Alan L. Hart was a twentieth-century Pacific Northwest physician and novelist who more recently became best known as the first person in the United States known to have had surgical gender transition. As a doctor, he practiced for several years in Washington state, specializing in public-health initiatives to counter tuberculosis. As a writer he published four medical novels, three of them with Western Washington settings, as well as a layperson's book about X-ray technology. His fiction addressed social and environmental themes along with (sometimes thinly disguised) commentary on prominent Tacoma and Seattle families and institutions.
A Singular Childhood
Hart was born October 8, 1890, to Albert and Edna Hart (1865-1938) in Hall's Summit, Kansas, and named Lucille. His father was a local businessman who died of typhoid in 1892. "Thankfully for his heirs," wrote Peter Boag in Re-Dressing the American Frontier, "when Albert departed this world he left them a nice estate. Edna packed up herself, her inheritance, and her toddler and soon returned to Oakville, Oregon, where her parents yet resided" (Boag, 9). Edna remarried in 1895, to J. W. Barton (1866-1938).
Hart was an only child, living on his stepfather's farm south of Albany in the hamlet of Shedd. His mother taught him at home, and he spent this childhood freedom pursuing his own interests, which leaned strongly toward outdoor, energetic projects and away from traditionally feminine clothing and activities. "You sneered at the mild games of the girls," he wrote later in a college essay. "You scorned playing house and were altogether superior to dolls" (The Takenah, p. 66).
It wasn't until the family moved a few miles north to Albany in the early 1900s that Hart attended regular school and began to realize how much his interests and attitudes diverged from those of most of his female classmates. In a pattern that continued through his life, he responded not by shrinking away, but by pursuing activities and friends on his own terms. He played as much as possible with boys and tried to avoid housework and girls' clothes. In school he distinguished himself in essay writing and public speaking. After graduating from Albany High School in 1908, he entered nearby Albany College (now Lewis and Clark College). In his junior year, the college yearbook, The Takenah, said Hart was "very active in the Student Body affairs and is a famous debater. We hesitate to mention it, but we fear that her dreams of blessed spinsterhood will be only dreams" (The Takenah, p. 18).
Moving Toward Manhood
After his junior year at Albany in 1911, Hart transferred to Stanford University (along with his classmate and romantic interest, Eva Cushman, whose fees he paid from an inheritance). Although he was still living as a woman at school, easy access to San Francisco provided more opportunity to explore male dress and activities. It also ate up his savings to the point that he left Stanford in debt and hustled up a variety of jobs, including commercial photography, to rebalance his finances. He returned to Oregon to complete medical school, graduating from University of Oregon College of Medicine in Portland in June 1917. Still presenting as a woman, the only one in that year's class, he was the winner of the Saylor Award for the student with the highest average grades over four years.
That same year Hart consulted J. Allen Gilbert, a Portland-based medical doctor with an interest in psychology. In his medical-school studies Hart had encountered academic descriptions of his situation. He was devastated to learn that the identity that had always felt natural to him was seen as a psychological aberration. The conflict between society's strictures and his own conviction that his true self was male became more unavoidable as he considered job opportunities and pursued romantic relationships with women. In the wake of one breakup, Hart considered and may have attempted suicide.
Becoming a Case
Because Gilbert published a journal article based on their sessions (referring to Hart as "H"), we have a detailed picture of Hart's childhood and adolescence and the increasing difficulty of living as a biological woman while feeling unreservedly male. The doctor's empathy and admiration for his patient is also clear as he describes their course of treatment:
"H had known for some time that she was 'not like other girls,' but her condition seemed so natural to herself and she was so strong and healthy that she gave that matter little thought. However, her mode of dressing -- men's coats, collars, ties, tailored hats, English shoes, etc. -- made her conspicuous and the object of so much criticism and conjecture as to make her very uncomfortable" (Gilbert, 317).
Gilbert was already aware that what would now be called "conversion therapy" was generally ineffective at changing sexual or gender orientation, but he made an attempt. He and Hart tried hypnosis, among other treatments, and when they didn't work, Gilbert wrote: "She came with the request that I help her prepare definitely and permanently for the role of the male in conformity with her real nature all these years" (Gilbert, 320).
In 1918 Gilbert performed a hysterectomy, which he defended as a practical accommodation to the difficulties of dealing with menstruation while wearing men's clothing and living as a man. It was also a guarantee against pregnancy, as both Gilbert and Hart accepted the view that Hart's condition was real, but also an aberration, and that people in that situation should not reproduce. This decision made Hart the first person in the U.S. known to have undergone gender-affirming surgery. Gilbert helped Hart complete a man's wardrobe, get a male haircut and a new legal name, and register for the draft, after which Hart made his "exit as a female and started as a male with a new hold on life and ambitions worthy of her high degree of intellectuality" (Gilbert, 321).
