The inspection of urine to determine the physical condition of a patient is regarded to be one of the oldest medical tools. Its roots can be traced back to Sumerian and Babylonian medicine, 4000 years ago.
Hippocrates and Galen
Written instructions on the urine are already found in the Corpus Hippocraticum, a collection of medical texts compiled by various authors of the so-called School of Hippocrates between the 5th and 4th century AD. In Ancient Greece, medical practitioners did not attach absolute importance to uroscopy. They defined the urine’s ideal colour and consistency and used urine disturbances mainly to make prognoses on the further course of disease, as is written in the Corpus Hippocraticum, book of Prognostic, XII:
“When the urine is not constantly stable, i.e. when at times it has a clear appearance, and at other times it contains a white, homogeneous sediment, in that case the disease will last longer and implies a higher risk. When the urine is reddish, and the sediment has the same colour and is homogeneous, the disease will last much longer but recovery can be relied upon…Clouds floating in urine have a good meaning when they are white, but a bad meaning if they are black. As long as the urine is yellow and thin, this signifies that the disease is still in an early stage. When the urine remains like this for a long period, it is to be feared that the patient will not resist much longer before the disease reaches the critical point.”
Galen of Pergamum (c. 129-210) is one of the most important representatives of Ancient Roman medicine. His judgements of the urine do not significantly differ from the ones found in the Corpus Hippocraticum.
Uroscopy in the Middle Ages
In the era of Byzantium (4th to 15th century), uroscopy gained major importance for the prognosis and diagnosis of an illness. From the 4th to the 7th centuries, authors like Oreibasios, Aetios of Amida, Magnus of Emesa and Paulus Aegineta gave practical instructions on uroscopy. However, a basic theoretical treatise which could also be used for teaching purposes was still missing. Theophylus Protosphatharius (probably 610-641) with his book De Urinis was the first to have a major impact on the development of uroscopy. For many centuries, authors of uroscopical texts referred to Theophylus’ work.
An important highlight on Byzantine uroscopy is the work of Johannes Zacharias Actuarius (1275-1328), particularly his manuscript in seven volumes De Urinis Libri Septem. Actuarius gave detailed instructions on how urine should be collected: “The urine should be collected in a large, transparent and clean bottle, possibly having the form of a bladder… The receptacle needs to have a content large enough to contain the urine of 24 hours… The urine also needs to be protected against heat, cold and sunlight.”
Succeeding the school of Byzantium, the Arabic school became the centre of medical science. As far as uroscopy is concerned, the Arabs made little progress and mainly referred to their Greek masters. Physicians like Avicenna (980-1037), Haly Abbas (died 980) and Abu Bakr Muhammad Ibn Zakariyya ar Razi (known as Rhazes) (850-923) had great impact on the development of medicine. Isaac Judeus (850-932) wrote his Liber Urinarium which was translated from Arabic into Latin in the 11th century.
The medical legacy of the Greeks and the Romans found its way back to the European occident through the Arabs, resulting in the foundation of the Medical School of Salerno. This rediscovered medical knowledge, however, had hardly changed since ancient times, with different schools of medicine only rewriting and republishing already existing manuscripts, improving them with only small additions and corrections.
Gilles de Corbeil (approx. 1140-1224) was a student of the Salerno medical school and he wrote the “scientific poem” Liber de Urinis. According to his own testimony his treatise was “produced and wrenched from the scripts of the ancient times.”
Uroscopy, the common practise of diagnosis
From the 13th century onwards treatises on the judgement of the urine were published all over Europe. Soon, the treatises began to be published in the vernacular, and served the physicians as guidebooks when consulting their patients. Uroscopy was commonly accepted and practiced throughout Europe. The examination of the “water” had an indispensable function and the club-shaped urinal known as “matula” became the guild symbol of the physician.
Bernhard Gordon of Montpellier (1285-1318), who also studied at the medical school of Salerno, commented on uroscopy, “…the science of urine-watching is that easy, that anyone can learn from it what he wishes…” As a matter of fact, the translations into the vernacular brought about an enormous popularisation of uroscopy, making this science accessible also to people who were not academically trained physicians. Soon uroscopy became an easy tool for the numerous quack doctors, charlatans, water doctors and uromantia practitioners who flourished especially in Germany.
It is not surprising that uroscopy was relegated from the ranks of science and became the domain of unlearned men. Uroscopists were well respected by their patients and indeed many chose the profession because of the fame and fortune associated with it. Although developments in medicine proceeded, patients saw uroscopy as their favourite means of diagnosis up until the 19th century.