Urine - Windows to Our Soul?

Nephrologists deal with urine a lot. Nowadays, we use urine to confirm diagnosis of nephrotic syndrome, glomerulonephritis and can be very suggestive for rhabdomyolysis, pre-renal/intrinsic AKI or even electrolyte imbalance. It can be used in other specialties like in pregnancy for preeclampsia and endocrine for diabetes (mellitus and insipidus).

I came across a historical article that put urinalysis or uroscopy practice into an interesting perspective. No doubt that physicians of the old, as old as the Sumerian and Babylonian, have been noticing the colour or smell or the urine changed with certain diseases. Sanskrit medical work described 20 different types of urine. Hindu cultures were aware that black ants were attracted to sweet urine (sign of diabetes mellitus). Hippocrates describe bubbles on the urinary surface as a sign of kidney disease (proteinuria). Infection may cause a lot of urinary sediment. Blood may be due to ulcers etc.
A Persian physician popularised the concept of 24-hour urinary collection for better delineating of the disease. He used a vessel shaped like a bladder to collect the urine, believing that the liquid will behave similarly as if it is in the body. Matula, which is a glass container with shape of a bladder was introduced by King’s Royal Physician in France. The Matula was famously ascribed to physicians in movie and films, with a scene of holding up the glass of urine against the light to examine it.

Of course, the physician in the middle age still believe in the theory disease due to imbalance of 4 humours – namely fire, air, earth and water. Some believe if the imbalance element are light, like fire and air – it will rise to the top and presentable in the urine.
The uroscopy has been so famous that books were published and became available to common people (Google, anyone?). Self-diagnostic colour wheels were included for people to diagnose their own condition without seeing the physician. Of course, doctors are no different. Some also used only urine to diagnose a condition (hence the famous quote: Treat the patients, not the disease/lab results). Unqualified medical practitioner, called leches, were rampant with the easy access to diagnostic tool, like the urine colour wheels (Sound familiar?).

The people were so obsessed with urinalysis that it spiralled uncontrollably. Physicians and leches started telling fortunes and predicting futures with urine, a practice known as uromancy. They read bubbles on the top of urine to tell the future.
With all these hypes, no wonder it causes a backlash. In 1637, activist Thomas Brian published a book Pisse Prophet that mock all these concepts to the extent that Physician seen with a matula became object of ridicule.

CONCLUSION1. Human observations are powerful. Some observations gave rise to factual information, like in urinalysis. So, open our eyes.

2. For centuries, the imbalance of 4 humours as cause of disease predominated the mind of physicians. Many lived and died without even knowing the idea of glomerular filtration etc. We may die without even realising some of the concepts that we believe in are totally wrong. So, open our minds.

3. A false and absurd idea will not go well with intellectual capability that God has given us. Although people can be fooled by the surroundings.

4. Newton 3rd law states that for every action, there is an equal and opposite reaction. If we are too forceful in combating things we don’t like, there will be an equally strong force resisting the change. Look at the issue on feminism and prior inequality of women, the right against science by the religious community and the rise of secularism, the issue of Wahabi/Salafi vs traditional understanding of Islam. Be in moderation.

https://www.ncbi.nlm.nih.gov/pubmed/17191081