Gertrude Herzfeld: The woman who dared to be a surgeon

Gertrude Marianne Amalia Herzfeld (1890-1981), the first practicing female surgeon in Scotland, overcame bias against women in medicine and pediatric specialists in surgery. After her graduation from the University of Edinburgh Medical School (1914), she became the first female house surgeon at the Royal Hospital for Sick Children, Edinburgh. In 1920, she became the first practicing woman surgeon to become a Fellow of the Royal College of Surgeons of Edinburgh. She left a handful of publications in pediatric surgery: a "radical cure" for inguinal hernia, i.e., early surgery (1925); a review of abdominal surgery in infancy and childhood (1937); surgery for the acute abdomen (1939); and intestinal obstruction (1945). They offer a twenty-year window into how children's surgery was once practiced, when operations were done in patients' homes, and decisions for operation depended solely on the history and physical exam without laboratory testing and radiological imaging. As a series of snapshots over two decades, they reveal how her practice evolved in such areas as fluid resuscitation and radiological reduction of intussusception. She remained steadfast to a careful physical examination and early operation. While she did not document her practice in the care of children with ambiguous genitalia and intersex conditions, she approached the formidable anatomic, psychological, and social challenges of her patients and their families with patience and understanding. Herzfeld was devoted to the care of yet another marginalized population that today is subsumed by the acronym LGBTQIA, yet another area where she was far ahead of her time. Level of evidence: Level VII.