REMARKS OF U.S. REPRESENTATIVE JOHN E. FOGARTY, SECOND CONGRESSIONAL
DISTRICT OF RHODE ISLAND AT ANNUAL MEETING OF NATIONAL TUBERCULOSIS
ASSOCIATION AT STATLER-HILTON HOTEL, NEW YORK CITY, MONDAY, MAY 25,
1964 at 9 AM

In 1958, just six years ago, I was privileged to meet with
you at your annual meeting in Philadelphia. These six years have
been extremely eventful years in tuberculosis control and years
during which I believe we have all learned many lessons. As I
attempt to remember back to that occasion, I seem to recall that
we were all flushed with the excitement of the successes o£ the
immediately preceding years in the campaign against tuberculosis.
We were experiencing the thrills which accompany any success. It
would appear, however, that we were all a bit presumptuous in our
assessment of the battle which the tubercle bacilli would continue
to give. This fact has become increasingly apparent during the
intervening years. As our Committee has annually made its assessment
of progress against tuberculosis, we have found that the quick, sure
victory for which we all hoped was proving to be most elusive. ‘The
experiences of these past six years have been a disappointment to
me as I presume they have been to you. At that time, we had the
1956 statistics before us and these showed a most encouraging 9-7
percent reduction in the number of new active cases. This degree
of decline, as I am sure you all know, has not been maintained,

and between the years 1961 and 1962 the decrease was less than 1

percent for the reporting of new active cases of tuberculosis in

the United brates.
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I would be the first to admit that I am not fully acquainted
with all of the subtleties which are required for a complete
understanding of the problem of tuberculosis control. This factor
probably accounts, at least in part, for my impatient attitude
toward the lack of progress that we have been making in recent
years. The fact that I am an impatient man by nature would help
to account for this fact also. Nonetheless, it seemed to me, and
on this point I agree with Congressman Laird, that there was
entirely too much waste. Waste of human lives, waste of time,
wake of tax dollars, and all on a disease which is unnecessary.
Again -- I would be the first to admit that I didn't know the
reasons for this lack of progress, but If was greatly concerned
that it might be due to an apathetic view coward a serious health
problem and a misuse of the potential which is ours.

Now, there is a natural tendency to say: "There ought to be
a law." But tuberculosis can't be legislated out of existence.

L accept the fact that it is the God given right of a man to die

of his tuberculosis if he so chooses. I do not, however, recognize
any such right to transmit tuberculosis to some unsuspeting

yietim. I have been concerned by the fact that with an inadequate
program we were allowing the transmission of tuberculosis to the
unsuspecting, creating in that act a personal tragedy and forcing
that person to accept a health liability for the remainder of his

Life -~ that of possibly developing active tuberculosis and perhaps
cf dying, from this unnecessary disease.

I agree completely with the previous speaker in his statement
that the health interest of the people of this Nation surpass the
political interests of any party. Whether it be Democratic or
Republican administration, I believe that all possible should be
done to protect the health of American citizens. Becaus of this
firm conviction, I have not been satisfied with efforts to
eliminate tuberculosis as recommended by both Democratic and
Republican administrations overthe past four or five years. Hach
year, I have reminded representatives of the Public Health Service
that, according to the information provided to our Subcommittee,
it was possible to reduce tuberculosis to the very minimum if not
to eliminate it. I asked whether or not such efforts were being
made. Hach year the answer was the same: “No.” -- that greater
effort would be needed if this accomplishment was to be realized.

it seemed to our Committee that the facts at hand, the knowledge
of the possible in relation to the eradication of tuberculosis,
simply did not jibe with the rate of progress. I too am not an
expert in medical matters. But it seemed to me that the time for
patient waiting was at an end ~~ that the situation called for
more affirmative, more agressive action. This is what Lead me to
suggest that our Subcommittee recommend to the Surgeon General

the appointment of a Task Force of persons expert in the field
of tuberculosis control to study this situation and to meke
recommendations as to the next steps required to bring about
the elimination of tuberculosis.

it is interesting to note that in the time intervening between
April, 1963, when this recommendation was made to the Surgeon
General, and the present there has been a considerable amount of
thought and activity relative to this same desired end. For
example, in the fall of 1963, and at the meeting of the Southern
Tuberculosis Conference, Dr. Lemaistre addressed that group on the
subject of “Tuberculosis Eradication -~ What Price?" He spoke of
the need for @ new approach if we are to eliminate tuberculosis
and the fact that this new approach required the use of all
present component segments of our tuberculosis program with better
organization and better administration. “There was also a comprehen-
Sive survey with a consequent report made by the NTA and the Public
Health Service relative to areawide planning of facilities for
tuberculosis services. Our ‘Committee was informed also of the
fact that your Association's Committee on Guidance for Tuberculosis
Programs, after lengthy study, brought forth a number of
recommendations, of objectives, of premises, which are strikingly
similar to those recommended by the Task Force appointed by the
Surgeon General. All seem to agree that prevention of new infection

is the primary basis currently available for increased acceleration
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in the decline of tuberculosis -- that a campaign which will
contain the tubercle bacilli where they are now is an absolute
must in any eradication program.

