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Withholding The Cannabis Chorea Cure = Pig Pharma Profits

What if there was a natural medicine that could not only control Huntington’s Chorea, as well as chorea stemming from other non-genetic diseases and conditions, but quite possibly cure it?

What if instead of having to take a medicine that may force you to think about suicide, you could take the extract of a simple flower and re-discover how good life is without chorea?

What if the medical profession published numerous medical journal articles about this natural medicine 150 or so years ago, when it was a standard successful treatment for chorea?

And finally, what if for the last 80 years or so the combined power of the US government and Pig Pharma corporations had made possession of this natural medicine grounds for slamming you in prison for a long, long time? That would be – let’s see, what’s the opposite of “Awesome”?

Huntington’s disease is a neurodegenerative disease and most common inherited cause of chorea. Other non-inherited causes of chorea are show in the graphic above.

Chorea is characterized by brief, semi-directed, irregular movements that are not repetitive or rhythmic, but appear to flow from one muscle to the next. When chorea is serious, slight movements will become thrashing motions.

The characteristic movements of chorea often include twisting and writhing. Walking may become difficult because of uncontrollable body postures and leg movements.

Unlike ataxia, which affects the quality of voluntary movements, or Parkinsonism, which is a inhibition of voluntary movements, the movements of chorea occur involuntarily, without any conscious effort to move a limb, an extremity (hands or feet), the head or neck, or any other part of the body. Because all movements associated with chorea are involuntary, it is classified as a hyperkinetic movement disorder.

The only answers that Pig Pharma has for Chorea are treatments, not cures. One of the most commonly prescribed “medicines” is tetrabenazine. Among the risks associated with tetrabenazine’s use are: sedation, fatigue, insomnia, akathisia, anxiety and nausea. Oh, and also tetrabenazine increases the risk of depression and suicidal thoughts and behavior in people afflicted with Huntington’s disease. So it doesn’t cure you, but it may make you decide to kill yourself. Nice drug. All the other Pig Pharma answers to Huntington’s Disease pose similar risks and do not cure Chorea.

In fairness, it is important to point out that one of the following reported cases of someone with chorea who was healed by Cannabis, was a young girl who had suffered from a bout of rheumatic fever a month prior to the onset of Chorea. It is well-established (in 2018) that one type of Chorea, Sydenham’s chorea, occurs as a complication of streptococcal infection, and that twenty percent of children and adolescents with rheumatic fever who are left untreated with antibiotics develop Sydenham’s chorea as a complication. So it is possible, even likely, that what Dr. Douglas is describing is a strep infection leading to Chorea – in other words, a sub-set of Chorea. However, since Cannabis is not an antibiotic, it seems unlikely that in this case being described its beneficial use in the treatment of Chorea would be confined to this single sub-set of the disease. Plus the instance of this young girl is only one of many Cannabis chorea cures that are described in this medical journal article from 1869.

Fortunately for people suffering from Huntington’s today, in most places Cannabis is available for self-treatment, and in the more advanced states there are even physicians who have bothered to learn and build on what their colleagues discovered 150 years ago, ignoring the poisons being pushed by Pig Pharma.

Here is one example of what has been known and withheld from those who suffer for eight generations. The research isn’t perfect, and the doctor is very much trapped in many of the false assumptions of his day, but he is clear on one thing – Cannabis is a powerful natural medicine that is safe and effective for treating neurological diseases like Chorea.

FROM THE EDINBURGH MEDICAL JOURNAL FOR MARCH 1869.

By Dr. Douglas F.R.G.P.E.

Vice-President of the Medico-Chirurgical Society of Edinburgh

February 4th, 1869

THE USE OF INDIAN HEMP IN CHOREA

The value of Indian hemp as a therapeutic agent is well established, but a singular difficulty has been experienced in securing for it the confidence to which it is evidently entitled. Without attempting to explain or to excuse this difficulty, I propose to illustrate what appears to me one of its most useful applications.

The negative virtues of the drug are amongst its chief merits. Dr. Russell Reynolds, who writes one of the most recent, and one of the best expositions of the value of this remedy, tells us, as the result of a manifestly practical and thoughtful experience, that it is a soporific, anodyne and antispasmodic; and that it relieves pain and spasm: that it does not leave behind it headache nor vertigo; nor does it impair the appetite nor confine the bowels. These important virtues accord with anything I have seen of its action; nor have I met with any annoyance in practice from its peculiar action on the emotional or intellectual state of the sick. We are apt to be deterred from the use of a remedy by such pictures of its more peculiar actions, as are given of the abuse of the drug in countries where it is resorted to as a means of intoxication, and of its action in the cases of patients who under its use became tortured by ocular illusions and spectres of horrible form.

I do not doubt that such effects result from the use of the drug; but, in prescribing it, I have not met with them, and I am disposed to think that they are to be avoided even more certainly than we can guard against the unpleasant effects of opium.

As in the case of other useful drugs, the contradictory and extreme views of the efficacy and certainty of its therapeutic action, urged by writers of high authority, have retarded confidence in cannabis Indica; and indeed its applications to disease seem scarcely to have been investigated with the reliance which its demonstrated energy would justify. It is now many years since Dr. Dominic Corrigan published a series of cases which underwent cure in the course of four or five weeks, mainly by the use of the cannabis Indica, in doses of five minims of the tincture, increased to twenty-five: one of the cases, being of ten years standing, was cured in a month. (Archives of Medicine. Edited by Lionel S. Beale, M.B. Vol. ii. London Medical Times, 1845.)

One cannot resist the impression that other elements in the treatment, besides the administration of the cannabis, had need to be taken into account in the explanation of such cures; and moreover, before the actual value of the drug in such cases can be determined, a minute statement of the clinical and pathological relations of each case would be required i.e., how far the case might be one of chorea arising in connexion with rheumatism, struma, cerebral or spinal disease, or in connexion with some more temporary source of irritation in the system, as from derangement of the digestive or of the generative or other functions.

Again, we find Dr. Wilks of Guy’s Hospital arguing that, because fifty remedies have been found to cure such a disease as chorea, it may be safely left to itself. Accordingly, Dr. Wilks, admitting the usefulness of Dr. Hughes favourite and useful remedy, rhubarb steeped in port wine, prescribes to his patients the syrup of orange, that students may witness the spontaneous cure of the disease; and his patients, like Dr Corrigan’s, left the hospital cured in about a month.

