m lari 
SERVICE FORCES MANUAL 
CIVIL AFFAIRS HANDBOOK 
GERMANY 
SECTION 13: PUBLIC HEALTH 
AND SANITATION 
nrcTDinrcn 4, 
RtOinWILU Dissemination of restricted “matter, - The information con- 
tained in restricted documents and the essential characteristics of restricted 
material may be given to any person known to be in the service of the United 
States and to persons of undoubted loyalty and discretion who are cooperating 
in Government work, but will not be communicated to the public or to the press 
except by au/ffio r \ zed military public relations agencies. (See also par. |8b, 
AR 380-5, jjPsep 1942.) /T 
HEADQUARTERS, ARMY SERVICE FORCES, 7 MARCH 1944 ARMY SERVICE FORCES MANUAL 
M 356 ■ 13 
Civil Affairs 
CIVIL AFFAIRS HANDBOOK 
GERMANY 
SECTION 13’PUBLIC HEALTH 
AND SANITATION 
HEADQUARTERS, ARMY SERVICE FORCES, 1 MARCH 1944 
■ ' ' ' ■ " ' ■ ! f 
RESTRICTED . . • Dissemination of restricted matter. - The information con- 
tained in restricted documents and the essential characteristics of restricted 
material may be given to any person known to be in the service of the United 
States and to persons of undoubted loyalty and discretion who are cooperating 
in Government work, but will not be communicated to the public or to the press 
except by authorized military public reflations agencies.* (See also par. 18b, 
AR 380-5, 28 Sep 1942.) RESTRICTED 
NUMBERING SYSTEM OF 
ARMY SERVICE FORCES MANUALS 
The main subject matter of each Army Service Forces Manual Is Indicated 
by consecutive numbering within the following categories: 
Ml - M99 Basic and Advanced Training 
MlOO - Ml99 Army Specialized Training Program and Pre- 
Induction Training 
M200 - M299 Personnel and Morale 
M300 - M399 Civil Affairs 
M400 - M499 Supply and Transportation 
M500 - M599 Fiscal 
M600 - M699 Procurement and Production 
M700 - M799 Administration 
M800 - M899 Miscellaneous 
M900 up Equipment, Materiel, Housing and Construction 
HEADQUARTERS, ARMY SERVICE FORCES, 
Washington 25, D. C., 7 March 1944. 
Army Service Forces Manual M 356-13, Civil Affairs Handbook - Germany, 
Section 13, Public Health and Sanitation, has been prepared under the 
supervision of The Provost Marshal General, and Is published for the 
Information and guidance of all concerned. 
SPX 461 (21 Sep 43). 
command of Lieutenant General SOMERVELL 
W. D. STYER, 
Major General, General Staff Corps, 
Chief of Staff. 
OFFICIAL: 
J. A. ULIO, 
Major General, 
Adjutant General. 
DISTRIBUTION: X RESTRICTED 
This study on Public Health and Sanitation in Germany was prepared for the 
MILITARY GOVERNMENT DIVISION. OFFICE OF THE PROVOST MARSHAL GENERAL 
by the 
RESEARCH AND ANALYSIS BRANCH. OFFICE OF STRATEGIC SERVICE? 
OFFICERS USING MATERIAL ARE REQUESTED TO MAKE SUGGESTIONS AND 
CRITICISMS INDICATING THE REVISIONS WHICH WOU&D MAKE THIS MATERIAL MORS 
USEFUL FOR THEIR PURPOSES. THESE CRITICISMS SHOULD 3E SENT TO THE CHIEF 
OF THE LIAISON AND STUDIES BRANCH. MILITARY GOVERNMENT DIVISION, PMGO, 
2807 MUNITIONS BUILDING, WASHINGTON 25, D. C. RESTRICTED 
CIVIL AFFAIRS HANDBOOKS 
tofi,oal orn i n 
1, Geographical and Social Background 
2, Government and Administration 
3, Legal Affairs 
4, Government Finance 
5, Money and Banking 
6, Natural Resources 
7, Agriculture 
8, Industry and Commerce 
9, Labor 
10, Public Works and Utilities 
11, Transportation Systems 
12, Communications 
13, Public Health and Sanitation 
14, Public Safety 
15, Education 
16, Public Welfare 
17, Cultural Institutions 
This study on Public Health and Sanitation 4n Germany was prepared 
for the MILITARY GOVERNMENT DIVISION, OFFICE OF THE PROVOST MARSHAL 
GENERAL by the RESEARCH AND ANALYSIS BRANCH OP THE OFFICE OP STRATEGIC 
SERVICES. INTRODUCTION 
Purposes of the Civil Affairs Handbook, 
The basic purposes of civil affairs officers are (l) to assist 
the Commanding General by quickly establishing those orderly conditions 
which will contribute most effectively to the conduct of military operations, 
(2) to reduce to a minimum the human suffering and the material damage 
resulting from disorder and (3) to create the conditions which will make it 
possible for civilian agencies to function effectively. 
The preparation of Civil Affairs Handbooks is a part of the effort‘-to 
carry out these responsibilities as efficiently and humanely as is possible. 
The Handbooks do not deal with plans or policies (which will depend upon 
changing and unpredictable developments). It should be clearly understood 
that they do not imply any given official program of action. They are rather 
ready reference source books containing tjhe basic factual information needed 
for planning and policy making. 
Revision for Final Publication 
This section on Public Health and Sanitation in Germany should be con- 
sidered as a preliminary draft. It will be revised at a later date. 
RESTRICTED RESTRICTED 
TABLE OF CONTENTS 
Sags 
Summary 1 
A, Public Health Organization and Services 2 
1. National Government 2 
2. Health Organization of Governmental Units 
of Intermediate Levels..,, 5 
3. Local Health Offices 5 
4. Social Insurance 11 
B, Assistance of Private Agencies 11 
C, Medical Personnel and Facilities,•••••• 12 
1, Medical Personnel 12 
2, Medical Education, ...» 13 
3, Medical Facilities and Supplies. 14 
4* Vaccinations and Immunizations 16 
D, Birth, Death, and Disease. 16 
1. Birth and death rates 16 
2. Infant mortality rates 17 
3. Diseases 18 
a. Tuberculosis 18 
b. Diphtheria.•••• 22 
c. Scarlet fever 23 
d. Trachoma. 23 
e. Typhoid fever and paratyphoid fever. 23 
f. Typhus ••••«•••••• 24 
g. Prostitution and venereal disease.,.,,.,.,.,.,..,,,, 25 
h. Malaria. 29 
4. Vitamins 30 
E, Sanitation 30 
Appendices 
1 32 
2 38 
3 39 
4 40 
$ 41 
6 42 
7.. 44 
8 47 
9 48 
References,. *50 RESTRICTED 
PUBLIC HEALTH ARP SANITATION 
Summary. 
The supervision of all public health services is in the hands 
of the Reich and Prussian Ministry of the Interior, which, through 
a minister of health, directs activities at all the lower levels. 
The* authority passes from Reich to state to district to county and 
municipal health offices. Most of the public health activities are 
actually carried out by health offices at the local level. These 
offices maintain "health1* card files with full information on all 
individuals of the community. The public health services are integrated 
with those of the athletic, velfare, police, and education departments 
of the government and of the Nazi Party. The whole mechanism represents, 
on paper, an elaborate structure which allows its Nazi higher officials 
a maximum degree of control. 
The growing shortages of medical personnel are reflected by the 
increasing number of women in medical schools, the number of older 
men continuing in practice, and the drastic shortening of medical 
curricula. 
Though recent German data on equipment and supplies are inadequate 
and susuect, it is evident that there are shortages in bandages, gauze, 
adhesive tape, soap, iodine, alcohol, rubber gloves, and instruments of 
all kinds. Much of the equipment available is of inferior quality. 
RESTRICTED 
1 2 
Hospitals are overcrowded and beds insufficient for admission of 
civilians - a situation which will become worse as wounded soldiers 
take over more civilian beds. 
Though the general death rate seems to be relatively low, and 
not on the increase, the Infant mortality rates have risen. 
