March 8, 2023
Editor’s note: This article is based on the first-place winning entry in the 2022 History of Surgery Poster Competition, which occurred in conjunction with Clinical Congress. An article featuring the second-place entry will appear in the April issue of the Bulletin.
In a long-forgotten chapter of trauma surgery history in America lies the daunting field of railway surgery. Railway surgeons were some of the first physicians to practice new ideas, form specialized societies, and revolutionize medical transport of critically ill patients. Early railway surgeons learned their trade in the field outside the confines of a hospital where they may have previously functioned as general practitioners.
Among these railway physicians was one of the first female surgeons in America—Sofie Herzog, MD.
In 1907, Dr. Herzog—an Austrian immigrant who was a leader, mother, maverick, and, above all, devoted surgeon—became the first female railway chief surgeon of the St. Louis, Brownsville & Mexico Railway in Texas. She served in a time marked by gruesome injuries resulting from war or railroad accidents. Dr. Herzog won over the hearts of the townspeople in Brazoria, TX, where she practiced until her death.
Known to this day for her remarkable success with bullet removal techniques, Dr. Herzog was mentioned at conferences across the country, where she was acknowledged as a professional woman in a man’s world. But more than all that, she was beyond her time.
Her wild eccentricities made her an outcast who was ready to challenge the norm, while her practice is a testament to the vigor that female physicians needed to gain the respect of their male colleagues, communities, and, most importantly, their patients.
Sofie Deligath was born in 1846 in Vienna, Austria, and was no stranger to the medical field. Her family included prominent and successful doctors and surgeons; among them was her father, who was an internationally known surgeon. At some point after having observed countless surgeons performing operations, she began to take her unofficial training seriously. Vienna was considered one of the best cities in the world for medical care, so young Sofie observed world-class care before her move to America.
At the age of 14, she married Austrian surgeon Moriz Herzog, MD, and, over the next several years, gave birth to 15 children, including three sets of twins; eight of their children died in infancy. The family emigrated to the US in 1878, and Dr. Moriz Herzog accepted a job at the US Naval Hospital in New York City.
Sofie had earned her midwifery certificate, and although women doctors were not unheard of, it still was incredibly difficult for a woman to complete her graduate education, let alone medical school. In fact, she was not satisfied with the level of education a woman could receive in America and returned to Vienna for training. She later was forced to attend medical school again in the US to earn a US-issued medical license.
Following her husband’s death and after practicing for 9 years in Hoboken, NJ, Dr. Herzog moved to Brazoria with her youngest child. At the time, Brazoria was known for its rustic charm and was not a place frequented by newcomers. Gunslingers were rowdy, making care for gunshot wounds a necessity.
The town did not have a physician at the time, and the residents were ecstatic when they heard a new doctor was moving to Brazoria. However, that enthusiasm was short-lived when it was discovered that the physician was a woman. In fact, residents of Brazoria initially were cold to Dr. Herzog.
Dr. Sofie Herzog (Courtesy of the Texas State Library and Archives Commission)
Dr. Herzog, who was 49 years old when she began treating patients in the small town, was different than most women. With her curly hair cut short like a man and her split skirt custom-made by a tailor for mobility, Dr. Herzog was the talk of the town. She also had opted to live alone rather than with family—a fact that was not well received by other women.
Added to this, Dr. Herzog’s preferred mode of transport was riding astride rather than side-saddle on her horse, an act only men were seen to do. However, her fervor for building her practice was unparalleled, and she soon won over the residents and became known as “Dr. Sofie.”
Dr. Herzog initially set up her practice in the house of her son-in-law Randolph Prell. This arrangement didn’t work for too long. Prell walked in on Dr. Herzog treating a smallpox patient in the living room and demanded that she not accept such patients in the household. She decided parting was for the best and built her combined office and living quarters soon afterward.
It was in that space that Dr. Herzog started to maintain collections of tools, preserved medical paraphernalia, and random novelties. One of her most infamous collections included a shelf of jars containing stillborn fetuses preserved in alcohol. Dr. Herzog apparently kept them for scientific reasons, but one can imagine how these jars unnerved her in-house patients.