Nevertheless, whatever preference we may have for a medicine expectant, that permits the sick to recover, over the heroic measures, whose advocates claim to have cured the patients who escape out of their hands, thoughtful practitioners will not be prevented from inquiring into the nature and the extent of special therapeutic actions by the scepticism of doubters nor by the rash generalizations of hasty observers.

Jane Williamson, aged 13, was admitted into the Chalmers Hospital under my care on the 15th of October last. She had the look of previously good health, and she was well nourished, but not robust. At the date of her admission, she presented the awkward gesture and the grimace of established chorea, though not severe in its degree. Temperature was natural; pulse 90, rather small; there was slight rheumatic pain of the knees and elbows, and an excited state of the heart’s action. The urine was loaded with lithates, it was normal in density, about 30 oz. in twenty-four hours. The bowels were easily regulated.

The treatment, in the first instance, consisted in the administration of a solution of the acetate of potash, with infusion of digitalis, and four minims of Fowler’s solution thrice a day.

The history of her previous illness given by herself and her friends was that, about a month previously, she was taken with a not intense attack of rheumatic fever. She suffered a good deal from the state of the larger joints; no symptom of cardiac inflammation appeared to have existed, but, for about a fortnight preceding her admission, she presented choreal action, gradually increasing indegree and affecting the extremities and face. . .

During the days immediately succeeding her admission, a rapid change occurred in the degree of the choreal movements, and in the state of the heart’s action. The latter became so disturbed, feeble, and excited, with feeble arterial pulse, as to cause serious anxiety for the safety of the patient, and at the same time the choreic agitation increased with such violent restlessness and 1 oiling in bed that excoriation occurred over the sacrum and both nates, while contortion of the features and tossing of the extremities, especially when their movement was attempted, continued excessive, the articular effects of rheumatism decreased, temperature became more natural, and urine healthy, but the bowels became torpid. The arsenic was persevered with, and a few 30-grain doses of bromide of potassium were given. Each dose was followed by a short period of quiescence, but, on the 20th, the excitement of the heart’s action became so alarming that 25-minim doses of tincture of Indian hemp were administered, followed by apparently marked, but only transient abatement of the spasmodic movement, which, as Dr. Hogg, the resident physician, reported, seemed to recur subsequently with increased and distressing severity.

On the following day, that is, the sixth of her residence in the Hospital, her condition seemed desperate, chiefly on account of the protracted and uncontrollable hurry of the heart’s action. She was ordered to have six minims of the tincture of cannabis every hour, the arsenic and other remedies being intermitted. The bowels were now well regulated, the excoriations of the back and nates had increased so as to form superficial sloughs of considerable extent, the pulse was small and so rapid as not to be counted, and the heart’s action was still feeble, rapid, and disturbed. She had four ounces of brandy per day. On the following day, having had twenty doses of the tincture, there was marked and increasing improvement. The violence of the tossing and rolling had diminished materially, though still it was necessary to have her secured in bed to prevent her falling or rolling over. From this time till the 15th day of her residence in the hospital, the tincture was administered from hour to hour, and she continued to make daily and progressive improvement. At that date (the 28th) she had been free of all the more violent spasmodic movements for two days and the heart’s action was quiet, pulse about 80, appetite good, bowels regular. She still presented a degree of the peculiar grimace, with awkwardness in protruding the tongue and in movement of the arms and hands. There was great mental lethargy, with languor and exhaustion, which made it impossible for her to be out of bed.

The tincture of hemp was now discontinued, and arsenical solution in four-minim doses resumed.

The subsequent progress of the case, though tedious, and so far disappointing, may be told in a few sentences. On the 1st of November, and on several occasions during the rest of that month, there occurred a renewal of the choreal state, which had not indeed absolutely disappeared, though it was often so trivial and even absent as to encourage the hope of an early recovery. Arsenic was perseveringly employed, with a carefully-regulated diet and general management, but on each occasion, of which three were noted, when an exacerbation of the choreic condition arose, a marked abatement of the muscular action resulted from the administration of small and hourly-repeated doses of tincture of hemp, relief sometimes arising so speedily as within six or eight hours. On one occasion the improvement was not decided for three or four days.

In the beginning of December, rheumatic symptoms recurred with slight febrile action and articular pains and renewal of choreic agitation. At the same time, marked excitement of the heart’s action was renewed, and now, for the first time, a faint soft diastolic murmur, indicative of aortic regurgitation, was with difficulty perceived. A weak solution of acetate and nitrate of potash was administered, and grain doses of opium four or five times in twenty-four hours. Pain arid fever abated, but not the spasmodic movement, and on the third day afterwards six-minim doses of tincture of hemp were given every two hours, followed by an immediate decrease of the chorea, which at once declined to its slightest degree in two or three days.

The patient now presented more marked indications of returning health. The state of mental lethargy into which she had early lapsed was now passing off; her appetite was revived, and on the 20th December she was able to be out of bed and to walk with assistance. Small doses of the iodide of potassium with the infusion of quassia were given, and improvement went on uninterruptedly; she did not, however, cast off the choreic jerk and awkwardness till the second week of January 1869. She has since had a very comfortable convalescence, but the diastolic murmur noted above continues strongly developed.

In the remarks I have to offer on this case, I confine myself to the points which illustrate the value and application of cannabis Indica in the treatment of choreal spasm. It is well said by Dr. Hughes, that each case of chorea, like each case of every other disease, should be separately studied; and though it may be regarded as one of a class, should still be viewed as a distinct individual of the class. In the case of my patient, the general characteristics of the attack point it out as an example of a large class of cases in which acute rheumatism constitutes the primary and originating source of chorea, while its special features simply declare the degree of chorea, with its repeated recurrences, and the unusual violence of agitation, to have been more than ordinarily severe, without any such personal or inherited constitutional peculiarity as exists in certain forms of this and of other nervous diseases.

Connected with the severity of the chorea, an inquiry of some difficulty arises out of the condition of the heart, particularly its disturbed action in the early stage, and the endocarditic lesion which occurred later, and which declared its presence only with the renewed rheumatic attack in the beginning of December. At the time of her admission and subsequently, notwithstanding the extra-ordinary hurry of the heart’s action, I persuaded myself that there was no organic nor inflammatory lesion, and I came to the conclusion that the severity of the choreic state had extended to the heart. The evidences of endocarditis subsequently developed cast doubt on my view of the previously choreic state of the heart; and there does not appear to be any means of solving the question beyond the opinion of those who saw the patient.