Special disease problems are tuberculosis, diphtheria, scarlet 
fever, the enteric diseases, and typhus, with,venereal diseases repre- 
senting potentially serious threats. 
Prophylaxis immunization against small pox is compulsory. No 
other immunizing procedures are required by law - a situation reflected 
in the high diphtheria Incidence for the part several years. 
Sanitary procedures have been generally at a high level in the 
past - detailed information is lacking at present, but it can be safely 
assumed that good sanitary control is becoming increasingly difficult 
under shortages of supplies and personnel. 
A. Public. Health Organization and Services (See Appendix 1 
for organization chart.) 
1. National Oovernment. Since 1936, all health organizations 
of the Reich are supervised by the Reich and Prussian Minister of the 
Interior. The ministerial director in charge of the public health 
section of the Ministry is also the head of the Reichscommittee for 
People1s Health (Seichsauegchuasee fur Volkseesundheitadienat). the 
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State Academy of Medicine (Staatsmedizinische Akadeinie) in Berlin, and 
the Prussian State Health Council (Preussischen Landesgesundheitsrates.) 
The public health section (Heich Health Office - Reichsgesundheitsarat) of 
the Ministry of the Interior has two divisions—medical and veterinary. 
It has executive and legislative powers, and deals with the following 
matters pertaining to public health; 
(1) Administrative reorganization 
(2) Hygiene of inheritance 
(3) Racial questions 
(4) Population policy 
(5) Education of medical and public health personnel 
(6) Affairs of publicly-employed medical personnel 
(7) Preventive medicine 
(8) Policing of food-handlers 
(9) Veterinary medicine 
(10) Drugs and poisons 
(11) Medical research *- 
(12) Baths, spas, hospitals, and insane asylums 
(13) Red Cross activities 
The Prussian State Health Council, an advisory body in 
administrative health questions, supervises the examination and 
employment of publicly-employed physicians. It is the supreme authority 
in advising the judiciary in matters requiring expert medical testimony. 
The State Academy of Medicine gives preparatory training courses 
for those physicians who wish to obtain public positions. 
The Reichscomraittee for People's Health is composed of all 
organizations interested in the field of health, population policies, 
inheritance, and racial affairs. This body coordinates the directives 
of the Interior Ministry with the activities of its own member bodies. 
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The Scientific Society of Public Health Physicians is composed 
of doctors employed by the Health Offices, and promotes the social 
and cultural affairs of its members. It publishes its own Journal, 
Die Qffentliche Gesundheitsdienst. 
An advisory body, the Council of Experts for Population and 
Pace Policies, prepares legislation in its own field. It is composed 
of leading Nazis and Nazi scientists. 
The Reich Health Office, supervised by the Interior Ministry, is 
composed of the following departments: 
(1) Medical department 
(2) Veterinary department 
(3) Department of hereditary biology 
(4) Department of racial affairs 
(5) Department of food chemistry 
(6) Department of hygiene of water, soil, and air 
(7) Department of pharmacology 
(8) Department of physiology 
(9) Department of industrial hygiene 
(10) Department of drugs 
(11) Department of biochemistry 
. Research is carried on by some of these departments and the 
results are available to the Ministry and to other interested groups; 
this research is sunervlsed by certain scientific institutes such as the 
Robert Koch Institute and the Institute for Water, Soil.and Air Hygiene. 
The Robert Koch Institute, nominally headed by the President of the 
Reich Health Office, is located in Berlin. The actual supervision of 
the Institute in 1939 was in the hands of its then acting president. 
Dr. Gilderaeister, who in cooperation with Haagen and others introduced 
into Germany a method of preparing typhus vaccine. The Institute is 
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divided into sections covering: Epidemiology, experimental therapeutics, 
tuberculosis, rabies, tropical diseases, sero-diagnosis, smallpox, 
histology and virus studies, chemistry. 
In 1939, the Robert Koch Institute had about 100 employees; among 
its important activities was the control of vaccine and serum preparation. 
The Institute for Water, Air and Soil Hygiene, located in Berlin, 
supervises the work of inspecting potential damage from unhygienic water, 
soil, and air. It is supposed to recommend corrective measures in its 
field. 
1 
2. Health Organization of Governmental Units of Intermediate Levels. 
The Reich Ministry of the Interior gives instructions to district 
authorities through the state or provincial governments. The district 
/ 
authorities include medical personnel who supervise the county health 
officers. Further details of organization are given in Appendix 1. 
1 
3. Local Health Offices. In accordance with the law of 1 April 
1935, all municipal and rural counties, numbering some 740, have 
health offices (G-esundheit samt). The claim is made that with few 
exceptions every county and independent municipality (Kreis und kreis- 
freie Stadt) has its own health office. The exceptions were said to 
have been made because of anticipated administrative reorganization. 
Municipal counties of more than 400,000 population. Municipal counties 
of more than 400,000 population may maintain several branches of the 
health office. The same is true of a health office which has juris- 
diction over several counties, or if its own county embraces several 
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large municipalities. Berlin, for example, has one principal health 
office and twenty branch offices. 
In general, the health offices are instrumentalities of the 
state. There are, however, certain municipalities which maintain 
their own health offices. In such cases, their functions are super- 
vised by state health officers and are carried out by the local 
health officer acting as an agent of the state. 
Usually, each office is headed by a physician (Amtarzt) who is 
a state employee, but he may in certain instances be a municipal employee. 
He must be a licensed physician, is required to pass special examinations, 
and must have practised medicine for at least five years. 'Exceptions to 
this last rule may be made by the Minister of the Interior. The 
physician must also prove his own and his wife's Aryan ancestry. 
i 
Similar qualifications are required for other medical personnel in the 
health office. Their duties may be specialized according to the 
departmentalization of the health office, and they may be appointed to act 
as deputies of the chief medical officer. 
In appointing medical personnel special attention is paid to their 
training in National Socialist ideology and outlook (Weltanschauung). 
This is to insure close ties between the health office and the Nazi 
Party Public health nurses serve as a link between the office and the 
general public. The offices are generally provided with physical 
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facilities in the state or communal buildings, and are financed by 
county contributions or funds from public bodies. 
Functions of the local health office comprise the following: 
a. n Health police" medical activities 
b. Hereditary and racial affairs 
c. Popular health education 
d. School health care 
e. Maternal and child advice 
f. Care for the tuberculous 
g. Care for venereal disease patients 
h. Care of the crippled and handicapped and of 
drug addicts. 
In general, the office supervises medical programs in the 
* 
counties and is responsible for the execution of all legislation 
pertaining to health. It serves alto to coordinate the medical activities 
of other public agencies. When requested it gives expert advice to 
governmental authorities and makes proposals to correct and improve 
health and hygiene. The office issues medical certificates whenever 
they legally required. The office cooperates in sports and athletics 
projects. The following is a more detailed survey of the activities of 
the local health office. 
a. It maintains files of the names of all physicians in 
the county and insures that medicine is practiced only by those who 
are eligible and qualified. 
b. It supervises the dispensing of medications by drug- 
stores in accordance with statutory regulations. 
c. It supervises the practice of midwifery and the training 
of midwives. 
d. It supervises the activities of other medical and health 
personnel, such as nureee, exterminator* (fumigators), and coroners. 
RESTRICTED 8 
e. It is required to periodically inspect local dwelling 
places and to report on their hygienic conditions. Likewise it must 
report on local soil and air hygiene. Building ordinances must he 
approved hy the health office and the health officer gives expert 
testimony as to their suitability as judged by water supply, garbage 
removal, and sewage disposal. 
f. It cooperates with the police in the supervising production 
and distribution of food. 
g. It must analyze epidemic diseases and report on their 
Incidence, and on their course, and must propose necessary preventive 
measures. The office enforces the reporting of such diseases and con- 
ducts investigations as to their orgins. The following protective 
measures are generally applied by the police but may be handled directly 
by the office; 
(1) Observation of sick persons 
(2) Restriction of immigration in the locality 
(3) Isolation of patients at home and in the 
hospital 
(4) Placarding of buildings 
(5) Restrictions on industry and commerce 
(6) Regulations on the closing of schools 
(7) Fumigation and disinfection 
h. It enforces smallpox vaccination. 
i. It participates in police activities concerning public 
health with respect to industrial and commercial enterprises. 
j. It is charged with the supervision of hospital institutions 
unless they are controlled directly by the state. Hospitals must be 
inspected at least once a year. 
k. It participates in the elaboration of vital statistics. 
