The exact number of lepers in the United States is not known at the present time, but in 1913 an investigation conducted by the United States Public Health Service by correspondence located definitely 146 cases of leprosy in the continental United States. The bulk of these were native-born Americans. The ostracism to which lepers are subjected frequently results in their interstate travel, thus placing them within the jurisdiction of the General Government, and constitutes a menace to the health of American citizens. I therefore respectfully repeat the recommendation made in my annual report for the fiscal year ended June 30, 1914, and urge upon Congress the necessity of enacting a law embodying the principles embraced in the act (H. R. 20040) passed by the House of Representatives February 24, 1915.

National quarantine.

In the interests of the public health, and for reasons hereinafter stated which are of especial importance at the present time, it is desired to recommend that the system of national quarantine should be made complete by the acquisition of the few remaining quarantine stations under State or local control.

Congress gave sanction to the national control of quarantine when it passed the act of February 15, 1893, containing in section 8 thereof the provision

That whenever the proper authorities of a State shall surrender to the United States the use of the buildings and disinfecting apparatus at a State quarantine station the Secretary of the Treasury shall be authorized to receive them and to pay a reasonable compensation to the State for their use, if, in his opinion, they are necessary to the United States.

Apart from this provision, the Treasury Department has consistently taken the stand that the prevention of the introduction of quarantinable diseases from foreign ports into the United States is essentially one of the functions of the National Government.

Between the years 1888 and 1915 the quarantine function at 67 different places has been transferred to national control. It has been proven that as a result of these transfers economy, efficiency, and uniformity in quarantine procedure have been realized. At the present time the only ports where there is no Federal quarantine are New York and Baltimore.

At no time within recent years have the so-called epidemic diseases prevailed throughout Europe to the extent they are prevalent to-day. During the fiscal year just passed cholera has traveled into the Balkan territory from Austria-Hungary, and probably from Turkey into Austria-Hungary. The disease has traveled from a number of points in Russia to the prison camps in Germany and to 23 localities in Silesia; also to Brandenburg, Posen, and Zirka.

It

has also been reported near Venice and Leghorn and at Palermo, Italy. Plague and typhus fever, as well as cholera, are also reported to have been spreading steadily, although because of meager sanitary reports now being received from Europe, it is difficult to determine accurately the extent of the infection.

With the increased tide of immigration that is certain to follow the cessation of hostilities abroad the prevention of the importation of these diseases will become a matter of vital importance. The principal gateway for immigration to this country is the port of New York. Here the Federal Government administers the customs and immigration laws, even to the medical inspection of arriving aliens, yet the quarantine regulations are made by the State authorities, and the National Government has nothing to do with restricting the entrance of quarantinable disease, although by far the greater part of this incoming traffic passes on into all sections of the United States, and the question of disease prevention through this port becomes essentially a national question.

It should also be mentioned that the United States is a party to two general international sanitary treaties, to which practically every nation of the world is signatory. Under these treaties international quarantine regulations have been formulated, and to render compliance with these regulations uniform throughout the United States national control of all quarantine stations is highly desirable.

Nor should it be forgotten that the present national quarantine system as conducted by the Public Health Service renders available a trained corps of sanitary experts who, in the event disease should enter a port, can be shifted to the scene of the outbreak, immediately strengthening the defense against the spread of the infection, and thus protecting the other sections of the country by proper supervision of all outgoing traffic.

Advantages of Federal control of quarantine.

1. Uniformity.—The origin of Federal quarantine was the necessity for unifying the various regulations at the different ports of the United States.

2. Simplicity.-Economy for the shipping interests in that one set of rules applies at all ports.

3. Flexibility.-Special requirements are made for any port, according to need, and the national regulations are so drawn as to allow great discretionary powers on the part of individual quarantine officers, thereby avoiding rigidity.

4. Training.-Officers are trained at the quarantine stations and at the Hygienic Laboratory of the Public Health Service at Washington.

5. Information.-Consular reports from all foreign countries to the Public Health Service, with free use of cable when necessary.

6. Nonpolitical.-Appointments in the Public Health Service are for life, dependent upon good behavior and efficient service. This is essential to scientific progress. Permanent appointments for quarantine work insure an accumulation of experience.

7. International sanitary treaties.-The United States is a signatory of two international sanitary treaties, under which are operated the international quarantine regulations, which are subject to revision every two years, in order to keep pace with scientific advance.

