This narrative reviews the foundations and development of surgery in Cincinnati beginning with the surgical pioneers and the founding of the first medical institutions by Dr. Daniel Drake. The amalgamation of multiple medical schools resulted in university affiliation and a “full-time” chairman of surgery. The arrival of Dr. George Heuer and his Johns Hopkins group caused great turmoil but resulted in a strong department of surgery and residency program. Drs. Reid, Carter, and Altemeier succeeded Dr. Heuer and each contributed to the department’s growth and success. Dr. Josef E. Fischer became chairman of surgery in 1978 and led the department through difficult times to its greatest expansion and development—bringing to a department with an outstanding history and tradition the reforms and modernizations needed to take it into the 21st century. Dr. Fischer has now returned to Boston and Harvard and was succeeded by Dr. Jeffrey Matthews in 2001. Under his capable leadership the department of surgery at the University of Cincinnati seems assured of a bright future.