Science and Quackery: Why Uroscopy was a Popular Diagnostic Tool in the Medieval World

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Uroscopy was one of the most popular diagnostic practices of the medieval world and many early civilizations observed that characteristics of urine changed in relation to the well-being of the body (Armstrong). The academic literate world believed that close examination of urine could provide clues regarding disease and other bodily ailments. The word uroscopy comes from the greek word “ouron,” meaning urine, and “skopeo,” which means to behold, examine, or inspect (Armstrong). For a long time uroscopy was only practiced by learned professionals mainly due to the fact that the literature was typically printed in latin. After the invention of the printing press, translations of medical texts and charts were easily accessible and began being used by ordinary people. Many professionals felt that uroscopy was prestigious until it was practiced across all social classes. The practice of uroscopy was popular during a time when medical accuracy was inconsistent, but despite its numerous shortcomings, uroscopy was popular for many centuries. This essay will examine some of the major successes and failures of uroscopy and its connection to class conflict and confirmation bias in order to gain a better understanding of why it was so popular for such a long span of time. 

Before discussing what the major successes and failures were in relation to uroscopy, a clear definition must be given to the word success. It was not until the nineteenth century that people had an accurate understanding of diseases and their relationship to microscopic germs. Much was left to be desired in terms of medical knowledge of the human body and doctors understood the medical field through their senses. It is difficult to draw a line between what was quackery and what was legitimate medical care in the medieval ages primarily because the scientific method did not exist. This meant that even learned physicians were oftentimes just drawing educated conclusions based off of what they could observe with their own eyes. Physicians had a limited, oftentimes totally inaccurate perception of the body which led to many misunderstandings, misdiagnosis, and a misconception that learned professionals during these centuries provided more sophisticated treatments than laymen who believed in a mixture of magic and faith. In terms of this essay, a medical success will be one that produced accurate results of which could be replicated again and again and remain accurate in today’s standards, or that helped overcome some sort of obstacle to health care that existed at the time. Failures will be defined as anything that harmed patients needlessly, relied solely on probability or guesswork, or moved the field of medicine further away from its roots in scientific observation. 

If uroscopy was so inaccurate in the ancient and medieval world, why is it used today as a diagnostic tool? This complex question has an equally complex answer, but first of all, it is important to note that urine does have the ability to tell doctors about a patient’s state of health. Laboratories are well equipped today and diagnoses are based off of the physical, chemical, and microscopic examination of a urine sample. Medical experts use science as the basis for their practice, meaning that a hypothesis is put through the scientific method where it is approached with skepticism and tested multiple times under varying conditions to see if the results of the experiment can be replicated. It is important to note though that medical experts of the medieval world did not have the same tools or knowledge available to them, therefore, their examination of urine looked very different from modern methods.  Early professionals believed that the features of urine could be used to identify just about every kind of condition that could affect the human body (Armstrong). Urine was examined in relation to the bodily humors, by its color, texture, sediment content, taste, and odor, and overtime, evaluating urine got more complex with specific charts and entire texts focusing on the various layers of urine and what they could reveal about different parts of the body.  

 Uroscopy progressed in popularity after Greek physicians began connecting it to the humors. Some early doctors believed that the body was regulated by four humors, blood, yellow bile, black bile, and phlegm. Medical experts believed that people became ill if the humors were out of balance by either being in excess or limited. Avicenna, a medieval physician, believed that the humors left sediment in the urine which created a useful guide to illness (Avicenna). For instance, if a patient’s urine had white sediment then it meant that they were in recovery, meanwhile red meant a disease of the blood and black meant that the soul was about to escape the body (Avicenna). In the fourth century Hippocrates hypothesized that urine served as a filtrate for the humors, but Galen later refined Hipporcrates’ theory by suggesting that urine filtered the blood rather than all four of the bodily humors (Armstrong). Urine was described as being a window into the human body since much of the  body was unexplored and off-limits to doctors due to the high risk of infection and death. This heightened the importance of observable phenomena because it enabled physicians to learn more about the general conditions of their patients even if their medical beliefs were not always based in accuracy. 

 The physical inspection of urine dates back over 4,000 years ago and the general characteristics of urine were thought to reveal a lot about the general health of the patient (“Uroscopy”). Medical experts believed that different diseases affected the characteristics of urine and the fact that urine could be examined through the various senses made it one of the most popular diagnostic tools of the premodern age. Physicians studied the color, texture, sediment content, odor, and even taste of the urine in order to reach conclusions about a patient. Johannes Zacharius Actuarius, one of the most celebrated Byzantine physicians, focused on studying the varying amounts of protein in urine and correctly observed that the more severe a disease or fever, the higher the amount of sediment that forms at the bottom of the viewing glass (Diamandopoulos 3). Although a lot of his ideas were strictly observational, he managed to draw accurate conclusions and he, like many other physicians that closely studied urine, had a modern sense of clarity and reason when it came to their process of diagnosis (Diamandopoulos 3). 

