Alan L. Hart

Alan L. Hart (also known as Robert Allen Bamford Jr., October 4, 1890 – July 1, 1962) was an American physician, radiologist, tuberculosis researcher, writer, and novelist. Hart pioneered the use of X-ray photography in tuberculosis detection; he worked in sanitariums and X-ray clinics in New Mexico, Illinois, Washington, and Idaho. For the last 16 years of his life, he headed mass X-ray programs that screened for tuberculosis in Connecticut. X-rays were not regularly used to screen for tuberculosis prior to Hart's innovation, and are still used today, which has led researchers to believe that he saved countless lives.

Early life

Hart was born on October 4, 1890, in Halls Summit, Coffey County, Kansas, to Albert L. Hart and Edna Hart (née Bamford). When his father died of typhoid fever in 1892, his mother reverted to her maiden name and moved the family to Linn County, Oregon. When Hart was 12 the family moved to Albany. There Hart was obliged to present as female to attend school, where he was treated as a girl. He continued to spend the holidays at his grandfather's farm, presenting as male among his male friends, "teasing the girls and playing boy's games".

During his school years, Hart was allowed to write essays under his chosen name "Robert Allen Bamford Jr." with little resistance from his classmates or teachers. It was common at the time for writers to use pseudonyms, including to assume names of a different gender. Hart published work in local newspapers and in school and college publications under this name, or as "submitted by an anonymous boy", or using the neutral "A. L. H." or "A. Hart". He used his legal name only under pressure from peers or seniors. His early work dealt with masculine subjects, even when he was asked to write on topics about life as a woman. When asked to write about female classmates or friends he portrayed them as prize fighters or boyish basketball players.

Hart attended Albany College (now Lewis & Clark College), then transferred with classmate and romantic partner Eva Cushman to Stanford University for the 1911–1912 school year before going back to Albany. Hart graduated from Albany College in 1912, and in 1917 obtained a Doctor of Medicine degree from the University of Oregon Medical Department in Portland (now Oregon Health & Science University); during this period, Hart also returned to Northern California to attend courses in the summer of 1916 at the Stanford University School of Medicine, then located in San Francisco. Hart was deeply unhappy that the medical degree was issued in his female name, limiting his opportunities to use it in any future life under a male name. College records show that at least one of the senior staff was sympathetic; his graduation records were indexed internally as "Hart, Lucille (aka Robert L.), M.D." Nonetheless, Hart knew that if he presented himself as Robert, any prospective employer checking his credentials would discover the female name or find no records for him at all. After graduation he worked for a short while (presenting as a woman) at a Red Cross hospital in Philadelphia.

Tuberculosis research Hart devoted much of his career to research into and treatment of tuberculosis. In the early 20th century the disease was the biggest killer in America. Doctors, including Hart, were realizing that myriad illnesses (consumption, phthisis, phthisis pulmonalis, Koch's disease, scrofula, lupus vulgaris, white plague, King's evil, Pott's disease and Gibbus) were all cases of tuberculosis (TB). TB usually attacked victims' lungs first; Hart was among the first physicians to document how it then spread, via the circulatory system, causing lesions on the kidneys, spine, and brain, eventually resulting in death. Scientists had discovered in the nineteenth century that tuberculosis was not hereditary, but an airborne bacillus spread rapidly among persons in close proximity by coughing and sneezing. This meant it might be treated, but with no cure for the disease in its advanced stages the only hope for sufferers was early detection.

X-rays, or Roentgen rays as they were more commonly known until World War Two, had been discovered only in 1895, when Hart was five years old. In the early twentieth century they were used to detect bone fractures and tumors, but Hart became interested in their potential for detecting tuberculosis. Since the disease often presented no symptoms in its early stages, X-ray screening was invaluable for early detection. Even rudimentary early X-ray machines could detect the disease before it became critical. This allowed early treatment, often saving the patient's life. It also meant sufferers could be identified and isolated from the population, greatly lessening the spread of the disease. Hart established numerous mass X-ray clinics to identify non-symptomatic TB cases in cities across the country. Public fund-raising drives, like the newly created Christmas Seal campaign, helped finance these efforts. By the time antibiotics were introduced in the 1940s, doctors using the techniques Hart developed had managed to cut the tuberculosis death toll down to one fiftieth of what it had previously been.

