Have you ever wondered how you would have managed to treat someone with active rheumatoid arthritis, tophaceous gout, or severe osteo-arthritis before the days of biologics, methotrexate, joint replacements, allopurinol, etc? The evolution of rheumatology in Sydney involved thoughtful and committed clinicians (the description of a physician working in the area of "rheumatism" was not known as a "rheumatologist" until 1940). The road was often difficult and there was considerable opposition from the established medical community to the development of the specialty of rheumatology. This talk will cover the 50 years of the development of rheumatology in Sydney from the 1930's to the 1980's and some of the "shoulders" upon which we stand.