Sunday, November 25, 2012

Rainbow urine? Urine analysis in medicine over the centuries

17th century print of a physician analyzing a patient's urine

Urine is the way that we get waste products in our bodies, out of it. Generally, we're quite happy to flush it away, except for those unpleasant times when we have to maneuver in such a way as to pee in one of the dreaded sample cups. As an EMT, one of the bad things we’re told to watch out for is“coffee grounds” in the urine (indicative of internal bleeding). Dark urine is indicative of dehydration. Other things to watch out for are things like really sweet-smelling urine, which is indicative of diabetes. Most of the analysis work in clinics and hospitals is done by electronic sensor arrays, a complex set of electronic equipment that can breaks down the chemical composition of the urine. Yet urine analysis was around long before there were complex technologies to do it.

Of traditional Asian medicines, urine analysis is a diagnostic tool that is relatively unique to Tibetan medicine. Chinese medicine did not pick it up until later, and Indian Ayurvedic medicine only uses it when diagnosing urinary diseases. One of the oldest extant Tibetan texts, The Lunar King, describes in great detail how to analyze urine by observation, to analyze the connections between urine, disease, and evil spirits, and how to engage in “urine divination.” The text is quite extensive, detailing analysis down to when and where the urine should be analyzed (at first rays of light, indoors), the container it should be analyzed in (no color), and the patient’s responsibilities before the urine sample is taken (moderate drinking, no sex, no white, yellow, or red drinks, no strong-tasting foods).

Once these conditions are set up, the color of the urine is examined. A few of the possible diagnoses are:

                        -Red indicates excessive blood

-Reddish-yellow indicates excessive lymphatic fluid

-Dark red indicates infectious disease from excessive blood

-Very yellow indicates bile

-Brown or bluish yellow is from phlegm

                        -Black indicates lymph and wind

                        -Green indicates cold.

                        -Brightness (“rainbow colors”) is cold and poison

The analysis also includes looking at smell, sediments, and whether the urine divides into layers over time. Urine analysis continues to be one of the primary markers of Traditional Tibetan Medicine.

While the Tibetans were analyzing urine on one side of the planet, the Greeks, the Arabians, and the Byzantines were also very interested in urine as a diagnostic tool, looking at much the same things that the Tibetans were: color, smell, sediment.

Urine analysis continued in western medicine as well for centuries. The following graphic is from the book Epiphanie Meidcorum by Ullrich Pinder, published in 1506. This graphic helps instruct physicians how to diagnose diseases from the varying colors of the urine. Like in Tibetan medicine, health in the western world was viewed as being a balance between different Humors. In Tibetan medicine, there are three: in Western medical systems, there are four. Abnormally colored urine indicates that the humors are out of balance--too much blood, perhaps, or too little lymph.

I actually have no idea what might cause dark green urine, but I have the feeling, if you see that in the toilet, you should probably go to a hospital.

Monday, November 19, 2012

World Toilet Day! (And play true/false with Matt Damon!)

Happy World Toilet Day, everyone!

Here is the "about" from the World Toilet Day website:

This international day of action aims to break the taboo around toilets and draw attention to the global sanitation challenge.

Can you imagine not having a toilet? Can you imagine not having privacy when you need to relieve yourself? Although unthinkable for those living in wealthy parts of the world, this is a harsh reality for many - in fact, one in three people on this globe, does not have access to a toilet! Have you ever thought about the true meaning of dignity?

World Toilet Day was created to pose exactly these kind of questions and to raise global awareness of the daily struggle for proper sanitation that a staggering 2.5 billion people face. World Toilet Day brings together different groups, such as media, the private sector, development organisations and civil society in a global movement to advocate for safe toilets. Since its inception in 2001, World Toilet Day has become an important platform to demand action from governments and to reach out to wider audiences by showing that toilets can be fun and sexy as well as vital to life. For more information and tools to share:

WTD's campaign focuses on the theme "Who gives a shit?" and features adorable kids like this one holding signs. (Check out more or post your own on their facebook page!)

Another promotional website is Toilet which encourages people to "Talk Sh*t for a Day!" You can join their feed on facebook or twitter, and they'll post toilet-related factoids to your feed all week!

Plus, watch and play this video with Matt Damon on sanitation facts. (Kudos to Matt Damon for being a spokesperson for sanitation!)

YEAH Matt Damon!

Facts from the campaigns:

*1 gram of shit can contain 10 million viruses, 1 million bacteria, 1 thousand parasites, and 100 worm eggs
*More people have a mobile phone than a toilet
*Shit diseases are responsible for more than 50% of the 9 million preventable child deaths each year
*More people die of diarrheal diseases than HIV, malaria, and TB combined
*The estimated gain in economic productivity if everyone had a toilet is $225 BILLION dollars.
*40% of the planet doesn't have a safe place to defecate.
*1.5 million children under 5 die every year from diarrhea.

So share with your friends, post on facebook, talk about it: sanitation is one of the world's greatest health problems, and we need to talk about it to get it done. Let's talk about it fearlessly, seriously, and let's aim for sustainable action.

We can do this.

Saturday, November 17, 2012

Why they removed the "shit" from my shit article

Hey all! I just found out I got an article published in the Society for Applied Anthropology Newsletter on sanitation: "The Stinky Revolution: how a horrible stench changed the course of urbanization." It draws on one of my favorite historical events that I also talk about in this blog post and this one--the Great Stink in London in 1857 that served as the catalyst for London's sanitation system.

