In this article based on a special lecture delivered at the 1995 annual meeting of the American Society of Anesthesiologists (ASA), the author provides an historical perspective on the birth of patient safety in the field of anesthesia. From personal anecdotes in the operating room to descriptions of emerging research around postoperative deaths, the presentation provides a unique perspective on the gradual emergence of safety efforts in anesthesia. In addition, Pierce discusses the factors that led him to develop the first ASA Committee on Patient Safety and Risk Management, host the first International Symposium on Preventable Anesthesia Mortality and Morbidity, and form the Anesthesia Patient Safety Foundation. Pierce closes by introducing the challenges that lie ahead in balancing the commitment to safety with the growing climate of cost-containment and productivity.