This article describes how surgery developed in Costa Rica and how it was nurtured to its present status. The practice of surgery in Costa Rica developed slowly as a charitable service. In the past 3 decades, it became accessible to 87.6% of the population through the creation of a national health service system. Our objective herein is to give the reader an understanding of how surgical practice originated and matured in Costa Rica, viewed in the broader context of medical practice in a fledgling and poor New World colony. Also discussed are social and political sentiments in the country that are thought to have helped evolve the present surgical standard.