A picture of William E. Ladd appears on this issue’s cover. The photograph is reprinted with permission from Springer-Verlag. It is from Bill AH. William E. Ladd, M.D.: Great pioneer of North American pediatric surgery. Progr Pediatr Surg. 1986;20:52-59. William E. Ladd (1880-1967) became a surgeon at the start of the twentieth century. Advances of the prior 100 years included the development of the stethoscope by Laennec in 1816, the introduction of ether anesthesia with Long’s and Morton’s independent discovery in the 1840s, the application of Pasteur’s germ theory with the development of antiseptic surgical techniques by Lister in 1865, and the expansion of diagnostic means by Roentgen’s discovery of x-rays in 1895. 1 Still, survival was rare for a newborn child with a significant congenital anomaly or any child requiring major surgery in the United States and abroad. 2 The prevailing conditions upon Ladd’s graduation from medical school were indeed primitive as we look back. Blood transfusions were not safe, intravenous fluids did not exist, and monitoring was not introduced into anesthetic management. There were no antibiotics to help prevent or treat infections, and there were few effective medications other than digitalis, aspirin, and opiates. Surgeons utilizing ether or chloroform anesthesia relied more on speed than on precision. The relatively few procedures performed concentrated on draining pus, relieving obstructions, and repairing broken bones. Major elective operations were more feared and talked about than performed. Furthermore, pediatric surgery was even more challenging than was adult surgery. In the words of Dr. C. Everett Koop, “Surgeons in general were frightened of children and distrusted anesthetists to wake them up after putting them to sleep.” 3 We will follow Ladd’s career through this era as he led the charge of the development of pediatric surgery, as we know it today.