Alan L. Hart - Tuberculosis Research

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 in fact 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.

In 1937 Hart was hired by the Idaho Tuberculosis Association and later became the state's Tuberculosis Control Officer. He established up 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 recognised as preeminent 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 (pub. Harper & Brothers), still a standard text today. The book was translated into several languages, including Spanish.

In 1948 Hart was appointed Director of Hospitalization and Rehabilitation for the Connecticut State Tuberculosis Commission. As in Idaho, Dr. Hart took charge of a massive state-wide 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.