South African Medical Journal

Suid..Afrikaanse Tydskrif VIr Geneeskunde

EDITORIAL VAN DIE REDAKSIE

DAGGA DAGGA

Dagga is the common South African term which describesthe coarse leaf-powder (containing seeds) made from theflowering top of the Indian hemp plant, botanically knownas Cannabis. The hemp plant originated in CentralEurope, but it now grows in most parts of the world,wild or in cultivation, as an annual. Any part of it, whenrubbed between the fingers, gives off a characteristic mintyodour, the flowering tops being slightly sticky to thetouch. The hemp seed (chenevis) is used in the manufac­ture of varnish and paint. It was formerly used for soap­making. In hot, dry countries (the plains of India) theplant is cultivated to produce textile fibres. l

The inebriating properties of hemp have long beenknown. Herodotus 2 wrote that the plant was cultivatedin Scythia and Thrace, and the inhabitants not only madeclothes from it, but also intoxicated themselves by roastingthe seeds on hot stones and breathing the vapours. To-dayan imposing number of narcotic preparations· is made fromthe hemp plant for consumption by addicts all over theworld. Drugs may be prepared for smoking (chira,hashish, marihuana, dagga) or for drinking (assis, chats­raki). In Eastern countries much ingenuity is devoted tothe making of sweet-meats which contain the Cannabisresin in mixtures of almond, chocolate or honey; thesesubstances have a reputation as aphrodisiacs in Arabmedicine.

Drugs which produce addiction generally have effectsregarded as pleasurable. That hemp has these properties isevident from the serious problem created by its controland use in the United States. The recent imprisonmentof a group of film actors focussed fresh public attentionon Cannabis addiction and showed that it is not confinedto the lowest economic groups of the population. Theimpression is that in South Africa dagga is used chiefly byColoured persons and a small number of the moredegenerate Europeans. There is a strong popular dis­approval directed against it.

At the Grahamstown Medical Congress, in 1935, aresolution was passed asking the Minister of the Interiorto arrange for an investigation of the likelihood that daggasmoking could produce psychotic states and intellectualdeterioration. As a result a study of dagga smoking 3 wasmade by the staff of the Pretoria Mental Hospital. The

1. R. J. Bouquet (1950): U. . Bull. arco!., 2, 14.2. Herodotus, HislOriae, IV, 75.3. Medical Staff, Pretoria Mental Hospital (1938): This

Journal. 12, 85.

284

Dagga is die algemeen bekende Suid-Afrikaanse term watdie growwe (saadbevattende) blaarpoeier beskryf watvan die blomtoppe van die lndiese hennep, in die plant­kunde bekend as Cannabis, gemaak word. Die hennep­plant het sy oorsprong in Sentraal-Europa maar dit groeinou wild of gekweek in die meeste dele van die wereldas 'n jaarplant. Wanneer enige deel daarvan tussen dievingers gevryf word, het dit 'd kenmerkende kruisement­agtige geur en die blomtoppe voel effens klewerig. Diehennepsaad (chenevis) word gebruik by die vervaardigingvan vernis en verf. Dit is voorheen vir die maak vanseep gebruik. In warm, droe lande (die vlaktes van Indic)word die plant vir tekstielvesels gekweek. l

Die bedwelmende eienskappe van hennep is reeds lankbekend. Herodotus 2 het geskryf dat die plant in Skithieen Thracie gekweek is en die bewoners het nie slegs kleredaarvan gemaak nie maar het hulle ook bedwelm deurdie saad op warm klippe te braai en die dampe in teasem. Op die oomblik word 'n indrukwekkende aantalnarkotiese preparate van die hennepplant vir verbruikdeur verslaafdes oor die wereld gemaak. Verdowings­middels om te rook kan gemaak word (chira, hasjish,marijuana, dagga) of om te drink (assis, sjats-raki). Indie lande van die Ooste word met veel vernuf lekkersgemaak wat die Cannabis-harpuis in mengsels vanamandel, sjokolade of helJning bevat; in Arabiesegeneeskunde word hierdie stowwe beskou as geslags·prikkelmiddels.

