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.