Before dealing with the specific recommendations of the
Task Force, I*d like to make just a comment or two relative
to the problem which confronts us. Congressman Laird has
outlined in some detail, statistics which indicate the propgortions
of this problem. Some of these figures really scare you <= at
least they scare me. The thought of 64,000 unhospitalized
patients with active tuberculosis that we know about to say
nothing of the number of persons with active tuberculosis that
we don't know about is a situation which I believe calls for
affirmative action. And then when I read the Task Force's
projection that if we continue our present program that at the
end of ten years, we will still have an approximate 39,000 new
active cases ~- 70 percent of the present number ~- this doesn't
seem a cause to rejoice.

I prefer the outlook approximated if the recommendations
are put into effect -- the reduction, for instance, of 97 percent
in relapsed cases. And I am most intrigued and encouraged by one
bit of testimony given to our Committee by Dr. Goddard of the
Public Health Service who, when testifying about the financial

savings which would accrue to the Nation, stated that this would
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amount to 1% billion dollars in a 10-year period. As I told
members of the House =~ not to accept these recommendations
would be a tragic example of being penny wise and pound foolish.

Now, I would like to refer to the specific recommendations
which have been made by the Task Force. I agree with Mr. Laird
that this campaign calls for the joint contributions of the
Federal Government, State governments, local governments, and
of tuberculosis associations. It seems to me that the Task Force
has taken this into consideration and has in factmentioned in
their Report the specific contributions which might be available
from these sources. I can in no way judge qualitatively the
recommendations which are made as to how long an unhospitalized,
inactive case should be followed or precisely which person or
groups are at particular risk of contracting this disease. You
most certainly are in a better position to make a judgment upon
this than I. It seemed to our Committee, however, that the
recommendations provide a pattern == an organized method of
approach which could be applicable throughout the entire United
states. Available too are yardsticks against which to measure
accomplishment and progress.

Most certainly, it should be possible to tell whether or not
tuberculin tests are given to all children entering school and to

all 14 year olds. It should be possible to concentrate upon the
further examination of positive reactors to this test and
associates of these reactors. It should be possible to
accurately record the precise number of school teachers and
school employees who are examined. Tt should be possible to
know specifically how many of the persons routinely admitted to
public hospitals in cities of over 250,000 population do actually
receive x-ray examinations. Certainly, we can tell whether or
not the recommended six teaching fellowships in tubercubsis have
been established in medical schools. Certainly, we can evaluate
Whether or not there are added opportunities provided to physicians
and other professional workers to bring their knowledge of
tuberculosis up to date. Certainly, we can watch carefully and
judge the progress made in the recruitment and training of persons
for assignment to States to work in tuberculosis control activities.
i personally think it very important that the recommended
central service for records and the use of automatic data processing
equipment should be begun without delay. If we are to commence this
total effort on a nationwide basis, it seems academic to me that a
central reference for the information needed relative to cases,
status of disease, and the other important medical data is imperative.
in these days of extremely rapid and incessant mobility by our
population, it is naive to consider the possibility of maintaining
this kind of information on anything other than the most sophisticated

electronic systems available.
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And on.one other point -~ the recommendation relative to
increased activity on applied tuberculosis research, particularly
that having to do with epidemiological studies -- I am not
unmindful of the fact that it was the recommendation of your
Committee, made through Dr. Shipman and Dr. Pfuetze, that in
their opinion the amount suggested by the Task Force was probably
below the minimum necessary. Quite frankly, I wish that our
Subcommittee and the House could have been a bit more generous
relative to both this item and some of the other points which I
have just enumerated, and by these I mean all activities recommended,
not just the grants needed to accelerate the actual control program.

As I have read the Report of the Task Force, and as I have
studied some of the other material which has been available
recently, I have been forced to accept grudgingly some of the
disappointments of the past six years, and I have learned to have
an increasing respect for the formidable adversary which is the
disease, tuberculosis. I am willing to admit that perhaps I have
been a bit too impatient. I am not unmindful of the progress since
Koch and Reantgen. Nor am I unmindful of the contributions that
many have made. But I agree with my colleague, we cannot be
satisfied with the present rate of progress if it is possible to

accelerate that rate of progress. I am proud of the part that our
Subcommittee had in the initiating of this blueprint for action.
Zam proud of the contribution made by the Task Force itself, both
in their study and in their recommendations. Sut this is simply the
start.

Through the next several years our Subcommittee, I can promise
you, is going to keep a close watch on the progress of this program.
You are in a much better position than we to make sure thet it does
succeed. Surely if in the tenth year of this campaign there are
more than the 22,000 newly reported active cases projected by the
Task Force, I will not say that our efforts have been without successe
But if after ten years the record shows not @ great deal of improve-
ment over our present campaign, which to my mind is too accurately
described as one of attrition, and unless results are evident to
indicate that we have greatly accelerated our efforts, I will be
extremely disappointed. In its Report, the Task Force stated that it
refused to accept as inevitable a continuing delay of progress
against tuberculosis. I share this view.

I promise you now that I shall co everything within my power to
support the program as recommended in this Task Force Report unless
and until there is evidence of a better method. I ask that each of

you give of your best efforts in this all-out campaign. Thank you.