Uroscopy


“I woll tel yow a medecyn For euery maner of vryn”: Uroscopy and the Theory of Everything

As old as disease, uroscopy was the science of diagnosis and prognostication by merely looking at urine. While today the caduceus is symbolic of physicians in white coats, their medieval counterparts appeared in long robes carrying a matula, flask, of urine. Urine at first was the ideal means of doing medicine, it provided physicians the ability to see the inner workings of the body. Developments in physiological theories conflated with humorism created a theory of everything for Medieval physicians who were able to establish diagnosis and prognosis from the visual analysis of urine. In the late fifteenth century, accompanied by developments in human physiology, medieval skeptics associated uroscopy with quack doctors and charlatans — even mixing cow’s urine with human urine in an attempt to fool physicians. Uroscopy was featured in scads of medical anthologies, and for a long time was crucial to medieval diagnosis and prognostication. This short essay will explore the practice of uroscopy, especially in an attempt to better understand the medieval persons’ cognition.

Uroscopy was born in Byzantium, but it was quickly adapted into medieval western Europe. Theophilos Protospatharios (7th century?) was the author of extant Greek medical texts, his treatise Peri Ouron (Περὶ Οὔρων) was highly esteemed in the middle ages, and is considered a founding text for uroscopy. Protospatharios’ treatise was a compilation of earlier works by Hippocrates (460-377 BCE) (Fig. 1) and Galen of Pergamon (129-200 CE), both who proposed the fundamental concepts used in medieval uroscopy. In Prognostics, Hippocrates comments on various characteristics of urine(1): color (Fig.2) (white, red, black), consistency (thin, thick, watery, clear, cloudy), sediment (smooth, leafy, farinaceous, absent), odor (fetid), and volume (deficient). Galen later provided a rational explanation on how imbalances of the four humours were represented in, and through, urine. The explanation of the process is as follows. The body constitutes of four humours: blood, phlegm, choler (yellow bile), and melancholy (black bile). Humors are associated with specific characteristics; blood is warm and moist, choler is dry and warm, phlegm is cold and moist, and melancholy is cold and dry. Different amounts of these four humours defined a persons temperament or complexion. A balanced amount of humors is called eucrasia, and an unbalanced amount is called dyscrasia. Complexions were not only internal characteristics, they had cognitive and physical implications, for example a choleric person, with excess of choler, was “quick to anger and yellow-faced, lean, hairy, proud, ambitious, revengeful, and shrewd.”(2) The four humours are produced as part of the Second Digestion, which happens in the liver by the cooking of moisture, which one drinks. Extra moisture which is not used up in the cooking process is released from the body as urine. The urine holds the imprint of the amounts of each humor produced. For example, lack of moisture in the cooking process results in dry humours, choler or melancholy. Choler being burnt moisture because of excessive heat, and melancholy undercooked(3). Therefore, urine color is not only an indication of biological processes, such as a digestive system that is correctly working, but it also stands for spiritual balance of humours. A urine that is colored means an excess of a humor, and thus a dyscrasic person which must be healed.

Uroscopy texts were generally found in medical anthologies, which unlike scholastic anthologies, were not incredibly formalized. Scholastic anthologies were formalized in the sense that they had the same content and specific arrangements. Medical anthologies were edited by anonymous people, and many had blank pages for the owner to add their own information. Of distinct importance was Gilles de Corbeil (1165-1213), royal physician to King Philippe-Auguste of France, wrote medical treatises in dactylic hexameter verse, which made it easier to remember(4). These anthologies focused on therapeutic and practical knowledge, rather than the science behind phenomena. Here, Faith Wallis in her article Signs and Senses: Diagnosis and Prognosis in Early Medieval Pulse and Urine Texts(5), gives two insights. (1) These anthologies followed roman medical tradition, in which the patriarch of a rural estate was also responsible for the wellbeing of his slaves and family, therefore all he needed was practical knowledge on how to heal, and medical science was of no interest to him. (2) A focus on the practical therapeutics, and not on the medical science, aligned with Christian teachings. Christianity valued secular medical care as a practical necessity or as an act of charity, but it rejected certain theoretical claims advanced by the ancient rationalist physicians, for example that disease was caused and cured exclusively by 'nature', a divine and intelligent principle governing an eternal cosmos. For Christians, God was the ultimate source of both disease and healing(6).

As we learned from Pedro Raposo, curator of medieval science objects in the Adler Planetarium, the earthly universe existed as interactions between the four elements: earth, water, fire and air. These elements existed in a constant state of creation and annihilation, of becoming and regression. It was surrounded by the endless ether, the stuff of stars, endlessly following the same circular motion. The ether was the domain of gods, of creators, and anything existing within is was immutable. Things on the Earthly sphere mirrored the ether, “[e]verything down here tries to go up or down — stones fall and flames rise — and everything down here always falls apart eventually, resolves into its elements or dies.” (7)

The matula (Fig.3) was the physician's tool for analyzing urine, it even became a symbol for doctors. Early vessels were cylindrical and made of baked or fired clay. As uroscopy was principally a visual science, transparent glass vessels replaced their opaque predecessors. The cylindrical shape was modified to a more bulbous, bladder-like shape. This allowed the urine to exist outside the body as it did inside, and thus be more indicative of the humors. Because of the bulbous shape, it could not be placed on flat surfaces, and therefore had to be carried around in baskets. Another relevant shape modification was in the lip of the bottle, which was made larger for ease of collection. Johannes Actuarius (13th c.) elaborated on the sediment that is present in the urine; his apical contribution was that sediment that is floating is symbolic of upward humour movement in the body, and sinking sediment is downward movement of humors. The increase interest in urinal sediment led matula’s to be made with gradations, that would indicate the loci of ailment, as well as humour movement in the body. Leonhardt Thurneiser (1530 - 1595) "liked to compare urine to a stream rushing down a mountain.”(8) He believed that urine passed throughout the whole body, and thus carried information of where the ailment was located. Thurneiser boiled urine in an anatomical furnace (Fig.4. - I), the urine vapor would — without any explanation on how — travel to one, or more, of the 24 layers in the vessel thus locating the source of the ailment.

