# 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 as a gold standard today, which has led researchers to believe that he has saved countless lives.
As a fiction author, Hart published over nine short stories and four novels, which incorporated drama, romance, and medical themes.
Circa 1917, Hart became one of the first trans men in the United States to undergo a hysterectomy.

## 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 five years old his mother remarried, to Bill Barton, and the family moved to Edna's father's farm. Hart wrote later, in 1911, of his happiness during this time, when he was free to present as male, playing with boys' toys made for him by his grandfather. His parents and grandparents largely accepted and supported his gender expression, though his mother described his "desire to be a boy" as "foolish". His grandparents' obituaries, from 1921 and 1924, both list Hart as a grandson. 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". According to a reminiscence piece in the Halls Summit News of June 10, 1921: "Young Hart was different, even then. Boys' clothes just felt natural. Hart always regarded himself as a boy and begged his family to cut his hair and let him wear trousers. Hart disliked dolls but enjoyed playing doctor. He hated traditional girl tasks, preferring farm work with the menfolk instead. The self reliance that became a lifelong trait was evident early: once when he accidentally chopped off his fingertip with an axe, Hart dressed it himself, saying nothing about it to the family."
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, Lucile (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. 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.
An experienced and accessible writer, Hart wrote widely for medical journals and popular publications, describing TB for technical and general audiences and giving advice on its prevention, detection, and cure. At the time the word "tuberculosis" carried a social stigma akin to venereal disease, so Hart insisted his clinics be referred to as "chest clinics", himself as a "chest doctor", and his patients as "chest patients". Discretion and compassion were important tools in treating the stigmatised disease.
In 1943, Hart, now recognized as pre-eminent in the field of tubercular roentgenology, compiled his extensive evidence on TB and other X-ray-detectable cases into a definitive compendium, These Mysterious Rays: A Nontechnical Discussion of the Uses of X-rays and Radium, Chiefly in Medicine (published by Harper & Brothers), still a standard text today. The book 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 held this position for the rest of his life, 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, Ph.D., M.D., 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. Gilbert was initially reluctant, but accepted that Hart was "extremely intelligent and not mentally ill, but afflicted with a mysterious disorder for which I [Gilbert] have no explanation". He accepted that Hart experienced himself only as a male, who described himself using phrases including "the other fellows and I" and asking "what could a fellow do?" Gilbert wrote, in case notes published in the Journal of Nervous and Mental Disease in 1920, that "from a sociological and psychological standpoint [Hart] is a man" and that living as one was Hart's only chance for a happy existence, "the best that can be done". Gilbert addressed the fact that Hart already passed as male, stating: "Many Kodak pictures of H have been exhibited as those of a man without being questioned." 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 Feb. 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.

### Life after transition

In Oregon, Hart suffered an early blow when a former medical school classmate outed him as transgender, forcing Hart and his wife to move. Hart found the experience traumatic and again consulted Gilbert, who wrote that Hart had suffered from "the hounding process ... which our modern social organization can carry on to such perfection and refinement". 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 doctor Harriet J. Lawrence (decorated by President Wilson for developing a flu vaccine), he secured a post as staff physician at Albuquerque Sanatorium.
The relocations, financial insecurity, and secrecy placed strain on Hart's marriage, and Inez left him in September 1923. She ordered him to have no further contact with her, and divorced him in 1925. The same year Hart married his second wife, Edna Ruddick; the union lasted until the end of Hart's life. In 1925 Hart moved to the Trudeau School of Tuberculosis in New York, where he also carried out postgraduate work; he spent 1926–1928 as a clinician at the Rockford TB sanatorium in Illinois. In 1928 Hart obtained a master's degree in Radiology from the University of Pennsylvania; he was in 1929 appointed Director of Radiology at Tacoma General Hospital. During the 1930s the couple moved to Idaho, where Hart worked during the 1930s and early 1940s; his work also took him to Washington, where he held a research fellowship as a roentgenologist in Spokane. During the war Hart was also a medical adviser at the Army Recruiting and Induction headquarters in Seattle, while Edna worked for the King County Welfare Department in the same city.
In 1948, after Hart obtained a master's degree in public health from Yale, the couple moved to Connecticut, where Hart had been appointed Director of Hospitalization and Rehabilitation for the Connecticut State Tuberculosis Commission. The couple lived for the rest of their lives in West Hartford, Connecticut, where Edna became a professor at the University of Hartford. After the Second World War synthetic testosterone became available in the US, and for the first time Hart was able to grow a beard and shave. He also developed a deeper voice, making him more confident and his public appearances easier.
During the last six years of his life Hart gave numerous lectures, and dedicated all his free time to fundraising for medical research and to support patients with advanced TB who could not afford treatment. He was a member of the American Thoracic Society, American Public Health Association, American Association for the Advancement of Science, and American Civil Liberties Union, among many others. Socially, both he and Edna were well liked, active community leaders. Alan was of Protestant faith 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".