In 1937, Hart was hired by the Idaho Tuberculosis Association and later became the state's Tuberculosis Control Officer. He established Idaho's first fixed-location and mobile TB screening clinics and spearheaded the state's war against tuberculosis. Between 1933 and 1945 Hart traveled extensively through rural Idaho, covering thousands of miles while lecturing, conducting mass TB screenings, training new staff, and treating the effects of the epidemic. These Mysterious Rays was translated into Spanish and several other languages.

In 1948, Hart was appointed director of hospitalization and rehabilitation for the Connecticut State Tuberculosis Commission. As in Idaho, Hart took charge of a massive statewide X-ray screening program for TB, emphasizing the importance of early detection and treatment. He lived out his life holding this position, and is credited with helping contain the spread of tuberculosis in Connecticut as he had previously in the Pacific Northwest. Similar programs based on his leadership and methodology in this field in other states also saved many thousands of lives.

Personal life

Transition Upon reaching adulthood, Hart sought psychiatric counselling and surgery to continue passing as a man. Hart's was the first documented transgender male transition in the United States, though sex reassignment surgeries had been carried out earlier in Germany, including on one man, treated by German sexologist Magnus Hirschfeld, who had won the right to serve in the German military. The 1906–1907 case of Karl M. Baer had set a new precedent for sex reassignment surgery by enlisting simultaneous support from psychiatric, legal, and surgical quarters. There was now medical and legal precedent for transitioning; Hart's approach to his own transition appears to have drawn on the Baer case.

In 1917, Hart approached Joshua Allen Gilbert, at the University of Oregon and requested surgery to eliminate menstruation and the possibility of ever becoming pregnant. He also presented Gilbert with a eugenic argument, that a person with "abnormal inversion" should be sterilized. He added: "Let him who finds in himself a tendency to criticize to offer some constructive method of dealing with the problem on hand. He will not want for difficulties. The patient and I have done our best with it."

Early female to male (FTM) reassignment surgeries involved the implanting of testicular tissue in place of the removed ovaries. Crystalline male hormones had been extracted in usable quantities from male urine by 1903, but it represented an infection risk.

Hart's surgery was completed at the University of Oregon Medical School over the 1917–1918 winter vacation. He then legally changed his name.

He interned at San Francisco Hospital. A former classmate recognized him there, and he was outed as transgender in the Spokesman-Review newspaper on February 6, 1918. The article's opening sentence referred to him by his birth name and with she/her pronouns, describing him as having graduated from Stanford "as a fluffy coed ... [who] affected boyish mannerisms".

In February 1918, he married his first wife, Inez Stark, at a Congregational church and moved with her to Gardiner, Oregon, to set up his own medical practice.

In an interview with a local paper, Hart declared that he was "happier since I made this change than I ever have in my life, and I will continue this way as long as I live .... I have never concealed anything regarding my [change] to men's clothing .... I came home to show my friends that I am ashamed of nothing".

Synthetic hormones were not immediately available. When given the opportunity, Hart began taking testosterone. His treatment led to masculinization, including a lower-pitched voice and facial hair. Hart set up a new practice in remote Huntley, Montana, writing later that he "did operations in barns and houses ... [till] the crash of the autumn of 1920 wiped out most of the Montana farmers and stockmen, and me along with them". He then took itinerant work, until in 1921, on a written recommendation from noted physician Harriet J. Lawrence (decorated by President Wilson for developing a flu vaccine), he secured a post as staff physician at Albuquerque Sanatorium. and served for eight years as vice president for his local Unitarian Church council.

Hart died of heart failure on July 1, 1962. The terms of his will directed his body be cremated and his ashes scattered over Puget Sound where he and Edna had spent many happy summers together.

Hart said once, in a speech to graduating medical students, "Each of us must take into account the raw material which heredity dealt us at birth and the opportunities we have had along the way, and then work out for ourselves a sensible evaluation of our personalities and accomplishments".