RESTRICTED 9 
l. It cooperates with the medical-care program for merchant 
mariners. 
m. It cooperates .with the many local organizations which 
are engaged in health matters such as; first aid, ambulance service, 
air-raid protective service, public baths, school baths, spas and 
mineral springs. 
n. It is charged with the regulation of burial grounds and 
crematoria. 
o. Under Naziism, the health office is designed to spread 
a propaganda relevant to mce and heredity. It engages in active and 
vigorous campaigns in these fields, in close cooperation with the 
Party. 
p. It integrates work pertaining to the health of schools, 
kindergartens, orphanages, and similar institutions. 
q. It is supposed to carry on preventive medical procedures', 
(a) The office gives prenatal and postnatal advice and 
supervises the health of infants and children. 
(b) It coordinates all activities designed to promote 
the welfare of patients suffering from tuberculosis, 
venereal disease, physical deformities, drug addiction 
and invalidism. The health office maintains one or 
more welfare offices for the tuberculous where exam- 
inations and advice are given free of charge. This 
work in tuberculosis is effected in co-operation 
with the sick funds organization and the Reich Anti- 
tuberculosis Committee, 
(c) Prostitution and anti-venereal disease campaigns are 
supervised by the health office- 
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r. It regulate# all athletic program* with a view to 
preventing serious sequellae a* a result of athletic activity, 
and takes measures to correct any pathology which may result. 
s. The office is charged with the duties entailed in admitting 
the insane, psychopaths, epileptics, and the mentally deficient to 
institutions. It may initiate steps leading to sterilisation as 
provided by law and supervises the custodial care of all these 
groups. 
t. The functions of the police doctor are Included in the 
work of this office, although arrangements can be made to have other 
medical personnel act as police doctors. 
u. The health office is required to promote an active 
population policy both qualitatively and quantitatively. This entail* 
race and heredity advice, family advice, and advice to prospective 
candidates for marriage. It grants health certificates to marital 
candidates and to applicants for naturalisation. 
As a result of the premarital examination the health officer 
can discourage any marriage* in order to "prevent the procreation of 
sick people", 
v. The health office maintains "a health file" (Erbbiologlsche 
Kartei) containing life and health records of the local population. 
This file is compiled with the help of the public registrars, police 
officers, and public and Party organisations. 
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4. Social Insurance. The various insurance departments such as 
health, old age, and accident cone under the Jurisdiction of the 
Ministry of Labor. 
A detailed description of German social insurance will be 
found in CAD Handbook IX; Labor, Part E. 
28 
B. Assistance of Private Agencies. 
The Red Cross is supervised by the Minister of the Interior, 
and Hitler is called its "protector”. All Red Cross members must 
swear loyalty to him. The organization is headed by an honorary 
president and by an executive president. The work of the president 
is supported by the advisory activities of hie council, members of 
which are appointed and dismissed by him. The president’s office is 
in charge of the various state offices whose Jurisdiction corresnonds 
to the military districts. State offices are headed by Red Cross 
State leaders appointed by the president. These officers in turn 
are in charge of Red Gross districts which correspond to the districts 
of the general administrative organization. The district office 
organizes and trains the operating units.(Here!tscheften). Each unit 
is subdivided into two or four platoons and each platoon has from 
two to four squads. Each squad is composed of twelve members. All 
members of the operating units must be "racially pure”. Apart from 
the operating groups, Red Cross activities are carried on by nursing 
RESTRICTED 13 
groups and general Red Cross organizations. 
The executive president, in his capacity as Brigadefuhrer. is 
closely associated with one of the more aggressive sections within 
the Party organization. The Red Cross locals are subdivided into 
male and female organizations. Hitler has decreed that the trans- 
portation of the sick shall remain solely the duty of the Red Cross, 
He delegated his Reichsrainlster of Health, Dr.-Conti, and the General 
Commissioner for Sanitation and Public Health, Dr. Brandt, to publish 
the executive arrangements necessary to jfulfll his decree. All other 
organizations which formerly transported sick patients were ordered to 
turn over this activity to the Red Cross. 
C. Medical Personnel and Facilities. 
1. Medical -personnel. In 1939, there were 47,725 
physicians in Germany; this represented a decrease of 2,000 from 
the preceding year. Appendices 2 and 3 tabulate medical personnel 
for the years 1936-1939. 
In 1942, there were 9,500 women physicians practising; this 
was an increase of nearly 3,000 over 1939 and represents the Nazi 
2 
attempt to replace the losses of medical personnel at the front. A 
great deal of the civilian medical burden is being carried by older 
physicians. There were practising, in May, 1943, 300 doctors aged 80 
3 
or older, and 3,000 over 70. 
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In some parts of the Reich, there is hut one-third the 
A 
former number of physicians. In order to spread the services of 
the limited medical personnel the authorities have permitted certain 
lapses in regular procedure. The inspection of the state and communal 
health offices - ordinarily done triennially - has been postponed until 
the end of the war. Medical certificates are no longer necessary for 
women who are to marry military personnel. There has been an attempt 
further to conserve personnel resources by collectivizing certain 
medical services. In 1942, there was a great increase in the number 
of "work-doctors’1 assigned to industrial plants; thus allowing each 
physician to carry a much greater case load. 
6 
2. Medical education. There are medical schools at the 
following places; Berlin, Bonn, Heidelberg, Breslau, Erlangen, 
Frankfurt am Main, Freiburg im Breisgau, Giessen, Gottingen, Greiswald, 
Halle-Wittenberg, Hamburg, Jena, Kiel, Cologne (Koln), Konigsberg, 
Leipzig, Marburg, Munich (Monchen), Munster, Rostock, Tubingen, Wurzburg 
There is also the Milltararzllche Akademie at Berlin. In 1941, 4,500 
physicians were graduated from medical schools. 
Since 1939, the medical course consists of ten semesters, 
including one year of clinical work. This represents a shortening of 
the entire course by one and one-half to two years. During the nine- 
week vacations of which there are three during a four-year period- 
medical students must Work as nurses or hospital attendants. Thi* 
work may be credited to their graduation requirements by substituting 
BESTPJCTSD 14 
it for the usual clinical experience, thereby shortening the course 
to four years (eight semesters). Courses in industrial medicine 
and aviation medicine have been introduced into the medical curricula. 
All male medical students are automatically in the military reserves, 
and go directly into military service upon graduation. 
The University of Freiburg has refused new applicants for 
the 1943-1944 term because of a shortage of teaching facilities. 
Gottingen has- taken in only 150 new students for this same term; 
# 
its total enrollment for the winter term is 1479. Heidelberg now 
has 1,800 students most of whom are women, Tubingen has 1,529 
enrolled students, as against 430 students in 1938-1939 and 1,357 
in 1942-1943, At this same university there has recently been estab- 
lished a chair for tropical medicine in connection with the German 
Institute for Medical Missions, 
3, Medical Facilities and Supplies. Appendices 4,5 and 6 
give the total number of hospitals and similar institutions, and beds. 
Although the hospital facilities were relatively adequate during 
peacetime, they are not now adequate for the civilian population since 
they are being used increasingly for war casualties. There has been 
an official attempt to discourage hospitalization, and in at least one 
city - Munich - a central admission office was set up for all the 
hospitals in that city. Eatients generally are advised to have hone 
deliveries. 