Another peculiar feature of her working quarters: reptile carcasses. Fueled by her curiosity, Dr. Herzog hired young men to capture snakes. After dissecting the reptiles to look at their anatomy, she used the carcasses to decorate her buggy and office. One of her most notable products of taxidermy was a 14-foot gator placed in the center of her office.
Sofie Herzog sits in her office with a taxidermied 14-foot alligator behind her.
Along with her ability to keep the residents of Brazoria in a state of constant shock, Dr. Herzog also enjoyed engaging in everyday activities such as knitting and crocheting. In her spare moments between patients, she would make scarves, shawls, and hats for her grandchildren and the children of the town.
With her devotion to Brazoria and her patients, it was inevitable that the townspeople soon thought of her as one of their own.
In 1904, the construction of the St. Louis, Brownsville & Mexico Railway through Brazoria began. By this time, Dr. Herzog had earned the respect of the local officials and frequently was called upon to treat injured workers up and down the line.
When it came time to employ a surgeon for Brazoria and after multiple recommendations, local officials hired Dr. Herzog. This resulted in significant controversy since there had never been a female railroad surgeon.
The officials sent Dr. Herzog a telegram stating they would “understand” if she resigned, as the position was not suitable for a lady. Dr. Herzog swiftly dispatched a return telegram assuring them that she needed no special treatment because of her gender, and they were welcome to fire her if she did not perform her duties. She never gave them any cause to fire her, and she kept the position until she suffered a paralytic stroke a few months before her death.
This hospital car—from 1899—includes an operating room. (From Railway Surgery: A Handbook on the Management of Injuries)
Dr. Herzog’s early cases were mostly births, emergencies, and illnesses among underprivileged members of the community. Many of the emergencies she treated were gunshot wounds, and Dr. Herzog’s success in treating these injuries was extraordinary for the times.
In fact, she had been in Brazoria for less than 2 years when she was invited to address the South Texas Medical Society about her method of removing bullets. In that address, Dr. Herzog stated that she already had removed 15 bullets and two rounds of shots without losing a single patient. By 1897, Dr. Herzog was the first female member of the South Texas Medical Society, and she was the first woman elected vice-president of the organization in 1903.
It was most likely after a shooting accident in Hoboken involving her son that Dr. Herzog decided the traditional method of removing bullets (probing) often caused death. She found that using a sterile finger helped with controlling infection and positioning the patient so that gravity would “bring the bullet to her” also was beneficial.
In the case of abdominal wounds, Dr. Herzog reported that she would hang the patient a couple of inches above the bed. In every case, she reported that the bullet “came to her” within 24 hours and that every one of her first 17 patients was up and about by day 12, “ready to shoot or be shot at any time.” Dr. Herzog’s success with bullet removal was a source of pride, and she began using recovered bullets to create a necklace to fasten around her neck.
Dr. Herzog was more than just a physician. She took an interest in making Brazoria a thriving community. She dabbled in real estate, buying and managing the Jefferson Hotel for many years while still treating patients. Dr. Herzog opened a large clinic near the railroad tracks next to her office, and she ran her own pharmacy.
Because she owned hundreds of books, Dr. Herzog also became the town’s first librarian, lending out her personal collection to readers. She even built Brazoria’s Episcopal church after a dispute with the local Catholic church over the terrible condition of the community’s Catholic cemetery.
In 1913, Dr. Herzog, who was 67 years old, married Marion Huntington and moved to his plantation 7 miles outside Brazoria. At an age when many consider retiring, Dr. Herzog commuted to her patients every day, making house calls and distributing medications from her pharmacy.
She worked until a stroke caused her to be hospitalized—a few months before her death on July 21, 1925. She was 79 years old. Per her request, Dr. Herzog was buried with her bullet necklace—a reminder of both her surgical skills and charming quirks.
Dr. Herzog embodied the Hippocratic Oath with her commitment to equity in her medical practice. She would treat all patients, regardless of racial background, and would travel dirt roads to deliver babies along the Brazos River. Embracing aspects of her gender role but never letting them stop her, Dr. Herzog carved out a place in the hearts of Brazoria, where she is remembered as an icon to this day.