8. Precedents. Sixty-seven State and local quarantine stations have already been transferred.

9. Quarantine a national function.-All immigrants entering the United States are examined by Public Health Service officers, and all persons, whether immigrants or incoming passengers, are examined for quarantine purposes at all ports in the United States, save at New York and Baltimore.

10. Arrangements for boarding are made to suit the needs of the port.

11. Facilities.-Equipment is provided in fixed relation to the amount of commerce and immigration. This applies also to the number of medical officers and attendants assigned.

12. Financial. The Government usually rents a quarantine plant at a nominal sum until its purchase as a result of an appropriation from Congress. No fees are charged for boarding or inspecting vessels.

13. Cooperation.-The quarantine service operated by the National Government has access, when necessary, to cooperation and aid from all branches of the Government.

PUBLIC BUILDINGS.

An examination of public-building legislation covering a period of several years shows a lack of system and a disregard of economic consideration in authorizing the construction of public buildings. Acquisition of sites has been authorized years in advance of any need for them, and buildings have been authorized at limits of cost bearing no reasonable relation to the needs of the communities in which they are to be placed. The limit of cost fixed by Congress appears to have dictated the type of building to be erected, and its cost has usually been made to equal that amount. Needless and unjustifiable waste of public money has resulted.

Several thousand public-building bills are introduced at each session of Congress. These are, as a rule, all referred to the Treasury

Department for estimate and report. No satisfactory report can be made in the absence of an investigation of local conditions by qualified inspectors. In the absence of both the necessary corps of inspectors or any appropriation for travel and subsistence of such a corps the department is forced to resort to the unsatisfactory expedient of obtaining data by correspondence. The information thus obtained, prepared by officials unfamiliar with the technicalities of the subject involved, is naturally unsatisfactory and at times unreliable. A very sensible plan for the correction of these conditions, and one which meets my entire approval, was suggested by one of my predecessors, Secretary Cortelyou, in a report to the Speaker of the House under date of December 7, 1908, as follows:

Further change, it is believed, could be made to great advantage. The present system employed in connection with bills for public buildings is not conducive to the best results. A great mass of bills is annually poured in on the department, with requests for early reports. In many instances the buildings authorized are unnecessary for the public business, and in the interests of economy the construction could be postponed for several years. Insufficient time is allowed for investigation as to the requirements of the building proposed, or, in fact, for an accurate estimate of cost. As a result, it frequently happens that a number of buildings are authorized which are not required, and, on the other hand, no appropriations are made for localities in which the Government is urgently in need of adequate buildings, and is in all probability paying large rent for insufficient quarters.

Public-building appropriations should be put on a basis similar to that now employed in connection with appropriations for river and harbor work. If this were done, the Congress would submit to this department a list of localities, with the request that at the next session a report be submitted showing:

1. The necessity or advisability of a building in the city or town suggested. This would necessarily embrace the size of the city, the cost of the building, and the price at which rented quarters are to be had.

2. If a public building is recommended, the area and probable cost of the site; the size, cost, and character of the building that should be erected; the branches of the Government service that would occupy it when completed, and the annual cost of its maintenance.

3. The amount of appropriation necessary to carry on the work during the ensuing fiscal year.

With such a report, carefully made in detail after consultation with the other departments interested, the Congress would be better able to judge of the advisability of authorizing a building and of the appropriation required. I am confident that by this method a great saving could be effected and that buildings could be more satisfactorily and economically distributed.

For the purpose of improving the conditions relating to the construction of public buildings I issued an order to the Office of the Supervising Architect establishing a classification of buildings. Its purpose is to provide a rational system of uniformity and business economy in designing and constructing public buildings, so that

buildings suitable to the public needs may be built without waste of Government money. Four classes have been established as follows:

CLASS A.

Character of building.-Marble or granite facing; fireproof throughout; metal frames, sashes, and doors; inte

Definition.-Buildings that include a post office of the first class with annual receipts of $800,000 or over; the site forming part of a city develop-rior finish to include the finer grades ment plan or situated on an important thoroughfare of a great city; improvements on adjoining property reaching the higher valuation of metropolitan real estate.

of marble, ornamental bronze work, mahogany, etc. Public spaces to have monumental treatment, mural decorations; special interior lighting fixtures.

By the application of the classification above indicated it is intended that buildings adapted to local conditions and in keeping with the importance of the communities in which they are to be erected shall be constructed, and under this policy like conditions will receive similar treatment. It is estimated that many thousands