Washington's tuberculosis rate, the second-highest among American cities last year, rose even higher during 1980.

So far this year, 327 new cases of TB have been reported -- one more than the total for 1979, according to Dr. Hazel Swann, chief of the District of Columbia's TB control program.She predicted the total would swell by 50 more cases before the year's end.

Swann told doctors at a D.C. Medical Society symposium yesterday that the city's TB rate -- nearly four times the national average -- has fluctuated from year to year but has stayed consistently high over the last two decades despite a steady decline in tuberculosis nationally since the introduction of drugs that cure it.

She blamed deficiencies in the city's TB control program, and the failure of private doctors to report tuberculosis cases, for the fact that the potentially fatal illness is still out of control in Washington.

The city's tuberculosis victims "are disenfranchised black males," she said. "They are people who do not work, who do not vote, and nobody really cares a damn about 'em as a matter of fact.

"Not only are these the people who have TB, they are the people who have problems with chronic alcoholism. They are the people who give us in Washington our tremendously high rate of cancer, hypertension and death from chronic diseases," she said.

Tuberculosis is an infection of the lungs or other organs with a hardly bacteria that can persist for years in a dormant state, then reactivate to produce fever, coughing, weight loss and other symptoms. Eradicating it depends on finding patients with active TB and testing those who have been exposed to them for evidence of an early, silent infection.

Both active TB patients and those whom they have infected must then take antibiotics for between nine months and two years. Swann said this necessity makes the disease a challenge to public health workers, since many urban TB patients have unstable homes and no regular doctor, and may place a low priority on medical care.

Swann said that 85 percent of the District's TB patients are treated in private hospitals or doctors' offices and that, despite a law requiring doctors to report cases, many do not do so. This month, to track down unreported cases, she asked D.C. governemnt pharmacies to supply the names of private doctors' and hospitals' patients who had begun getting free TB drugs at the public pharmacies during October. Of the 47 TB patients, only seven had been reported to the health department, even though 10 unreported patients had been taking medicines for more than a year, she said.

However, Swann said reporting of tuberculosis has improved in the last year, and may partly explain the increase in cases. She said the influx of refugees contributed almost nothing to the 1980 total. This is because Indochinese refugees, who account for 2.2 percent of new cases nationally, have not settled within the District in large numbers, while Cuba -- the other source of refugees newly arrived in Washington -- has one of the lowest TB rates in the Western Hemisphere.

Swann said pockets of tuberculosis have persisted for decades in certain neighborhoods, with the highest TB rates always occurring in Wards 1 and 2, downtown and other parts of Northwest Washington, and Ward 5, a section of northeast Washington containing several large housing projects.

"On North Capitol Street, on Seventh Street, on 11th Street, on Kenyon Street year after year after year we get a high incidence of TB," she said.

She faulted the city's control program, which she took over in mid-1979, for not following through diligently to ensure that patients stayed on medication, and for not using the most up-to-date drugs.

She said treatment in the city's TB clinic has been modernized, and TB workers who had been sent firing notices in September as part of cutbacks in the Department of Human Services have since been reinstated by the department, following publicity. The program's 1981 budget will allow Swann to hire three more nurses to improve monitoring of patients.

Swann urged private physicians to report tuberculosis, saying that without such cooperation the city program would continue to fail. "I believe that the reservoir of tuberculosis can be eradicated in the District of Columbia," she said.