Interview Transcript
Interview
Dr. Francois Marc LaForce with Interviewer Chris Zahniser
Transcribed: January 24, 2009 | Duration 0:41:18]
Interviewer: This is an interview with Jack[sic] LaForce on July 11,
2008 at the Centers for Disease Control and Prevention in
Atlanta, Georgia, and it's about his role in the Smallpox
Eradication Project. The interviewer is Chris Zahniser.
With this interview, we are hoping to capture for future
generations, the memories of participants and their families,
involved in eradicating smallpox. This is an incredibly
important and historic achievement and we want to hear about
your experience. I have some questions to guide you, but please,
feel free to recount any special stories or anecdotes that you
remember about events or people. The legal agreement you signed
says that you were donating the oral history to the U.S. Federal
Government and it will be in the public domain. For the record,
could you please state your full name and that you know that you
are being recorded.
Francois LaForce: My full name is Francois Marc LaForce. I do know I'm
being recorded and I agree to this.
Interviewer: Thank you very much. Thank you for coming and sharing your
stories about the Smallpox Eradication Program with us today. I
guess I'd like to start by asking you to talk a little bit about
growing up and how you became interested in the health field?
Where you went to college? What you thought you might want to be
when you grew up? How you got into all of this?
Francois LaForce: Sure. I was born and brought up in the State of New
Hampshire and my father died when I was quite young. I was about
13 years old when my father died. We were a large family, six
children with a mother and not much money. So everybody went to
work. One of the positions that I started working at was in a
drug store, a local drug store, and that was my first initiation
into the health field, a drug store called Precourt
[inaudible0:2:21] Pharmacy in Manchester, New Hampshire, and
worked there from the time I was probably 15½, and on for maybe
the next 10 years while I went to medical school college et
cetera. I think it was that experience that brought me into
contact with people who were ill, people who needed help,
counsel in terms of medical issues and I became progressively
more interested in the field. I went to College at Saint Anselm
College which is a Benedictine Liberal Arts School in
Manchester, and decided to major in Chemistry. I became very
interested in the Sciences and as I finished college, I started
putting things together in terms of individual career plans and
I thought that perhaps medicine might be a way of meeting some
of the needs that I had, needs in terms of a science; these were
all areas that I enjoyed and I did quite well with in school. At
the same time I felt that I really wanted to have a human
element to my career. When I say a human element, I have always
enjoyed the challenge of helping people and so - and I make no
bones about that. This is one of the driving forces that makes
me "me". So putting all of that together, in my last year
decided, instead of going on to Post Graduate work in Chemistry,
to apply to medical school. I was accepted, went to medical
school, started in 1960, finished in 1964 and after, did my post
graduate training at a large city hospital in Boston, that is
the Boston City Hospital which at that time was 1000-bed Public
Hospital for the poor and the disadvantaged of Boston. I was
fortunate to be in a wonderful teaching service called the
Harvard Teaching Service. The second and fourth medical service
and spent two very happy years as an intern and first-year
resident.
But this was Vietnam. This was the era of Vietnam and every
physician was in the military functionally; and initially I had
been drafted into the air force and Dr. Charles Davidson who was
one of the leaders in the medical service at the Boston City
Hospital asked that if I could postpone going into the service.
In other words, he didn't ask me, but he basically said, would
this be acceptable if I postponed going into the service if he
asked whether the Centers for Disease Control would have a
position for somebody like myself; so through a very curious
chain of events, I ended up coming to the Centers for Disease
Control here in Atlanta in 1966, never having traveled further
South than New York because I was in medical school in Jersey
City. I didn't know much of anything, but I do know that one of
the questions somebody asked is, "Do you like to travel?" Well
never having traveled, I answered the question, "Yes. I'd love
to travel." So they said, "Well, this is probably for you." So I
ended up here and I spent two years as an Epidemic Intelligence
Service Officer and quite soon found myself in a variety of
environments that I found terribly interesting including a month-
long assignment South of the Mekong River doing malaria work for
the then Malaria Eradication Program. I really enjoyed the new
culture, all the challenges that were associated with the Thai
culture. Later, I guess it was 1967, there was a plague epidemic
in Nepal, about 40 miles South of the Chinese border and I soon
found myself being helicoptered across the Himalayas into an
area, a desolate area in the middle of the mountains where
people were dying of this unknown malady.
