[Foam in urine: from Hippocrates to the Medical School of Salerno]

The formation of persistent little bubbles in urine, similar to those of beer, was noticed since ancient times by the first scholars of uroscopy. The diagnostic interest, rare and uncertain in Hippocrates, has increased over time. The Hippocratic school limited itself to observe the sign without interpreting the pathophysiology and they did not compare it with other clinical signs. Hippocratic texts only expressed an opinion on the severity and prognosis of the pathology which had produced it. Galen does not differ much from the Hippocratic school, however he tries to interpret the cause of the formation of bubbles in urine. Certainly, because of being unfamiliar to the laws of fluids and to the surperficial tension of liquids, he believes that the air contained in the bubbles of the foam in the urine comes from inside the organism. However, he realizes that the foam in urine is formed only when the urine is denser (more viscous).The Byzantine uroscopy, with Theophilus Protospatharius and Stephen of Athens considers the presence of foam quite important. In fact, they state that the bubbles appear in the urine when there is a severe failure of the organism. It is a sign of the attempt of the body to eliminate the bad humours produced in the different zones where digestion takes place. Several authors from the School of Salerno express different opinions on the production of foam in urine. Cofone affirms it derives from the putrefied blood in dense urine and he also uses this sign for diagnostic and prognostic results. Mattheus Archiepiscopus confirms Galens belief that the foam derives from wind bubbles produced in the stomach. The "De Urinis" of Maestro Mauro is strongly influenced by the writings of Constantine the African, who reports the experience of Isaac. The "humani corporis regiones" and the "regiones urine" are described and therefore Mauro tries to localize in which region of the body the bad humours were produced. In particular, the chapter on "De ycteritia" is an exact description of the foam in urine generated by the elimination of bad humours produced in excess by the liver (bile salts).