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At certain points in history loci of surgical activity emerge that require general attention. What causes them? The answer is complex. The stimulus is often in retrospect attributed to a strong leader who is then canonized and serves as an inspiration for further progress. Although leadership is necessary, something more is needed. Money is, of course, essential, but it takes more than money, and even something more than well-trained surgeons. The additional ingredient must be a surge of population into an area where an enlightened profession and public stand ready to meet the challenge. Such is the setting in southern California where the needs of an incredibly enlarging population have resulted in the recent development of additional medical campuses which now total five. These together with more than 200 hospitals in the area have attracted medical talent that clamors for expression. The surgeons there have sought this through the local