The Art of Medieval Diagnosis of Illnesses


Physician teaching students about the qualities of urine, Paris, 1300s, (British Library, Harley 3140, f. 32v)

Having written, albeit briefly, about the four humours in the last post, this one is about how various ailments were diagnosed in the Middle Ages (and beyond that, for that matter). It is easy to look back at medicine in older days and laugh at the things that now seem absurd to our eyes, but it must be remembered that today we have the benefit of recent scientific discoveries (knowledge of bacteria and viruses, for example) and such technical advances as microscopes, blood and urine tests. They didn’t have any of those and had to make do with observations and theories.

So, if a physician was called out to see a sick patient, how did he go about diagnosing it in order to prescribe the right remedy? Here are a few things he would take into account:

1. The patient’s own description of his or her symptoms.

2. The physician’s observations of the patient’s demeanour and skin colour. They might also listen to the lungs and take the patient’s pulse which represented the ‘heat’ or spirit of the body.

3. The physician would ask about any dreams the patient might have been having – certain colours, for example, might indicate a humour out of balance.

4. Look at which humour is generally prevalent in the person, what time of year they were born and so on in order to see which humour was at fault.

5. Inspect the urine, faeces and blood for colour, smell, and in some cases, taste. These excretions were thought to contain the discharged excesses of bad humours and so proved one of the foremost methods of diagnosis. In particular, urine played a large part and urine bottles, used to inspect the colour of urine were a common tool of the physician’s craft.

Medieval urine flask from the Museum of London

Medieval urine flask from the Museum of London

This diagnostic method, now known as urology may have had its flaws but examination of urine certainly could tell a physician a great deal. If you think about it, we still test urine (and blood and faeces) today to determine whether illness is present – although with a great deal more accuracy.

Once the urine was collected, the colour and consistency were inspected as this could indicate specific conditions. Charts were also used to measure the colour against.

The urine would also be smelled and sometimes tasted. A sweetness would indicate what we know as diabetes today, although in the ancient and medieval world it is thought it was a rarer condition than what it is now.

Diagnostic chart, England, c.1406, (British Library, Harley 5311).

Diagnostic chart, England, c.1406,
(British Library, Harley 5311).


Below is part of a treatise on medicine called the Rosa Anglica. It details the colours and textures of urine if an imposthume (swelling or abscess) is present in any part of the body:

(34) Let us speak now of the urine, that is, of the urine of those who have this disease, i.e. imposthumes*. Note, if there be two colours on the urine, the colour of camel wool on top, and the lower part the colour of inopus**, that is the sign of an imposthume. If the urine be that of a brutish beast, that is a sign of frenzy; if the matter be dense and watery, it signifies lethargy.

(35) Item if the urine be red-brown, turning one day to the colour of inopus, and leaden on top, with saffron coloured foam; that is a sign of a hot imposthume on the liver. Item if the urine be turbid, scant and raw, that is a sign of a cold imposthume on the liver. Item if the urine be thick in substance, and somewhat high coloured, together with many little bright granules in its midst, that is a sign of an imposthume of the stomach, from phlegm.

(36) Item if the urine be low in colour, according to Egidius, and thin in substance, and much radiance in it like a sunbeam, with little bodies like ashes underneath; that is a sign of an imposthume or stoppage of the spleen. Item if the urine be black in colour like the hue inopus, at the beginning of the disease, that is a sign that death will result [therefrom]; at other times it typifies an imposthume on the kidneys, if it be scant.

(37) Item if the urine be of the colour called cyanose, which is a composite colour of white, black, and red along with fatty corpuscles, that signifies an ulcer in the bladder [arising] from an imposthume therein. If there be red sand in it, that shows the kidneys are not sound; sometimes this sand comes from the burning of sanguine humour in the veins, and then the urine is high coloured: if it come from the kidneys it is not high coloured, but whitish, being drawn from them before it is digested: in this way the sand results from the burning of blood, and is soft; at other times it signifies a stone in the kidneys, and is not soft, but hard, as is generally clear in the matter of stone.

(Rosa Anglica pps 187-189)


* any unnatural swelling pustule or tumour

** black


Once the physician had an idea of what was responsible for the illness, he could then prescribe a remedy to try and rebalance the humours and get the body, if possible, back to health again.

Sources: Rosa Anglica Sev Rosa Medicine, Johannis Anglici: An Early Modern Irish Translation of a Section of the Mediaevel Medical Text-Book of John of Gaddesden, Edited With Introduction, Glossary and English Version by Winifred Wulff, Irish Texts Society, Simpkin, Marshall, Ltd, M. A. 1923 (This can be accessed online for free at:


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2 Responses to The Art of Medieval Diagnosis of Illnesses

  1. Marsha Lambert says:

    Fantastic post.

  2. Marilyn Smith says:

    Really interesting to read how their examination of urine was so detailed.

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