The different cultures of North and South produced surgeons with subtle but identifiable differences in approaches to thoracic surgery. Some of these factors still represent a strength of the Southern thoracic surgeon, who is, at least spiritually, a descendant of early Southern surgical leaders. Background, contributions, observations, and attitudes of surgeons of the Confederate States of America are examined. Southern thoracic surgeons are urged to demand intellectual accomplishment and scientific achievement, even in the face of a changing, unstable, unpredictable sociopolitical environment of which we have little understanding and even less control.