The bladder-shaped flask that physicians used to examine urine samples became the symbol of medical elites for many centuries. Overtime, uroscopy grew more complex as color charts and other ways of examining urine were contrived. For instance, Gilles de Corbeil, the royal physician to King Philippe-Auguste of France, described twenty different types of urine (Armstrong). Uroscopy got more complex overtime because not only were doctors expected to examine the urine itself for medical meanings, but it also became a common belief that different parts of the  collection vessel represented areas of the body (Armstrong). This meant that the characteristics of the urine near the top of the vessel were summarizing the health of the head, the middle was the torso and organs, and so forth (Armstrong). Some of the best ancient and medieval physicians prescribed to uroscopy because it allowed doctors the opportunity to try and make sense of the inner workings of the body (Diamandopoulos 3).  

A-classic-image-of-uroscopy-The-Physician-by-Gerrit-Dou-1613-1675-a-Dutch-painter

Uroscopy for the longest time was reserved for the elite medical professionals. The bladder shaped flask became the symbol for the medical field; the equivalent of the stethoscope in the postmodern age. For centuries physicians were not expected to cut into the body. Cutting was very dangerous and was only seen as a last resort. This meant that physicians had to find ways to diagnose patients from what they could see on the outside of a patient’s body. After the invention of the printing press, translated versions of medical texts became accessible to ordinary people who oftentimes used the charts for self-diagnosis at home. No longer reserved for the elites, uroscopy quickly fell out of popularity with many medical professionals who claimed that the practice was being discredited by the lower classes. Laymen began making money through the practice of uromancy which involved using urine to interpret the future. Urine analysis began being closely identified with magic and it was even used in the sixteenth and seventeenth centuries to identify witches (Rosenhek). They tried to find a scientific way of discovering if a person was evil, and they believed that mixing a person’s urine with metal objects to see if it would force a cork off of a bottle was a reliable and universal test (Rosenhek). Pisse Prophets discredited uroscopy and the art of analyzing urine fell out of favor by professionals for many years (Seifer). Brian Thomas in the seventeenth century published, Pisse Prophet, which explained why uromancy was nonsensical and instructed all learned professionals to abandon the practice altogether (Seifer). It is important for modern scholars to note that uroscopy was just as inaccurate as uromancy and was equally based in observation and lacked a scientific backing. The class conflict that rose out of the popularity of uromancy had more to do with status and reputation than it did with actual scientific standards. Thomas Brian explained that, “…he has patients who want answers no matter what, even if there isn’t one, and they want a positive one” (Rosenhek). His quote provides another reason why uroscopy and uromancy were so popular for such a long span of time. People demanded answers during a time where science was not advanced enough to provide them and people wanted to hear positive affirmations about their lives and health. The demands of people most likely affected the diagnoses that physicians gave because they wanted to keep their patients and be seen in a positive light. This was also true in regards to the pisse prophets who made their living off of telling people their fortunes which were most likely predominantly positive. 

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Uroscopy was also widely used by professionals because the practice enabled doctors to get around the Catholic Church’s strict restrictions on physical contact, particularly in regards to female patients (Rosenhek). The catholic church was extremely powerful in the middle ages and they set up a series of rules that all practicing physicians were expected to abide by. Some of these regulations included restrictions on what areas of the body can be touched during an exam and what parts of the body can be unclothed and these rules were mainly in place with women in mind (Rosenhek). Doctors were supposed to respect the sanctity of their female patients, therefore, bodily fluids became the easiest way for physicians to examine women and make conclusions about their health. 

Another  major reason behind the popularity of using urine as a diagnostic tool was the fact that the procedure was painless and noninvasive. Patient’s craved answers and wanted them quickly and urine analysis began being seen as an art-form by the middle ages. With urine charts and ancient texts available, physicians became so confident with their ability to examine urine samples that many stopped seeing patients face to face altogether. This meant that patients sent samples to their doctors and were diagnosed without ever being seen or physically examined. Thomas Linacre, the founder of the College of Physicians in London responded to the rapidly growing number of doctors using urine to diagnose patients that they have not seen by stating that, “…if a patient were to bring in their shoe, they would have equal chance of accurate diagnosis in comparison to urine” (Armstrong). Professionals like Thomas Linacre tried to warn doctors not to rely solely on urine alone because examining a patient could reveal more than a simple anonymous sample. It was not uncommon for people to send fake urine samples to test their doctor’s competency or to receive favorable news (Armstrong). Literature from the medieval period tells the story of a young woman who sent in the urine of a cow in a desperate attempt to avoid a positive pregnancy diagnosis (Armstrong). After the physician studied the sample, he revealed to the woman that both her and her cow were expecting (Armstrong). Another instance of a fake urine sample was written about by a monk at St. Galli about a doctor, Notker II (Ekkehard IV 186). Duke Henry of Bavaria tried to trick the doctor by sending him the urine of a chambermaid but Notker II was not fooled and announced that an unheard of miracle must be occurring because the Duke will give birth (Ekkehard IV 186). Impressed with his knowledge and inability to be fooled, the Duke requested Notker II to be his personal physician for life (Ekkehard IV 186). Although these results were not universal among all physicians, these kinds of stories would have promoted uroscopy at that time. Over time, booklets were published with questions physicians needed to ask in order to have a better chance at spotting a fake (Ekkehard IV 186). Although uroscopy gave doctors a means of examining another feature of the body, many doctors placed too much confidence in the practice and their reputations and their patients suffered as a result. 