Unfortunately, the editors decided to change all my uses of "shit" to "feces"--I find this interesting. It was a lengthy back and forth with the student editor about it, and I defended (quite strongly) using "shit." "Shit" is used in social science contexts because, quite frankly, there aren't very many good synonyms for it. Rose George in her book The Big Necessity is the one who converted me to using "shit" instead of the easier, more gentle synonyms.

Let's go over them, shall we?

Feces: this is a medical, clinical term, that doesn't really speak to lived realities of shit. (When you have a river of it, you don't think of it as feces--you think of shit.)

Dookie, caca, poop, number 2: Childish. We're uncomfortable with the act, so we render call it by childish things (because children are allowed to defecate; adults can't talk about it) or use a euphemism.

Waste: Ambiguous. Shit is waste, and so is poor spending by the government.

This is why I use "shit" in non-medical contexts. It's not that I particularly enjoy swearing or shocking people (although whether the word itself should be shocking is up for debate). It's because it's the best alternative in most situations.

Online Etymology dictionary writes of its origins:

O.E. scitan, from P.Gmc. *skit-, from PIE *skheid- "split, divide, separate." Related to shed (v.) on the notion of "separation" from the body (cf. L. excrementum, from excernere "to separate"). It is thus a cousin to science and conscience. Despite what you read in an e-mail, "shit" is not an acronym. The notion that it is a recent word may be because the word was taboo from c.1600 and rarely appeared in print (neither Shakespeare nor the KJV has it), and even in "vulgar" publications of the late 18c. it is disguised by dashes. It drew the wrath of censors as late as 1922 ("Ulysses" and "The Enormous Room"), scandalized magazine subscribers in 1957 (a Hemingway story in "Atlantic Monthly") and was omitted from some dictionaries as recently as 1970 ("Webster's New World"). Extensive slang usage; verb meaning "to lie, to tease" is from 1934; that of "to disrespect" is from 1903. Shat is a humorous past tense form, not etymological, first recorded 18c. Shite, now a jocular or slightly euphemistic variant, formerly a dialectal variant, reflects the vowel in the Old English verb (cf. Ger. scheissen).

It's origin--that of being from the Latin for to separate--is benign. So I'm a bit frustrated that they decided not to stick with "shit"--especially considering this newsletter is for anthropologists, who really shouldn't be shocked anymore--but I do understand it. Unfortunately, most of English's curse words relate to either religion or the body (or bodily acts).

"Shit," though, because it carries so much weight rhetorically, is uncomfortable to use in many contexts. I'm reserved about using it in my daily life--I don't use it when generally discussing my research to most people (such as my boyfriend's mother) in a casual context and in the twenty minutes of an undergrad lecture I did on disease ecology where I spoke about diarrhea, I stuck with "feces" the whole time. (People were already uncomfortable talking about the topic.)

So you can check out my sanitized article in the newsletter above. Hopefully, when I write my dissertation, I get to choose the synonym I use.

Saturday, November 10, 2012

Guest bloggers wanted!

Hi everyone!

I'm so excited to say that Flush has reached over 1000 page views! Thank you all so much for reading, posting, linking, and sending me things!

I'd like to expand the blog by inviting others to contribute. Any blog post on any topic related to shit, toilets, sanitation, disgust, the body, or whatever you think is relevant. Lengths and styles are flexible. A post can be a photo essay, a reflection on a news article, a video, your musings on a particular topic from a unique point of view, an excerpt a post on your favorite (or least favorite) toilet in your area...Everything is on the table! You will, of course, get full credit.

Please contact me at j a b a r r [at] emory . edu if you would like to participate!

Thanks so much all!

Toilet theme park and other mini posts/links

When multiple people send me something, I have to include it. (Thanks Howie and Holly!)
South Korea recently opened a theme park/museum in memory of a past mayor, who was so concerned with good public toilets that he built his house to look like one. The park includes a bunch of statues that show people defecating in various postures, including (I think my favorite) The Thinker.


Also included in this week's list of links is a podcast from Freakonomics, in which they discuss how the French tried to take care of the rats in the sewer problems in the French quarter in Vietnam, and how they utterly failed. (It's several minutes in to the podcast.) The French attempted to kill off the rats by placing a bounty on rats. However, this made people bring in rats from the outside to collect the bounty. This sort of fear of rats coming through the toilet, incidentally, seems to speak to our fear of things coming up the down hole in the toilet. (Think of those python in the potty urban legends.)

Here's a short but interesting article on a village in India who is trying to use public shame--including drums and whistles--to stop public urination. It includes this interesting quote:
"Officials say cultural and traditional factors, a lack of education and too few toilets are the prime reasons why millions of Indians defecate in the open."
Too few toilets--very true. 1.2 million people do not have toilets in their homes in India. But "cultural and traditional factors"? I may not object to their blaming "culture" (whatever that is) if they at least went into a little bit of detail about what they mean. Unfortunately, "culture" is often used in this sort of short-hand way to obviate responsibility for poor infrastructure. Because in many cases, can you really say it's a "cultural thing" when people don't want to use latrines because they're smelly? I remember going into a public restroom in San Diego by the sea shore where there were no doors on the stalls, because I didn't feel comfortable being that exposed. This is very easily a "cultural thing" (body shame in American culture), but how often would people call it that?
Secondly, it would be interesting to examine who is shaming whom. How do other power structures--like class and caste--play into this use of shame? This is very much an example of the sort of thing that Community-Led Total Sanitation advocates--community shame used to create public health change. But is it effective in the long run, and is it ethical?