Then I was very fortunate on that trip, Phil Brochman, who was
the head of the epidemiology group, was really my mentor and I
owe Phillip an enormous amount - that trip was also very
formative because it taught me that I could pretty much work in
almost any environment. Really, that didn't bother me one way or
the other. I mean, floors were as good as a bed; that was never
an issue. So I finished my EIS training, went back to Harvard,
finished my clinical training in infectious disease but kept a
very strong working relationship with the Centers for Disease
Control, particularly Phil Brochman and the EIS program. Phil
approached me; it would have been probably in either the summer
of 1974-and said that there were some issues with the Smallpox
Eradication Program, there were problems as far as the India
program: new outbreaks, and would I consider lending a hand as a
smallpox officer; and it meant going overseas for three or four
months at a time. I thought it over and talked it over with my
wife and decided to accept that challenge and left for India. It
would have been probably either the 30th or 31st of December of
1974; such that I was in India either the 1st or the 2nd of
January 1975; and at that time smallpox had broken out in a
major way in Bangladesh. So working in Delhi, I met Stan Foster
and Stan was the head of the Smallpox Eradication Program in
Bangladesh; and he said, "Marc, why don't you come over and work
with us?" So he talked with the people in Delhi and before I
knew it, Nick Ward, Stan Foster and myself were on a plane; and
I bet it wasn't 24 hours after I got there-I was on a plane
going to Dhaka. So I landed in Dhaka and spent probably two days
being "briefed". Now I would point out to you, I didn't know
anything about smallpox at that time. I knew a fair amount about
a lot of other diseases, but I remember Nick Ward saying, "You
don't know anything about smallpox? You come with me."
So he brought me to the sort of local hospital. We went through
the clinical manifestations of it, and at the same time, he's
telling me about the epidemiology, what the challenges of being
a field worker were, etcetera, etcetera, etcetera. There was an
opening in the Northern part of Bangladesh, a place called
Kurigram Subdivision which is close to the end of nowhere and
Stan basically said, "Look there's a gap, there's a major
epidemic that's going on in this area. The officer has just
left. We'd like to send you up there." So, that's how I ended up
in the Kurigram Subdivision, and to get up there, required a
plane flight to a small local airport and then somebody getting
on a land rover and then getting to this river and then the land
rover being put on two boats that are lashed together and then
the boats going across this fairly wide river and you're on it.
So we'd get to the other side and that's the Subdivision. There
were no roads. It was essentially a land rover and these muddy -
they weren't muddy, this was the dry season, but what the
remnants were of the bullet cart roads.
Interviewer: Did you have a team that you worked with?
Francois LaForce: Yes - When I first went over there was no team. I
was just sort of brought there and introduced to Dr. Rouff who
was the Bangladeshi Medical Officer who was there; and that was
pretty much it. I was very lucky in that there were some
Missionaries there and they offered to house me. It was part of
a compound and they were Missionaries. Maybe they weren't
exactly Missionaries, but they were part of a group called a
Rongpur Rajpur or no, I'm sorry, Rongpur Dinajpur[0:13:04]
Rehabilitation Project. But they had a series of huts that were
on a compound and one of the huts didn't have anybody and they
offered to sort of let me use the hut. So I was very lucky. I
ended up with a hut. Then it was necessary to figure out how
much petrol there was because there's nothing. Everything you
brought over, you brought over yourself and I soon found out
that there wasn't very much petrol; that I needed to obviously
get an interpreter, and there was a driver that was there and
that was pretty much it.
Interviewer: Did you have a Bangladeshi medical counterpart?
Francois LaForce: Yes. The medical counterpart was Dr. Rouff.
Interviewer: Okay.
Francois LaForce: But he also had many, many other administrative
functions and I soon found myself on my own with the interpreter
and my driver, and we essentially became a team for the next
three months.
Interviewer: How did you go about identifying an interpreter?
Francois LaForce: Well, I asked around and it was a young man whose
father had been an administrative type who had worked under the
British Raj when the British were there. So he had managed to
make sure that his son knew some English. I was introduced to
the son and the son was - I don't think he was much more than
maybe 17 years old, but he certainly knew Bangladesh, and he and
I had no difficulties at all exchanging information in English;
and so, what I then did, I trained him to sort of work with me
in terms of the smallpox, or the needs of a smallpox medical
officer.