Verdowingsrniddels wat. verslaafdheid veroorsaak, hetgewoonlik 'n uitwerking wat as aangenaam beskou word.Oat hennep hierdie eienskap besit, blyk duidelik uit dieernstige probleem wat deur die beheer en gebruik daarvanin die Verenigde State van Amerika geskep is. Dieonlangse gevangesetting van 'n groep filmakteurs hetopnuut die aandag van die publiek op verslaafdheid aanCannabis gevestig en het getoon dat dit nie tot die laagsteekonomiese groepe van die bevolking beperk is nie. Dieindruk bestaan dat dagga in Suid-Afrika hoofsaaklik deurKleurlin~e en 'n klein aantal ontaarde blankes gebruikword. Sterk afkeur van die oubliek is daarteen l!:emik.

Op die Grahamstadse Mediese Kongres van 1935 is 'nbesluit aanl!:eneem waarin die Minister van BinnelandseSake gevra is om 'n ondersoek te reel na die moontlikheiddat die rook van dagga psigotiese toestande en verstande·like agteruitgang kan veroorsaak. As gevolg daarvan is'n ondersoek na die rook van ~!!a 3 deur die personeelvan die hospitaal vir sielsiekes te Pretoria gedoen. Die

1. Bouquet, R. J. (1950): U.N. Bull. Narcot. 2, 14.2. Herodotus, Historiae. IV. 75.3. Geneeskundige Personeel, Pretoriase Gestig vir Sielsiekes

(1938): Hierdie Tydskrif. 12, 85.

28 April 1951

28 April 1951 S. A. TYDSKRIF VI R GE'N EESK U N DE 285

conclusion was that dagga produces effects very similarto those of alcohol. The investigators were not preparedto state that dagga produces moral and mental deteriora­tion; they suggested that moral deterioration precedes theaddiction and predisposes to the use of dagga.

In the absence of more extensive clinical and sociologicalinvestigations, it is difficult to be sure how large a socialproblem dagga has created in South Mrica. (It was notlong ago that some farmers doled out a pipeful of daggato their labourers at the end of each day, in much thesame way as many farm-workers are now given a tot ofwine.) Its sale or use is prohibited by law, and thevigilance of the police is strict; a short time ago a seniorpolice official was fined because of his connexion withthe dagga trade.4 It is not known how much more seriousthe effects of dagga are than those of alcohol. Daggaproduces in the smoker drowsiness, euphoria andoccasional psychotic episodes, but alcohol is guilty of evengraver actions. It is not certain to what extent daggacontributes to the commission of crime in this country.Alcohol does so in undeniable measure.

The hemp plant, regardless of statutory prohibition,continues to be cultivated secretly, sometimes hidden inmealie lands or on obscure islands in rivers. The runners,who carry the finger-shaped packets for sale, have to racktheir wits afresh now that chimneys and hollowed tablelegs are suspect, and the significance of a penny nailedto the threshold has become known. The furtive smokeris himself in constant danger of being betrayed to thepolice by the distinctive odour of his cigarette.

Mayor la Guardia was concerned by rumours thatmarihuana was smoked by large sections of the popula­tion of New York, and even by school children. In 1938,on the recommendation of the New York Academy ofMedicine, he appointed a committee to study the effects ofmarihuana. The Committee's report 5 is one of the mostauthoritative investigations of the problem.

It is probable that the effects of dagga closely resemblethose of marihuana. No direct relationship was foundbetween the commission of crimes of violence in NewYork and marihuana. It was smoked for the sake of con­viviality and to obtain a temporary feeling of adequacy.Smoking stopped spontaneously when the desired effectwas attained; unlike the alcoholic, the marihuana addicthas no desire for more of the drug as soon as he feels• high'. Smoking could also be stopped abruptly withoutmental or physical distress comparable to the deprivationsymptoms in morphine addicts. The effects of Cannabisappear immediately and pass off in from one to threehours. Although some subjects become restless andtalkative, most experienced a sense of well-being, relaxa­tion and unawareness of the surroundings, followed bydrowsiness. There was difficulty in focussing and sustainingmental attention.

4. The Cape Times. 9 September 1950.5. Mayor's Committee on Marihuana (1944): The Marihuana

Problem in the City of New York. Pennsylvania: JaquesCattelI Press.

gevolgtrekking waartoe gekom is, was dat dagga gevolgehet wat baie met die van alkohol ooreenkom. Dieondersoekers was nie bereid om te se dat dagga moreleen verstandelike agteruitgang veroorsaak nie; hulle hette kenne gegee dat morele agteruitgang verslaafdheidvoorafgaan en aanleiding tot die gebruik van dagga gee.