It certainly seems unlikely that endocarditis capable of causing such extreme disturbance of the heart’s action should have existed, unaccompanied from the outset by other indications of its presence.

This point possesses some interest in connexion with the view advanced by Dr. Russell Reynolds, that Indian hemp has been of no service in those affections of mind, sensation, or motility, which are simply functional in their character, or, at all events, have no established morbid anatomy. On the other hand, that it has afforded notable relief in cases where organic disease existed.

I do not agree with this view, but it would be beside my object to discuss it here. On the supposition, however, that the view is a sound one, it suggests that, in my patient, the organic lesion had originated in the heart at an early stage of the attack, and, consequently, the beneficial effects of the cannabis were so readily exerted. On the whole, the conclusion is a fair one, that endocarditis was present earlier than appeared; though still, I cling to the view that the disturbed action was, in the first instance, functional and choreic.

The practical interest of my case, however, consists in the illustration it affords of the special use and application of cannabis in the treatment of choreal spasm, and of the mode in which the remedy may be administered in many cases, if not in all. I have already remarked on the mistake, as it seems to me, of looking for general curative results in this or in any disease from the mere general application of special therapeutic observation or experience.

I think the cases and cures of chorea by tincture of hemp reported, to whlch I have referred, illustrate the fallacy of such reasonings; but, on the other hand, the case of my patient suggests that there is a special, and perhaps a frequently useful, application of the drug in such circumstances. The impression which the case leaves on my mind is, that cannabis has a peculiar value and power in controlling the irregular movements of chorea, which ever and again are terribly distressing, and possibly even dangerous, to the patient; and it would be of no small moment to determine the extent and limit of its influence, and to ascertain whether or not choreic action, even in slighter cases, might not be moderated by this remedy.

The result of repeated trial in my patient seems to show, on the one hand, that the violence of choreal action was speedily moderated; and the protracted duration of the case, on the other hand, makes it sufficiently evident that the virtue of the remedy did not reach farther in the direction of removal and radical cure of the disease. This points to an important question in the treatment of chorea, which has been mooted by many writers on the subject, viz., how far the chorea is to be dealt with as an independent condition, and how far its treatment and removal will be best achieved by the treatment of the diseased state out of which it has sprung?

I think that systematic writers and clinical lecturers have dealt with the subject of chorea too much as an independent disease, and that the late Dr. Babington, of London, in his justly-admired paper on chorea, indicated a sound and philosophic principle, when he advised that when the disease has arisen by metastasis of rheumatism, it should be treated in the same way as pericarditis is treated.

Recognising, then, the principle that our chief aim in the treatment is to combat the constitutional state, or the local disease in connexion with which the chorea has arisen, I conclude farther, from the case I have read, that an important aim must sometimes, if not at all times, be to allay the severity of the choreal state by the use of cannabis, or by other means. On this point, I cannot resist quoting from M. Trousseau his earnest utterances in the behalf of tartar emetic as a means of subduing the violence of choreal agitation: “Unfortunately,”says that learned physician, “there are cases in which the convulsive agitation is of such violence that all known means are without avail, and the physician too often sees poor young girls perish miserably, the skin rubbed and deeply ulcerated by incessant friction, that no appliance can obviate.

But surely, in such circumstances, cannabis Indica is a far more appropriate remedy than tartar emetic, affording, as M. Trousseau adds, “if  though only in exceptional cases, a chance of success where  we appeared impotent.”

The limit of the therapeutic action of cannabis Indica in these cases is incidentally indicated, with a thoroughly practical wisdom, by Dr Williams and by Dr Walshe. So long ago as in 1843, Dr Williams is reported to have said, in the course of a discussion, that he had found it “ relieves chorea during its exhibition, but without radical effect on the disease.”

In 1849, Dr Walshe, in a clinical lecture, says: “Not only was its sedative effect marked in degree, but it was almost immediate in point of time, leaving no doubt on my mind as to the reality of its influence.”

The recurrent attacks of chorea in the case of my patient afforded the means of direct illustration of the efficacy of the drug in subduing the choreal state. for repeatedly the same result was witnessed in the speedy and more or less complete subsidence of the agitation under the use of the remedy, and the decided effect produced on the heart’s action tends to confirm me in the impression that the disturbed state of that organ was largely choreal.

As to the mode of administering the remedy, small and frequent doses proved both safe and effective, and great advantage appeared to arise from increasing the frequency of the dose rather than its amount. Believing, as I do, that cannabis Indica is a remedial agent of value in many and various maladies, I am prepared to recommend this mode of seeking its effects by frequent rather than by larger doses at longer intervals. Such a mode of prescribing it has not been usual; but I find, quoted from an American source, the account of a case of hiccup treated in this way by eight-drop doses of a fluid extract, administered hour by hour, in which recovery from an attack that had defied treatment for five days took place in a few hours.

I have brought this case under the notice of the Medico-Chirurgical Society, not on account of any novelty in its history, nor on account of any conclusions it very positively points to, but simply to bring anew to the light of day an important therapeutic fact, which seemed like to be buried in the pages of undisturbed magazines, and which, probably, has an important application, not only to distressing and dangerous cases of chorea, but even to slight and ordinary cases, as well as to cases of other spasmodic diseases, such as hiccup, irritable heart, asthma, tetanus, and the like.

If you would like to have a copy of this 1869 article by Dr. Douglas as a PDF file please email me with your request.

 


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Historical Insights Into Hashish

Courtesy of 420 Magazine

Before getting to the promised insights, dear reader, please indulge me for a few paragraphs.

Readers of this blog know that I am fascinated by lost knowledge, and by the phenomenon of history repeating itself for new generations who believe that their experiences are unique in the history of the human race.

So it is with the current “Opioid Crisis”. The historical reality is that absolutely none of this current “Crisis” is new – not in kind, not in scale, not in consequences, not in causes, and certainly not in the ineffectual “solutions” that are (once again) being proposed.

I am in the process of editing and preparing to re-publish a lengthy and complex book from 150 years ago by a New York doctor, Alonzo Calkins, who wrote the book for members of the medical profession of his time. His objective was to make clear the deep historical roots of the love affair between people and mind/body altering substances. Although it is clear that Dr. Calkins disapproved – to put it mildly – of any kind of mind-alteration with the possible exception of vigorous exercise and (Christian) prayer, he was also clearly a person with a deep grasp of world history and human nature.