Exposure and Fighting Back
Living for the first time openly as a man, Hart got a job at the City and County Hospital in San Francisco. He enjoyed the work and the camaraderie with his fellow clinicians until a Stanford classmate recognized the person she had known as Lucille and told the hospital. In a letter to the writer Mary Roberts Rinehart three years later, Hart described it as a personal disaster:
"This coming to my ears, I went to the Superintendent of our hospital – told him the truth of the case – showed him my documentary proofs and voluntarily resigned. He gave me assurance that he would squelch any further notoriety about the hospital. Imagine my feelings, therefore, only a few days later, to open the Examiner one morning and find a garbled account the whole thing smeared in broad head-lines across the page. The story was carefully written to convey the impression that I was a rank imposter and had fled before the righteous indignation of the authorities; it had been inspired by the young woman who had recognized me and the heads of the hospital I had just left …
"I had been prepared for criticism and ridicule – I was accustomed to them. But it had never occurred to me that people might want to hound and persecute me for my change in role. I had lived as a woman because that was my social standing, and had been made fun of and called 'half-man' and now when I had faced the situation and righted the grotesquely false position in which I had lived for so long, it seemed that the public would damn me because I had once, perforce, worn skirts. I tried to get other hospital work. I went to the men who had been my chiefs and told them the truth and asked their aid in securing another position. To a man they turned me down. I tried to get other sorts of work and failed for the same reason as soon as I gave my name …
"Finally I made up my mind to face the music without any attempt at concealment, so I went back home to the little town where I had been raised and had gone to school. It was the hardest thing I ever did" (Hart to Rinehart, August 3, 1921).
The decision to return home paid off. Hart brought with him a document signed by Dr. Gilbert, asserting his true identity as a man, and showed it to the editor of the Albany Democrat. The paper had already run a story on February 18, 1918, downplaying the attention given to Hart's choice of clothing, writing that "for years she has shunned the fluffs and frills of the girl, wearing tailor-made coats and other parts of her attire of a mannish appearance" ("Dr. Hart Does Work …"). Hart's mother pointed out that women were wearing pants as they participated in the war effort in factories and workshops. She maintained a hospital was no different. In a follow-up story on March 26, the Democrat went the rest of the way toward accepting Hart as a man: "Dr. Hart Explains Change to Male Attire: Real Identity Discovered and Proof Held; Truth Beyond Question."
Hart had met with a reporter at the home of his mother and stepfather, who supported his new identity. "I had to do it," he said. "For years I had been unhappy. With all the inclinations and desires of the boy, I had to restrain myself to the more conventional ways of the other sex. I have been happier since I made this change than I have been in my life and I will continue this way as long as I live … I came home to show my friends that I am ashamed of nothing" ("Dr. Hart Explains …"). From then on, the Democrat published Hart's achievements and visits home, presenting him as a male without qualification. But it was still difficult to find work in medicine. He ended up in remote Gardiner, Oregon, at the height of the Spanish flu epidemic, running a hospital for loggers. The setting and the difficulties of the job showed up in his first novel, Dr. Mallory, published in 1935.
Marriage and Moving
Also in 1918, Hart married Inez Stark (1891-1986), who had been a music teacher in the McMinnville, Oregon, school district. When the Gardiner job ended they moved to Huntley, Montana, in 1919. Hart's practice covered 70 miles of rough roads and poor farmers. In his novel The Undaunted, published in 1936, his main character had practiced in Montana and recalled "the glowing pride in which he had stood the next morning on the tiny porch of that tarpaper shack with a living mother and a living child to his credit. Tired, disheveled, spattered with blood, he had faced the reddening eastern sky as a man ought who has fought for two lives and won them both" (The Undaunted, 6). Hart struggled to make a living at his practice until the postwar recession that hit farmers especially hard.
He next worked briefly at a private hospital in Thermopolis, Wyoming. During that time he wrote a remarkable letter to Mary Roberts Rinehart, a mystery writer and former nurse, married to a doctor, who was in Wyoming at the time. It read in part, "I should not have the temerity to approach you as I am doing were it not for two things: First, the fact that both you and Dr. Rinehart belong to the medical world – of which I, too am a part – and second, my conviction that you are as big and liberal as your stories would indicate …" (Hart to Rinehart, August 3, 1921).
After explaining his situation and the traumatic end to his first employment as a man in San Francisco, he asked for advice about publication. "In the height of my trouble in 1918, I wrote a first draft of an autobiography – or rather it boiled out from me without let or hindrance. This Spring I have gone over it and rewritten it … I want to ask you to read it and give me your opinion of it and advise me as to its publication" (Hart to Rinehart, August 3, 1921). He included in his packet some personal letters, with a poignant request: "These papers I should like to have returned as I value them highly. I have had to throw overboard almost all the associations and friendships and foundation of the first twenty-seven years of my life; the little that is left, I prize."
