The Signs and Causes of Gout
If the head is heavy and sluggish and there is drowsiness, and there is a soft white waxlike swelling of the occiput, and the skin overlying the skull is thick and cold and contains a serous humour that descends on the neck and shoulders, elbows, hands, the curve of the back, hips, knees and feet: then the damp head is author of the groaning gout. But if these signs are absent, and the part is immediately painful and swollen, pale or red with but slight fever: then the liver with its swollen blood-vessels is at fault, for the humour sited in the brain and liver is discharged into the joint. And, when phlegm is suspect, the swelling is white and yet there is hardly any pain: but if there is painful throbbing of the part and dilated vessels, and the part is swollen and inflamed, the trouble is in the blood. If the swelling is slight and pale in colour, yet with sharp pains, then yellow bile predominates. But if the colour is dull or black, and the part feels cold and pain penetrates the bones, then the flux that causes this is excited by turgid humour that inflates the joints, or by poisons born of venery or wine or noxious food.