The history of the University of Southern California’s Department of Surgery begins with the birth of the Los Angeles County Hospital (LACH) on May 28, 1858, 10 years after California was ceded to the United States by Mexico and 22 years before the founding of the University of Southern California (USC) in 1880. The College of Medicine opened in 1885 and was based at LACH. Professional care was rendered entirely by community-based attendings; contracts were awarded to the lowest bidder and fee schedules were set by the County Medical Society. In 1886 the first 3 interns were appointed, and were responsible for managing the surgical patients and assisting the attending surgeons who were responsible for the patients. Interns were expected to do most of the surgery. The surgical service typically operated on 4 to 5 emergency patients per night, and the caseload then, as it is now, was appendicitis, strangulated hernias, bowel obstruction, and trauma. In 1922 the first 3 resident training programs were established (orthopedics, otolaryngology, and oral surgery) and the first surgical resident, Dr Marcus Rabwin, was appointed.