Because of its easy availability for inspection, urine was for many centuries the focus of attention. The foundation of the "science" of uroscopy is generally attributed to Hippocrates (460-355 b.c . ), who hypothesized that urine was a

Biomarkers in Drug Development: A Handbook of Practice, Application, and Strategy, Edited by Michael R. Bleavins, Claudio Carini, Malle Jurima-Romet, and Ramin Rahbari Copyright © 2010 John Wiley & Sons, Inc.

filtrate of the "humors," taken from the blood and filtered through the kidneys, a reasonably accurate description. One of his more astute observations was that bubbles on the surface of the urine (now known to be due to proteinuria) were a sign of long-term kidney disease. Galen (a.d. 129-200), the most influential of the ancient Greco-Roman physicians, sought to make uroscopy more specific but in reality added little to the subject beyond the weight of his reputation, which served to hinder further progress in this as in many other areas of medicine.

Five hundred years later, Theophilus Protospatharius, another Greek writer, moved things one step nearer to the modern world when he investigated the effects of heating urine and hence established the world's first medical laboratory test. He discovered that heating urine from patients with symptoms of kidney disease caused cloudiness (in fact, the precipitation of proteins). In the sixteenth century, Paracelsus (1493-1541) in Switzerland used vinegar to bring out the same cloudiness (acid, like heat, will precipitate proteins).

Events continued to move both farther north and closer to modernity when in 1695 Frederick Deckers of Leiden in the Netherlands identified this cloudiness as resulting from the presence of albumin. The loop was finally closed when Richard Bright (1789-1858), a physician at Guy ' s Hospital in London, made the connection between proteinuria and autopsy findings of abnormal kidneys.

The progress from Hippocrates' bubbles to Bright disease represents the successful side of uroscopy, but other aspects of the subject now strike us as a mixture of common sense and bizarre superstition. The technique of collecting urine was thought to be of paramount importance for accurate interpretation. In the eleventh century, Ismail of Jurjani insisted on a full 24-hour collection in a vessel that was large and clean (very sensible) and shaped like a bladder, so that the urine would not lose its "form" (not at all sensible). His advice to keep the sample out of the sun and away from heat continues, however, to be wise counsel.

Gilles de Corbeil (1165-1213), physician to King Philip Augustus of France, recorded differences in sediment and color of urine which he related to 20 different bodily conditions. He also invented the matula, or jorden, a glass vessel through which the color, consistency, and clarity of the sample could be assessed. Shaped like a bladder rounded at the bottom and made of thin clear glass, the matula was to be held up in the right (not the left) hand for careful inspection against the light. De Corbeil taught that different areas of the body were represented by the urine in different parts of the matula. These connections, which became ever more complex, were recorded on uroscopy charts that were published only in Latin, thus ensuring that the knowledge, and its well-rewarded use in treating wealthy patients, was confined to appropriately educated men. To further this education, de Corbeil, in his role as a professor at the Medical School of Salerno, set out his own ideas and those of the ancient Greek and Persian writers in a work called Poem on the Judgment

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Project Management Made Easy

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