The book is: “Opium And The Opium-Appetite: With Notices Of Alcoholic Beverages, Cannabis Indica, Tobacco And Coca, Coffee And Tea, And Their Hygienic Aspects and Pathologies Related” by Alonzo Calkins, MD, New York, 1870. (I will have this ebook available on Amazon in a week or so and will post a link in the sidebar of this blog.).)

Dr. Calkins lived near the end of the great Age of Exploration. For centuries before he wrote this book thousands of explorers, adventurers, writers, physicians and entrepreneurs of all kinds had been ranging the earth sampling all of the many and varied ways that people use mind-altering natural substances.

As far as Dr. Calkins was concerned, using drugs outside of a medical context is a destructive and immoral activity, so his book was not written in praise of all of those discoveries of colorful and imaginative ways that people of the world have found to get high. He was, however, a competent and observant physician, and he understood that in addition to people seeking to alter their minds in order to just plain have a good time, most people who use mind-altering substances are seeking ways to deal with misery, pain, disease, poverty, hopelessness and the general brutality of their existence.

This acknowledgement of the legitimacy of the human need for drugs, and the extensive documentation he offers, should give Dr. Calkins’ book a place in the library of anyone today who seeks to learn the lessons of the past in order to better understand the profound dilemmas we face today – dilemmas like 60,000+ Americans dying of pharmaceutical overdose. These numbers, so alarming to the breathless media, hypocritical politicians, parasitic “professionals”, and privileged classes, are really nothing new. Not at all. They are, however, absolute proof that people never learn, and especially that people who fancy themselves to be “in charge” never learn.

As long as societies that can well afford to change do not, and as long as a tiny minority keeps all the wealth and power of the society to themselves and continues to allow pain, disease, poverty, hopelessness and brutality to dominate the lives of the majority, the “drug problem” will never, not ever, be solved. Violent revolutions, however, can and do occur with regularity, and they are always about the same evils that “cause” the “drug problem”.

That is because, as Dr. Calkins’ book makes so clear although the author himself does not realize that he is making this point, in the end the “problem” is not drugs. It is the life that so many people are forced to lead by the cruelty, ignorance and selfishness of others.

So, that said, here is one of the many interesting chapters in Dr. Calkins’ book, chock full of those historical references I promised. Although I have been an avid investigator of the history of both Cannabis and Opium for many years, some of the following observations on Hashish were brand new to me, as I hope they will be to you as well. Keep well in mind the limitations of the time in which Dr. Calkins wrote, and have fun!

Chapter XXV: Opium And Cannabis Indica Contrasted

“Fallax Herba veneni.” – Virgil.

“That juice – the bane, And blessing of man’s heart and brain – That draught of sorcery, which brings Phantoms of fair forbidden things.” – Moore

The authorities upon Cannabis besides those to be specified are Rhases, Kaempfer, D’Herbelot, Herault, Mantegazza, and others. The solid extract (which is procured from the summitates of the herb) is called Hashisch in Arabia, Gunjah and Chumts in India (where it is also familiarly known as the “Herbe des Fakirs”), Bust or Shoera in Egypt, El Mogen by the Moors, and among the Hottentots Dacha or Dagga (Von Bibra). Bangue (Bang) or Bendji is the spirituous extract.

Cannabis as a stimulating narcotic has for some centuries at the shortest been known and familiarly used in India, Persia, Bokhara, and other countries, and in some of the Islands. In Egypt, particularly among the lower orders, it takes precedence of opium, and is chewed or sometimes smoked from the gozeh (Lane). Bhang – the more active preparation – is conspicuous for its inebriative and delirative operation.

The Massagetce (as is related by Herodotus), a people on the Araxes, had a seed (conjectured to have been this same seed of Indian Hemp or perhaps of the Datura), which thrown upon hot stones sent forth a vapor that excited boisterous mirth and shouting. Davis the navigator on visiting Sumatra found such a seed, a little only of which being eaten gave to every object a metamorphosed appearance and turned the man for the time into a fool. Dampier observed among the natives of this island an herb which produced exhilaration and then stupefaction, making the eater lively or dull, witty or foolish, or merry or sad, according to the predominant temperament.

Hashisch far surpasses opium in relative power. A dose of twenty centigrammes of the resinoid repeated three or four times shows activity in half an hour, but the full effect is not attained short of three times this space. The duration of action is three to four hours (Steeze of Bucharest). Irregularity and uncertainty in action are doubtless to be ascribed to adulteration (Schroff).

The full impression once produced the brain is speedily affected with a sensation of extraordinary elasticity and lightness and the senses become wondrously acute, a tingling as from an electric shock is felt shooting from the spinal centre to the periphery of the body, the vault of the cranium is lifted off as it were by the expansive force within, the skull seeming as if enlarged to the dimensions of a colossus; and now with one impetuous rebound the experimenter rises above this low commonplace of terrene existence to soar in a purer ether above.

If still conscious of a lingering upon the confines of earth he sways himself along in a balancing gait as though he were under a sort of ivresse. External impressions as from the pricking of a pin or a stroke from the hand may perchance pass unheeded. Objects in the immediate range seem invested with an unwonted splendor, human faces take on a seraphic lustre, and the man for the time feels himself to be possessed of the power of ubiquity. According to the varying humor things around may seem to have assumed a fantastic dress, when peals of laughter will break forth; or suddenly a change will have come over the spirit, when under the impressions produced by lugubrious images and depressing apprehensions the mind will be wrapped in cloudiness and gloom (Polli).

The appetite is assisted by moderate doses but made ravenous for the time by large ones, and the digestive function is correspondingly aroused while constipation is obviated, and the various secernent processes go on in their normal way (Dr. Teste). Not until after long-continued and excessive use does appetite decline, as is observable of the Arabs, says Auber, who finally get fleshless and withered as the general tendency to decay becomes more distinct and progressive.

An excessive dose hinders the approach of sleep; a moderate one brings on a sopor speedy and irresistible. This sleep may be profound and stertorous, or it may partake more of the dreaminess of ecstasy. In the story of Mahmoud lord of the Black Isles, the wife, to cover up her absence for the night, administers just before going out a powder that soporizes him immediately and effectually for the time, or until she shall return again to awaken him with a perfume placed under the nostrils.

