A generation ago in Swaziland gout was seldom seen except in British colonials with a taste for red wine and strong spirits. Now, several times a week, middle-aged men hobble in, grunting with pain. New cases are at a loss to explain the sudden onset but the evidence is there for everyone to see – an ankle, knee or big toe being red, swollen, hot and tender.

Modern African men consume impressive amounts of commercial beer and beef. Liver, kidneys, intestines and other offal are delicacies at the barbecues or braais which are scattered round towns and villages and seldom short of carnivorous clientele.

All are mandatory at weddings and funerals, the bride, groom or deceased being of lesser concern judging by the critical comments if the hosts stint on quantities. Our patients will usually recall such weekend feasts a few days before their gout symptoms began. Women are largely spared the affiction as are consumers of traditional maize beer.

The treatment is straightforward in acute cases but the aim is prevention, each sufferer being given a list of items liable to cause future misery – these are discussed at some length, several being tasty and requiring self-discipline to either avoid or take in reduced amounts. They include strong coffee, shellfish and prawns, and some vegetables. Oddly, several varieties of aspirin, in combination with some of the other precipitants mentioned, can sustain gout to the puzzlement of the swallower.

Pain-wise, a dislocated shoulder joint is on a par with acute gout. Those in attendance at the anaesthetic show relief as the ugly deformity clunks back into place, always a satisfying sound. Jaw dislocations do occur after yawning and the alarm of the patient at their deformity spreads to those around him. Fortunately, a mild muscle relaxant, a quiet room, and gentle manipulation will find him able to talk and even smile.

Elderly knees are often deformed battlegrounds, knobbly and with scars of past conflicts long forgotten, too far gone for knee replacements even if they were available. That does not prevent their owners from using them. Martha, a cousin, was a renowned competitive cyclist in her youth, well known in Uganda. Decades later and with grossly deformed joints, she regularly cycled from her thatched hut to Gulu 70km away, returning in a few days to regale us with gossip and news from the metropolis.

When a youngster appears with joint pains and swelling, alarm bells ring. People in Scotland may remember when rheumatic fever was found in many towns and cities, dreaded because of its effect on the heart and its valves, either at the time or years later. Here it still occurs, the child complaining of several warm swollen joints which come and go. Mum may remember a sore throat the previous month.

By this stage there is no curative treatment but current and future heart damage can be reduced with inexpensive medicine. Our son was diagnosed with rheumatic fever by his anxious dad some years ago when many of his joints swelled up with a rash, fever and misery. My paediatrician colleague disagreed and his correct treatment worked rapidly. He also reminded me why medical people should hand over their family’s illnesses to objective third parties.

The old borough hospital in Falkirk was an endless introduction to joint and bone disorders. As newly-qualified resident doctors we spent three months there, completely at sea medically but gathered into the tolerant bosom of the several hundred mainly long-stay oldsters. We learned that Guinness could be prescribed on the NHS for patients in need of extra nourishment, as many were.

However, on one of the evening ward rounds with the night sister, I was summoned by one granny who whispered in my ear: “Laddie, I need my arthritis syrup. The joints are a scunner tonight with the cold.”

When I asked sister for help, she reached down into the medicine trolley and produced a bottle of VSOP brandy.

“Mrs Rafferty usually gets two medicine cupfuls, doctor.”

Dr David Vost studied medicine at Glasgow University and works at a hospital in Swaziland. He and his family live on a farm in Northern Uganda near the Albert Nile. davidvostsz@gmail.com