Insanity from hasheesh (extract) by John Warnock, MD, Medical Director, Egyptian Hospital for the Insane, Cairo

In the report for the year 1899 of the Bengal asylums, it is stated that 45 out of 220 cases admitted were due to the use of Cannabis Indica.

In Egypt, statistics are available since the year 1895. During the six years 1896–1901, out of 2564 male cases of insanity admitted to the Egyptian Asylum at Cairo, 689 were attributed to the abuse of hasheesh, i.e., nearly 27 per cent. Very few female patients used hasheesh, and it is noteworthy that insanity is more than three times as common among the hasheesh-using sex as among women, who, comparatively, seldom use the drug.

I think this difference in the insanity rate between the sexes is significant, and goes a long way to prove the importance of hasheesh as a cause of insanity among Egyptian men. Let it also be remembered that in England insanity is more frequent among women than among men (35 to 31).

My experience does not confirm the Indian Commission's belief that Cannabis Indica only sometimes causes insanity. In Egypt it frequently causes insanity. As to whether excessive use of hemp drugs is commoner here than in India I can give no opinion, but many thousands use it daily here. Probably only excessive users, or persons peculiarly susceptible to its toxic effects, become so insane as to need asylum treatment. Whether the moderate use of hasheesh has ill effects I have no means of judging, and this paper is now read to elicit the opinions of my colleagues in Egypt, whose daily practice must give them opportunities of studying the effects of the ordinary use of hasheesh. I should be grateful for information on this question.

I have never met with dysentery or bronchitis as the direct result of the use of hasheesh.

Again, in my experience, I find that persons insane from hasheesh have a proneness to commit crimes, especially those of violence, and I have a strong suspicion that much disorderly conduct results from hasheesh smoking, just as alcohol among Europeans leads to such misconduct.

To sum up, the use of Cannabis Indica in Egypt seems to have graver mental and social results than in India, and is responsible for a large amount of insanity and crime in this country.