The authors gratefully acknowledge the assistance and contributions of the Texas State Library and Archives Commission, Texas Outlaw Writers, Brazoria Heritage Society, and Houston History Magazine in compiling images and historical information related to this article.
“Driving the last spike. C.M. & P.S.R.R.” (McKay, Rollin H., 1909). A railroad worker kneels on tracks surrounded by Roadmaster George Nick (holding spike hammer). (LC-USZ62-29461, Library of Congress Prints and Photographs Division, Washington, DC)
During the late 1800s, railway surgery was thought of as a “de facto” specialty led by a cavalier group of physicians considered to be some of the earliest trauma surgeons.
The development of railroads in the mid-1800s spurred intercoastal migration to remote areas devoid of medical care within the US. More than 250,000 miles of unregulated tracks manned by thousands of industrial trains offered ample opportunities for traumatic injury among passengers and employees.
In 1888, railway accidents accounted for 5,282 fatalities and more than 25,000 injuries. By 1899, there was a 50% increase in deaths, with 7,123 fatalities and more than 40,000 injuries. To treat this type of trauma, a new breed of physicians interested in emergency surgery, limb salvage, and shock developed.
During the early days of railroad expansion, part-time private medical practitioners were commissioned along popular cross points. However, rapid growth into underdeveloped areas of the western country created a need to hire full-time surgeons.
Sadhana Anantha is a fourth-year medical student at the University of Miami Miller School of Medicine in FL.
Anderson G. More Than Petticoats: Remarkable Texas Women. Washington, DC: Rowman & Littlefield, 2013.
Bell C. The Duty and Responsibility of the Attending Physician in Cases of Railway Surgery. Medico-Legal J. 1896;14:77-81.
Brand AJ. Dr. Sofie Herzog and New South Brazoria, Texas: Gender, medicine, and entrepreneurship (unpublished thesis). 2000. Available at: https://digital.library.txstate.edu/handle/10877/14754. (Access restricted). Accessed February 1, 2023.
Doten CW. Recent railway accidents in the YS. Publications of the American Statistical Association. 1905;9(69):155-181.
Downing LC. Early Negro hospitals: With special reference to nurse’s training schools. J Nat Med Assoc. 1941;33(1):13-18.
Goldthwaite C. Texas Dames: Sassy and Savvy Women Throughout Lone Star History. Mount Pleasant, SC: Arcadia Publishing, 2012.
Herrick CB. Railway Surgery: A Handbook on the Management of Injuries. New York, NY: William Wood & Co, 1899.
Humphries F. Brazoria woman doctor was one of south Texas most noted characters. Houston Chronicles: Freeport Facts. January 14, 1936.
Jones MB. Dr. Sofie followed daughter to Texas. The Brazosport Facts. January 18, 1961. Brazoria Heritage Society Photo Collection. Accessed February 1, 2023.
Penland R. Sofie Herzog: The first woman surgeon breaking boundaries in Texas. Houston History. July 30, 2016. Available at: https://houstonhistorymagazine.org/wp-content/uploads/2016/07/Sophie-Herzog.pdf. Accessed February 1, 2023.
Rogers MB, Smith SA, Scott JD. We Can Fly, Stories of Katherine Stinson and Other Gutsy Texas Women. Lufkin TX: Ellen C Temple Publishing, 1983.
Rutkow IM. Railway surgery: Traumatology and managed health care in 19th-century US. Arch Surg. 1993;128(4):458-463.
Silverthorne E. Herzog, Sofie Dalia (1846–1925). Handbook of Texas Women Online. Texas State Historical Association, 1995. Available at: https://www.tshaonline.org/handbook/entries/herzog-sofie-dalia. Accessed February 1, 2023.
Silverthorne E. Herzog, Sofie Dalia (1846-1925). Texas State Historical Association. Updated October 30, 2019. Available at: https://www.tshaonline.org/handbook/entries/herzog-sofie-dalia. Accessed February 1, 2023.
Washington State Library. Today’s American woman. The Tacoma Times. 1911. Accessed February 1, 2023.