Professor Terence Doyle
In King Henry IV, the doughty Sir John Falstaff asks “Sirrah . . . what says the doctor to my water.” To which his page replies “He said, sir, the water was a good healthy water but for the party that owned it he might have more diseases than he knows for.” Urinoscopy, or the diagnosis of disease by studying the urine in the absence of the patient, was common in seventeenth century medicine, although the practice was outlawed by the College of Physicians in 1555.
Specifically, Thomas Linacre, the founder of the College, formulated a statute forbidding apothecaries from carrying water of their patients to the doctor and afterwards giving medicine in consequence of the opinions they received concerning it. However, in a highly competitive medical marketplace, physicians (a tiny minority of practitioners overall) were probably compelled to meet popular demand for the practice. In Twelfth Night, to diagnose Malvolio’s strange behaviour, a page suggests they “carry his water to the wise-woman.”
In 1637, Thomas Brian, a physician practicing in Colchester published a small book called The Pisse-Prophet, or Certaine Pisse-Pot Lectures. It was subtitled “wherein are newly discovered the old fallacies, deceit, and juggling of the Pisse-pot science, used by all those (whether Quacks and Empirics, or other methodical Physicians) who pretend knowledge of Diseases by the Urine, in giving judgement of the Same.” Much of the book offers tongue-in-cheek tips on how to be a successful urinoscopist. The first thing is to hold the urine up to the light and then place it on the windowsill to allow the sediment to settle. This give time to engage the messenger in conversation, so that the physician may learn “anything, concerning the sicke party, that hee shall desire to know”. It is helpful to ask “what the party useth to do in time of health.” This may establish the patient’s age and social situation. Next, in order to learn the patient’s sex, ask “how long hath your friend been sicke?” In answering this, the messenger “must needs say, He or She”—so indicating the gender.
Knowing the duration of the illness is also important in guessing its nature, since acute and chronic diseases usually have different patterns of symptoms. Furthermore, the shorter the time between the onset of symptoms and the arrival of the urine, the more severe and alarming the disease is likely to be and the more likely the patient is to be febrile. Brian suggests that since “every sharpe disease hath an hot and burning fever joined with it” the physician “needs now to doe no more but to give a description of a Fever.” Since these febrile conditions are associated with “great oppression of the stomach by choler . . . obstruction of the liver and spleene, causing great heat (which causes great drought, and much desire of drinke), causing great pain in the head and backe which likewise causeth want of sleepe and rest.” Having described these symptoms, the physician “cannot but have hit the nayle on the head.”
If the illness is of longer duration then the signs may be more subtle and a more guarded approach is required. Brian suggests reciting rather vague symptoms in the hope that the messenger might recognise one. He might say that the patient “walkes up and downe, hath a crude stomach, no appetite to meate, . . . and by reason of the ill disposition of her stomach, is often pained in the head”. With any luck the messenger may interject and say that the patient “is troubled with a great paine in the head indeed”. To loosen the messenger’s tongue he suggests plying them with “a cup of good English Beere . . . with Nutmeg and Sugar in it . . . and thus are the perverse dispositions of crosse messengers better corrected.”
The most difficult situation is where the messenger truly knows nothing about the patient. In this case the physician’s first priority was to avoid embarrassment. The wisest thing is to pick a somewhat vague but impressive sounding disease and then exaggerate the symptoms. Thus, he might pronounce “the party to be sicke of a bastard Plurisie” and declare that “the party would hardly recover, further adding that hee should have been let blood a week agoe, and that . . . it would now be too late.” By exaggerating the severity of the disease “whether the partie live or dye I shall be sure to be magnified for my skill, or if he die, for that my predictions prove true; and if he live, for that I recovered him of so dangerous disease.” If one were called to a patient previously attended by another physician, it is wisest to make much of the other’s incompetence and “shuffle off the disgrace upon my brother Doctor.”
Brian’s tract was one of many, such as John Cotta’s A Short Discoverie of the Unobserved Dangers of Several Sorts of Ignorant and Unconsiderate Practisers of Physicke in England (1612) and James Primrose’s Popular Errours, or the Popular Errours of the People in Physicke (1651), which derided contemporary medical practice. The title page of Brian’s The Pisse-Prophet has a pertinent quotation, probably originating with the Roman satirist Petronius, but also used by Robert Burton in The Anatomy of Melancholy, “si populus vult decipi, decipiatur”—”if people wish to be deceived, let them be deceived.”
Professor Terence Doyle teaches in Dunedin School of Medicine and is a doctor at Dunedin Hospital.