Uroscopy

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People showing a sample of urine to the physician Constantine the African. Konstantinderafrikaner.jpg
People showing a sample of urine to the physician Constantine the African.

Uroscopy is the historical medical practice of visually examining a patient's urine for pus, blood, or other symptoms of disease.

Contents

The first records of uroscopy as a method for determining symptoms of an illness date back to the 4th millennium BC, and became common practice in Classical Greece. Later reaching medical predominance during the Byzantine Era & High Middle Ages, the practice eventually was replaced with more accurate methods during the early modern period, with uroscopy being considered inadequate due to the lack of empirical evidence and higher standards of post-Renaissance medicine.

In modern medicine, visual examination of a patient's urine may provide preliminary evidence for a diagnosis, but is generally limited to conditions that specifically affect the urinary system such as urinary tract infections, kidney and bladder issues, and liver failure.

History

Records of urinalysis for uroscopy date back as far as 4000 BC, originating with Babylonian and Sumerian physicians. [1] At the outset of the 4th century BC Greek physician Hippocrates hypothesized that urine was a "filtrate" of the four humors, and limited possible the diagnoses resulting from this method to issues dealing with the bladder, kidneys, and urethra. [2] This in turn led another Greek physician, Galen, to refine the idea down to urine being a filtrate of only blood, and not of black bile, yellow bile, or phlegm.

Byzantine medicine followed, since it was rooted in Greco-Roman antiquity, the application and study of uroscopy continued – eventually becoming the primary form of ailment diagnosis. Byzantine physicians created some of the foundational codifications of uroscopy, with the most well known example being a 7th-century guide on uroscopic methods: Theophilus Protospatharius's On Urines. The work, along with others, became widely popular and accelerated the rate at which uroscopy spread throughout the Mediterranean. Over time these Byzantine works inspired further interpretation by other prominent culture's scholars (like the Arab Jewish Isaac Israeli ben Solomon and his urine-hue classification chart), though greater propagation led to a widened application of uroscopy and eventually uroscopic diagnoses of non-urinary related diseases and infections became standard. [3]

Pivotal in the spread of uroscopy, Constantine the African's Latin translations of Byzantine and Arab texts inspired a surge in uroscopic interest specifically in Western Europe throughout the High Middle Ages. [4] Despite this popularization, the practice of uroscopy was still mostly centered around the principals Hippocrates and Galen first postulated, although aided by Byzantine interpretations that were further disseminated during this period in works by French physicians of the era Bernard de Gordon and Gilles de Corbeil. [4]

The practice was upheld as the main standard of medical diagnosis until the beginning of the 16th century, when influence from cultural movements like the Renaissance inspired the re-examination of its methods, both to re-evaluate its effectiveness and explore new applications. During this period, a lack of empirical evidence supporting uroscopy and the introduction of new medical practices developed using the scientific method contributed to its gradual decline among licensed physicians. Early modern doctors, like the Swiss medical pioneer Paracelsus, began researching more empirically qualified approaches to diagnosis and treatment – an integral part of the Medical Renaissance and its redefining how we look at medicine —which only further hastened the decline of uroscopy. [4] Since the beginning of the 17th century the practice has been largely considered unverifiable and unorthodox, and became a subject of satire (including multiple satirical references in the plays of Shakespeare). It was still practiced by "unlicensed practitioners" by popular demand up until around the beginning of the 19th century. [1]

Though uroscopy is no longer popular in modern medicine, examples of its preliminary diagnostic utility still exist in simplified and empirically proven forms. [5]

Incidentally, as the decline of uroscopy continued a new form of divination emerged from its remnants in "Uromancy" – the analysis of one's urine for fortune-telling or state-reading purposes. Although uromancy initially gained interest in the 18th and 19th centuries, it is rarely practiced and unknown to most in the present era.[ citation needed ]

Procedures and conventions

The Medical Alchemist vt. The Uroscopy by Franz Christoph Janneck (1703-1761), (Science History Institute) The Medical Alchemist by Janneck FA.2000.00.275.jpg
The Medical Alchemist vt. The Uroscopy by Franz Christoph Janneck (1703–1761), (Science History Institute)

Practitioners of uroscopy are referred to as uroscopists. In the era in which uroscopy was a popular way of thinking, one of the major benefits was the lack of surgical operations, lending itself to the most conservative of adherents to the Hippocratic Oath.