EBSTPJCT3D 16 
Despite the great productive capacity which Germany had 
for the manufacture of medical equipment, it is fairly certain tha 
shortages exist in all types of medical equipment, as is evidenced by 
the planned looting of all removable hospital accessories in the 
occupied countries. A military circular maybe quoted here; "All 
physicians are directed to apply the greatest economy in the use of 
bandages and medicaments. Bandages must be washed and reused. This 
applies especially to elastic bandgaes. If new elastic bandages are 
requisitioned, the old ones must be turned in. Under no conditions 
may splints be thrown away; the padding is to be removed and the 
splints used again. Gauze and cotton wool must also be used very 
economically, and the greatest economy is required in the use of 
adhesive tape. Owing to the tight raw material situation, we have the 
greatest difficulties in obtaining these supplies. Often it suffices 
to use adhesive tape half the width of the roll. Drugs of any 
kind may be given only in really urgent cases. Only as much is to 
be dispensed as is actually used by the men. Under no conditions 
should soldiers be allowed to carry with them drugs prescribed some 
5 
time in the past-1* 
In 1942, it was extremely difficult to get prescriptions filled. 
In one area at least - Bad Nauheim - aspirin was unavailable, codeine 
and alcohol were difficult to get, and iodine non-existent. Sulfonam- 
PSSTRICTO 16 
ides could be obtained. Syringes and needles were of poor quality. 
There was a shortage of bandages, dressings, and so forth, and those 
available were ersatz. Rubber gloves were likewise of poor quality 
26 
and very difficult to get. 
4. Vaccinations and immunizations. The only immunization 
compulsory by law is that for smallpox. All other prophylactic 
immunizations are voluntary, although on occasion local authorities 
have decreed the im unization of all school children in an affected 
25 
area. The idea of immunization has never been a popular one in 
Germany; the opposition was heightened by the disastrous results of 
the experimentation with BCG vaccine in Lubeck in 1930. 
D. Birth. Death, and Disease. 
1. Birth and death rates. The causes of death in Germany 
for 1936 are given in Apoendix 7. Although the Reich has used every 
propaganda method to inspire a greater birth rate, the rate has 
dropped in each of the last several years. In 1940, the rate for the 
large German towns was 17.5 ner 1000 population; in 1941, 16.3; and 
7 
in 1942, 13.9. The birth and death rates in Germany for 1937 are given 
in Anpendix 8, The situation as regards fche birth rate is so serious 
that it has evoked from Dr. Conti, iri 1943, the comment that the 
population of Berlin will die out in three generations if the birth 
8 
rate continues to decline as it is doing at present. 
RESTRICTED 17 
A contradictory report states that births were 11.4 percent higher 
in the first three months of 1943 as compared with the same quarter 
of 1942, and that only in districts exposed to air raids was there a 
9 
decrease, attributed to the evacuation of pregnant women to safer zones. 
The great concern of the authorities with the falling birth-rate is 
shown in the decree forbidding the manufacture and sale of contrace- 
ptives in 1941, except for limited supplies for army use, marked 
’’for prevention of disease only”. Promulgation of birth control 
% 
information is discouraged. Abortionists are liable to severe penalty, 
including death. 
2. Infant Mortality rates. The infant mortality rates per 
thousand live births, based on the territory of 1937, and including 
Austria, Sudetenland, Danzig, and Memel, increased from 62 in 1938 
to 70 in 1942. During the same period the United States rates ranged 
downward from 50 to 44. Tables for Germany and the United States are 
given below. 
INFANT MORTALITY RATES PER 1000 LIVE BIRTHS IN GERMANY BASED 
ON TERRITORY OP 1937 INCLUDING AUSTRIA, SUDETEN DISTRICTS, DANZIG, 
and 3 • ___ 
1938 62 
1939 62 
1940 65 
1941 64 
1942 70 
10 
UNITED STATES INFANT MORTALITY RATES PER 1000 LIVE BIRTHS 
1938 50 
1939 47 
1940 46 
1941 45 
1942 44 
EESTSICTED 18 
In 1942, a competition was arranged among all oractiticners to 
lower this high and increasing birthrate in Germany. Two prizes 
totaling 5,000 EM were to be given to the winners. It is unlikely 
that this commercial approach to an important health problem will 
be leflected in any immediate lowering of the infant mortality rate. 
Factors which contribute to keeping the rate high are shortages of 
physicians and hospital facilities, midwifery, malnutrition, poor 
living conditions, and maternal fatigue. 
3. Pi senses. The mortality and morbidity figures for the 
last five years are given in Appendix 9. It is evident that certain 
diseases stand out as particular problems at the present time. These 
include scarlet fever and diphtheria, which have been epidemic and 
tuberculosis, widespread in all age groups. 
a. Tuberculosis. Dr. Leonardo Conti boasts that the tuber- 
culosis mortality rate in Germany was only 81 per 100,000 population 
in 1942; this is almost double the United States* tuberculosis mortal- 
11 
ity of 46.9 per 100,000 population for the three-year period 1939-1942. 
In April 1943, the Reich tuberculosis assistance scheme 
became effective. It applies to those having a taxable annuel 
income below 7,200 EM., insofar as the necessary assistance is not 
granted by social insurance systems or guaranteed in other ways. The 
7,200 RI£, is raised to 8400 EM. for married people, to 9,000 EM. for 
RESTRICTED 19 
married people with one child, and to 9,600 EM,, 10,200 EM., and so 
forth for families with two, three or more children. Officials, 
employees, and workers of the Heich railways receive full assistance 
from the Railways themselves. This assistance includes home treat- 
ment, hospital and sanitarium care, and complete social security for 
11 
the patients and their families. Conti calls tuberculosis "the peril 
to our national strength1' and states that this new scheme concentrates 
the protective organizations, which have hitherto operated separately, 
into two great protective groups, the Social Insurance Institutes for 
Insured Persons, and the Provincial or Gau Welfare Associations for 
non-insured persons with an annual income up to, for instance, 9,000 EM. 
for married people with one child. 
Before the establishment of the new assistance scheme, 
tuberculosis patients who were not insured had to pay for themselves. 
The middle classes were often debt-ridden for the obligations involved 
in tuberculosis therapy and often the disease was neglected for purely 
financial reasons. Destitute patients had been cared for by the 
Public Assistance Offices, The new tuberculosis scheme has rendered 
a great service by allowing treatment and cure without expense to the 
individual and by granting support to the families engaged in war 
service. The Belches expenditures on the new scheme is estimated at 
20,000,000 to 25,000,000 EM. annually. In addition, there will be the 
RESTRICTED 20 
additional expenditures by the Social Insurance Institutes, which will 
12 
increase their benefits to adjust to the new scheme. 
Dr. Conti and the Berlin public health officer, Dr. 
Sutterlin, further state that the reporting of tuberculosis is 
compulsory. The physician personally reports the case and the patient 
is invited to appear before the public health office. This office 
ascertains the names of individuals living in the patient's vicinity 
in order that they may be warned against infection through contact 
with the patient. The office not only compiles data but discusses the 
case with the public health workers and whenever possible arranges for 
a radiographic study. When necessary the patient is sent to a 
sanitarium, with the large insurance companies participating in the 
costs; otherwise, he is allowed to return home after having received 
the necessary sanitary instruction. If the patient stays at home, 
the public health office keeps his family under surveillance; they 
are examined from time to time, and workers from the office visit 
them periodically to make sure that the patient is properly Isolated 
and following instructions. As long as patients are cared for in 
sanitaria, the office does not keep them under surveillance, but as 
soon as a patient returns to his home he must submit to compulsory 
11, 12 
periodical examinations. 
RESTRICTED 21 
The anti-tuberculosis society works with the tuberculosis 
health office. Although theoretically public health workers may be 
men, in practice the greater part of the work is done by women who 
undergo a three-year training course and are given special instruction 
in tuberculosis. The scope of this work is illustrated by the follow- 
ing statistics; Berlin's 23 tuberculosis public health offices employed 
41 physicians and 124 public health workers in 1941 and between them 
made 97,000 home visits in that year. Among the preventive measures 
is the examination of all persons in constant contact with children. 
All teachers, especially in kindergartens, are subject to compulsory 
medical examinations. However, house-servants are not included in these 
11, 12 
compulsory examinations. 
The statistical tables themselves give the best refutation 
of the above official enunciate of the Nazi public health leaders. 
Tuberculosis is widespread and on the increase in all its forms. The 
increase occurred despite the extensive anti-tuberculosis propaganda 
carried on by welfare and health organizations of the Eeich. The Nazi 
campaign to employ tuberculous patients, forcing them to mingle freely 
with non-tuberculous workers, acts as an excellent metnoo, of spread. 
