Dr. Lindsey Fitzharris is a bestselling author and medical historian with a doctorate from the University of Oxford. Her debut book, The Butchering Art, won the PEN/E.O. Wilson Award for Literary Science in the United States; and was shortlisted for both the Wellcome Book Prize and the Wolfson History Prize in the United Kingdom. Dr. Fitzharris is the creator of the popular blog, The Chirurgeon’s Apprentice, where an earlier version of this article originally appeared. She is also the host of the YouTube series, “Under the Knife”, and has written for a variety of publications, including Scientific American, The Guardian, The Lancet, New Scientist, and The Huffington Post. Her next book will be on the birth of plastic surgery told through the incredible story of Harold Gillies, the pioneering surgeon who first united art & medicine to address the horrific injures that resulted from World War I.

In an older episode of Dr. Oz, the good doctor pontificated about the color of some unfortunate woman’s urine in front of millions of viewers. She offered up a cup of what looked like diluted molasses to Dr. Oz for judgment. “Dehydration,” he decreed. “More water!”

(As if she didn’t have a sneaky suspicion of this already from the looks of the dark, murky fluid residing in the bottom of the plastic cup.)

Watching this spectacle reminded me of the medieval urine wheel used to diagnose disease based on the color, smell and taste of a person’s urine. And yes, I did say taste. I’ll return to that point in a minute.

Before stethoscopes, blood tests and x-rays, a pot of pee was a crucial diagnostic tool. Due to the enduring influence of the Greco-Roman physician, Galen (131-201 AD), medical practitioners believed that urine was vital in gauging the health of a person’s liver, where blood was thought to be produced. Analyzing urine was the best way to determine whether a patient’s four humours (blood, phlegm, yellow and black bile) were in balance.

The wheel consisted of 20 colors ranging from “white as wellwater” to “ruddy as pure intense gold” and lastly “black as very dark horn.” George III (1738-1820) reportedly had purple urine. This could have been a sign of a rare condition known as porphyria which can manifest itself in many of the neurological disorders for which the “Mad King” was known.

Of course, examining a person’s urine inside a dark chamber pot proved problematic, so practitioners created a round-bottomed glass flask shaped like a bladder called a matula. Indeed, the image of the doctor holding up the urine-filled flask to the light came to epitomize medicine during this period, and is still a recognized symbol today.

The smell and taste of a patient’s urine were equally important when determining a course of treatment, and often corresponded with specific colors. In 1674, the English physician Thomas Willis described the urine of a diabetic as “wonderfully sweet as if it were imbued with honey or sugar.” He also noted that diabetic urine was often the color of honey, something observed by earlier practitioners using the urine wheel. Willis went on to coin the term mellitus (literally honey sweet) in “diabetes mellitus,” and for a long time, the condition was known as “Willis’s disease.”

The urine wheel may not have been useful in diagnosing diseases as we understand them today; however, it was used in standard practice during the medieval period. By the 16th and 17th centuries, urine wheels had become so prolific due to the printing press that all sorts of people were using them, including unlicensed medical practitioners, or quacks. The practice of uroscopy – using urine to analyze a patient’s health – soon turned into uromancy, which was something altogether different.

Uromancy is the art of divination using urine. Piss prophets (as they were known) each had a different method for predicting the future. Some took omens from the urine’s color; others from its taste. Most commonly, piss prophets “read the bubbles” seconds after it hit the divination bowl. The presence of large bubbles spread far apart signified that the urinator was about to come into a lot of money. Conversely, the presence of small bubbles packed tightly together signified illness, loss, or the death of a loved one. Even pregnant women visited piss prophets to the hopes of learning the sex of their babies.

Naturally, there was a lot of quackery going on in the practice of piss prophecy. But as far as the reasoning behind uromancy and other forms of medical divination was concerned, it was actually not too far from beliefs and practices which were pretty much mainstream at the time. The principle of “occult correspondence,” according to which all things in the cosmos were somehow interrelated, was also at the basis of the astrological medicine taught at the universities. In fact, giants of early modern science like Galileo not only taught astrology to medical students, but really believed in it. And it’s worth remembering that the Latin occultus simply means “hidden,” and is in this sense still sometimes used in modern medicine (as in “occult blood”).

Today, physicians no longer cast our horoscopes or taste our urine, nor do they spend much time contemplating its smell or color (Dr. Oz aside). That said, asking a patient to pee into an impossibly tiny cup is not an uncommon request, as anyone entering a hospital or medical office today knows. One can’t help but think the experience would be much more enjoyable if the doctor, upon being presented with the warm cup of cloudy liquid, poured it into a divination bowl and told us we were all going to be rich.

Just like Dr. Oz.

© 2019 Lindsey Fitzharris

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