Matula (flask)

A uroscopy flask, also known as a "matula", is a piece of transparent glass – this is imperative as colorations, along with any deformations, in the glass may lead to a misdiagnosis – that is circular at the bottom, while there is a thin neck at the top, and an opening for the patient to urinate in.

Urine wheel

Uroscopy Wheel Uros Rad.jpg
Uroscopy Wheel

The uroscopy wheel is a diagram that linked the color of urine to a particular disease. It usually has twenty different uroscopy flasks with urine of different colors aligned around the border of the circle. Each flask has a line that connects it to a summary of a particular disease. This allowed doctors to have a quick reference guide to twenty different types of urine. [6]

Temperature

The temperature at which the urine is examined is a very important factor to consider in the process of uroscopy. When a patient urinates, the urine will be warm, so it is necessary for it to stay warm for proper evaluation. The external temperature should be the same as the internal temperature. When the temperature of urine goes down the bubbles in it will change. Some of them will disappear, but some will remain. With the temperature decrease, particles and impurities will be more difficult to evaluate. They will move toward the middle of the flask, then sink to the bottom. They will all mix, making it more difficult to see the impurities.

Another problem with urine cooling is that it would become thicker. The longer that it had to cool down the more likely it was that the crystals in it would bond together, causing it to thicken. This could lead to a false diagnosis, that is why doctors usually inspected the urine quickly.

Richard Bright in the 19th century invented a technique that allowed doctors to examine a patient's urine effectively after the temperature had dropped. The process involved heating water, then inserting the uroscopy flask containing cooled urine. This would heat the urine causing the crystals that formed during loss of temperature to break down. As a result, the urine will become thin again. This process is very effective, but a doctor should "also be careful not to shake them much before you inspect them for you will move the particles and destroy the bubbles and dilute the deposits and confuse the situation," (The Late Greco-Roman and Byzantine Contribution to the Evolution of Laboratory Examinations of Bodily Excrement. Part1: Urine, Sperm, Menses and Stools, Pavlos C. Goudas).

Common diseases identified by uroscopic methods

Diabetes

In 1674 English doctor Thomas Willis submitted into medical literature a peculiar (and peculiarly found) relationship he'd observed: people with type 1 diabetes usually have sweet-tasting urine — this is due to an oversaturation of glucose in the blood, the excess of which is excreted out via urine, as the diabetic lacks sufficient insulin to process the high amounts of glucose.

Jaundice

Yellowish discoloration of the whites of the eyes, skin, and mucous membranes caused by deposition of bilirubin in these tissues. It occurs as a symptom of various diseases, such as hepatitis, that affect the processing of bile. Also called Icterus.

Doctors would test by using their vision. If the urine had a brownish tint then the patient would most likely have jaundice.

Kidney disease

The kidneys are supposed to filter excesses (especially urea) from the blood and excrete them, along with water, as urine. When they are not performing this task the patient has a kidney disease.

Doctors would test urine using a visual examination. If the urine was red or foamy, the patient had kidney disease.

See also

Related Research Articles

<span class="mw-page-title-main">Kidney</span> Organ that filters blood and produces urine in humans

In humans, the kidneys are two reddish-brown bean-shaped blood-filtering organs that are a multilobar, multipapillary form of mammalian kidneys, usually without signs of external lobulation. They are located on the left and right in the retroperitoneal space, and in adult humans are about 12 centimetres in length. They receive blood from the paired renal arteries; blood exits into the paired renal veins. Each kidney is attached to a ureter, a tube that carries excreted urine to the bladder.