This powder there is reason for believing was some preparation (simple or compounded) of the hemp. In another of the stories of the “Nights,” that of the Jew Physician, is a similar incident described. So the chamberlain of Ala-ed-Deen is suddenly thrown into a profound sleep by the use of a powder which Ahmed Kamakim an arch-thief throws upon his face. Unlike that after the opium-sleep, the sensation on awaking is one of refreshing.

The mental condition is an ideal existence, the most vivid, the most fascinating. Time and space both seem to have expanded by an enormous magnification; pigmies have swelled to giants, mountains have grown out of molehills, days have enlarged to years and ages. De Moria in wending his way one evening to the opera house, seemed to himself to have been three years in traversing the corridor. De Saulcy having once fallen into a state of insensibility following upon incoherent dreamings, fancied he had lived meanwhile a hundred years. Rapidity as well as intensity of thought is a noticeable phenomenon. De Lucca after swallowing a dose of the paste saw as in a flitting panorama the various events of his entire life all proceeding in orderly succession, though he was powerless in the attempt to arrest and detain a single one of them for a more deliberate contemplation. Memory is sometimes very singularly modified nevertheless, there being perhaps a forgetfulness not of the object but of its name proper, or the series of events that transpired during the paroxysm may have passed away into a total oblivion.

The normal mental condition is that of an exuberant enjoyance rather than the opposite, that of melancholy and depression, though the transition from the one state to the other may be as extreme as it is swift. Oftener the subject is kept revolving in a delirious whirl of hallucinatory emotions, when images the most grotesque and illusions the drollest and most fantastic crowd along, one upon another, with a celerity almost transcending thought (Mirza Abdul Roussac).

Command over the will is maintainable, but temporarily only. As self-control declines the mind is swayed by the mere fortuitous vagaries of the fancy; and now it is that the dominant characteristic or mental proclivity has its real apocalypsis. The outward expression may reveal itself under a show of complacency and contentment in view of things around, or suspicion, distrust, and querulousness of disposition may work to the surface, or maybe a lordly hauteur that exacts an unquestioning homage from the “profanum vulgus” by virtue of an affected superiority over common mortals, is the ruling idea of the hour; or peradventure the erotic impulses may for the time overshadow and disguise all others.

Amid the ever-shifting spectacular scene the sense of personal identity is never perhaps entirely lost, but there does arise in very rare instances the notion of a duality of existence; not the Persian idea precisely, that of two souls occupying one and the same body in a joint-stock association as it were (the doctrine as alluded to by Xenophon in the story of the beautiful Panthea), but rather the idea of one and the same, soul in duplication or bipartition else, and present in two bodies.

The rapturous delights inspired by the beatific visions thus find expression in an exclamation of an aged Brahmin: “O sahib, sahib, you can never know what perfect pleasure is until you see as I have seen and feel as I have felt – spectacles the most gorgeous, perfumes the most delicious, music the most transporting and bewildering.”

The inspiration of the Pythian priestess at Delphi has been attributed to opium and again to hashisch, and not unlikely both conspired to the effect. This improvisatore power was amusingly developed one day in a pupil of Dr. O’Shaughnessy’s, upon a trial of ten minims of the tincture. The young man in the ecstasy of the excitement assumed the airs and language of an Indian rajah, talking learnedly and haranguing with great volubility in a lively display of brilliant fancy and logical acuteness, to the admiration of friends no less than to his own astonishment as subsequently felt (for the recollection of his scenic personations survived the performance), inasmuch as a habitual taciturnity and an unostentatious carriage were so congenial and habitual to the young man. The paroxysm having lasted six hours, a retransformation occurring somewhat suddenly was complete nevertheless.

Note. In a Prize-essay lately read before the American Philosophical Society by H. C. Wood, M.D., the Professor records an experimentation with somewhat unexpected results, as conducted upon himself. The preparation used was an extract made from Kentucky hemp, in quantity about half a drachm. The effect, which began in three hours, lasted into the following day. At midnight a profound sleep had come over him, and in the hours of waking there was noted an anesthesia affecting the entire skin. The characteristic expansion of time and space was a conspicuous symptom. Mental action as an effect of volitional effort was mostly restrained, from the embarrassment experienced in attempts towards a concentration of the thoughts. A sense of impending death besides hung over him at intervals. In a student who experimented with a grain dose, there was developed a hilarious excitement simply, with a sexual erethism ensuing which did not relax short of three days. This scientific paper (the first contribution of the kind to the medical literature of America) should command the attention of the Profession.

This singular excitant, extensively known in the age of the Crusades appears to have been used by the Saracens for a double purpose, to kindle up the ardor of the soldier against the Paynim, and in larger dose to beguile his adversary into a careless security and so to facilitate the stealthy use of the poignard. In the neighborhood of Mount Libanus there existed from the beginning of the twelfth century for about one hundred and fifty years a military organization, made up for the most part of rude hordes gathered out of the tribes of Kurdistan. Ishmaelitish by genealogy, vindictive in their passions and implacable in their resentments, while professing fealty to the Crescent they campaigned oftener in reality, “their hand being against every man and every man’s hand being against them. Their generalissimo was known as “Le Vieux de la Montagne” (Von Hammer).

At Allamut and Massiat were their famed gardens, secluded by high walls from the vulgar gaze but within adorned with every decoration and luxury that could entrance the vision and captivate appetite; and here presided girls of enchanting beauty and ravishing seductiveness, the houris of the scene. Into this “outer court of the temple,” the youthful aspirant to the honor of a matriculatory membership having been previously drugged with hashisch, was mysteriously conveyed, here to breathe the balmy airs of a terrestrial paradise, introductory to the solemn oath of covenant which at once exacted entire and unquestioning obedience and which denounced an abjuration on peril of life.

Such were the Herb-eating Assassins, the “Hashasheen” (De Sacy). A final dispersion was carried out by the victorious sword of Hulakii, when Aldjebal, Khalif of Baldrach, after sustaining a siege of three years was shut up in a tower by Ulau, there to perish in his solitude by a lingering death (Benjamin of Tudela).

Hashisch, more energetic in action than opium, is in comparison prematurely exhaustive also. Rapid deterioration of the physical forces is to be expected, and as is thought a determination towards phthisis may be established. The ultimate mental condition is that of dementia. The santons (holy men) of Egypt, those distinguished objects of popular veneration in their wanderings from town to town, are living illustrations of this degenerescence, in their corporeal as well as in their mental decay.