Rinehart apparently expressed interest, if not active encouragement, because he wrote again on August 12 and prepared to send her the manuscript. "It is hard for me to tell you what my feelings were when I had read your letter. I had hoped but hardly dared expect courtesy and understanding of this type. I appreciate it with my whole heart." The autobiography was never published, but he did not give up on his plans to write.
Later in 1921, he and Inez relocated once again, to Albuquerque, where he was staff physician at the Albuquerque Sanitorium until 1924. Five years of bouncing from job to job and state to state in poverty may have been too much for Inez. She left the marriage in 1923 and rebuffed his attempts to reconcile. (The protagonist of his first novel is a rural doctor whose wife is discontented with his hard work for low pay.)
Back Home and Back East
Returning to Oregon in 1924, Hart attended a summer writing class at the University of Oregon, where he confided in his professor, William Franklin Goodwin Thacher (1879-1972). "I came to know him well," Thacher wrote many years later, "and heard his story, told frankly and without embarrassment, from his own lips, as well as from others who had known this anamolous [sic] personality in the early years" (Close, 47).
There he also met Edna Ruddick, a New York transplant who was teaching in Powers, a Coquille Valley town belonging to the Smith-Powers Logging Company. Their relationship developed quickly, and once Inez divorced him, they announced their engagement in February 1925. Edna finished out the teaching year in Powers while Alan moved in with her parents in Ridgefield, Queens, to take advanced training at the New York Post-Graduate Hospital. They married in New York City that May. His and Edna's interests were well aligned. She was energetic and intellectual, active in social work and public health campaigns focused on tuberculosis, and she had an interest in writing.
A Home in Spokane, and Tacoma, and Seattle
By 1926 they were in Spokane, both involved in tuberculosis prevention. Alan worked at Sacred Heart Hospital but spent much of his time conducting clinics and speaking to medical associations in Washington and Idaho. In a time when newspapers still referred to TB as the White Plague, Hart was a fervent advocate of using increasingly available X-ray technology for early diagnosis, which could cut the mortality rate, and for establishing sanitariums where patients could be quarantined and monitored.
Despite their frequent moves and the constant possibility of exposure, both Harts were active socially and made connections wherever they lived. Edna was a frequent presenter in the Spokane branch of the American Association of University Women, heading its poetry section and speaking in November 1926 on "Negro poets" ("Programs …"). She also volunteered with Community Chest fundraisers for social-welfare organizations as well as her work on tuberculosis education. Before leaving Spokane for Philadelphia in October 1928 for Alan's graduate work, they gave a dinner dance for 26 friends.
In Philadelphia, the couple lived in a boarding house while Alan worked on a masters degree in radiology. His graduate studies completed, they returned to Washington in 1930, where Alan became the director of the radiology lab at Tacoma General Hospital. They moved to a house on N 26th Street and immediately plunged into community life. The Tacoma Daily Ledger ran a picture of Edna Hart and other social notables, calling her "a charming newcomer" ("Visitors, A Bride …"), and they both began a regular run of notices in the local papers for activities in the Pierce County Tuberculosis League, the American Association of University Women, Girl Scouts, and other service groups. Edna was a founding officer of a women's auxiliary to the Pierce County Medical Society
Edna and Alan worked together on tuberculosis education. The Christmas Seal campaign (still an annual project of the American Lung Association) involved a range of educational and promotional work. This included theatricals – one in 1931 acted out a story based on the year's Christmas Seal stamp image of an overloaded British stagecoach. Edna, who had been active in dramatics in college, played "a confused passenger who doesn't know where she's going" ("Christmas Seal Sale …").
Alan was often on the road, running x-ray clinics that he called "chest clinics" to avoid the stigma associated with tuberculosis and speaking on TB prevention. Newspaper coverage followed him up and down the state as he spoke to service clubs, medical associations, and high-school students, preaching the value of scientific exploration and the role of prevention in public health.
Always interested in the meaning of his life and profession as well as its practical consequences, he continued exploring ideas in science and spirituality. In July 1932 the Harts went to Bainbridge Island for a lecture course on spirituality by Jiddu Krishnamurti (1895-1986), an Indian philosopher who advocated a harmony between rationality and love that could only exist outside of religions and politics. That August they headed to San Juan Island for an adult camp featuring cruises and lectures put on by the Academy of Science. These interests showed up in subsequent lectures, such as "Problems in Education," "The Romance of Modern Medicine," and "Spirituality in Modern Science." Other summers he and Edna took their vacations near Lake Cushman on the Olympic Peninsula, giving him a chance for the outdoor life he had relished as a child.