<span class="mw-page-title-main">Nephrology</span> Medical study concerned with the kidneys

Nephrology is a specialty for both adult internal medicine and pediatric medicine that concerns the study of the kidneys, specifically normal kidney function and kidney disease, the preservation of kidney health, and the treatment of kidney disease, from diet and medication to renal replacement therapy. The word "renal" is an adjective meaning "relating to the kidneys", and its roots are French or late Latin. Whereas according to some opinions, "renal" and "nephro" should be replaced with "kidney" in scientific writings such as "kidney medicine" or "kidney replacement therapy", other experts have advocated preserving the use of renal and nephro as appropriate including in "nephrology" and "renal replacement therapy", respectively.

<span class="mw-page-title-main">Clinical chemistry</span> Area of clinical pathology that is generally concerned with analysis of bodily fluids

Clinical chemistry is a division in medical laboratory sciences focusing on qualitative tests of important compounds, referred to as analytes or markers, in bodily fluids and tissues using analytical techniques and specialized instruments. This interdisciplinary field includes knowledge from medicine, biology, chemistry, biomedical engineering, informatics, and an applied form of biochemistry.

<span class="mw-page-title-main">Cystoscopy</span> Medical procedure; endoscopy of the urinary bladder via the urethra

Cystoscopy is endoscopy of the urinary bladder via the urethra. It is carried out with a cystoscope.

<span class="mw-page-title-main">Proteinuria</span> Presence of an excess of serum proteins in the urine

Proteinuria is the presence of excess proteins in the urine. In healthy persons, urine contains very little protein, less than 150 mg/day; an excess is suggestive of illness. Excess protein in the urine often causes the urine to become foamy. Severe proteinuria can cause nephrotic syndrome in which there is worsening swelling of the body.

The excretory system is a passive biological system that removes excess, unnecessary materials from the body fluids of an organism, so as to help maintain internal chemical homeostasis and prevent damage to the body. The dual function of excretory systems is the elimination of the waste products of metabolism and to drain the body of used up and broken down components in a liquid and gaseous state. In humans and other amniotes, most of these substances leave the body as urine and to some degree exhalation, mammals also expel them through sweating.

<span class="mw-page-title-main">Urinalysis</span> Array of tests performed on urine

Urinalysis, a portmanteau of the words urine and analysis, is a panel of medical tests that includes physical (macroscopic) examination of the urine, chemical evaluation using urine test strips, and microscopic examination. Macroscopic examination targets parameters such as color, clarity, odor, and specific gravity; urine test strips measure chemical properties such as pH, glucose concentration, and protein levels; and microscopy is performed to identify elements such as cells, urinary casts, crystals, and organisms.

<span class="mw-page-title-main">Hippocratic Corpus</span> Collection of around 60 Ancient Greek medical works

The Hippocratic Corpus, or Hippocratic Collection, is a collection of around 60 early Ancient Greek medical works strongly associated with the physician Hippocrates and his teachings. The Hippocratic Corpus covers many diverse aspects of medicine, from Hippocrates' medical theories to what he devised to be ethical means of medical practice, to addressing various illnesses. Even though it is considered a singular corpus that represents Hippocratic medicine, they vary in content, age, style, methods, and views practiced; therefore, authorship is largely unknown. Hippocrates began Western society's development of medicine, through a delicate blending of the art of healing and scientific observations. What Hippocrates was sharing from within his collection of works was not only how to identify symptoms of disease and proper diagnostic practices, but more essentially, he was alluding to his personable form of art, "The art of true living and the art of fine medicine combined." The Hippocratic Corpus became the foundation upon which Western medical practice was built.

