If a couple can’t have children and you want to know whose ‘fault’ it is, what do you do? Well, if we’re talking about Renaissance Italy, you might give this experiment a try.
‘To know whose fault it is that conception does not ocurr, if the woman or the man, in case they have been married for a long time. Take two bowls, and in which of them you should add wheat or another grain. In one of them you should have the man urinate, and, in the other, the woman. You should leave the bowls rest for three days. Then look into the bowls and you will find that, in the bowl in which the person who is responsible for the absence of conception [urinated], there will be worms, while in the other one there will not. This way you will know that it is because of the person whose urine has created worms that the fruit [the baby] is not produced.’
This recipe is from a 1529 book called Dificio di ricette, or ‘House of Recipes’ and I came across it recently when I was preparing a talk. I know what you’re thinking: this experiment doesn’t sound very scientific, does it?! And yet, I don’t think many 16th-century readers would have been surprised to find it in a collection full of medical recipes. That’s probably because of how central ‘uroscopy’ was in medicine at the time.
What is Uroscopy?
Uroscopy meant examining urine to understand what a patient was suffering from and how they might be treated. Since antiquity (and I’m thinking of Sumerians and Babylonians here), the colour, consistency and odor of urine had been used to assess health. Plus transparency, sediments and even taste. Let’s put a pin on the ‘tasting’ bit here; we’ll come back to it later. Suffice it to say that uroscopy played a big role in medicine. This was true for Chinese and Ayurvedic medicine as well, but I’ll stick to European medicine here. The Greeks – and that can be seen in the writings in the Hippocratic corpus – truly developed uroscopy, and it appears in many classical sources. Later, the Roman physician Galen would categorise urine even further, connecting different appearances to various bodily conditions. In the medieval period, uroscopy became central to European medical practice, which makes sense when you think of how much of medieval medicine was informed by Greco-Roman traditions.
Uroscopy was a widespread practice, and it appears in popular culture and folklore in general. But not everyone was so serious about what urine might reveal about someone. In Boccaccio’s 1353 Decameron, the collection of stories characters tell each other while relaxing in the Tuscan coutryside, waiting for the plague in Florence to pass, there’s a brilliant tale about how uroscopy could be used to trick people. Calandrino, who is depicted as – let’s be generous and say – ‘not very clever’ is fooled by his friends and a physician, who make him believe he is pregnant, to everyone’s amusement. He ends up taking a potion to induce a ‘painless miscarriage’. It’s very funny and silly, but I may be partial because I love these stories. In another one, Calandrino believes he can become invisible. Stories like this indicate just how much people believed urine could reveal about someone’s body, and how central fluids were to health.
As I have mentioned several times on this channel, the humoral theory was central to how the body was understood: the balance between the four humours determined health, and their imbalance caused illness. But what’s urine to do with it? Well, medical writers believed that when people ate, the food was digested and turned into blood, which would sustain life. The process of digestion, which was believed to involve not only the stomach and intestines but also the kidneys and the liver, produced excrements, including urine. So, there would be clues in the patient’s urine which would be able to tell physicians much about their bodily state, and especially what was going on with the patient’s humours.
Physicians often relied on urine specimens as diagnostic and prognostic tools, using color-coded charts to interpret its various characteristics – there are many colourful ones in medieval manuscripts, and I confess that I’m always happy when I come across one of these urine wheels! Imagine you’re a medieval physician going for a call at a patient’s house. You would probably ask for an urine sample as soon as they woke up in the morning, but you wouldn’t examine it straightaway. You’d allow for some time to go by, with the sample ideally kept out of sunlight, so that any particules might settle in the bottom of the glass flask, and any separation between different parts of the liquid to become apparent. You would then match its colour to the urine chart you had on you, combining theory with practice. So, this was a key skill for physicians, and the urine flask, or matula, even became an identifying symbol for doctors at the time. By the 16th century, these urine charts were available in printed books (and readers could have them coloured), making them much more accessible. Uroscopy was a testament to a doctor’s skill, and it could tell much about a patient’s current bodily state and what the future might hold, especially where having children was concerned. So, let’s go back to the intriguing idea of using urine to learn about fertility.
Urine and Fertility
Modern pregnancy tests using urine test for the pregnancy hormone hCG (human chorionic gonadotropin), which can be found in the blood as well. However, no one knew what hormones were in the 16th century. But, of course, people worried about fertility and a couple’s ability to conceive. In a much earlier book in Middle English, ‘The Dome of Uryne’ – I swear that’s the actual title – it was stated that if a woman’s urine was clear after having sex, that meant she had conceived, probably because the male ‘seed’ had remained inside her body. But what if pregnancy doesn’t happen?