Interviewer: How did you go about identifying the cases that were
occurring?
Francois LaForce: Cases were easy to identify. Smallpox is such a bad
disease.
Interviewer: How about getting the reports to you? Was that hard?
Francois LaForce: Ah! Yes; that was very hard, under the normal
circumstances, there was a surveillance team that was based in
Kurigram and the surveillance team had these small motorbikes,
and of course I was the provider of the petrol for motorbikes.
So I was the supply sergeant as well as the gas station
attendant to make sure that none of it disappeared for other
things. If you can imagine, it all became part of a daily
routine. As you know, part of the - or the most important issue
in managing smallpox outbreaks is No. 1, recognizing the cases.
Once you recognized the cases, then you can put into play what's
called ring vaccination or you can establish a perimeter around
these cases so that that perimeter is all immunized; so that
there are no cases, or no disease can spill over outside of this
perimeter. In order for this to work, you've got to get there
quick, you've got to identify every single contact that that
individual had when the individual was potentially infected; and
lastly, you really had to organize yourself to make sure that
everybody is immunized. So it meant that when you came into a
particular village, you had to get a lot of information fairly
quickly and part of the magic of creating this team, is we got
very good at who would do what, in terms of: 1) there was a map
that had to be drawn to figure out exactly where we were and
which huts, etcetera, etcetera. Secondly, the contacts had to be
done and if there were contacts that had left the area, you then
had to notify the district where the individual had gone. The
only means of communication that we had was this radio that you
could hook onto the car battery and that's what I - you had to
take the car battery out everyday just to sort of make sure that
we could communicate across not only to Dhaka - and Andy
Hegel[inaudible0:17:41] who was there then served as the
connector with all the other areas in Bangladesh.
So once you did all of that, if you did your work properly, you
were able to carefully identify all the cases and quite soon the
individuals that you had vaccinated you could see evidence that
they had been vaccinated. So you usually stayed in the area long
enough to make absolutely sure that you were satisfied that this
was okay. You then hired one or two house guards because there
had to be house guards in order to make sure that no one would
come to see that particular individual unless they had gotten
immunized. So you left vaccines with that individual and you
paid them a little bit of money to actually serve as house
guards. So you had to recruit young kids, or somebody you ended
up having to recruit within the village as well as speaking to
the village elders and explaining exactly what this is all
about; and if you did not do that then you did not get very good
cooperation. After a while you develop almost a sixth sense, you
know, was I really smooging[0:18:55] or communicating with this
individual, and if I was, chances are everything was going to go
well. So once that was set up then it was a question of
responding to all the rumors, because there might be a runner
who would come from village X, Y and Z and say there's a new
rash illness in a young boy or an old man or something like
that, you need to come see. So that was sort of the information
package that we had.
Interviewer: How did you divide up the roles? Sounds like there were a
lot of tasks going on and it was basically you, your interpreter
and your driver. What exactly did you do and then what other
responsibilities did the other two individuals have?
Francois LaForce: I did pretty much everything. As I said, we matured
as a team; Zoha was the name of the interpreter, the young boy
then became very good as we went into a village, of making sure
that I saw the right village elder, that he brought all the
people around, and he did all the explanations; and I understood
a little. You find, after a while, that you can understand some
Bengali, but clearly he knew exactly how it was done and we'd
sort of rehearsed it, that these are the important points that
we needed to - and he was a very, very clever young man. The
driver really made sure that the transport stuff was okay, and
the driver always had tea with all the other individuals, and he
was essential the spy-I won't say spy, but he was sort of the
intelligence officer for us. He just smooged[inaudible 0:20:46],
he spent time in the village, etcetera; then he'd come back and
he'd say, "It was fine, there are no problems. This man is
having a little trouble with this, you may want to go see him
individually." Over a period of time it probably took three or
four weeks for all of this to gel, but when I first got there,
there were a lot of cases. I mean a lot of cases, all over the
place and we worked from morning till night just trying to keep
up with cases and with the stuff that had gone on, and I didn't
feel that we really mastered that situation until probably well
into the second month. But by the second month all the old cases
were then either had recovered, or died when that was all
finished, and we were now managing the sort of new stuff and I
was very proud of what we were able to get done.