In August 1941, a circular was issued by the Ministry of the Interior 
and the Ministry of Labor, to the effect that the danger of infection 
in cases of tuberculosis was strictly limited and that as long as the 
RESTRICTED 22 
cough was not too bad and the tuberculous person behaved in a 
disciplined manner, no further precautions at the place of work were 
necessary. The number of cases of open tuberculosis in industry is 
relatively high in spite of the precautions taken. Of 386 cases (men) 
13 
in Berlin, 60 percent represented gainfully employed individuals. 
Other factors contributing to higher incidence of tuber- 
culosis are lengthening of work hours, lowering of standards of living 
malnutrition - both overt and subclinical - and deficiencies in 
medical care. Although there are sporadic reports of tuberculosis 
roentgenograph!c surveys, using microfilm techniques, it is likely 
that these surveys are necessarily limited by personnel shortages. 
Even if the entire country were completely surveyed for new cases, 
the lack of facilities and the employment of tuberculous workers would 
prevent any progress. A further stumbling-block is the distribution 
of tuberculous dairy animals to the poor after condemnation. Inadequate 
supervision of ditiry herds, and failure to condemn all tuberculous 
cattle are very serious since 35 percent of cattle stock are said to 
U 
have tuberculosis. 
b. Diphtheria. The rising and widespread incidence of 
diphtheria for the years 1937-1942 is Indicated by Appendix 9. The 
occurrence of 124,000 cases for the first 6 months of 1943 as compared 
5SSTRICTED 23 
with 121,000 cases for the same period in 1942 indicate that the 
disease is.not under control. When all these figures are compared 
with the reported cases in the United States for the 5-year period 
1937-1942 - a mean of 24,180 cases annually - it is seen that there 
has been no rigid application of known -nubile health principles.^ 
Among the factors operating to increase the incidence of this disease 
are overcrowding in homes and in bomb shelters, malnutrition, lack 
of isolation and hospital facilities, and lay and medical indifference 
to immunization, as well as a possible serum shortage. 
c. Scarlet fever. As compared with 127,482 and 126,395 cases 
of scarlet fever in the years 1941 and 1942 in the United States, 
Germany had 279,000 cases and 402,000, respectively, in those years 
(Appendix 9). The governmental health authorities seem to believe in 
the efficacy of anti-scarlet fever sera, judging by their regulations 
decreeing widespread immunization against the disease. Hitherto it 
is seen that the decrees have had little effect in decreasing the 
extent of the scarlet fever epidemic. 
d. Trachoma. From 533 reported cases in 1938, trachoma 
cases have jumoed to 5,600 in 1940, and 9,200 in 1941, and remain high 
in 1942 with 8,"600 cases reported (Appendix 9), 
e. Typhoid fever and paratyphoid fever. Typhoid fever, which 
was no major problem in 1937 and 1938, was reported in 1942 for 16,000 
patients. Paratyphoid fever for the same year had increased to 6,000 cases. 
F5STPJCT3D 24 
A total of 22,000 cases for these enteric diseases compares un- 
favorably with the reported incidence of 6,700 cases for 1942 in 
the whole United States (Appendix 9), 
Reported cases for the first eight weeks of 1943, total 
15 
3,230. The continued upswing in the incidence of these diseases 
indicates that they will present a very serious disease problem. 
f. Typhus (Fleckfleber). The table below gives the incidence 
and mortality from typhus during the uast 5 years in Germany. 
MORBIDITY AND MORTALITY FROM TYPHUS IN GSBMANY 1939-1943 
16 
1939 1940 1941 1942 1st quarter. 1943 
Cases 2 556 1969 2043 969 
Deaths 0 95 326 96 
It is evident that there has been a marked increase in the number of 
cases, and that the total for this year will be higher than for any 
of the preceding war ye~rs. At the end of August 1943, the Germans 
said that the disease had assumed epidemic proportions. Of the 
969 reported cases in the first quarter of 1943, 889 are said to be 
16 
among imported foreign workers, of whom 69 died of the disease. The 
elaborate preacutions taken by the Nazis indicate their anxiety over 
epidemic spread. They have set up stations for the triple delousing 
of soldiers and civilians returning from the East. Chemically impregnated 
under-clothing, supposed to resist and kill the body louse, was reported 
17 
invented this summer. A central institute for typhus control is said 
RESTRICTED 25 
to have been recently established in Berlin. Educational movies for 
the lay public have been prepared. Although one spokesman states 
that typhus vaccine exists in quantities sufficient to immunize every- 
one in the danger zones, it is highly improbably that this could be 
18 
done if there were an epidemic. Soap shortages, malnutrition, short- 
ages of medical personnel and facilities, all Join to make typhus 
a very serious disease threat to the Belch, and the situation can only 
grow worse as the war continues. 
5 
g. Prostitution and venereal disease. The law of 13 
February 1927, concerning the campaign against venereal diseases, 
abolishes all previous restrictions on prostitutes to carry on their 
profession in certain districts. It also allows anyone to rent 
living quarters to prostitutes over 18 years of age. In abolishing the 
former restrictions, which had proved to be of doubtful value and 
had possibly contributed to the exploitation of prostitutes, the law 
ceases to penalize the practice of prostitution as such. Insofar as 
penalties are retained, they are concerned only with the practice 
of prostitution in an "offensive11 manner (accosting), or in forbidden 
neighborhoods near churches and schools. 
The main emphasis of the statute is the requirement that 
persons infected with venereal diseases must pay frequent visits to 
RESTRICTED 26 
physicians. In order to further this aim, the law provides the 
machinery for granting free treatment to indigent persons. All per- 
sons likely to spread venereal diseases (prostitutes) are made subject 
to a system of regular official medical control. Physicians in 
private practice are required to report to the public health author- 
ities any infected person not following the prescribed treatment. 
Although this policy, especially during the economic crisis in the 
1930's, led to a noticeable Increase of the on the streets, 
particularly in the urban centers, it is said to have had the advantage 
of effecting a higher degree of voluntary cooperation by prostitutes 
in the measures of health control. 
Prior to assuming power f th« Nazis tried to make political 
capital of what they called the lenient attitude of the Weimar Republic 
towards MImmorality” . After first coming to power, the legislative 
changes were few, the most important being a sharp decrease in the 
punishment provided for procurers. On the other hand, police super- 
vision soon became stricter. The problem of the control of prostitu- 
tion seems not to have been of major importance before 1939, This 
fact may have been due partly to the greater promiscuity in the 
Third Reich and partly to the iraporveraent of the economic situation. 
RESTRICTED 27 
with the corresponding diminishing number of those who practised 
prostitution illegally. The following table gives the most recently 
available figures on the principal venereal diseases; 
to 
Batio of 
Syphilis 
Oonnorhea 
Casas 
New cases 
of 
Gronnorhea 
New cases 
of 
Syphilis 
New cases of 
venereal diseases 
per 10,000 popu- 
lat i on. 
1937 
1; 3.6 
273,000 
75,000 
gen 
66.4 
Women 
23.1 
1934 
1:4.1 
175,000 
43,000 
— 
— 
1940 
1:4.7 
161,000 
34,000 
23.1 
12.9 
Estimates of total number of persons 
vlth syphilis 
1930 700-900,000 
1939 . 300-400,000 
No increase in venereal disease incidence is shown by 
the above figures; but it should be remembered that there was little 
increase in the last war, the rate per thousand population rising only 
from 20,4 before the war to 20.5 during the war, while a great 
increase in the incidence of venereal diseases set in after the 
20 
return of military personnel to civilian life. 
At the beginning of tht present war there was an attempt 
to return to the method of restricting prostitutes to certain houses 
and districts. This was true particularly in regions having a large 
number of foreign workers, for whom a supply of foreign prostitutes, 
assigned to special houses, was introduced. Although the official 
RESTRICTED 28 
reports on venereal disease are conflicting, it is a fair assumption 
that the war has brought an increase in venereal disease. 