<span class="mw-page-title-main">Hematuria</span> Medical condition

Hematuria or haematuria is defined as the presence of blood or red blood cells in the urine. "Gross hematuria" occurs when urine appears red, brown, or tea-colored due to the presence of blood. Hematuria may also be subtle and only detectable with a microscope or laboratory test. Blood that enters and mixes with the urine can come from any location within the urinary system, including the kidney, ureter, urinary bladder, urethra, and in men, the prostate. Common causes of hematuria include urinary tract infection (UTI), kidney stones, viral illness, trauma, bladder cancer, and exercise. These causes are grouped into glomerular and non-glomerular causes, depending on the involvement of the glomerulus of the kidney. But not all red urine is hematuria. Other substances such as certain medications and foods can cause urine to appear red. Menstruation in women may also cause the appearance of hematuria and may result in a positive urine dipstick test for hematuria. A urine dipstick test may also give an incorrect positive result for hematuria if there are other substances in the urine such as myoglobin, a protein excreted into urine during rhabdomyolysis. A positive urine dipstick test should be confirmed with microscopy, where hematuria is defined by three or more red blood cells per high power field. When hematuria is detected, a thorough history and physical examination with appropriate further evaluation can help determine the underlying cause.

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<span class="mw-page-title-main">Heat exhaustion</span> Heat-related illness caused by the loss of water and electrolytes through sweating

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Dysuria refers to painful or uncomfortable urination.

<span class="mw-page-title-main">Pyelonephritis</span> Medical condition

Pyelonephritis is inflammation of the kidney, typically due to a bacterial infection. Symptoms most often include fever and flank tenderness. Other symptoms may include nausea, burning with urination, and frequent urination. Complications may include pus around the kidney, sepsis, or kidney failure.

<span class="mw-page-title-main">Pyuria</span> Symptom of urinary tract inflammation

Pyuria is the condition of urine containing white blood cells or pus. Defined as the presence of 6-10 or more neutrophils per high power field of unspun, voided mid-stream urine, it can be a sign of a bacterial urinary tract infection. Pyuria may be present in people with sepsis, or in older people with pneumonia. Others additionally require discoloration, clouding or change in the smell of urine for a pyuria to be present. Without these additional features, there is said to be leukocyturia.

<span class="mw-page-title-main">Byzantine medicine</span> Common medical practices of the Byzantine Empire

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Abdominal guarding is the tensing of the abdominal wall muscles to guard inflamed organs within the abdomen from the pain of pressure upon them. The tensing is detected when the abdominal wall is pressed. Abdominal guarding is also known as 'défense musculaire'.

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<span class="mw-page-title-main">Urine test strip</span> Diagnostic tool used in urinalysis

A urine test strip or dipstick is a basic diagnostic tool used to determine pathological changes in a patient's urine in standard urinalysis.

The history of medical diagnosis began in earnest from the days of Imhotep in ancient Egypt and Hippocrates in ancient Greece but is far from perfect despite the enormous bounty of information made available by medical research including the sequencing of the human genome. The practice of diagnosis continues to be dominated by theories set down in the early 20th century.

<span class="mw-page-title-main">Abnormal urine color</span> Medical condition

Normally, human urine color is straw-yellow. Urine color other than straw-yellow sometimes reflects an abnormality—an underlying pathological condition—in human beings.

References

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  2. Armstrong, J.A. (March 2007). "Urinalysis in Western culture: A brief history". Kidney International. 71 (5): 384–387. doi: 10.1038/sj.ki.5002057 . PMID   17191081.
  3. "Doctor's Review | Liquid Gold". www.doctorsreview.com. Archived from the original on 2021-10-21. Retrieved 2019-03-29.
  4. 1 2 3 Eknoyan, Garabed (2007-06-01). "Looking at the Urine: The Renaissance of an Unbroken Tradition". American Journal of Kidney Diseases. 49 (6): 865–872. doi: 10.1053/j.ajkd.2007.04.003 . ISSN   0272-6386. PMID   17533032.
  5. "Urine color - Symptoms and causes". Mayo Clinic. Retrieved 2019-03-29.
  6. Laskow, Sarah. "What a Chart of Urine Tells Us About the History of Color Printing". Atlas Obscura. Retrieved 7 August 2022.