The image of the physician went from a respected figure to one of quackery and charlatans. As we have seen, medical anthologies were not as formalized as scholastic anthologies. Tess Tavormina, a medieval literature scholar from Michigan State University, explains in her podcast Prognosis v. Diagnosis in Middle English Uroscopic Texts(9), that uroscopy wheels, ubiquitous in the medical anthology, (Fig.2) serve the purpose of “cheat sheets.” By the 14th century "the science of judging the urine is so easy that all can learn what they wish to learn”(10). “Uroscopy had drifted largely into the hands of quacks, who abounded in every land”(11). Quack doctors would travel around the rural countryside and sell their potions to unsuspecting folks, who believed the ‘physician,(12)’ especially because of his charts. Here, we have the example of Roger Clerk of Wandsworth, who charged Roger atte Haccke twelve pence for a potion to his wife Johanna. “[..] Roger Clerk was tried before the mayor and alderman of London in the Chamber of Guildhall for impersonating a physician…”. Roger Clerk sold a fever amulet, with a supposed invocation of the body and blood of Christ, to be used on Johanna, but upon inspection by the London court they found that the amulet was merely a piece of parchment tore from an old book — Roger Clerk was illiterate. He was paraded throughout the city in an unsaddled horse with his amulet and a whetstone(13) hanging on his neck, as well as two matulas, one before him and one on his back.

Uroscopy was so popular because it had its foundations in a medieval theory of everything, which incorporated humourism, God, and physiological phenomena. The lack of formalization in medical anthologies led them to be used by folks-people, which referenced “cheat sheets” and used urine to diagnose anything. Uroscopy then becomes a study of the microcosm of the human body, which as we have seen in Raposos’ explanation, is a representation of the divine ether.

  1. Atenas, Esteban De, and John M. Duffy. A Commentary on the Prognosticon of Hippocrates.
  2. Britannica, The Editors of Encyclopaedia. "Humour."
  3. Wallis, Signs and Senses
  4. D’Irsay, The Life and Works of Gilles De Corbeil
  5. Wallis, Signs and Senses
  6. Ibid.
  7. Harvey, “The Judgment of Urines.”
  8. White, "A New Look at the Role of Urinalysis in the History of Diagnostic Medicine."
  9. Tavormina, "Prognosis v. Diagnosis in Middle English Uroscopic Texts."
  10. Demaitre, Doctor Bernard De Gordon: Professor and Practitioner.
  11. Eknoyan, Looking at the Urine
  12. Skemer, Binding Words: Textual Amulets in the Middle Ages.
  13. The whetstone was symbolic of a liar.

References Atenas, Esteban De, and John M. Duffy. A Commentary on the Prognosticon of Hippocrates. Berlin: Akademie Verlag, 1983.

Britannica, The Editors of Encyclopaedia. "Humour." Encyclopædia Britannica. June 16, 2017. Accessed March 28, 2018. https://www.britannica.com/science/humor-ancient-physiology.

Bush, R. B. ""Urine Is an Harlot, or a Lier"." JAMA: The Journal of the American Medical Association 208, no. 1 (1969): 131-34. doi:10.1001/jama.208.1.131.

Canton AD, Castellano M. Theory of urine formation and uroscopic diagnosis in the Medical School of Salerno. Kidney International 1988;34:273–7.

Demaitre, Luke E. Doctor Bernard De Gordon: Professor and Practitioner. Toronto: Pontifical Institute of Mediaeval Studies, 1980.

D'Irsay, Stephen. The Life and Works of Gilles De Corbeil. N.Y., 1925.

Harvey, Ruth. “The Judgment of Urines.” Canadian Medical Association Journal 159, no. 12 ( 1998): 1482-1484.

Eknoyan, Garabed. "Looking at the Urine: The Renaissance of an Unbroken Tradition." American Journal of Kidney Diseases 49, no. 6 (2007): 865-72. doi:10.1053/j.ajkd.2007.04.003.

Gonzalez-Crussi, F. A Short History of Medicine. New York: Modern Library, 2007.

Skemer, Don C. Binding Words: Textual Amulets in the Middle Ages. University Park, PA: Pennsylvania State University Press, 2006.

Tavormina, Tess. "Prognosis v. Diagnosis in Middle English Uroscopic Texts." MixCloud (audio blog), May 26, 2012. https://www.mixcloud.com.

Wallis, F. "Signs and Senses: Diagnosis and Prognosis in Early Medieval Pulse and Urine Texts." Social History of Medicine 13, no. 2 (2000): 265-78. doi:10.1093/shm/13.2.265.

White, W. I. "A New Look at the Role of Urinalysis in the History of Diagnostic Medicine." Clinical Chemistry. January 01, 1991. Accessed March 28, 2018. http:// clinchem.aaccjnls.org/content/37/1/119.