American surgery, from its humble beginnings in colonial times and especially around 1760, embarked on a long voyage, continuously responding to challenges and worthwhile enterprises. The ascendancy of science, from the late 19th century to our times, gave to this discipline social and cultural empowerment and a well-justified authority. Academic, economic, and political forces, in addition, delayed or sometimes stimulated the acceptance of the surgeon's profession. Patients and society recognized, through various historical American eras, how acceptance was linked to the improved results of less morbidity and mortality. They also recognized that tolerance to pain did not have to be an ingredient of surgery in this century. From this historic review, it is evident that science, surgical research, and good clinical training represented the most important forces shaping the surgery of our day. As one considers the social transformation of American surgery, the road winds from an unsophisticated discipline, suffering from lack of knowledge and minimal interest in science, to growing sophistication, increased knowledge, and full commitment to research and scientific development.