Modern readers, used to diagnostic tests that rely on radiography, cytology, blood chemistry, surgical biopsies requiring anesthesia and sterile fields, and similar procedures, might wonder why medieval medicine put so much emphasis on uroscopy – the macroscopic inspection of urine – as a clue to patients’ maladies. The answer lies in a combination of the ease and safety of collecting regular urine samples from patients on the one hand, and on the other the not unreasonable assumption that what came out of the body reflected what was happening within the body. Before microscopy, antisepsis, anesthesia, x-rays, and the countless other scientific advances that allow us to peer inside the body, medieval Western physicians – like traditional healers in some other cultures – made the most of urine as a “faithful messenger” (Theophilus, De urinis) of the body’s inner workings.
If collected and examined properly, medieval doctors believed, urine would allow them to diagnose such illnesses as fevers, respiratory disorders, epilepsy, headache, diabetes, and so on, and to determine how quickly a patient could overcome a particular malady. Because the urine reflected the whole organism, the Liber Uricrisiarum is necessarily about more than just the urinary symptoms of disease. It is, instead, encyclopedic in its scope, explaining the composition and operation of the organs, humors, veins, arteries, and even the universe, which is the macrocosm of the human body. The study of uroscopy, at least as Henry Daniel presents it, leads to a comprehensive understanding of the human body in its entirety.
The importance of uroscopy to medieval medical knowledge did not begin with Daniel. Uroscopy had been a part of medical practice since the Classical period (Hippocratic and Galenic texts often mention uroscopic symptoms of disease, albeit unsystematically), and many uroscopic treatises had been translated from Greek and Arabic into or composed in Latin by 1200, making this knowledge accessible to medical educators and learned practitioners in the West. By Daniel’s time, uroscopy had long been a defining feature of the healing profession: physicians were frequently depicted holding up urine flasks in manuscript illustrations in the thirteenth and fourteenth centuries, an artistic tradition that continued into the nineteenth century.
The principal sources of uroscopic theory and practice in the western Latin and vernacular traditions are a series of treatises that remained in circulation well into the Renaissance: 1) the relatively brief De urinis of the Byzantine writer, Theophilus Protospatharius (?7th c.), found in Latin possibly by the mid-eleventh century; 2) the much more extensive and sophisticated De urinis of Isaac Israeli (c. mid-9th to c. mid-10th century), translated into Latin most probably by Constantinus Africanus in the late 11th century; and 3) the verse Carmen de urinis of Giles of Corbeil (c. 1140 – c. 1224), written c. 1200, which provided a highly systematized classification of the colors and contents of urine that informed the organization of many later treatises.
Uroscopy treatises were composed by other writers (e.g., various masters of the medical school at Salerno), but the works of Theophilus, Isaac, and Giles achieved especially wide dissemination through their inclusion in or association with the Articella, a medical teaching anthology used in European schools of medicine from the twelfth to the sixteenth centuries. Many uroscopy texts take the form of commentaries on or paraphrases/expansions of Theophilus, Isaac, or Giles; known or attributed writers of such texts include Bartholomew of Salerno, Gilbertus Anglicus, Walter Agilon, Peter of Spain, and Bernard de Gordon.
Beyond its frequency and ubiquity in learned texts, uroscopy is also significant because of the broad spectrum of medieval practitioners for whom it was of professional interest. At one end of that spectrum, the procedure was part of the formal training of academic physicians, who encountered it in the Articella anthology and other works noted above. At the other end of the spectrum are brief lists and simplified overviews, some in Latin or vernacular prose and others in diagrammatic or tabular form for ease of consultation and retention. The latter texts were probably aimed at readers like “the ordinary practitioner[s]” whom C. H. Talbot envisions as the owners of folding “almanacs” or girdle books with medical content, or possibly even at lay audiences. Some Middle English uroscopic texts do retain much of the sophistication and complexity of their academic sources – most notably, Henry Daniel’s Liber Uricrisiarum – but many of them are better seen as somewhere in the middle of the spectrum between works of full-blown academic origin and popular remedy-books. Even the simplest vernacular uroscopy treatises retain some echoes, if only in the colors to be observed, of their learned ancestry.
Page header image: London, British Library, Harley MS 5311.