The health authorities, 
at any rate, must have thought so, when they took the initiative of 
putting the decree of 21 October 1940 on the statutebook. This decree 
formally legalized the return to the old -practice of restricting prosti- 
tutes to certain areas to the various local health authorities. 
In addition, the decree forces prostitutes to undergo a 
weekly examination by a venerologist. Th® physician reports his 
findings on a certificate to the health department, and records the 
examination in the control book of the prostitute. If she fails to 
submit to the examinations compulsory means are used. The law also 
puts heavy penalties on the infected persons who have intercourse, or 
those who refuse or stop medical treatment. It increases the physician1-s 
responsibility in reporting to the health authorities. The physician's 
duties have been considerably amplified in a later decree of 30 September 
1942 which puts on him the burden of investigating the source of the 
infection in every individual case and of reporting his findings to 
the health authorities. 
The practices, as they have developed under the social 
conditions now prevailing in Germany, constitute a complete reversal 
of the methods developed under the Republic. The emphasis on social 
controls has given way to older police methods. It is questionable 
RESTRICTS!) 29 
whether the threat of severe penalties was instrumental in obtaining 
the voluntary cooperation of infected persons in seeking treatment 
at an early stage, or whether the duties laid on doctors to report to 
the health authorities have not undermined the confidence in them, 
and thus kept infected people away from treatment. 
It is quite certain that we do not have a complete picture 
of the venereal disease incidence from any current German statistics, 
but it is fair to assume that the return of the peripatetic German 
army will result in a sharp upswing in the venereal disease curve. 
21 
h. Malaria. Although malaria is not as prevalent as it 
was 25 years ago, it remains endemic in many areas. The principal 
areas of enderaicity are the Rhine Valley, the southwestern regions of 
the Steiermark and Burgenland, and the lowlands of northwestern 
Germany. In the Bratislava region, it is reported that approximately 
10 percent of the population is malarious. Reports in 1939 indicated 
that there was an outbreak of considerable size in the Hannover area. 
The principal malaria vectors in all these regions are: Anopheles 
maculipennis messeae and Anopheles maculipennis atroparvus. In the 
region of Freiburg im Breisgau, Anopheles maculipennls typicus is 
also a malaria vector. 
RT5STRIC TED 30 
4. Vitamins. During the winter months, the diets cf 
heavy industrial workers were supplemented by vitamin preparations 
distributed in factories by the Labor Organization, Vitamins were 
not distributed to the unemployed, to workers over 65, or to children. 
In general, the public was unable up to 1942 to purchase vitamin 
preparations on the open market, nor was there any educational camp- 
aign to make them vitamin-conscious. I.G. Farben and Merck were the 
principal German manufacturers of synthetic vitamin preparations, the 
latter having exchanged processing information with its American 
counterpart probably until 1941. The Swiss division of Hoffman La 
22 
Roche has also supplied large amounts of synthetic vitamin preparations. 
It is reported that Merck has recently ceased deliveries of vitamins 
to Switzerland (November 1943) and that their vitamin production has 
drooped 40 percent. This is said to be because of bomb damage to 
marcotics-producing plants which has forced Merck to substitute the 
23 
manufacture of morphine for the army for vitamin manufacture, 
E, Sanitation 
A description of water supply in Germany will be found in 
CAD Handbook X; Public Works and Utilities, Section C, Prior to 
the war, water sanitation was at a high level. The increasing number 
of enteric diseases during the war years means that all waters are 
suspect until examined on the spot. In rural areas, the use of night- 
soil as fertilizer is a practice which facilitates the spread of enteric 
ESSTRI0T2D 31 
diseases. Sewerage oractices are described in CAD Handbook X, Section 
D, Street-cleaning and garbage removal are under state control arid 
severe penalties are imposed for public nuisances. 
Pasteurization, which was practiced more widely in 
Germany than in any of the other Western European countries, was 
being neglected in 1942. Even in Berlin, the storekeeper dispensed 
milk by dropping into a large open vat and pouring it into containers 
brought by the customer. Such milk always left a heavy, dirty sediment 
26 
on standing. It is obvious that milk distributed in such fashion can 
be responsible for milk-borne epidemics 
P2STRICTKB 32 
APPENDIX 1. ORGANIZATION OF HtBLIC HEALTH SERVICES 
IN GERMANY 1 
Per Qffentllche Qesundheitadienai 
(Numbers refer to corresponding numbers on chart. 
English translation below.) 
1. Reichs-und Preussisches Ministerium des Innern 
(Ubt. Volksgesundheit) 
2. Reichsstatthalter Landesregierungen, 
3. Fur Preussen Oberprasidenton. 
4. Hegierungsprasidenten (Bezirksinstanz). 
5. Gesundheitsamter in jedera Stadt-und Landkreis. 
6. Reichsarbeitsministerium, 
7. Reichsversicherungsamt. 
8. Landesversicherungsanstalten. 
9. Krankenkassen. 
10. Reichsausschuss flir Volksgesundheitsdienst beira Reichsund 
Preussischen Ministerium des Innem, 
a. Volkspflege; Rassenkunde, Rassenpflege, 
Erbkundo, Erbpflege, Familienkunde, Fanilienpfleg®. 
b. Allgeraeine Gesundheltspflege: Volksernahrung, 
Bekampfung der Volkskrankheiten und Volksschaden. 
11. Arbeitsgeraeinschaft mit: 
a. Deutsche flir Rassenhygiene, 
b. Reichsbund der Kinderreichen Deutschlands z. 
Schutze d. Farailie. 
c. Volksbund der deutschen sippenkundlich Vereine, 
d. Verband bffentl. Lebensversicherungsanstalten 
Deutschlands, 
e. Deutsches Hygiene-Museum. 1 
f. Volksdeutsche Buhne, 
g. Bund Kinderland. 
12. Untergruppen des Reichsausschusses fur Volksgesundheitsdienst. 
RES TRIG TED 13* a, Reichsarbeitsgemeinschaft fiir Mutter und Kind, 
b, Reichsarbeitsgemeinschaft zur Bekampfung dee 
Krvippeltums. 
c, Reichsarbeitsgemeinschaft fiir Rauschgiftbekampfung, 
d, Reichsarbeitsgemeinschaft fiir VolksernAhrung, 
e, Reichstuberkuloseausschuss, 
f, Reichsarbeitsgemeinschaft fiir Krebsbekampfung. 
g, Reichsarbeitsgemeinschaft z, Bekampfung der 
Geschlectskrankhelten. 
h, Reichsarbeitsgemeinschaft fiir Arznei und Heilmittelwesen, 
I, Reichsarbeitsgemeinschaft fiir Krankenhauswesen, 
J, Reichsarbeitsgemeinschaft fiir bemftliche 
Gesundheitsfiihrung, 
k. Reichsarbeitsgemeinschaft fiir Rettungswesen, 
14* Staatsmedizinische Akademie, 
15, Landesgesundheitsrat Sachverstandigenbeirat fiir 
Bevolkerungs- und Rassenpolitik. 
16, Reichsgesundheitsamt mit wissenschaftlichen Instituten. 
17, Rotes Kreuz — Rettungswesen. 
18, Oeffentliche Wohlfahrtspflege, 
19, Provinzlalverwaltung. 
20, Kreisverwaltung, Landrat, Stadtkreise, 
21, Wohlfahrtsamt. 
22, Jugendsarat. 