Quite unlike opium in one characteristic, hashisch is a powerful aphrodisiac (O’Shaughnessy), ranking second on the list perhaps, or after arsenic. The power of the latter indeed appears remarkable. In the Edinburgh Medical and Surgical Journal is a case from Dr. Parker, that of a young man thirty years old at his death, who began the use at the age of four. A double effect ensued, a prodigious development of the sexual organs in size, and a proportionate exaltation of function amounting to an impetuous and uncontrollable salacity.

Deleterious as is hashisch in the ordinary habitual use, it may be counteracted or neutralized very effectually for the time by the free use of lemon-juice. Dr. Castelnuovo a resident in the country for thirty years observes, that the people of Tunis understand the secret thoroughly and avail themselves habitually of the benefits.

Bearing an analogy to the poppy from their more intimate relationship to cannabis are Hyoscyamus, Belladonna, and the Datura family. The first – reckoned by Von Hammer to have been identical in origin with the bendji – produces giddiness and stupidity. Belladonna, that “insane root that takes the reason prisoner” (rather is it one out of a number of such), excites delirium and the risus sardonicus (Ray).

The pathologic mental phasis is described by Winslow as a species of “hallucination without fantasia,” i.e. a metamorphosis of things actual in idea rather than a display of mere fanciful creations without analogies in natural things. A pathologic condition has been remarked simulating delirium tremens. The recollection of past phenomena is found to have been obliterated “at once and irrecoverably.”

Datura brings spectral illusions, but leaves a persistent, perhaps incurable stupidity. A singular effect wrought upon the memory is in the interchanging of the names of objects, there being at the same time a conscious perception of the incongruities. The daturas possess strong erotic powers, and a species is used in India by courtesans upon themselves and for the benefit of their visiting friends. The cordial sometimes made by digesting the seeds in wine is especially dangerous to the sex by a double action, exciting physical desire most actively for the time and making the subject oblivious altogether of any faux-pas adventures hazarded.


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Medical Cannabis & Hashish In Old Europe

The consciousness that Cannabis is a powerful natural medicine was well-developed in Europe of the 1800s. Knowledge of the medical uses of Cannabis, Coca Leaf and Opium came to Europe from the Andes and Asia first through explorers and traders of the 1600s and 1700s, then increasingly through travelers, writers, adventurers, scholars and missionaries in the 1800s.

Of course Cannabis also came to Europe as Hashish at the same time as it arrived as dried, pressed flowers, so Europeans had a Cannabis concentrate to work with from the earliest days. In the beginning there was some confusion over whether Cannabis flowers and Hashish were the same thing – a confusion soon to be mirrored with Coca Leaf transmuted into Cocaine, and Opium Sap transmuted into Morphine and Heroin.

Americans who find the history of Cannabis fascinating will enjoy browsing the following essay, which I discovered in a public domain EU document. The entire document is mostly about drug control in Europe, but this essay which is intended as background for discussions of control happens to be the best concise history of early medical use of Cannabis in Europe that I have read, and so I’m happy to share it with you here on Panacea Chronicles.

Cannabis as medicine in Europe in the 19th century
Manfred Fankhauser

As in the previous centuries, hemp was predominantly used in the 19th century as a fibre material. Herbal cannabis played a marginal role as a medicinal plant, although its seeds were used medicinally, mostly in the form of pressed oils or hemp milk as medicine against gonorrhoea or cystitis. In tandem with prevailing interest in plants, products and culture from the Orient, medicinal use of cannabis arrived in Europe from the East during the 18th century.

Much has been written on the historical knowledge in Europe of the psychoactive properties of hemp prior to the 18th century: among readers of Herodotus’ description of Scythian cannabis-incensed burial rites; by alchemists, in particular the herb Pantagruelion lauded by author François Rabelais; via knowledge of Islamic medicine via al-Andalus, and elsewhere (Bennett et al., 1995; Booth, 2003; Mercuri et al., 2002).

However, widespread scientific writings on its psychoactive properties came later. For example, Gmelin wrote in 1777 of the Eastern use of bhang for stupefying (‘etwas Betaeubendes’), mind-clouding (‘Benebelung des Verstandes’) and intoxicating effects (Fankhauser, 2002); and in 1786 the Comte d’Angiviller thanked a certain Boulogne for his sending of Indian hemp plants with the prophetic words ‘Cette plante sera peut- être un présent intéressant pour l’Europe’.

At the end of the 18th century, the French naturalist Sonnerat informed Lamarck’s 1873 Encyclopédique de botanique of Cannabis indica (Emboden, 1974) and brought Indian hemp home to France after a journey to the Orient. Napoleonic campaigns in Egypt and the Near East introduced colonial troops — notably the scientists Silvestre de Sacy, Rouyer and Desgenettes — to hashish (Abel, 1980; Booth, 2003).

European interest in this ‘new’, or rather rediscovered, plant grew only hesitantly. The first comprehensive description of the medical usefulness of Indian hemp in Europe was written in 1830 by the German pharmacist and botanist Friedrich Ludwig Nees von Esenbeck. Until that point in time, use of hemp for medical purposes had remained at a low level.

This situation changed significantly prior to the middle of the 19th century. William B. O’Shaughnessy (1809–1889/90), an Irish medical doctor stationed in Calcutta, India, published in 1839 a comprehensive study on Indian hemp. Thanks mainly to his On the Preparations of the Indian Hemp or Gunjah, Cannabis indica now also became recognised within European-school medicine. O’Shaugnessy used various hemp compounds in his investigations, partly with great success, against the following indications: rheumatism, rabies, cholera, tetanus, convulsions and delirium tremens.

With hashish he had found a well-suited medicine to give his patients relief, and in the case of cramps, even total disappearance of symptoms. For concluding remarks, he wrote: ‘The presented cases are a summary of my experience with cannabis indica, and I believe that this medicine is an anticonvulsivum of great value’ (O’Shaughnessy, 1839).

Europe reacted promptly to this new knowledge from India. This is not surprising as until then no adequate treatment existed against recognised diseases such as rabies, cholera or tetanus. Great hopes were based on O’Shaughnessy’s results. The French were the first to engage themselves intensively with the plant. As early as 1840, the French medical doctor Louis Aubert-Roche (1809–1874), who resided in Egypt, used hashish seemingly successfully against pestilence (Hirsch, 1884–1886). Nearly simultaneously, his compatriot and friend, the psychiatrist Jaques Joseph Moreau de Tours (1804–1884), began to experiment with hashish. He started out with experimenting upon doves and hares, giving them large doses of hashish extracts with their fodder. Then he tested hashish on friends, colleagues, patients and himself. He was convinced that hashish was the supreme medicament for use in psychiatry. His book, Du Hachich et de l’aliénation mentale (1845), caused a great sensation at the time, and is still understood as the origin of experimental psychiatry and psychopharmacology (Weber, 1971).

