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.

Isaac Judaeus

An Andalusian Arab named Ibn Juljul wrote Ṭabaqāt al-aṭibbā’ w’al-hukamā’ ("Generations of Physicians and Wise Men") in the late 900s. It is one of the only sources for biographies of several early scholars, philosophers, and doctors. In it we learn details about the life and career of Isaac Israeli ben Solomon, who is sometimes called simply Isaac Judaeus.

He was born in Cairo and became known as an oculist (we've talked about medieval eye treatment before).  About 904 he became the court physician to Prince Abu Mudhar Ziyadat Allah III in Kairouan, capital of Tunisia. He studied general medicine while there.

After the death of Ziyadat in 909, Isaac became doctor to Caliph 'Ubaid Allah al-Mahdi, the founder of the Fatimid dynasty. The caliph enjoyed the witty repartee of his Jewish physician. Isaac began lecturing on medicine, and many people came to hear him speak as his fame spread. He continued to learn, studying astronomy, mathematics, medicine, and natural history.

He wrote medical manuals in Arabic which, in the Arabic-speaking world, were considered gems, but were unknown in Western Europe. The 12th century saw translators in Toledo striving to make many works available to a wider audience. Gerard of Cremona translated Isaac's Liber de Definitionibus (Book of Definitions) and Liber Elementorum (Book on the Elements) into Latin. Christian scholars started noticing his work, such as Albertus Magnus, Aquinas, Roger Bacon, Nicholas of Cusa, and Vincent de Beauvais.

One of his works dealt with the urinary tract, which I covered a few years ago.

The years of his life are given as different dates according to the source. Encyclopedia Britannica says born 832/855, Egypt—died 932/955) and that he lived more than 100 years. His death has been declared as 932, 940, 942, 950, and 955.

One of his pupils, Dunash ibn Tamim, wrote a commentary on a work of Jewish mysticism that quotes Isaac so extensively that later scholars thought it was written by Isaac himself. Dunash and this work, the Sefer Yetzirah, will be our next line of topics.

Isaac Israeli ben Solomon

Some of the works translated at Toledo by our old friend Gerard of Cremona were the Book of Definitions and the Book of Elements into Latin from Arabic. Written by Isaac Israeli ben Solomon (alias Isaac Israeli the Elder, alias Isaac Judaeus), sometimes known as Isaac the Jew, they and his other works became standard works in medicine at Salerno.

Isaac Israeli ben Solomon was born in Egypt around 832CE. Growing up in Cairo, he became known as a skilled oculist (illustration is from an Arabic manuscript on oculism, showing the parts of the eye). About 904CE he was made court physician to Emir Ziyadat Allah III of Ifriqya (and I really should talk about him and there in the near future). A few years later he traveled to Kairouan, Tunisia and studied under a famous Arab physician, then became the doctor to 'Ubaid Allah al-Mahdi, who founded the Fatimid dynasty. al-Mahdi found Israel charming and witty.

In Kairouan he started writing his treatises, which were considered "more valuable than gems," and giving popular lectures on medicine and other topics in science. All his treatises were written in Arabic. Besides the ones mentioned above, they also include The Book on Fevers, a work on food and remedies called Universal Diet, and more. He also wrote books on philosophy, metaphysics, logic, a commentary on Genesis, and a treatise on the difference between the spirit and the soul. The Latin translations of many of these were quoted by Albertus Magnus, Aquinas, Roger Bacon, Nicholas of Cusa, and others.

Next I want to delve into one of his works specifically. I don't think I've ever indulged in what they call "dad jokes," but let me just say "urine for a treat."