The Department of Surgery at the University of Cincinnati College of Medicine evolved through the efforts of pioneering American surgeons in parallel with the growth of the city of Cincinnati itself. Dr Richard Allison, the first surgeon in this region, arrived in 1790 during the establishment of Cincinnati’s first garrison. As the population increased, so did the number of distinguished medical and surgical practitioners, and among the most notable was Dr Daniel Drake. After serving an apprenticeship with Dr William Goforth, then Cincinnati’s premier physician, Drake was awarded a diploma in medicine in 1805, reputedly the first such diploma issued west of the Allegheny Mountains. In 1819, Drake obtained charters from the state of Ohio to establish both the Cincinnati College, which later became the University of Cincinnati (UC), and the Medical College of Ohio, which was the second medical school established west of the Allegheny Mountains. Drake then acquired the Commercial Hospital and Lunatic Asylum in 1821 under the aegis of the Medical College of Ohio with the caveat that the hospital must care for the poor, whose cases in return could serve the purpose of teaching. Thus, the Commercial Hospital and Lunatic Asylum of Cincinnati became the first true teaching hospital in the United States.