The works of Moreau de Tours had an impact not only in medical circles, but also among writers and artists. The poet Théophile Gauthier (1811–1872), for instance, received hashish samples from Moreau de Tours. In 1843 he described extensively a self-experienced hashish intoxication in the Paris newspaper La Presse under the title ‘Le Club des Hachichins’. The club of hashish eaters, of which Gauthier was one of the founders, had regular meetings in Hôtel Pimodan on the Seine island of St Louis.

He and Charles Baudelaire (1821–1867) shared a penthouse in the hotel for several years. Other prominent club members were Alexandre Dumas (1802–1870) and Honoré Daumier (1808–1879) (Moreau, 1904). Further well-known contemporaries such as Honoré de Balzac (1799–1850), Gustave Flaubert (1821–1880) and Victor Hugo (1802–1885) participated occasionally (Behr, 1982).

Inspired by Moreau de Tours and later by pharmacy professor Eugène Soubeiran (1797–1859), the pharmacist Edmond de Courtive published in 1848 his widely noted dissertation, Haschish. In addition to chemical analysis, he carried out self-experiments with miscellaneous hashish compounds and gave exact descriptions of their physical and psychic effects (De Courtive, 1848).

Many medical doctors took advantage of the promising results of the pioneers O’Shaughnessy, Aubert-Roche and Moreau de Tours and used these new drugs for therapeutic purposes. Initially, primarily doctors from the colonial powers of England and France showed interest in the use of compounds made of Indian hemp. The necessary commodities or compounds were imported in great quantities to Europe from the colonies, especially from India (Smith and Smith, 1847). Hemp was in this period sold to Europe primarily in three commercial variations:

Ganjah: consists solely of the blooming tips of the female, carefully cultivated plant. Mostly 24 blooming tips are bundled in a length of approximately 1 m, and 11 cm thickness.

Charras: consists of the resin, which is extracted foremost from the blossom, but also from leaves and stalks of the female plant. Today, the extracted resin is called hashish.

Bhang: extracted from the leafless stalks of the female hemp plant. Bhang was predominantly exported to Europe in powder form.

In Europe ganjah was the first to be pharmaceutically exploited. Initially, the fields of application known to O’Shaughnessy were adopted. Later on, the therapeutic application of hashish was considerably extended. In particular, the English and French medics applied this new wonder drug against tetanus (Martius, 1844). Encouraged by many positive reports, especially from England, the Bulgarian medic Basilus Beron intensively engaged in this problem in a dissertation. His work concludes:

I was so contented that, after having used almost all known antitetanic drugs without result, the sick person that had been assigned to me was totally cured after use of the Indian hemp (…) wherefore the Indian hemp is strongly recommended against tetanus. (Beron, 1852)

Homeopathy, founded by Samuel Hahnemann (1755–1843) and rapidly advancing in this period, was also quick to include Indian hemp in its medical catalogue. Towards the middle of the 19th century, in addition to the illnesses already mentioned, Indian hemp was mainly used against neuralgia and other pains, chorea, hysteria, insanity, haemorrhage and insomnia. Since prepared products did not yet exist, cannabis extracts and tinctures were mostly used.

The real success story of cannabis as a medicine began in the second half of the 19th century after the publication of Beron’s dissertation in 1852. In the same year, Franz von Kobylanski published a dissertation on the effect of cannabis as an oxytocic (1852). Four years later, the German Georg Martius wrote his comprehensive work Pharmakognostisch-chemische Studien über den Hanf, which attracted much attention.

Interest was also aroused by the experiments of the Viennese Carl Damian Ritter von Schroff (1802–1887). Martius was among the few who did not deem cannabis compounds as harmless. He wrote that:

the Indian hemp and all its compounds show great diversity concerning the degree and type of effect according to individual differences in healthy as well as in pathological conditions. It therefore belongs to the unsafe agents, and the medic should under all circumstances use it with great care.
(Von Schorff, 1858)

At the same time, Ernst Freiherr von Bibra (1806–1878) published his standard work, Die narkotischen Genussmittel und der Mensch. Here, he discussed hashish for over 30 pages. In addition to experiences of others, he describes a self-experiment with hashish. His concluding judgement was as follows: ‘Recent experiments and experiences made on the medical effect of the hemp plant and its compounds very much point to their advantage’ (von Bibra, 1855).

In this period, most European countries, as well as the USA, included Indian hemp in their national pharmacopoeia. The monographs Herba Cannabis indicae, Tinctura Cannabis indicae and Extractum Cannabis indicae enjoyed increased prominence,
whereas Semen/Fructus Cannabis and Oleum Cannabis became more and more rare. It was first of all France and England, and to a lesser extent the USA, that significantly contributed to the definitive breakthrough of the drug into Western medicine.

The study of Indian hemp was even pursued in Germany. A comprehensive work of Bernhard Fronmüller, written in 1869, is frequently cited. He had studied the qualities of the hemp plant for a long time, and carried out cannabis experiments within the framework of ‘clinical studies on the euthanising effect of the narcotic drugs’ with exactly 1 000 test patients. These test patients suffered from heavy insomnia due to various illnesses. The results of his investigation were positive. Thus, he concluded in his work: ‘The Indian hemp is, among the known anaesthetic drugs, the narcosis which most perfectly achieves a replacement of natural sleep, without particular repression of expulsions, without bad repercussions, without paralyses’ (Fronmüller, 1869).

Well-known medical experts or pharmacologists of the time wrote more-or-less comprehensive essays on Cannabis indica. Some of these articles criticise the unreliability of hemp compounds. Indeed, the standardisation problem continued to be an issue for cannabis compounds until they disappeared. Kobert is one of very few who discussed the dangers of long-term consumption: ‘The habitual consumption of any effective hemp compound deprives the human being and brings him to a mental institution’ (Kobert, 1897).