Interviewer: Were you going back to your hut each night, or were you
needing to [crosstalk0:21:53]?
Francois LaForce: Sometimes I did, sometimes I - you slept pretty much
wherever you ended up. If I was anywhere near, I would try to
come back to the Missionaries' hut in Kurigram, because I did
want to make sure that I had a shower, because it was so dusty
and so dirty that essentially I showered with my clothes on. I'd
just walk in, and usually they had to pump the water up, because
there was never any water that was above, and that took a while
to make sure there was enough water, and I was the lucky one
because they had set up a sort of shower and at least all I did,
I just showered with my clothes on and then took my clothes and
then washed them as I showered. Then hung things out in the room
for them to dry, and had an old kerosene burner, and I usually
kept the rice and just cooked whatever was around: vegetables,
and whatever, and rice.
Interviewer: When you were going into the villages and you found a
case, and you were immunizing the family members and the people
in the neighboring houses; were people receptive to you in
taking the vaccine, or did you ever have any problems or any
challenges in that situation?
Francois LaForce: Not often, I think most of the people were really
well aware of smallpox, guti bifunto[inaudible0:23:33] is what
they called it, and no one liked this disease because it marked
you. It's like George Washington, that's why his face was the
way it was. People didn't like smallpox, so we didn't have -
occasionally you had some young guy who really was unhappy with
this, that or the other thing, and gave you a little bit of a
hard time but that wasn't very often. I think for the most part
- and the Bangladeshi's are wonderful people. Oh my God! They
really went out of their way to help you; I really have
incredibly warm feelings for them. But you asked in terms of the
accommodation, if we were a ways out, like way in the North in
la Munajad[inaudible0:24:11] or something like that, chances are
you just sort of - if there's an administrative place, like a
health officer place, usually you could put two tables together,
and you just inflated a mattress, and you put a mattress on top
of the table and that's where you slept. That wasn't that
unusual, I slept in a car a couple of times, the car was a land
rover, I used the land rover a couple of times, not
preferentially but it was that you never had anything else to
do.
Interviewer: How much time did you need to walk back into the villages
compared to driving?
Francois LaForce: Actually some of the times, because some of the
outbreaks - that's an interesting question. We were in a place
called the Chars or the riverbed of the Brahmaputra River. They
had just finished a famine also on top of all of this. That was
one night I'll never forget that as long as I live when I saw
the rats run. There was no food in that area, just no food. The
famine had come in 1975, or the floods had come and they had a
bad yield the year before and then this swept it away, so there
was really very little food; and I remember one night just
literally seeing this carpet of rats just leaving the area. It
was the most amazing thing I've ever seen. Coming back to the
story about the Chars and walking, the Chars had this very, very
sand, extremely fine-finer than beach sand, and so once you got
even a land rover stuck in there, you could usually work it out
with a winch and stuff like that to get it moved out, but it was
such a pain in the neck, that basically I would say we might as
well walk it. So if you had epidemic areas that were like what
we saw on these islands, or something like that; that was in the
Char; it was most of those you walked to. It wasn't that bad, it
wasn't that bad at all because the time of the year was during
the dry season, and I didn't find it uncomfortable at all.
Interviewer: Were you there during the wet season also?
Francois LaForce: No. No! I left just before the wet season began. I
always remember that, because the last night I was there they
had a huge rainstorm.
Interviewer: Were you in Bangladesh then for three months or
longer than that?
Francois LaForce: Yes, yes. It was a little over three months, and
then went back to the U.S. and I had a lot of trouble
readjusting to the United States after that. First off, I never
used a knife and a fork while I was over there. You just get
used to using your hands for everything, and I came back I must
admit, my wife thought I was crazy. I really was a little nutty.
Interviewer: Did you have any problems with the food or the
water?
Francois LaForce: No. I could always buy enough rice, as long as I had
rice and tomatoes you could make it. I lost 15 or 20 pounds
during that particular exercise, but I spent a lot of the time
alone; but there was the other smallpox team across the river,
and I would go across that river where we had our own regional
meetings, and stuff like that. Then when we all met there we all
ate at restaurants, I mean a local restaurant, and had food
there. It wasn't bad.
Interviewer: You had mentioned earlier about needing to be careful that
people didn't steal the petrol, and I'm wondering: How you
monitored that and did you have episodes where you needed to be
very concerned about other things disappearing-supplies? Or
cautious about security, or the police or anything else in the
areas where you were?
