The seven books of Paulus Ægineta, volume 1 (of 3)

by Aegineta Paulus

SECT. XIV.—ON THE INDICATIONS FROM THE URINE.

As concerning the alvine discharges, so also with respect to the urine; using that of healthy persons as a rule, we shall hence form our indications of that of persons in disease. That urine, therefore, is best, which is nearest to that of healthy persons. Such is that which is at the same time of a faintish golden, or faintish saffron colour, and which, moreover, is moderate as to consistence. There are three varieties of turbid urine; for, either straightway after being voided it deposits a sediment; or it always remains the same; or it is voided pure, but afterwards becomes turbid; of these, the third is bad, the first favorable the second intermediate between them. That which is wholly unconcocted, being altogether watery, is symptomatic of digestion being entirely gone in the venous system; and when it is passed frequently, the disease is called diabetes, which is the worst of unconcocted urines. Next to these is the thin and white urine, which resembles water. Nearly allied to these, is another kind of urine, appearing in many diseases, and which is very like to the thin and white. The palish is next to this. The pale may also be of a faintish golden colour, and is concocted in proportion as it partakes of this colour. It ought, however, to be as much different from water in thickness as in colour, if it is to be properly concocted. But if it preserve exactly its natural colour, and have a white, smooth, equable, and copious sediment, it is indicative of perfect digestion. A greater quantity than natural indicates that a crude humour is purged off; but if it is somewhat thicker than natural, and has a certain sediment, it is not then altogether unconcocted. But if it have gritty, scaly, furfuraceous, black, livid, green, or fetid sediments, such urine is altogether unconcocted and particularly mortal. But urine of a proper colour, and which at the same time has white, smooth, and equable sediments, or certain cloud-like appearances, or substances swimming in the middle of a like kind, is of all others the best. Of these characters, the sediment is of the most importance; next, the substances swimming in it; and third, the cloud-like appearances on its surface; and, on the whole, of the substances which float in the urine, the more they sink downwards so much the better.

Commentary. See Hippocrates (Prognost. ii, et de Vict. Acut. c. 46); Galen (Comment. de Crisibus, i, 12); Celsus (ii, 7); Theophilus (de Urinis); Actuarius (de Urinis); Abicianus (de Urinis; De Urinis secundum Syros, de Urinis secundum Persas, de Urinis Commentatio, ap. Phys. et Med. Græc. Minor. ed. Ideler); Aëtius (v); Avicenna (iv, 2, 1, Cantic. p. 1); Averrhoes (Collig. iv, 21); Haly Abbas (Theor. iv, 12, x, 10); Alsaharavius (Theor. viii); Rhases (ad Mansor. x, 30, and Contin. xxxi); Psellus (Opus Medicum.)

