Return to work: a historical perspective.

A time to refocus I suspect that many rheumatologists in the UK are unaware that the origins of our speciality were closely bound up with government schemes to improve employment opportunities. The Second World War left behind injured servicemen and women and civilians; repairing both physical and mental damage was a priority. Large numbers of injured and unemployed workers needed assistance at a time when labour was required to rebuild the country and start to repay the nation's debt. Experience in the services had shown that active rehabilitation could greatly increase the chances of achieving full employment after injury [1]. Departments of physical medicine were set up in general hospitals or attached to regional orthopaedic centres, to find answers and coordinate rehabilitation services [2–5] and employment rehabilitation units were built [6]. Initial finance came not just from the health department, but also from employment services, works departments and heavy industry. Much expertise came from the services: many of our leading lights in the 1950s, 1960s and 1970s originally held service appointments. In those formative years, the stock in trade were young adults with industrial or military injuries. Resettlement, retraining and alternative employment opportunities with assistance from employment resettlement officers in addition to the arcane crafts of the physiotherapist, remedial gymnast, occupational therapist, orthotist and psychologist resulted in multi-specialist ward rounds, requiring a very different approach to medicine. Being the wonderful thing that it is, medicine replaced these clinical problems with something new: articular disease caused by tuberculosis, poliomyelitis and the ravages of thalidomide embryopathy provided fresh multitudes of young adults with special employment problems that became a social focus. The very name of this journal, metamorphosing from the Annals of Physical Medicine, through Rheumatology and Rehabilitation to Rheumatology, says much about the change in our work, approach and expectations. The merger of a scientific society and a guild-type professional society to create the British Society for Rheumatology (BSR) also reflected the changing emphasis of the fiel-d—only the determined efforts of members brought the marriage off smoothly. A 1977 article from the British Medical Journal [7] gives us a historical insight, in a discussion of the importance of the employment resettlement officer and the changes occurring to rehabilitation staff and services. The authors were Derrick Brewerton, later President of the Heberden Society, who had already achieved worldwide fame for his team's work on the frequency of the B27 antigen in AS …