‘The vulgar sort are so strongly prepossest (by reason of their ignorance) that Physicians can discern (by the Urine) the Disease, the conception, the sexe, the parties age, with many other such absurdities, that I feare it will bee an hard matter to dispossesse them of that opinion.’1
Dr Thomas Brian of Colchester was nevertheless determined to try. His 1637 book, The Pisse-Prophet, or Certain Pisse-pot Lectures, set out to debunk the popular process of urine-casting and show people that when doctors claimed the ability to diagnose disease through the urine alone, they were generally talking out of their backsides.
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Urine inspection had a respectable history – it was considered important in ancient Greco-Roman and medieval Islamic medicine. These physicians, however, saw it as just one part of a more detailed examination of the patient’s signs, symptoms and medical history. By contrast, in medieval and early modern Western Europe, doctors were expected to be able to diagnose and give a prognosis for any disease through examination of a urine sample sent by a messenger – without the patient present.
The physician used a clear, bulbous flask called a matula, made from good quality glass and shaped so as not to distort the view of the liquid within. He looked at the colour, the consistency, and the sediment, referring if necessary to a urine chart showing the spectrum of hues. There were numerous combinations of these characteristics, and each permutation indicated a different disease.
A urine colour chart from 1506. Wellcome Images.
Interpreting the urine was perceived as a complex job requiring knowledge and skill. To the average patient, a bottle of piss just looked like a bottle of piss, so the physician's ability to assess its properties and glean the body's secrets made for an impressive performance. Like later diagnostic tools such as the stethoscope and the x-ray, urine-casting or uroscopy sought to reveal the inner mysteries of the human body; urine was thought to capture the present state of the system and bring it out into the open for inspection. The process was therefore logical given the limitations of diagnostics at the time.
Thomas Brian – a Cambridge-educated physician – knew all about ‘the cunning tricks that Physicians have to make the messengers confident of their (falsely) pretended skill’. He had used them himself in his time and now wanted to make amends for deceiving his patients. His book is a lively, funny and honest account of his methods, written in English rather than the Latin of his profession because he wanted to educate the general population against the myth of the ‘pisse-prophet’ or ‘pisse-monger’.
Brian shows us that people were in the habit of sending their urine to the physician via a messenger, often providing no information about the patient. The doctor therefore had to perform a sort of ‘cold reading’ in order to guess the nature of the disease. Some messengers were more forthcoming than others and would give him an idea of the age, sex and symptoms of the patient. The colour of the urine could give some hints too - if it was a ‘high red colour’, this denoted fever, so Brian would reel off the common symptoms of great heat, thirst, headache, nausea, lack of appetite and sleeplessness. Most patients with an acute illness would have at least one of these, and the messenger would hopefully be impressed at the doctor’s ability to deduce all this from the urine.
Some ‘pisse-messengers’, however, were shrewd and gave nothing away; the physician had to look for other clues. If, for example, the messenger had travelled some distance and wore a rural style of attire, this suggested the patient lived in the country. Brian tells us that country people were known for not consulting a doctor until they were at death’s door (something that is not unheard of among today’s farmers either.) It could therefore be assumed that the patient was very unwell. Having observed what he could, the doctor then made a show of examining the urine and coming to a fancy-sounding conclusion:
‘I now therefore take the Urinall (since the messenger can tell me nothing) and looke better upon the water, as if I could tell miracles by it … and from thence I conceive, that according to the fopperous Pisse-maximes, and rules of our great Pisse-prognosticatours, there is a great commixture of superabundant humours.’
A physician inspecting urine. Oil painting attributed to Pieter de Bloot, Netherlands, 17th century.
Before attempting a cure, it was important for the doctor to cover his own arse by emphasising that the patient was unlikely to survive:
‘And now whether the partie live or dye I shall be sure to be magnified for my skill; if he die, for that my predictions prove true; and if he live, for that I recovered him of so dangerous a disease.’
Brian might send some medicine (which on occasions he admits was an electuary mainly composed of quince marmalade) or recommend blood-letting. As a physician, he would not carry out the latter himself but tell the patient to send for a surgeon. Again, if the patient got better, he could take the credit for recommending the treatment; if things went wrong it was the surgeon’s fault.
For some doctors, the process of cold reading made use of an assistant. The messenger would be met by a servant and told that the doctor was busy but would see him or her soon. The servant then struck up a conversation and found out as much as possible about the patient and disease, making sure to convey this to the doctor before the messenger was admitted.
As uroscopy was such an unscientific skill, people could gain a reputation for it without going to the trouble of studying Hippocrates and Galen for years at university. Brian used his book to name and shame certain unqualified practitioners – Trigge, a shoemaker who ‘pretendeth great learning among silly people’ and convinced them that he was a Cambridge graduate and Fellow of the College of Physicians. There was ‘little Doctour George’ of Westminster, and someone by the name of Fashions, ‘who furnisheth Apothecaries with Harts-hornes, and Stagges pisles, and professeth great skill in curing Consumptions’.
Such people, along with the local community healers known as cunning men and women were, in Brian’s opinion, ‘the most vile and base ignorant Asses in the world’. Yet, as he spent the whole book pointing out, the most highly educated physicians did not have much more insight when it came to analysing urine.
Urine-casting gradually fell out of favour among the medical profession but the popular belief in it was slower to die out. In the early 19th century, one Cameron the Piss-Prophet carried on the dubious practice in Oxford Street, leading the husband of a patient to make this perennially appropriate comment:
'Well, well! what a world we live in! All is humbug; and he who can humbug best is the cleverest man.’2
I’ll be speaking to Cambridge Skeptics about the Golden Age of Quackery on Tuesday 27 February 2024 at The Alexandra Arms, CB1 2LL. Doors open 7pm, talk starts 7.30. Free admission but booking recommended as space is limited.
Old Operating Theatre job opportunity
The Old Operating Theatre Museum is looking for an Education Officer to devise and deliver innovative, curriculum-based educational sessions for primary and secondary schools, sixth form/further education colleges, universities, and other special interest groups. Application deadline 27 February 2024 - click here for full details.
Thomas Brian, The pisse-prophet, or, Certaine pisse-pot lectures Wherein are newly discovered the old fallacies, deceit, and jugling of the pisse-pot science, used by all those (whether quacks and empiricks, or other methodicall physicians) who pretend knowledge of diseases, by the urine, in giving judgement of the same, London, 1637.
