Abstract
Gout is an ancient disease with a prevalence that has increased dramatically worldwide over recent years. This paper briefly reviews the recent literature on the frequency of gout and geographic variation in contemporary populations and attempts to provide a synthesis of reported cases of gout in the past. The palaeopathological evidence of gout in the Asia Pacific region is focussed on and the biocultural context of food and ritual influencing the selection of hyperuricaemia is discussed. It is proposed that the prehistoric selection pressures leading to the high prevalence of diabetes and other 'diseases of modernisation' may also, at least in part, explain the high frequencies of hyperuricaemia and gout in modern Pacific Islanders.