By afwesigheid van uitgebreider kliniese en sosiologieseondersoeke is dit moeilik om seker te wees van dieomvang van die maatskaplike probleem wat dagga inSuid-Mrika geskep het. (Dit is nie so lank gelede nie datboere 'n pypvol dagga aan die end van elke dag aan hullearbeiders uitgedeel het, soos baie arbeiders vandag op dieplase 'n dop wyn kry.) Die verkoop of gebruik daarvanis deur die wet verbied en die waaksaamheid van diepolisie is streng; kort gelede is 'n senior polisie-amptenaarbeboet weens sy verband met die daggahandel.4 Dit isnie bekend hoeveel ernstiger die gevolge van dagga invergelyking met die van alkohol is nie. Dagga veroorsaaklomerigheid, 'n welsynsgevoel en af en toe psigotieseepisodes by die roker, maar selfs ernstiger inwerkingekan aan alkohol toegeskryf word. Dit is nie duidelik inwatter mate dagga tot rnisdaad in hierdie land bydra nie.Alkohol doen dit wel in onteenseglike mate.

Die hennepplant word ten spyte van die verbod deurdie wet nog steeds in die geheim gekweek, sorns versteekin rnielielande of op afgesonderde eilande in riviere. Dieverspreiders wat die vingervormige pakkies te koop rond­dra moet hulle verstand opnuut inspan noudat skoorsteneen uitgeholde tafelpote onder verdenking staan en diebetekenis van 'n pennie wat op 'n drempel gespyker is,bekend geword het. Die versigtige roker loop self altyddie gevaar dat die kenmerkende geur van sy sigaret hornaan die polisie verraai.

Burgemeester la Guardia was besorg oor gerugte datmarijuana deur groot dele van die bevolking van NewYork en selfs deur skoolkinders gerook word. In 1938het hy op aanbeveling van die New York Academy ofMedicine 'n kornitee aangestel om die gevolge vanmarijuana te bestudeer. Die Kornitee se verslag 5 is eenvan die mees gesaghebbende ondersoeke van die probleem.

Dit is waarskynlik dat die gevolge van dagga 'n noueooreenkoms met die van marijuana vertoon. Daar isgeen regstreekse verband tussen die pleeg van geweld­misdade en marijuana gevind nie. Dit is ter wille vandie gevoel van vrolikheid gerook en om 'n tydelike gevoelvan voldoening te kry. Die rook daarvan het spontaanopgehou wanneer die begeerde uitwerking verkry is;anders as in die geval van alkohol, het die verslaafde aanmarijuana, sodra hy ,hoog' begin voel geen begeertevir meer van die verdowingsrniddel nie. Die rook daarvankan ook opeens gestaak word sonder die geestelike enliggaamlike nood wat met die ontnemingsimptome vanmorfienverslaafdes vergelyk kan word. Die uitwerkingvan Cannabis word dadelik merkbaar en dit verdwynweer binne een tot drie uur. Alhoewel sommige rokersrusteloos en spraaksaam word, ondervind die meeste 'ngevoel van welsyn, ontspanning en onbewustheid van dieomgewing gevolg deur lomerigheid. Dit is moeilik omverstandelike aandag toe te spits en te handhaaf.

4. Die Cape Times. 9 September 1950,5. Mayor's Committee on Marihuana (1944): The Marihuana

Problem in the City of New York. Pennsylvania:Jaques Cattell Press.

286 S.A. MEDICAL JOURNAL 28 April 1951

In company, the subjects were given to talkativeness andgood-natured joking. The pleasurable effects of mari­huana, usually regarded as euphoric, were frequentlyinterrupted by apprehension of varying degree. In alimited number of persons there were alterations inbehaviour giving rise to unconventional acts, anxietyreactions, antagonism and eroticism. However, any tend­ency towards violence was expressed verbally and not byphysical actions. Physical symptoms experienced weretremor, ataxia, dizziness, a sensation of floating in space,nausea and a desire to urinate. Psychotic episodesoccurred very rarely and were of short duration, beingcharacterized by mental confusion and delirious excite­ment, with periods of laughter and of anxiety.

It was concluded that marihuana does not change thebasic personality structure of the individual. While itlessens inhibition and brings out what is latent in thethoughts and emotions, it does not evoke responses whichwould be totally alien. Marihuana is not a drug of addic­tion, comparable to morphine and, if any tolerance isacquired, it appears to be of a very limited degree. Thedrug produces its effects in man through its actions on thecentral nervous system.

