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White as Well-Water, Livid as Lead: Understanding Urine Collection Bite

A colourful billboard for our Collection Bite earlier this year, by the fantastic Caroline Hall (Visitor Engagement)

Though many of us may feel a bit reticent about closely examining the subtleties of our own urine, we are all familiar with how this dynamic liquid can be an indication of our wider health. Whether it’s pregnancy, medical tests or simply a sign of dehydration, urine is still essential for understanding the body in health and disease.

As an unstable liquid that can be easily physically and chemically examined, urine has been central to the diagnosis of disease for thousands of years. Whilst we might be surprised to hear a healthcare professional today declaring our urine “pale as the reduced juice of meat”, or (more alarmingly) “deep blue as of very dark wine”, we still expect them to make observations about our bodily functions that are often dependent on sight, sound and touch. Perhaps they are not consulting urine wheels, or holding a matula (a glass flask designed for examining urine) up to the window for a closer look, but they may be drawing conclusions using the colour chart of a Dipstick urine test.

In February, the Historic Reading Room of the John Rylands Library featured a pop-up collection encounter displaying an eclectic selection of items from our special collections and some fascinating objects from the Museum of Medicine and Health (MMH). From 16th-century books and manuscripts to an early 20th-century urine sugar testing kit, we had some great discussions with visitors about how urine diagnosis has changed over time. Some highlights are showcased below for your virtual enjoyment!

On Urines, c.16th century (Eng MS 1310)
This medical manuscript on urine dates from the beginning of the 16th century, but is a copy of a text originally written in the 12th century, in turn based on the writings of the 7th-century Greek physician Theophilius Protospatharious. Theophilius’ work was a leading text on uroscopy for centuries. You can see that page is headed by the word “pale” and features drawings of glass flasks called matula, designed specifically for the examination of urine. The text offers medical diagnoses based on the colour of the patients urine. The colours are black, ‘bloo’, white, ‘glauk’, milky, ‘karapos’, pale, ‘citrine’, ‘rufe’ and ‘subruf’, rubicund, ‘ynopos’ and green. This may seem like a random selection to us, but variations on these definitions were in use for centuries. View our digitised copy here.

Ulrich Pindar, Epiphaniae medicorum, 1506
This early-printed work on medical diagnosis was written by Nuremberg physician, publisher and printer, Ulrich Pindar (d. 1519). It is a text intended for the use of physicans and is divided into three sections treating uroscopy, analysis of the pulse, and various types of fever. The ‘urine wheel’ shown above was an established diagnostic tool for physicians. Pindar depicts himself at the centre of the wheel holding a matula filled with urine up to a window. The colours described on the wheel include ‘yellow as of a reduced lemon’ and ‘white as well-water’. The image above is from a copy at the Wellcome Library, our copy (Medical (pre-1701) Printed Collection 1903) is uncoloured, and therefore more limited as a diagnostic tool!
Credit: Wellcome Library, London. Wellcome Images

William Prout, An inquiry into the nature and treatment of gravel, calculus, and other diseases connected with a deranged operation of the urinary organs, 1821 (Medical (1800-) Printed Collection
J15 P35)

Prout’s guide to urinary diseases offers a detailed description of the constitution of urine, which depends on laboratory analysis but also sensory observation. Healthy urine, he writes, ‘when recently voided and still warm, is a transparent fluid of a light amber colour. At this time its odour is aromatic, and somewhat resembles that of violets’. The development of colour printing in the 19th century allows Prout to include a coloured chart illustrating different colours of urine associated with particular sediments. The ‘Yellow Sediments’ mainly exist in healthy urine, which dominantly consists of water, urea and lactic acid. The ‘Red or Lateritious Sediments’ he associates with ‘crystalled gravel deposited during fever or inflammation’, and ‘Pink Sediments’ with excessive ammonia (nowadays a sign of a Urinary Tract Infection).

Urine sugar testing kit, Eli Lilly, USA, c.1940s (MMH 1994.026)
This portable testing kit for sugar in urine includes a test tube with metal shield, a pipette for the precise measurement of urine, 40 tablets of Methenamine for timed buring, 60 tablets of Copper Sulphate and a colour chart. The test tube would be filled with cool tap water to the black line and attached to the metal shield, the pipette would then be filled with urine to an upper mark and added to the water. By adding a tablet of Copper Sulphate and burning one tablet of Methenamine below the test tube, a chemical reaction takes between the sugar in the urine and the Copper Sulphate, producing a particular colour. Comparing the mixture to the colour chart gives an indication of how much sugar is present. This test wouldn’t be used to diagnose Diabetes, but may be used to monitor levels of glucose and ketones in urine.

With thanks Caroline Hall, a wonderful co-presenter, and Steph Seville for kindly lending a number of objects from MMH for the day. Find out more about the Wellcome-funded project that facilitated this event here. Caroline has posted about the event from a Visitor Engagement perspective on the Faculty of Biology, Medicine and Health’s Patient and Public Involvement and Engagement (PPIE) blog here.

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