Diagnostic Methods

The medieval medical practitioner felt that the key to diagnosing
a person’s ailments was assessing the person’s humoral balance
to determine the nature of the illness and to prescribe the
appropriate cure. This diagnosis rarely involved physical examination
of the patient, which was considered unnecessary, and
of course, male practitioners were prohibited from examining a
female patient.

Observing the patient was the first step in making a diagnosis.
This permitted the physician to identify the person’s normal
temperament, so that the physician could then identify whether
the person had departed from normal behavior and what would
bring the person back in balance. (See the sidebar “Identifying
and Treating a Patient’s Illness” on page 39.) Part of the humoral
imbalance needed to be considered in the context of the person’s
zodiac sign. Physicians generally carried with them a small handbook
that contained helpful charts, including an astrological chart
to make a proper diagnosis. The two items that needed to be considered
next were the patient’s urine and blood.
Though medieval practitioners had no understanding of the
chemistry of these substances or exactly what they were looking for
when they collected them, they believed it was important that these
two substances be evaluated. A uroscopy, known then as a way to
evaluate the health of the liver by checking the urine, was such an
integral part of medieval medicine that the clear glass beakers used
to hold and then examine the patient’s urine became a symbol of the
medical profession. Medieval textbooks ran full color illustrations of
the 20 recognized colors of urine. The urine colors were displayed
in graph form and ranged from colors signifying illness (blue, black,
and dark red) to those that were viewed as healthier, including several
shades of yellow right through to almost clear. Physicians considered smell and texture
(thin and watery or thick and greasy), and they looked for any sediment or other solids in
the urine. A medical writer from the 13th
century noted that  thick urine that was whitish or bluish-white indicated “dropsy, colic,
the stone, headache, excess phlegm, rheum in the members, or a flux.” Some of the elements
noted are ones that are still evaluated today: Red in the urine was understood to indicate
blood in the urine,and grit that was visible
in a urine sample might lead the practitioner to consider the
presence of kidney stones. As with blood analysis, the results were
interpreted along the theory of humoral balance.
Physicians sometimes performed bloodletting and observed the
strength of the flow and the speed of clotting afterward to analyze
imbalances. The blood was often collected in a bowl or a cup, and
they studied it for its odor, its warmth (or lack thereof), and its
texture.
Checking the pulse was also important. Physicians realized it
reflected on the state of the heart, and there were many classifications
of what the various conditions of the heartbeat meant. They
learned to evaluate the pulse for duration, breadth, strength, and
regularity of beat. In the 13th century, physicians wrote of distinguishing
among the following five considerations:

otion of the arteries
condition of the artery
diastolic and systolic duration and pressure