At the last turn of the century American surgery was in the midst of a number of paradigm shifts, involving transitions in technology, surgical practice, surgical specialization, patient care, surgical training, and medical economics. Charles B. G. de Nancrede was a leader during this formative period. A key figure in the transition from antiseptic to sterile technique in American medicine, he was also a prolific writer, a bold surgeon, and a great surgical educator. De Nancrede created one of the earliest prototypes of the modern multispecialty surgical departments. The coming turn of the century promises new transitions comparable to those of the past.