This article is part of a series about transgender people whose contributions have benefitted humanity.
If you’ve never had tuberculosis and don’t know anyone who has, you can largely thank the work of early physician, radiologist, tuberculosis (TB) researcher and novelist Dr. Alan L. Hart.
Hart was born on October 4, 1890, in Halls Summit, Kansas as Alberta Lucille Hart.
He attended Albany College, now known as Lewis and Clark College, in Portland, Oregon, and obtained his Doctor of Medicine degree in 1917 from the University of Oregon in Portland.
Hart devoted most of his career to researching tuberculosis, the biggest killer of Americans in the early 20th century.
Dr. Hart pioneered the use of Roentgen rays, now called X-rays, in the early detection of tuberculosis. Hart was one of the first physicians to figure out that tuberculosis spread to other organs in the body via the circulatory system. After X-rays were discovered in the early 1900s, they were typically used only to diagnose broken bones and tumors, but Hart believed they could also detect tuberculosis. In exploring this possibility, he discovered that even the most rudimentary X-ray machines could spot tuberculosis early, before symptoms appeared, enabling prompt treatment that saved countless lives.
Hart became the first person to invent both fixed and mobile screening clinics for tuberculosis.
Dr. Hart established fixed mass X-ray clinics in cities and towns around the U.S. that helped identify early, non-symptomatic cases of TB across the country, and invented mobile clinics that could make screening for TB available across the country. From 1933 to 1945, Hart traveled thousands of miles throughout rural Idaho lecturing, conducting mass screenings and training people in early detection of TB. His efforts were invaluable in the early treatment of the disease. It also meant that people infected with TB could be identified early and isolated from the general population, a public health strategy that massively reduced the spread of the often fatal disease. Public fund-raising drives like the Christmas Seal campaign helped finance his efforts. After antibiotics were introduced to treat TB in the 1940s, doctors continued to use the techniques Hart developed to cut the death toll from tuberculosis down to just one fiftieth of what it had been before the use of his pioneering techniques.
Hart transitioned from female to male in 1917, making his the first documented transgender female-to-male medical transition in the United States.
You can read more about the life, career and accomplishments of Dr. Alan L. Hart at his Wikipedia page.
What stands out in this history is how much of the impact came from organisation rather than technology alone. X-ray machines already existed, but turning them into a screening system, with fixed clinics in towns and mobile units travelling through rural Idaho, is what moved detection from the sick patient to the apparently healthy population. That shift from treating symptoms to finding disease early is the foundation of modern public health screening, from mammography to lung cancer CT programmes.
It is also worth remembering how hard it was to read those early films. Exposure times were long, image contrast was poor, and the radiologist had to learn to recognise subtle shadows of early lesions by eye, often under dim light. Training local staff to interpret them consistently, as Hart did on his lecture tours, was probably as important as the equipment itself.
There is an interesting echo today: chest X-rays are one of the main areas where AI image analysis is being tested to help flag possible TB cases, especially in regions with few radiologists. The lesson from Hart’s era still applies, though. A better image or a clever algorithm only helps if there is a system around it that reaches people, follows up on findings and gets them into treatment.