Francois LaForce: Yes and no. Mostly the answer is that I really
wasn't that concerned. First off I'm a pretty big guy and I was
older than the rest of people, I was over there when I was 35
years old, so I wasn't a 24, 25 year old kid, I was already
pretty grown up, and so no one actually ever hassled me. How you
kept track of it, is the old British way. I had a long stick and
you marked it, and you put it into these barrels, because that
was what you did. You basically - I lugged over those 55-gallon
drums, that's how that stuff came over. So for every trip that I
made after that we had at least two barrels and then I had it in
a locked area, and I had the only key so they provisioned
themselves on that basis. Then after a while you get to know
people, people who are very honest. I didn't have any
difficulties.
Interviewer: Changing the subject a little bit.
Francois LaForce: Sure.
Interviewer: Dr. Foster mentioned that you kept a diary when you
were there.
Francois LaForce: Yes, when I went over there I decided that this was
so different, the country, everything was so different to me.
This was so different from Thailand, quite different from Nepal,
because Nepal was in the high country. So I did, I meticulously
kept a diary every single day, after I came in, showered, had
something to eat, I had a kerosene lantern, this was like Abe
Lincoln. I lit the lantern and sat down and wrote my diary as
well as a letter to my wife and kids, then once a week I tried
to get the letters posted. But I kept a diary, and then when I
went back to the United States I had my secretary transcribe it,
and then I'd put pictures in that particular diary, and then had
it bound by a German bookbinder, because I wanted this to be in
my library. My personal library, this was the piece. I didn't
share it with anybody. I didn't share it with anybody - the only
person who knew I had a diary was Stan Foster, and subsequently
I copied the diary and I sent a copy of that diary to Dave
Sencer.
Interviewer: Oh! Wonderful! So it will become part of this
history.
Francois LaForce: Yes, it is a part, and everything that I've told you
is in that diary.
Interviewer: Thank you. Are there other memorable events that occurred,
things that especially just stand out in your memory?
Francois LaForce: Yes, I was getting ready to leave - it was my last
trip to Dhaka before I went back up country and in those days
the smallpox medical officer, was what I call the Bagman. The
bagman meant you had all the money, and so all these people that
you had to pay, and you had to, so many people, the workers who
were doing the immunizations, and all that sort stuff. So you
had to do all of that, you had to maintain Imprest Accounts, and
a certain amount of money was given over to you. I always
carried it in my satchel, and I remember my last trip into
Dhaka, before I went up country, they had identified somebody to
replace me, a young man coming from Norway, and: Oh God!
Everything was fine, we had no new cases, I think I was down to
one case for this whole area of three million people, and I
really was on cloud nine and so I flew up there, and I remember
going to a hotel. There is one InterCon hotel in Dhaka at that
time and I remember saying I'm going to splurge, I'm going to
buy a beer at this InterCon hotel, and I went back up country,
and I was only going to be up there for two days to make this
transfer, give this guy my kerosene burner, show him all that
stuff and get him introduced to the Missionaries, so he had a
place to stay, and everything was going to be alright, then my
driver runs up to me and he said, "Your money no good." I said,
"What!" The Government of Bangladesh had decided, because of all
the currency problems they had had, to discontinue honoring
Hundred-Taka Notes. I had a satchel full of One Hundred Taka
Notes to pay my people.
So here I was with money that was no good up country. So I said
I've got to fly back with the satchel. I made my way back and
was able to put some money together with small notes that people
had, so I put all of that stuff together and then got off the
plane, and only this time when I got off the plane, police were
there; and the police were specifically there to catch the money
smugglers. In other words, those people who were trying to bring
money back in before the deadline. I think I had two days to
turn the money in, or else the money was worthless. So I showed
up and all of a sudden got brought into a back room and I have a
satchel-I don't know how much money I had, maybe Thirty
Thousand, Forty Thousand Taka in notes, and then with a couple
of guys with machineguns and then, he was just like this; and I
said, "What on earth is going on?" This was a little nerve
wracking until finally, I said I'm with WHO; and they say, "We
don't know anything about this stuff, you are a smuggler, you
don't have your other papers." I didn't have any other papers, I
never use papers when I was in Bangladesh; everybody knew who I
was.
