In the days before X-ray machines and scanning machines, medical or quasi-medical practitioners needed all the help they could get in trying to diagnose what was wrong with a patient. Potentially what was passed out of the body or seeped out of breaks in the skin could be useful and, not unreasonably, the colour, consistency, smell and even taste of the patient’s urine was considered helpful in diagnosing their malady.
Uroscopy which is the technical name for examining a patient’s urine has a long tradition and dates back to ancient Egypt, Babylon and India. Its importance as a diagnostic tool was enhanced by the adoption of the original Hippocratic oath which forbade doctors to perform any form of surgery, “I will not cut for stone, even for patients in whom the disease is manifest”. Urine was considered vital in gauging the health of a patient’s liver where blood was thought to be produced and analysing the waste fluids was a good way to check whether the body’s four humours – blood, phlegm and yellow and black bile – were in balance.
By the middle ages the theory of urine was sufficiently developed to allow a so-called wheel of urine to be developed which developed 20 categories of urine based on colour, smell and taste. The development of printing coupled with the almost universal acceptance of the wheel as a diagnostic tool was such that by the 16th and 17th centuries unscrupulous practitioners or quack sprung up to gull the innocent or desperate patient.
All that was needed was a sample – it was not always necessary for the patient to accompany the specimen, although, as we will see, this could have its dangers. To assist in the process a glass flask with a round bottom called a matula was developed, making it easier for the patient to fill and the doctor to examine.
But some practitioners were not content to examine urine to diagnose existing complaints. The practice of uromancy developed where practitioners claimed that they could foretell the future from someone’s urine. Whilst some took special cognisance of the colour or taste of the urine the most common approach was to read the bubbles in the urine as soon as the fluid hit the bowl. Large bubbles denoted that the urinator was about to come into money whilst small bubbles denoted an illness or an impending death. (This has given me an idea for the next village fete!).
Although the examination of urine was directly attributable to Thomas Willis’ discovery of 1674 of diabetes mellitus, by the turn of the 19th century many had consigned uroscopy to the bin of quackery and practitioners earned the pejorative name of piss-prophets. But there was still a corner in the market for the clever uroscopist as Dr Cameron of Wells Street, just off Oxford Street in London, demonstrates.
He seems to have set up operations around 1809 and focused his marketing efforts in emphasising the long pedigree of urine inspection and appealing to those who were sceptical of more modern medical procedures. Not all of his patients were satisfied though, as this story from the Medical Adviser of 1824 shows.
A Holborn inn-keeper consulted Cameron about some chest pains. Cameron gave him some pills which caused acute discomfort but after a month had done nothing to alleviate the original problem. In order to exact his revenge on the piss-prophet the inn-keeper sent his ostler with a urine sample and requested a diagnosis.
After inspecting and tasting the urine, Cameron concluded that the sufferer was in a bad way but that he could be cured. He asked how old the patient was – 24- how hard he worked – lots of heavy loads – and whether he was a drinker – two pails of water a day. Based on this evidence Cameron concluded that the problem was a bad back. Of course, the sample had been provided by a donkey!
Medicos still examine urine – I doubt they taste it – but the reliance on it as a primary diagnostic tool has somewhat waned.