Acute gout is extremely painful. It starts typically in the middle of the night with severe pain at the base of one of the big toes. The pain is usually so severe that it wakes the victim out of a sound sleep. It has been described by someone who has had it as similar to the feeling which would occur if the big toe joint were pried apart with a red hot poker. Victims of acute gout may be in so much pain that they cannot even bear the weight of bed clothes over the involved joint. Until the late 1920's gout was frequently considered to be a rare or vanishing disease, at least in the United States. This, however, has proved not to be the case and gout is fairly common. It is almost entirely a disease of men and cases in women are exceedingly rare. There seems to be a family tendency toward gout.
Gout does not appear often before early middle age. In addition to the family tendency, those who are heavy meat eaters and frequently drink wine or beer seem especially liable to the disease. Attacks for some unknown reason tend to come most frequently in the spring and fall. Constituents of certain foods, called purines, seem to be partly responsible for the trouble. Purines may produce an excess of uric acid (which is one of its products) in the blood. This crystallizes as urates and is deposited in the joints where the pain originates. Some foods contain purines in especially large amounts, including sweetbreads, liver, kidney, squab, and calf's tongue. Others, like veal, pork, beef, sausage, meat gravies and several kinds of fish, also have a high purine content and generally have to be avoided by those who have gout.
The chronic form of the disorder is usually called gouty arthritis. As a rule this comes only after many years of repeated attacks of acute gout. The crystalline-like urates, made by the breaking down of purines, are deposited in and near the joints, forming large (even egg-sized) whitish deposits. Gout generally can be treated quite successfully in its early stages. Adjustment of the diet and hygienic living conditions are important. A drug called colchicine is frequently used not only for the acute attack but in small doses in between. Not so much can be done for gouty arthritis which is, however, not very painful as a rule.