23* Standesamt, 
24, Gesundheitsaussicht und Gesdndheitschutz: Ueberslcht 
ilber das allgemeine Medizinalwesen (Aerzte, Zahharzte, 
Apotheker, Heilprakticker, arztliches Hilfspersonal, 
Desinfektoren); beamtete Aerzte; Ueberwachung der 
Apotheken und des Verkehrs mit Arznei, Geheimmiteln 
und Giften; aussicht ilber Krankennauser und - 
anstalten; Aussicht ilber Bader, Krankentransport-*, Rettungs- 
und Bestattungs- wesen; Seuchendbekampfung; Wohnungs- und 
Ortshygiene; Mitwirkung bei Handhabung der Baupolizei, der 
Wasservesorgung und der Beseitigung der Abfallstoffe; Schutz- 
pockenimpfung; Desinfektion; Schadlingsbekampfung; Ungezie- 
ferbekampfung; Wasser-, Boden- und Lufthygiene; Gewerbehygiene; 
Ueberwachung des Verkehrs mit Lebehsmltteln, Milch, Fleisch 
STRIP 34 
und Gebrauchsgogenstanden, der Lebensndttelgeschafte und- 
markte; Zusamraonarbeit mit dem bffentlichen Veterlhardienst; 
Gerichtsarztliche Tatigkeit (Begutachtung, Mitwirkung als 
Sachverstandige usw,); Vertrauensarztliche Tatigkeit; Amts- 
arztliche und arztliche Zeugnisse fiir Behorden, Versicherungen 
und Privatpersonen, 
25* Erb- und Rassenpflege: 
Eheberatung; Durchfiihrung des Ehegesundheitsgesetzes; 
Durchfuhrung des Blutschutzgesetzes; Durchfuhrung des Gesetzes 
zur Verhutung erbkranken Nachwuchses; Ehestands-darlehensunter- 
suchungen; Siedleruntersuchungen; Utersuchungen Einzuburgemder; 
Erbbiologische Kartei, Slppenpflege; Erziehung zu Erbgesundheit 
und Rassenreinhelt; Erb- und Rassenkunde. (Vortrage und Ausstel- 
lungen.) 
26, Gesundsheitspflegei 
Beratung fur Schwangere; Wochnerinnenbetreuung; kutter- 
beratung, Sauglingsfursorge; Hebammenwesen; Beratung fur 
Kleinkinder; Aussicht der Kinderheime, kindergarten, Krippen 
u. dergl. Pflegekinderwesen; Schulgesundheitspflege, Schulzahn- 
pflege; Auswahl erholungsbedurftiger Kinder; Forderung der 
Korperpflege und Leibesubungen; Besichtigung sportlicher Anlagen; 
Beratungs stelle fiir Sportausubende; Mitwirkung beira Luftschutz- 
Sanitatsdienst; Volksbelehumg; Aussicht uber Geisteskranke, 
Psychopathen, Epileptiker und Idioten; Aussenfursorge fiir Geis- 
teckranke; Aussicht uber Privatpflegeanstalten fiir Geisteskranke; 
Sonstige Krankenfiirsorge (Geschwulst-, Krebs-, Zuckerkranke 
usw,); Alkohol- und Rauschgiftbekampfung; Fiirsorge fiir Suchtige, 
Sieche und Korperlich Behinderte; Beratung fiir Geschlechtskranke; 
Bekampfung der Geschlechtskrankheiten; Beratung Tuberkuloser; 
Bekampfung der Tuberkulose. 
PUBLIC HEALTH SERVICE IN GERMANY 
(English translation of preceding list) 
1, National and Prussian Ministries of the Interior. 
2, National governors for the State governments, 
3, Provincial governor of Prussia (highest officer of Prussia), 
4, District governor (a district being a part of a Prussian 
province) 
RESTRICTED 35 
5* Health officers In each urban and rural county. 
6. National Ministry of Labor. 
7. National Insurance Department. 
8. Provincial insurance divisions, 
9. Workmens sickness funds, 
10. National Commission for Public Health Service in the 
National and Prussian Ministries of the Interior, 
a. Public Welfare: science of race, race welfare, 
heredity, protection of heredity, science of the 
family, family welfare, 
b. Health Welfare: nutrition, campaign against disease and 
injury. 
11. Group cooperating with* 
a. German Society for Race Hygiene, 
b. National Association of Children1s Societies of 
Germany for Protection of the Family. 
c. People*s Organization of German Genealogical Societies, 
d. Society of Public Life Insurance Institutes of Germany, 
e. German Hygiene Museum, 
f. People*s Theater, 
g. Children*s Land Society (for sending children to farms) 
12. Sub-group of the National Committee for Public Health Service 
13* a. National Committee for Maternal and Child Care, 
b. National Committee for the Prevention of Crippling 
Disabilities, 
c. National Committee against Drug Addiction, 
d. National Committee for Public Nutrition, 
e. National Tuberculosis Association. 
f. National Association, 
g. National Anti-Venereal Disease Association, 
h. National Committee for Medications and Medical Equipment, 
i. National Committee for Hospital Affairs, 
j. National Committee for Professional Health Guidance, 
k. National Committee for First Aid Activities, 
14 State Academy of Medicine, 
15, State Health Council for Population and Race Policies, 
RESTRICTED 16. National Health Office with Scientific Institutions. 
17. Red Cross — First Aid Activities. 
18. Public Welfare Activities. 
19. Provincial Administration. 
20. County Administration, County Administrator, Municipal 
Counties. 
21. Welfare Office, 
22* Youth Office. 
23. Public Registrar. 
24. Health Supervision and Protection: supervision of general 
medical affairs (doctors, dental surgeons, druggists, "health 
practitioners", medical assistants, exterminators); state-employed 
physicians; supervision of drugstores, of the handling of medications, 
of secret and poisonous chemicals; supervision of hospitals and 
institutions; supervision of baths, and ambulance, rescue, and 
burial services; campaigns against epidemics; housing, and sanitary 
hygiene; cooperation in matters of building inspection, water supply, 
and sewage disposal; small-pox vaccination; disinfection; campaign 
against noxious animals; campaign against vermin; water, soil, 
and air hygiene; industrial hygiene; supervision of food handlers 
of milk, meat, utensils, food stores and meat markets; cooperation 
with the public veterinary service; police doctors (expert testi- 
mony); company physicians; medical certificates for public auth- 
orities; insurance companies, and private individuals. 
25. Genetics and Race Hygiene: Marriage Advisory Council; execu- 
tion of the Marriage Health Law; execution of the Race Protection 
Law; execution of the Law for the Prevention of Children with 
Hereditary Diseases; examination of candidates for marriage loans*; 
examination of prospective settlers; examination of candidates for 
naturalization; genealogical affairs and files; education in matters 
pertaining to inheritance-purity and race hygiene; science of 
heredity and race, (Lectures and exhibitions.) 
26. Medical Care: prenatal advice; postpartem care; maternal 
advice; infant welfare; midwifery, pediatric advice, supervision 
RESTRICTED 37 
of children1s homes, kindergartens, foster homes, and similar 
child welfare matters; school health care, school dental care; 
selection of children in need of recreational and health facilities; 
promotion of personal hygiene and athletics; inspection of athletic 
facilities; advisory of air raid precautions service; popular 
instruction; supervision of the insane; psychopaths, epileptics, 
and Idiots; extra-mural care of the insane; supervision of 
private institutions for the insane; other medical care (turaora, 
cancer, diabetes, etc,); campaign against alcoholic and narcotic 
poisoning; care for drug addicts» Invalids, and the physically 
handicapped; advice for venereal disease patients; anti-venereal 
disease campaign; advice for tuberculous patients; anti-tuberculosis 
campaign. 
RESTRICTED 38 
1226 
1937 
1228 
1222 
Licensed physicians 
48,B48 
49,732 
47,725 
Licensed dentists 
13,037 
13,966 
14,833 
15,006 
Licensed pharmacists 
11,461 
11,549 , 
11,819 
12,432 
Pharmacists’ assistants 
4,591 
4,647 
4,215 
3,858 
Midwives 
25,765 
25,143 
24.377 
23,745 
Dental technicians 
20,889 
21,035 
20,732 
20,885 
Bathers, masseurs, physiotherapists 
12,140 
12,682 
12,370 
12,431 
General nurses 
131,259 
131.407 
132,288 
135,450 
Pediatric nurses 
9,202 
9.787 
10.633 
11,002 
Obstetrical nurses 
1,333 
1,517 
1,470 
1,483 
Disinfectors (exterminators) 
5,709 
5,842 
5,767 
5,816 ' 
Unlicensed “health practitioners*1 
12.936 
12.417 
10.035 
10.067 
TOTAL 
296,166 
298.840 
298.279 
299,900 
Men 
132,322 
133,275 
131,653 
129.828 
Women 
163,844 
165,565 
166.626 
170,072 
29 
APPENDIX 2, NUMBER OF HEALTH PERSONNEL IN THE REICH 1936 - 1939. 