Of the ancient authorities who have treated of the urinary discharges, Theophilus and Actuarius are most particularly deserving of attention. Besides the watery portion, the ancients distinguished three distinct substances in the urine: 1st, the hypostasis or sediment, which is the part that falls to the bottom; 2d, the enæorema, or substances which float in the watery part, but have not weight to subside; 3d, the nubeculæ, or cloud-like appearances seen floating on the surface, or as they may be called the scum. All the different appearances which these substances put on, including every imaginary shade of colour, are described with surprising minuteness, and connected with the morbid conditions of the system which gives rise to them. In fact, there is no part of our task which we are obliged to discharge in so unsatisfactory a manner to ourselves as the present; for, to give our readers anything like a competent exposition of the knowledge possessed by the ancients on the morbid appearances of the urine, we would require to transfer to our pages the whole contents of the large treatise of Actuarius. We shall now give a few extracts from his work and that of Theophilus. They state that the urine of sedentary persons has more sediment than that of persons who pursue an active course of life; that the urine of women, from this cause, has generally more sediment than that of men; that of children more than that of adults; and that of persons who live grossly, than the urine of temperate persons. Theophilus thus delivers the characters of oily urine. When in fevers the urine assumes the colour of oil, it indicates that the fat of the body is melting down. When the appearances of the urine resemble oil still more, it indicates an increase of the melting of the fat; and when the urine in consistence and colour appears exactly like oil of a dark colour, it prognosticates a collapse and death. (§ 17.) This accords with what is stated in one of the aphorisms of Hippocrates: “When in ardent fevers the urine has an oily sediment, it prognosticates death.” The tare-like urine, as it was called from the resemblance of the sediments to the colour of the tare (ervum ervilia), but which might be better called the grumous, since, as Actuarius explains, they bear a close resemblance to clots of blood, is said by Theophilus to be indicative of melting of the flesh. The scaly urine derived its name from small substances resembling the husks or hulls of grain in the urine, and in febrile diseases was supposed to indicate great disorder of the general system, but otherwise to be connected with an affection of the bladder. The furfuraceous, which derived its name from the resemblance of the sediments to bran, was also held to be symptomatic of local disease of the bladder, or of constitutional disorder in fever. The gritty, so called from the resemblance of the substances in the water of the urine to large particles of ground grain, was reckoned by all the authorities, from Hippocrates downwards, as a very bad symptom in fevers. Fetid urine was supposed to indicate melting or putrefaction of the body. Actuarius gives a curious account of urine without sediment, which he ascribes to its being attracted to some part of the system which is the seat of inflammation or erysipelas. (v, 5.) The enæorema, or substances in the middle of the urine, are said by Actuarius sometimes to resemble spiders’ webs, sometimes specks of oil like what appears in fat broth when cooled, and at other times hairs, as will be more fully stated elsewhere. The nebulæ, or scum on the urine, is said to put on various appearances, as, for example, that of bullæ or bubbles, of which mention will be made in another place. From a passage in Theophilus (v, 8), it may be inferred that the ancients sometimes applied external heat as a test of the characters of the urine. On the main the differences in the colours of the urine were held to depend on the mixture of bile in the urine, and sometimes, though rarely, of blood.

As a specimen of the doctrines of the Arabians, although, in fact, entirely borrowed from the Greeks, we shall select a few of the observations of Haly Abbas and Alsaharavius. According to Haly, thinness of the urine indicates deficient digestion. Thickness, on the other hand, is the product of excessive digestion, or arises from the presence of pituitous humours in the body. When the sediment is white, it is a favorable symptom; when yellow, it is from yellow bile; when red, it is from a sanguineous plethora and imperfect digestion; and if of long continuance, it must proceed from inflammation of the liver. If, after intense redness, the urine becomes black, it is a most fatal symptom. When the urine is moderately fetid, it is connected with indigestion; but when very fetid, with putrefaction. Alsaharavius delivers the characters of the different kinds of urine in nearly the same terms. He properly cautions the physician not to allow himself to be imposed upon by the colour of the urine, which may sometimes acquire a tinge from the patient’s having taken saffron, cassia-fistula, or the like. Such tricks, he says, are often practised upon water doctors. According to Rhases, it is an unfavorable symptom when the urine does not become turbid in the course of the fever. Yellow urine without sediment is said to be unfavorable.

Prosper Alpinus has stated correctly the doctrines of Hippocrates and Galen, but is entirely silent respecting those of Theophilus and Actuarius. (u. a.)

Besides the ancient authors referred to by us in this chapter, the works of the following writers de Urinis exist in manuscript, but have never been published: 1, Athenæus, quoted by DuCange (ex Cod. Colbert, 3614); 2, Constantinus Africanus (in Bibl. Cæsarea); 3, Joannes Episcopus (Cod. Reg. 3497); 4, Maximus Planudes and Meletius Monachus (Cod. Reg. 3175); 5, Nicephorus Blemmydes (in Bibl. Cæsarea); 6, Anonymus, &c. (Cod. Colb. 3614 and 4230, et in Bibl. Cæsar.); 7, Piropulus (in Bibl. Corsliniana, 448.) See Fabricii (Bibl. Grac. xiii, 779.) The treatise of Abicianus, noticed by Fabricius, has been published by Ideler. It proves to be a mere compilation from the works of Avicenna.