To make a long story short, I was allowed one phone call, and I
made the phone call and I've forgotten the name of the guy that
I got, but I got one guy at the Smallpox Office who actually
came down and straightened it all out. I'm not exactly sure what
he did -
Interviewer: Wow!
Francois LaForce: But all I know is that I got out - and I didn't get
out with the money.
Interviewer: The money stayed there?
Francois LaForce: The money stayed there, but he got all the receipts,
he got everything that was needed and I was okay. But I thought
that was a very, very strange event; and it took the better part
of a day. I thought it was a wonderful lesson to me in terms of
saying: Oh, everything is fine, we've done this great job,
everything is fine; and the next thing you know is that I have
these police officers with a couple of machineguns that look
pretty serious and there was a lot of money in the bag.
Interviewer: Right.
Francois LaForce: You know-it was like one of these movies.
Interviewer: You were lucky to walk out of there, I think.
Francois LaForce: No, I would say the other part of it was being able
to experience in a profound way, a culture, a people, who were
desperately poor but proud, industrious, intelligent-they taught
me an enormous amount. They taught me a lot about myself. We
have these strange fantasies about ourselves: we're wonderful,
we are great, we're not; and as I told Stan Foster before I
left, the experience there taught me that I'm not as nice as I
thought I was. I think that sort of insight has been incredibly
useful to me.
Interviewer: Were there times that had to - when you say, not as nice
as you thought: that you had to be more directive, or -?
Francois LaForce: Yes, I jailed people.
Interviewer: For not getting vaccines?
Francois LaForce: No. I had a bunch of people who had smallpox and I
had no way of controlling them because they were a bunch of
kids, so what I did, I found a jail, in this town that had this
jail in it, and I jailed them all.
Interviewer: [crosstalk0:37:43]
Francois LaForce: You know, it was a way of quarantining it, but I'm
not sure I'd want to talk to a Human Rights person about that
kind of stuff. That's why these are obviously insightful things-
I almost felt towards the end that this was a military campaign,
that's how this was approached. That these were essentially
Military Rules: expediency, getting the job done, getting this
done, getting that done, and then working it out. I tried to be
kind, but sometimes I wasn't.
Interviewer: Sometimes you couldn't be. I feel like I could keep you
for another set of hours.
Francois LaForce: I think there is one other thing that is worth
reflecting on, that experience was so profound for me that I've
never left international health after that experience. I then
took a sabbatical and joined [inaudible name 0:38:45] Henderson,
and as one of the Charter Members of the Expanded Program on
Immunization, Stan Foster and I worked together through the 80s
for combating Childhood Communicable Diseases Program in Africa,
then I continued international activities that have been
finished over the last ten years: developing a Meningitis
Vaccine for Sub-Saharan Africa.
So I think back, and I'm not sure that ever would have happened
to me have I not had the type of experiences that I had in
Bangladesh. We are so fortunate, as Americans, particularly. We
are so fortunate with the freedoms we have, with the wealth that
we have-I just felt there had to be some way either to repay, or
acknowledge all of the comforts that had been afforded to me and
my family-and my family.
Interviewer: It sounds like you've just had a fabulous
experience.
Francois LaForce: Absolutely.
Interviewer: You answered my closing question, which was going to be;
how has this affected your continued career in public health? I
think you just did a very nice summary.
Francois LaForce: Very dramatically.
Interviewer: Absolutely. Absolutely-it's just one of those unique
experiences, even though it sounds like you were a little bit
older than many of the people that were out on the Smallpox
Eradication Campaign, but it still directed you very clearly, to
do other international, global health activities.
Francois LaForce: That is correct-that is correct.
Interviewer: Anything else Marc, before we stop?
Francois LaForce: No. No. As I've said before, I consider that time an
extremely formative time for me and something that I will always
treasure.
Interviewer: Well, thank you very much. Thank you for spending the time
and sharing with us, memories of your experience in Bangladesh.
Again, it sounds like an incredible experience and certainly a
part of the legacy of CDC. I know you were proud to have been
involved in the eradication efforts.
Francois LaForce: Absolutely.
Interviewer: Thank you.
Francois LaForce: You are welcome.
[End of audio - 0:41:17]
Mark LaForce Oral History
June 11, 2008
Dr. LaForce describes his experiences as an epidemiologist in Bangladesh in 1973