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Pregnancy and diabetes are two case studies that illustrate many of the positives and negatives of uroscopy in the medieval world. Both pregnancy and diabetes can be identified through urine samples but the accuracy of the diagnosis differed with both. Diagnosing pregnancy in the premodern age was less accurate than diagnosis diabetes. With a lack of reliable contraceptives in existence, many doctors used urine to determine if a female was pregnant. This practice existed since the ancient Egyptians who poured urine on grains to see if they would germinate (Eknoyan). Of course, the urine of pregnant women does not actually make seeds germinate, so doctors had a fifty-percent chance of getting it right. A much later example of urine being used unreliably to determine pregnancy involved injecting urine into baby rabbits to see if the hormones made them show signs of early-onset ovulation (Pickover 334). Urine does actually contain human chorionic gonadotropin, a hormone only present in pregnant women, but tests that accurately detect this hormone did not exist until the 1970s (Pickover 334). In reality, physicians during the medieval era tried to approach medicine in a practical way but their lack of technology and understanding made many of their diagnosis and hypotheses inaccurate and unreliable. 

One instance where a doctor got it completely right revolved around Thomas Willis and diabetes. He, and other earlier physicians observed that some patients had unusually sweet-tasting urine. Thomas Willis, a graduate of Oxford University, was the first to connect the sweetness of urine to the effects of diabetes (Roberts). He named this condition “diabetes mellitus” because mellitus is a greek word which means sweet like honey (Roberts). Over a century later, English doctor, Matthew Dobson proved that people with diabetes were actually urinating sugar by evaporating urine samples and examining the white residue left behind (Roberts). Some diseases were accurately diagnosed in the past through observation alone, but more often than not, physicians were making educated guesses based off of the medical knowledge that existed at the time. 

Despite the many failures of uroscopy, it remained the foundation of diagnostic medicine for centuries in part because it was painless and noninvasive, provided physicians with another avenue to explore the human body, seemed like a rational way to understand the world of disease, allowed doctors to side-step the church’s strict regulations regarding physical conduct with patients, and oftentimes served as a confirmation to the patient’s beliefs and provided them with the answers that they sought to receive. There were a few accuracies that came out of medieval uroscopy, but the medical field lacked in understanding and technology. The way that many learned professionals approached urine analysis was on track with modern scientific procedures and their observations helped set the stage for urine’s importance in the medical field in later years.

Until Next Time-

N.F.

Sources:

  • Armstrong, J.A. “Urinalysis in Western Culture: A Brief History.” Science Direct, El Sevier Vol. 71, Issue 5, pages 384-387. https://www.kidney-international.org/article/S0085-2538(15) 52380-6/abstract.
  • Avicenna. “Song of Avicenna.” Medicine and Healing in the Premodern West: A History in Documents. Ed. Winston Black. Broadview Press: New York, 1977.
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  • American Journal of Kidney Diseases, Vol. 49, Issue 6, page 865-872. June 2007.           ajkd.org/article/50272-6386(07)00697-X/fulltext.
  • Hippocrates. “Aphorisms.” Source Book of Medical History. Trans. Francis Adams. Dover Publications: New York, 1942.
  • “Medieval Urine Wheels-Episode 7-Under The Knife.” Under The Knife-Youtube. 17 March, 2020. Accessed 22 March, 2020. https://www.youtube.com/watch?v=lf90Kop7Cz4.
  • Pickover, Clifford. The Medical Book: From Witch Doctors to Robot Surgeons, 250 Milestones in the History of Medicine. Sterling Press: New York, 2012.
  • Roberts, Jacob. “Sicking Sweet: Relics from a lab hint at centuries spent trying to solve diabetes.” Science History Institute. 8 December, 2015. Sciencehistory.org          /distillations/sickening-sweet.
  • Rosenhek, Jackie. “Liquid Gold.” Doctor’s Review. September, 2005. Accessed 6 April, 2020. doctorsreview.com/history/sept05_history/.
  • Strasinger, Susan King and Marjorie Schaub Di Lorenzo. Urinalysis and Body Fluids. F.A. Davis Company: Pennsylvania, 2014.
  • “Uroscopy.” European Museum of Urology. Accessed 6 April, 2020.  history.uroweb.org/history-of-urology/diagnisis/looking-at-urine/uroscopy/.

 

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