How will history judge us? One of the ways in which the NESS can be judged is not only through the people who have led it and served it but also through those people whom it has chosen to honor. The Distinguished Service Award in honor of Nathan Smith was first given in 1985, and has now been given to 9 individuals, 7 of them from Massachusetts. The first recipient, in 1985, of the Smith award was Claude E. Welch, MD, of Boston, who was an outstanding role model in clinical surgery and everybody's "Mr Surgery" in New England. He was a superb clinician and a great teacher, widely respected throughout the world for his surgical skill, knowledge, leadership, and great academic accomplishments. The next recipient, in 1989, was Francis D. Moore, MD, of Boston, who was the fifth Moseley Professor of Surgery at Harvard Medical School and surgeon-in-chief at Peter Bent Brigham Hospital, Boston. Moore has been considered one of the most influential figures in surgery during the past century. He was on duty as a surgical resident at MGH on the night of the Cocoanut Grove fire on November 28, 1942, in which almost 500 people died, and was immediately thrust into the maelstrom of trying to provide care for the injured and severely burned patients. That experience led Moore back to the research laboratory, where he conducted the elegant studies of fluid balance, body composition, and metabolism that eventually led to his major classic text, The Metabolic Care of the Surgical Patient. Moore has received innumerable awards for his accomplishments, including the Medallion for Scientific Achievement and the Flance-Karl Award of the ASA. Moore also was a guiding spirit behind the development of the kidney transplantation program at Peter Bent Brigham Hospital. In 1991, the Smith award was given to Moore's colleague at Peter Bent Brigham Hospital, Joseph E. Murray, MD, who performed the first successful kidney transplantation (Figure 1) in 1954, arguably the high point of surgery in Massachusetts in the 20th century. Murray received the Nobel Prize for Physiology and Medicine in 1990 (Figure 2) for his contributions to the technique and science of transplantation and to the control of the immune response, the 10th surgeon to be so honored. Murray was president of the NESS in 1987, and received the Medallion for Scientific Achievement from the ASA. The next Smith award was given in 1992 to George R. Dunlop, MD, of Worcester, Mass, a former president (in 1966) of the NESS. Dunlop was also an outstanding clinical surgeon and leader, who served as president of the ACS from 1976 to 1977. In addition, he served on the Joint Commission for the Accreditation of Hospitals and became the chair of that organization as well. In 1994, the Smith award went to John F. Burke, MD, also a former president of the NESS (in 1990), for his outstanding work in developing a technique for skin grafting of extensively burned patients with skin grown from autologous cells. He also received the Jacobson Award for scientific achievement and innovation from the ACS in 1999. In 1999, the Smith award went to John A. Mannick, MD, Moore's successor as Moseley Professor of Surgery at Harvard Medical School and surgeon-in-chief at Brigham and Women's Hospital, for his pioneering work in vascular surgery and in immunology. The society has, therefore, chosen to honor its leaders for their scientific and clinical contributions and for their leadership of other major national surgical organizations. But there is another facet to the Smith award, because in 1995, it was given to Frank J. Lepreau, Jr, MD, of Massachusetts. Lepreau was vice president of the NESS in 1977, but he was honored for his commitment to community service and to the care of underserved and impoverished patients in New England and in other parts of the United States and the world. Similar considerations prompted the granting of the Smith award to Harry McDade, MD, of New Hampshire in 1996. The award given to John H. Davis, MD, of Vermont in 1997 was based not only on Davis' contributions to surgical education and scholarship but also on his personal courage and equanimity in dealing with the effects of a devastating illness. These recipients of the Smith award reflect the values that the NESS honors, and they all reflect, in different ways, the basic principles articulated by Samuel J. Mixter in 1916.