During his time in Tacoma Hart was also working on his writing. He mined his years of diaries and medical notes for material for fiction. In 1932 he was elected president of the Tacoma Chapter of the League of Western Writers and was a featured speaker at several meetings, switching to the Seattle chapter when he and Edna relocated there.
The radiology job at Tacoma General ended in 1932. Later gossip suggested that his gender situation had been discovered after he fainted at work. His own explanation alluded to hard economic times for the hospital. Either way, there was no public disclosure of his transition, and he continued much the same work in Seattle as a consultant on public health initiatives for TB. They lived at least part of that time at 901 NE 43rd Street, in a 1920s apartment building that is still in use next to the UW Medical Center. His former wife, Inez Stark, also lived in Seattle at that time, teaching art at James Madison Intermediate School.
Leaving Washington
Hart continued to make frequent trips to Idaho, conducting x-ray clinics and speaking on public health, and the couple moved to Boise in the early 1940s. He lobbied for establishment of a new Idaho tuberculosis hospital, a project that repeatedly failed to get funding from the state, and he made his frustration clear to reporters. "I'm not so sure we have advanced from early day medical practices, except in the acquirement of scientific research and wealth," he was quoted in the Spokesman Review in 1937. "Human beings are living in a $1,000,000 age, equipped with a 10-cent brain" ("Session Lauds …").
When the federal funding for a new TB hospital lapsed the next year without the state agreeing on a site for it, Hart told members of the North Idaho Anti-Tuberculosis association: "We lost the sanitarium in 1919 and again in 1938 because of political boondoggling – while your friends and mine were dying" ("Sanitarium Lost …"). He was still pushing in 1940, writing that at least 90 beds were needed for TB patients and that Idaho's response to a major public health problem was "entirely inadequate" ("T. B. Hospital's Need …). It took another six years to get the sanitarium established. In 1946 Hart combined donated buildings from the former Gooding College with ones surplused from the former Japanese relocation camp at Minidoka to create the Idaho Tuberculosis Sanitarium, which operated for 30 years.
Public Health and Publications
The writing Hart had been working on since the 1920s came to fruition in a series of novels featuring independent-minded doctors and societal commentary. Dr. Mallory came out in 1935, The Undaunted in 1936, In the Lives of Men in 1937, and Dr. Finlay Sees it Through in 1942. While not explicitly autobiographical, all drew on his experiences in practice and included the kinds of commentary on medical practice and meaningful life that he used in his lectures. He also contributed articles to medical journals on the diagnostic uses of x-rays.
Still picking up extra work where he could, Hart spent six months back in Seattle in 1943, shooting x-rays at the Army induction center. In 1947 the Harts left the Northwest for Hartford, Connecticut, where they spent the rest of their lives. Edna promptly became the religious-education director for the Unitarian Meeting House in Hartford, as well as volunteering with the YWCA and the Foreign Policy Association. By 1949 she was teaching child psychology at Hillyer College, part of the University of Hartford. Alan, by now in his mid-50s, joined the state tuberculosis commission and also taught psychology at the University of Hartford. He continued to give community lectures on such topics such as "Putting Up Defenses, and How to Deal with Our Problems" and "Middle Age – A Trial Balance."
The Harts were increasingly vocal on social issues. Edna was on the Board of Directors of the Greater Hartford Association for Mental Health, campaigning against stigmatizing people with mental illness, and Alan was a signer of a pointed full-page ad in the Hartford Courant that castigated neighbors who would not speak out against racial discrimination in housing. Headlined "Closed Doors in Our Community?" it said that "We are surprised that some people will call new neighbors 'undesirable' without meeting, talking with, sometimes without even seeing them. We Are Not Those Neighbors" ("Closed Doors …")
Alan died in 1962, at 71, of heart failure. He specified that his personal papers be destroyed at his death, and Edna followed through. In the 1970s, when his life story was pieced together by activists and researchers on gay and transgender topics, Edna also rebuffed contacts eager to hear more about their life and relationship. She lived another 20 years, staying active in community work most of that time and sharing her home with a succession of college students in need of housing. She died March 21, 1982, at 88.
Following Alan's wishes, Edna left most of their quarter-million dollar estate to the Medical Research Foundation of Oregon. The Alan L. and Edna Ruddick Hart Fund was established "in loving memory of my late husband Alan L. Hart, MD, a graduate of the University of Oregon Medical School, whose mother died of leukemia, whose life was devoted to medicine and whose earnest wish was to someday give financial support to medical research in its efforts to conquer leukemia and other diseases" (Moore). She also fulfilled his wish that, despite his long absence from the Northwest, his ashes be scattered on the Olympic Peninsula near Port Angeles.