While it does not at present appear likely that daggawill provide as serious a problem as does its Americancounterpart (for in some cities the drug is reported to haveobtained a hold even on children 6), a careful study of thesocial effects and psychological actions of dagga is longoverdue.

6. Walton, R. P. (1938): Marihuana: America's New DrtlgProblem. Philadelphia: J. B. Lippincott Co.

In geselskap was die proefpersone geneig om spraak­saam te wees en grappies te maak. Die aangenameuitwerking van marijuana wat gewoonlik as euforiesbeskou is, is dikwels deur vrees van 'n wisselende graadonderbreek. By 'n beperkte aantal persone was daargedragsveranderings wat aanleiding gegee het tot onkon­vensionele dade, vreesreaksies, vyandigheid en erotieseverskynsels. Alle neiging tot geweld is egter slegs deurwoorde gelug en nie deur dade nie. Die Yolgendeliggaarnlike simptome is ondervind: bewerigheid, ataksie,duiseligheid, 'n gevoel van in ruimte te sweef, mislikheiden 'n begeerte om te urineer. Psigotiese episodes hetuiters selde voorgekom, was van korte duur en is geken­merk deur verstandelike verwarring en ylhoofdige opge­wondenheid met tydperke van gelag en vrees.

Daar is afgelei dat marijuana nie die basiese persoon­likheidstruktuur van die individu verander nie. A.lhoeweldit inhibisies verrninder en wat in die gedagtes enemosies latent is na die oppervlakte bring, verwek ditnie reaksies wat heeltemal vreemd is nie. Marijuana isrue 'n verdowingsmiddel met 'n verslaafdheidsvermoewat met momen vergelyk kan word nie en wanneer weer­stand verkry word, skyn dit slegs in beperkte mate tE. wees.Die verdowingsrniddel veroorsaak sy uitwerking by diemens deur sy inwerking op die sentrale senuweestelseI.

Alhoewel dit nie op die oomblik waarskynlik lyk datdagga so 'n ernstige probleeril sal skep as sy Amerikaanseteenvoeter nie (want daar word berig dat die verdowings­rniddel in sommige stede selfs 'n houvas op kinders gekryhet 6) is 'n sorgvuldige ondersoek van die maatskaplikegevolge en sielkundige inwerking van dagga reeds lankagterstallig.

6. Walton, R. P. (1938): Marihuana: America's New DrtlgProblem. Philadelphia: J. B. Lippincott Mky.

ANNOTATI6>N

HAEMYTHOLOGY: 11

By POLIOCYTE

Haemoglobin ESTimation. It is a general rule that themore instruments that have been invented for a certainestimation, the less satisfactory the results are. Duringthe hundred years since Welcher 1 first compared the redcolour of a drop of blood with a series of colour scales-the procedure now going under Tallqvist's name-morethan one method for haemoglobin estimation has beensuggested every year.

In spite of this avalanche of instruments, the haemo­globin estimation is to-day the simplest and one of themost accurate haematological investigations. With a well­calibrated instrument the error is less than 3% 2; but it isstill advisable to look at the patient's mucous membranesbefore accepting any given figure. In one clinic it wasnoticed that although the patients were as white as labora-

1. Welcher. H. (1854): Vrtschr, f.d. Prakt. Med. 44, 11.2. Biggs, R. and MacMillan, R. L. (1948): J. Clin. Path., 1,

269.

tory coats, the haemoglobins were all about normal. Atechnician suffered from hay fever and when blowing outhis pipettes different quantities of upper respiratorysecretions found their way into the diluting fluid. Theturbidity produced was duly read as haemoglobin in thecolorimeter. Perhaps an ingenious soul may invent yetanother machine: the anti-histarninic haemoglobinometer!

The enfant terrible of haematology, the 'haemoglobinpercentage', remains eternally young like the children ofthe weekly comics. The story goes that one unfortunateperson (with 15.5 gm. of haemoglobin per 100 rnl. ofblood) was first given a blood transfusion in Bern becausehis haemoglobin was 87 % (Sahli), and later had a pinttaken off in London as the percentage there was 112(Haldane). As patients are, he naturally enjoyed theexcitement and has since gone to the Riviera for a smallrest.

The haemoglobin content should be expressed in gm.