The recipe I started the article with, the experiment in which both the man and woman should urinate in grain, dates from much earlier than that 16th-century book in which it was printed. In the 12th-century compendium of women’s medicine, the ‘Trotula’, the very same recipe can be found:
‘…If a woman remains barren by the fault of the man or herself, it will be perceived in this manner. Take two pots and in each one place wheat bran and put some of the man’s urine in one of them with the bran and in the other [put] some urine of the woman [with the rest of the bran], and let the pots sit for nine or ten days. If the infertility is the fault of the woman, you will find many worms in her pot and the bran will stink. [You will find the same thing] in the other [pot] if it is the man’s fault. And if you fidn this in neither, then in neither is there any defect and they are able to be aided by the benefit of medicine so that they might conceive.’
Experiments like these appeared in Latin manuscript books and, later, in printed books in vernacular languages such as Italian or French. If people wanted to know about the fertility of women i particular, there were similar ways, like this one, also from the 16th-century book called ‘House of Recipes’:
‘To know if a woman will be able to conceive, or not. Take wild mallow and have the woman urinate over it for three days once per day. If you see that the said mallow dies, say that the woman cannot have children. If the mallow remains alive and whole without being corrupted, it is certain that the woman can have children.’
In both cases, the symbols are clear: worms are connected to death and infertility, thriving plants are linked to life and fertility. For conception to happen, heat was needed, too – and this idea appears in both medical texts and popular culture. For instance, in Shakespeare’s Measure for Measure, when characters are discussing Angelo, the main antagonist, Lucio, says:
‘Some report a sea-maid spawned him; some, that he was begot between two stock-fishes. But it is certain that when he makes water his urine is congealed ice; that I know to be true: and he is a motion generative; that’s infallible.’
So, Lucio is saying that Angelo was born from a sea-nymph, or conceived by two dried fish. When he urinates, only ice comes from his body. He’s a puppet without the ability to reproduce. The implication is that only someone who is infertile would be so ruthless and cruel a leader.
Uroscopy in Decline
Before the age of high-tech laboratories, physicians would use their senses to analyse urine: sight, touch, smell and even, sometimes, taste. (I know, that sounds very unpleasant!) But for Arabic medical writers, such as Ibn Sina and Rhazes, this could provide the physician with clues. And their works were translated and widely read in medieval Europe, even if this doesn’t seem to have been a common practice. In any case, thinking of something like diabetes, it could be a way of finding out what was wrong with a patient. The history of uroscopy involves both book-learning and empirical knowledge, not to mention folk traditions. Some people even believed that urine might give a clue as when someone would die!
By the end of the Renaissance, physicians’ trust in uroscopy as a diagnostic tool was dwindling. Having been embraced by empirics of all sorts, it was increasingly seen as the domain of the charlatan. And yet many patients still trusted the method. It was perhaps helpful that this was a convenient and easy, not to mention cheap, way of diagnosing people, so no wonder it was so popular. While in the 12th-century Trotula the recipe about urinating in grains seems to have been aimed at a learned readership – it’s written in Latin, after all -, in the 16th-century Dificio di ricette or House of recipes the experiment was available in plain Italian, printed in an inexpensive book, that many people would have been able to buy. And buy the book they did; it was a huge best-seller.
The practice of uroscopy continued after the Renaissance, though its importance declined in the 17th and 18th centuries. The urine flask, which had long been a symbol of the physician’s profession, started to be used more and more in satyrical images depicting quacks. The tides were shifting. By the 19th century, the advent of microscopy and laboratory techniques shifted the focus to chemical and microscopic analysis of urine. Diabetes is perhaps the best example, as the chemical tests could indicate the level of sugar in the urine and help diagnose patients.
Uroscopy may be a thing of the past, but the medical world relies heavily on urine samples to find out what is happening with someone’s body and how to treat them: modern urinalysis is, of course, a useful tool in medicine. The hormone-based pregnancy tests are perhaps the best example of this connection of urine and medicine in everyday life. So, whenever I come across one of these weird-sounding recipes, or a colourful urine chart, I’m reminded of this deeply human wish from both medical practitioners and patients to find out what was happening inside the mysterious body, and how this desire has remained real throughout the centuries.
References
J. A. Armstrong, “Urinalysis in Western culture: A brief history”. Kidney International 71(5), 2007, pp: 384–387.
Articella and other tracts (12th-14th century), Wellcome MS. 801A.
Bill Bynum and Helen Bynum, ‘The Matula’, The Lancet 387(10019), 2016.
Gilles de Corbeil, Carmina de judiciis urinarum (early 15th century), Wellcome MS. 7.
Monica Green, (ed. and trans.), The Trotula: An English Translation of the Medieval Compendium of Women’s Medicine (2002).
Katherine Harvey, Troubled Waters: Reading Urine in Medieval Medicine, Public Domain Review, 2023.
Isaac Judaeus, Liber urinarum (1481).
Michael Stolberg, Uroscopy in Early Modern Europe (2015).
M. Teresa Tavormina (ed. and trans.), The Dome of Uryne: A Reading Edition of Nine Middle English Uroscopies (2020).
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