& Urine Wheels: Color Me Medieval

From Almanach, tabula festorum, mobilium ab anno 1364 usque annum domini 1462: manuscript [Physician’s belt book]. York, England, 1364. The Rosenbach Museum & Library, Philadelphia, MS 1004/29

A few relatives with more blogging experience than myself have gently suggested that I might want to reconsider my alphabetical approach to research coverage. After all, what am I going to do when I come across a compelling Z item and I’m up to my eyeballs in the letter B? That would be pretty frustrating, wouldn’t it?

I hear this advice, and it sounds very sensible. But I also am thinking: Don’t you take my alphabet away from me.

Then, while working on some A’s (and feeling absorbed in Arsenic and Attoseconds), I happened to come across the above picture of a medieval urine wheel. It’s beautiful. Sigh. Can’t I have my alphabet and eat it, too?

I can and I will, I’ve decided. I’ll simply use &, the ampersand symbol, for those nuggets of research that grab my attention and pull me out of my place in the alphabet. I’ll come right back. Promise.

Now on to that urine wheel with its colorful flasks and Latin descriptions. This particular image comes from a 14th-century almanac and medical reference book that’s in the collection of the Rosenbach Museum and Library in Philadelphia. As the museum’s website explains, the book would have been attached by a cord to the physician’s belt. Pretty handy.

I knew just the person to contact for a little more commentary: Dr. Steven Peitzman. He helped me with an article I recently wrote on Dr. Benjamin Rush’s 200-year-old mental health treatise, Diseases of the Mind, for The Pennsylvania Gazette. In addition to traveling around the country to give talks about the history of medicine, Peitzman is a nephrologist who teaches at Drexel University.

Peitzman explained to me that urine wheels were used long ago in a practice known as uroscopy. “It involved looking at urine in the flask, swirling it, and looking at the particulate matter and the color.” Sounds more like a wine tasting to me. But Peitzman says, “It wasn’t quackery. It was part of learned medieval medicine,” and its use extended through the Renaissance. “Probably other than the patient’s story, the biggest parts of diagnosis were uroscopy and feeling … the contours and strength of the pulse,” Peitzman says.

The colors of the urine wheel in the above picture were used to describe different states of “digestion,” though Peitzman says the meaning is a little different than how we use the term today, and refers more to “the complete utilization of food in a balanced way.”

So prevalent was the practice of uroscopy that one can find many examples of it in 17th-century Dutch art. “You’ll see numerous paintings of a physician holding a urine flask up to the light,” Peitzman says. “Sometimes it’s a young physician, sometimes an old physician, and usually it’s a young woman patient. These are narratives that are sometimes interpreted as the woman being lovesick. Sometimes the male lover is off in the corner of the painting. Those interpretations have been further extended to [include the question of] whether she is worried about pregnancy,” Peitzman adds. (The doctor, by examining the urine, would be trying to settle that question.)

By the mid- to late-18th century, urine wheels had fallen out of favor. But urine analysis experienced a resurgence in the following century with the use of microscopes to observe properties that couldn’t be observed before with the naked eye. Then, in the early 20th century, most hospitals began to set up diagnostic labs that could measure a variety of chemicals in the urine to provide information about renal diseases.

By the time Peitzman entered medical school in the 1960s, urine dipsticks were in wide use, making it possible for physicians to perform on-the-spot chemical analysis. (The dipsticks’ pads contain a reagent that changes colors in the presence of some substance in the urine, such as blood, sugar, or bile.)

“You compare the color in the pad with the color chart on the bottle in which the dipsticks came,” Peitzman says. “It’s very much like the color wheel, except you’re not comparing the urine color itself. You’re comparing the color change of the indicator pads on the dipstick.” More useful than its medieval counterpart, surely. But perhaps not quite as beautiful.

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