The period 1880 to 1900 can be considered a peak in the medical use of cannabis. The use of hashish compounds had become commonplace in almost all European countries and in the USA. Nonetheless, it was still scientists from England, France, Germany and the USA who persistently continued cannabis research. It is, therefore, not a coincidence that most of the products on the market (‘specialities’) originated in these
countries. It is first of all through the contribution of the company E. Merck of Darmstadt, Germany, that cannabis compounds became more widely used in Europe towards the end of the 19th century. One of the preferred source materials in the production of cannabis compounds in this period was Cannabinum tannicum Merck. In addition, the company Burroughs, Wellcome & Co. in England produced cannabis compounds. In the USA, cannabis compounds were manufactured by Squibb and sons in New York (‘Chlorodyne and Corn Collodium’), and, later, Parke-Davis & Co. in Detroit (‘Utroval’ and ‘Casadein’) and Eli Lilly (‘Dr Brown’s Sedative Tablets’, ‘Neurosine’ and ‘The One Day Cough Cure’). These companies delivered sufficient quantities of high-quality raw materials and produced compounds for the market.

Probably the most-used hemp compound was the sleeping pill Bromidia, of the American company Battle & Co. This was a combined drug, that is, in addition to cannabis extract it contained bromine potassium, chloral hydrate and henbane. While single compounds dominated during the 19th century, combination compounds were preferred in the 20th century. Most cannabis drugs were for internal use, but there existed topical compounds, for instance, creams or the common clavus tinctures.

In the meantime, France continued its 50-year tradition and honoured medical doctors and pharmacists with doctoral degrees based upon works on hashish. In 1891 Georges Meurisse (born 1864) published his work Le Haschich, and five years later Le chanvre indien by Hastings Burroughs (born 1853) appeared. The latter is strongly based on Villard’s work, but also upon his own therapeutic experiments. He summarises: ‘In therapeutic doses, the Indian hemp is safe and would deserve to be more frequently used’ (Burroughs, 1896).

In Germany, the PhD students H. Zeitler (‘On Cannabis indica’, 1885) and M. Starck (‘How to apply the new cannabis compounds’, 1887) first wrote their graduation dissertations, before the pharmacist Leib Lapin in 1894 published his dissertation, ‘A contribution to the knowledge of Cannabis indica’, under the guidance of the leading figures Johan Georg Dragendorff (1836–1898) and Rudolf Kobert (1854–1918). In the first part of his work, he gives an overview of ‘common, manufactured and officinal hemp compounds’ in use at the time. In the second part he describes the pharmacology of ‘cannabindon’, a cannabis derivate first studied by him. In the preamble of his investigation, he makes a remark which shows the uncertainty that existed regarding the medical safety of Indian hemp:

Had it been so simple to solve the hashish question, it would certainly have been solved by one of the numerous previous investigators. I believe that I have contributed to the definitive resolution, and this belief gives me the courage to publish the following as a dissertation.
(Lapin, 1894)

A scientific contribution of extraordinary importance within the cannabis research of the 19th century was the so-called Indian Hemp Report of 1894. This census, carried out by Great Britain in its colony India, primarily studied the extraction of drugs from cannabis, the trade in these drugs and the implications for the total population. Additionally, the study set out to clarify whether prohibition of the compounds might be justified, and an expert commission was established for this purpose. Its report impressively shows the significance of the stimulant and drug cannabis in India towards the end of the 19th century. The main conclusion of the commission was: ‘Based upon the effects of the hemp drugs, the commission does not find it necessary to forbid the growing of hemp, nor the production of hemp drugs and their distribution’ (Leonhardt, 1970).

Towards the 20th century, Indian hemp enjoyed an important position in the materia medica of Western medicine. Evidence of misuse of cannabis compounds was practically non-existent until then. Kunkel writes:

The chronical misuse of cannabis compounds — cannabism — is believed to be widespread in Asia and Africa. It results in chronic, heavy disruption of the entire organism, especially mental disorder — attacks of raving madness and a subsequent condition of weakness. It is not observed in Europe, Indian doctors report however daily frequent cases of this disease.
(Kunkel, 1899)

To sum up, hashish played a significant role as a medicine in Europe and in the USA towards the end of the 19th century. The most important applications were against pain, especially migraine and dysmenorrhoea, pertussis, asthma and insomnia. Additionally, hashish was relatively frequently used as an additive in clavus supplements. Rare applications were stomach ache, depressions, diarrhoea, diminished appetite, pruritus, haemorrhage, Basedow syndrome and malaria. Cannabis compounds were also used in numerous single cases, partly with good results. These were, however, of smaller significance.

Typically, doctors who worked intensively with cannabis drugs for years would classify them as valuable medicines. Others criticised them, and frequently looked upon them as worthless or even dangerous. However, both groups agreed on the unpredictable effect of cannabis compounds.

After keen use of cannabis compounds around the turn of the century, they disappeared completely in the middle of the 20th century. The main reasons for the disappearance of hashish medicaments are medical developments. Even before the 20th century, new, specific medicines were introduced for all main applications of cannabis compounds.

Vaccines were developed for the treatment of infectious diseases (cholera, tetanus, etc.), which not only fought the symptoms as cannabis did, but also gave protection against infections. Other bacterial illnesses, such as gonorrhoea, that were frequently treated with cannabis could somewhat later be treated successfully with chemotherapeutica.

Cannabis indica received competition as a sleeping and tranquillising drug in the form of chemical substances such as chloral hydrate or barbiturate. Contrary to the numerous opium drugs, cannabis compounds were also replaced as analgesics by chemical substances. In this area, aspirin achieved great importance shortly after its introduction in 1899.

Another reason for the decline of cannabis as medicine was pharmaceutical instability. The varying effectiveness of the hashish compounds has often been noted. Very different factors, such as origin, age, storage and galenic preparation, affected effectiveness of the medicine. Unlike, for instance, alkaloid drugs such as opium, the isolation of active ingredients was not successful until the middle of the 20th century. This resulted in standardisation problems. There were also legal constraints. The use of cannabis compounds became more and more restricted in international and national law.

Hashish compounds were defined as anaesthetics sometime in the 20th century. This complicated their use enormously, until finally a general ban made it impossible to apply them.

Finally, economic aspects contributed to the decline in use of medical cannabis. Import into Europe of high-quality Indian hemp became more and more difficult due to constraints in the producing countries (mainly India) and the influences of the two world wars. Laws of supply and demand also applied to cannabis, resulting in a massive price increase for raw materials (e.g. herba Cannabis indicae) as well as for compounds (e.g. extractum Cannabis indicae).