THE 
DIAGNOSIS 
OF THS 
MOR PH IN DISEASE. 
J. B. MATTISON^ M.D., 
Medical Director, Brooklyn Home for Narcotic Inebriates. 
Read before the American Medical Association, 
Atlanta, Ga., 6th May, 1896. 
Reprint : 
Medical Record, 22d August, 1896. THE DIAGNOSIS 
OF THE 
Morphin Disease. 
BY 
J. B. MATTISON, M.D., 
Medical Director, Brooklyn Home for Narcotic Inebriates. 
On first thought, the title of this paper may seem 
somewhat trite ; but a more sober second one will 
be likely to convince the reader that some cases 
of the morphin disease-disease, not "habit"-in- 
volve conditions so obscure as to make the diagnosis 
by no means easy ; and the purpose of' this paper is 
to present certain facts along somatic lines that will 
clear away doubt in suspected cases. 
There are morphinists who, so far as outward 
symptoms under ordinary conditions obtain, present 
no proof. Again and again, in my experience, this 
fact has been noted ; and if this be so with one whose 
professional life is exclusively given to the study of 
this disease, it goes without saying that it is much 
more likely to occur with one engaged in general 
work, by whom minor evidence of this toxic condi- 
tion might easily be overlooked. 
I have known a doctor take morphin fifteen 
years, and present himself for treatment without 
showing the slightest sign of his drug disease. He 
was cured and has been free six years. Of course, 
this was a very exceptional case, for usually the 
stamp of this neurosis is soon patent; but such a 
case is likely to reoccur and possibly involve such 
2 3 
interests along medico-legal lines as to make a cor- 
rect diagnosis of more than common importance. 
This case in point: Nine years ago the wife of a 
medical man brought suit against him for divorce. 
He was charged with being a morphinic. The charge 
was denied, and a countercharge made that she was 
a morphinist. This was denied, and in proof of de- 
nial, she was examined by two physicians, who gave 
evidence that she was free from the disease. They 
were mistaken-she had been taking morphin daily 
for six years ! They failed to make crucial test of 
her true condition, and so erred. She lost her suit, 
but, en passant, it may be said that the outcome was 
a happy one ; for she came under medical care, re- 
covered, was reconciled and reunited to the doctor, 
has since added to the census, and remained well. 
Another case : In the appeal for a new trial for 
Carlyle Harris-who, you will recall, was killed for 
alleged murder of his wife with morphin-evidence 
was offered to prove that she was a morphinist, and 
so might have died from an overdose self taken. 
The appeal was denied, and in his opinion, refusing, 
Recorder Smyth-the trial justice-laid special stress 
on his belief that had Mrs. Harris been a morphinist, 
the fact would have been known to her husband, in 
whose behalf, on the trial, no such claim had been 
made. 
I have no hesitation in saying that in this part of 
his opinion Recorder Smyth made a grave judicial 
error. Why ? Because many a case of morphinism 
in a wife has persisted for years unknown to her 
husband, or even her doctor. That is a fact-just 
such a case of morphin-cocainism is now under my 
care ; and, granting that the judge's belief along 
this line was the main reason for his refusal, if this 
fact had been properly presented and insisted on by 
comoetent counsel, it might have secured a new trial 
for Harris ; which was. in my opinion-the claim as to 
the morphin being undecided-undoubtedly his due. 4 
Many and varied as are the tokens of this toxic 
neurosis, it is safe to say there is not a single symp- 
tom infallible as a sign of the disease. This state- 
ment may be contrary to the general opinion in and 
out of the profession, but it is true. Anything like 
a "snap-shot diagnosis'' in morphinism may be 
quite unreliable, and should never be made. The 
usual various sequelae-many of which may present 
in other disorders-are known to you, and details 
need not detain. The point of most value in this 
paper is a statement of the fact that we have at com- 
mand two tests that are certain to detect chronic 
morphin taking. They are enforced abstinence and 
urinalysis. 
Concerning the first, so imperative is the demand 
of the system for a sufficient supply of morphin at 
more or less regular intervals, when it becomes part 
and parcel of the daily need, that any withholding 
beyond a certain time is sure to be followed by symp- 
toms that settle the narcotic status beyond dispute. 
The length of this abstinence needful to determine 
the question varies according to temperament and 
condition ; but as patients require the drug daily or 
usually more often, forty-eight hours' withdrawal 
will suffice for proof. Possibly, in some extraordinary 
case, a longer time may be needed ; but, as a rule, 
two days will do. 
Regarding the renal test, various methods will 
serve ; but the simplest of which I know is that of 
Dr. E- H Bartley, professor of toxicology in the 
Long Island College Hospital. This is the Bartley 
process : To the suspected urine add carbonate of 
sodium to make it alkaline. In this put a portion 
of chloroform; shake well, allow it to settle, draw 
off, and add a small amount of iodic acid. If mor- 
phin be present, a violent tinge appears. 
With a consensus of symptoms usually noted, and 
the time and urine tests, the diagnosis of the mor- 
phin disease need never be long in doubt. 
Prospect Place, near Prospect Park.