Urinalysis, Part 2

We started a conversation yesterday on the use of urine by medieval Western European physicians to determine health. I thought today we'd go into exactly how the urine was an indicator of health.

Examining sediment in the urine was one case, which was described yesterday in a paragraph from Giles Corbeil's (fl.1200) poem De urinis. Later elaborations on this suggest the urine would settle into layers of different colors. A large layer on top could indicate a problem with the head. Som sediments indicated kidney stones.

Smell and taste were also ways to examine urine. Smell was obvious, but taste was also used at times; sweetness was an indication of diabetes.

Visual examination was the first and most common method, and was the reason why a glass flask became the symbol in illustrations of a physician. Hippocrates (c.460–375 BCE) started the business of the look of urine having significance. He felt it was the output of all four humors of the body, could indicate which was deficient or superabundant, and could be used to predict the progress of a disease.

White or pale yellow urine was healthy, but black or foul-smelling urine predicted an increase in disease. White sediment meant the illness would be long but not fatal. Completely colorless urine was the sign of a disease of the brain (these days it means excess hydration with water).

If there were bubbles in the urine, long-term kidney disease was the cause. The modern term proteinuria is now used for this condition, denoting protein in the urine and indicating damaged kidneys.

In the circular diagram above (found in the 14th-century manuscript Bodleian Library MS Savile 39), we see the "color codes" for urine. They range from the pale urine of decent health to the reddish-gold denoting healthy digestion to the dark flasks of impending death.

Urine travels in containers, and could be collected and sent to a physician or an expert urologist if you had none nearby. Isaac Judaeus, an expert on urology, criticized this idea; he believed diagnosis without seeing the patient in person was pointless.

Tomorrow we'll discuss the punishment for urinal malpractice, and look at a couple urinalysis patients.