may fairly
be attributed to the effects of the cannabis. There is
one point particularly worthy of note,-viz., the length
of time that the symptoms came on after the administration
of the medicine; and I would ask, had she
remained quiet in the recumbentposition,would the more
violent symptoms have been avoided Upon all those
points which appear of interest, and upon the effects
which others have observed to fullow the exhibition
of the cannabis, I am most anxious to learn their
experience; and in order to gain such information,
I have been induced to lay thus at length before the
readers of the Prouincial Journal, the foregoing case
and observations; and feeling, moreover, as I do,
most strongly, that it is the duty of every man to give
to his professional brethren the advantage of his experience,
which important object this Journal is
so well calculated to carry out.
Clifton, February, 1847.

Source: A Case of Dysmenorrhcea in Which the Tincture of Cannabis Indica was Employed
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