RESTRICTED RESTRICTED 
39 
APPENDIX 3. MEDICAL.PARSOEUBL. SPECIALISTS. 1938 & 1939. 29 
Total number 
Jan. 1, 1938 
All special- 
ists, Jan. 1, 
1939 
Total Humber 
Number per 100 
physic- 
ians 
Women 
Total Number 
'number per 
100 spec- 
ial! st s 
of the 
sane spec- 
ialty 
Surgeons 
2454 
2455 
5.1 
22 
0,9 
Obstetricians and 
Gynaecologists 
1938 
1802 
3.8 
114 
6.3 
Orthopedi st s 
452 
390 
0.8 
10 
2.6 
Oculi sts 
1378 
1252 
2.6 
65 
5.3 
Otorhino laryngolo- 
gists 
1590 
1457 
3.1 
16 
1.1 
Dermatologists and 
venereologists 
1694 
1376 
2.9 
51 
3.7 
Urologists 
228 
196 
0.4 
1 
0.5 
Neurologi st s and 
psychiatrists 
1604 
1404 
- 2.9 
95 
6.8 
Eorntgenologi sts 
375 
372 
0,8 
10 
2.7 
Oral surgeons 
218 
209 
0.4 
6 
2.9 
Internist s 
2400 
2348 
4,9 
78 
3.3 
Gastroenterologists 
210 
131 
0.3 
- 
- 
Pulmonary disease 
specialists 
592 
572 
1.2 
40 
7.0 
Pediatricians 
1244 
1028 
2.2 
< 
332 
32.3 
Total 
16,437 
14,992 
31.4 
841 
5.6 40 
30 
APPENDIX 4. MT3DIC/.L INSTITUTIONS IN SSHMAMY. 1 JANUARY 1938 
Type 
Number 
Number 
of Beds 
General hospitals 
3.091 
375.979 
Institutions for tuberculosis - adults 
Institutions for tuberculosis - children 
202 
37 
28,112 
5.174 
Institutions for infants and children 
163 
16,281 
Institutions with permanent medical facili- 
ties for cripples 
44 
8,278 
Eye hospitals 
96 
3,576 
Skin and venereal disease hospitals 
36 
3,022 
Institutions, with permanent raedicel facili- 
ties, for the chronically ill or incurable 
125 
22,838 
Hospitals for the insane, epileptics, etc. 
266 
177.723 
Institutions for mental defectives 
54 
20,615 
Hospitals for neuropathology 
59 
3.393 
Institutions for alcoholics and drug addicts 
14 
644 
Maternity hospitals 
236 
11,239 
Gynecological institutions or clinics 
112 
2.981 
Other specialized institutions 
255 
12,093 
Sick-wards in penal institutions 
98 
3,541 
Total for the Reich (including Ostmark 
Eeichsgau but not the Sudetenland) 
4.888 
695,490 41 
Number 
Number of 
beds 
Days of care 
given (millions) 
Overhead 
expenses 
(food, house- 
hold) 
(millions,BM) 
Personnel 
expenses 
(millions, 
Other 
exnenses 
HM)(millions 
RM) 
Income Contribu- 
(mill- tions from 
, ions.RM) Province 
(millions,RM) 
Hospital.8 and 65 
sanitaria 
69,257 
26.0 
22.6 
35.7 
23.7 
66.6 
15,4 
Other institu- 30 5,346 
tions (invalids, handicapped, 
tuberculosis) 
1.6 
1.3 
1.5 
1.7 
4.5 
0.6 
Training institu- 
tions for the deaf 
and dumb 27 
1,180 
0.5 
1.2 
3.0 
0.6 
1.5- 
3.3 
Training institu- 
tions for the 
blind 11 
1,945 
0.6 
1.2 
1.7 
0.9 
2.0 
1.3 
Total 133 
77,728 
28.7 
26.3 
42.0 
26.9 
74.6 
21.1 
31 
APP3IJDIX 5. HEALTH INSTITUTIONS 07 mIT. T3AR. 1936, 42 
APPENDIX 6. Of FEE SC® S CASED FOE AND TOTAL EXPENDITURES POE WELFARE INSTITUTIONS OF 
ASSOCIATIONS OF MUNICIPALITIES AND DISTRICTS 31 
Budget Tear 
Sanitaria and 
Convalescent 
hones 
Hospital and 
maternity homes 
Institutions for insane, 
Mind, deaf, dumb and 
crippled 
Homes for 
and chronics, and 
other homes. 
1927 
335.8 
512.3 
183.5 
234.6 
1928 
316.2 
531.4 
210.5 
326.4 
1929 
284.8 
579,6 
201.7 
331.4 
1930 
260.0 
661.9 
202.9 
338.6 
1931 
179.7 
731.1 
222.7 
*313.5 
1932 
149.6 
909.3 
209.2 
295.2 
1933 
130.3 
893.2 
215.7 
271.4 
1934 
133.4 
829.8 
220.2 
269.5 
1936 
137.0 
803.3 
230.1 
282.4 
1936 
55.7 
(adults only) 
740.7 
246.7 
297.1 
Namfoer of persons cared for (thousands) 43 
Budget Year 
Sanitaria and 
convalescent 
homes 
Hospital and 
maternity homes 
* 
Institutions for insane, 
blind, deaf, dumb and 
crinoled 
Homes for aged 
and chronics, and 
other homes 
1927 
39.2 
76.4 
149.6 
85.0 
1928 
38.9 
80.5 
168.5 
100.4 
1929 
37.7 
89.3 
176.0 
112.2 
1930 
33.7 
103.0 
183.1 
120.9 
1931 
23.6 
114.3 
181.0 
101.8 
1932 
16.6 
128.7 
155.0 
89.4 
1933 
15,8 
139.8 
156.6 
88.8 
1934 
16.4 
110.2 
155.6 
85.8 
1935 
17.0 
110.0 
158.9 
89.5 
1936 
11.6 
(adults 
only) 
93.2 
155.9 
88.6 
TOTAL EXPANDITUTffiS (MILLIONS 07 BM) 
APPENDIX 6 (GOUT1D.) 44 
RESTRICTED 
32 
APPENDIX 7. CAUSES OF DEATH. GERMANY, 1936 
Number of 
deaths 
Causes of death 
A. Infectious and parasitic diseases 
1. Typhoid and paratyphoid fever 
2. Typhus 
3. Smallpox 
4. Measles 
5. Scarlet fever 
6. Whooping cough 
7. Diphtheria 
8. Grippe 
9. Dysentery 
10. Plague 
11. Pulmonary tuberculosis 
12, Extra-pulmonary tuberculosis 
13, Syphilis 
14, Sepsis other than puerperal fever 
15. Malaria 
16. Parasitic diseases 
17, Other infections and parasitic diseases 
£- Neoplastic diseases 
18. Malignant growths 
19. Others 
Other general diseases 
20, Acute articular rheumatism 
21, Chronic rheumatism and gout 
22. Diabetes 
23. Avitaminosis 
24, Diseases of the thyroid end parathyroid glands 
25, Other general diseases 
Nl&ea_ee_g_of _the blood and bloodforming organa 
26. Anaemia 
27. Leukemia and other diseases of the blood 
and the bloodforraing organs 
E. Chronic poisopj^ga 
28, Acute and chronic alcoholism 
29, Other chronic poisonings 
F• Diseases of the central nervous system and the 
sensory organs 
30. Meningitis 
31, Tabes dorsalis 
32. Apoplexy and paralysis 
33, Progressive paralysis 
34. Schizophrenia and other mental diseases 
35, Epilopsy 
36, Other diseases of the nervous system 
37. Diseases of the eyes, ears, and mastoid 
2U>M 
525 
0 
0 
1,843 
1.313 
3,126 
7,372 
19,433 
148 
0 
40*240 
7,267 
2,334 
3,215 
38 
92 
4,642 
maw 
98,693 
5,295 
auas 
1.026 
2,264 
12,983 
888 
2,162 
1,175 
&J01 
2,066 
3,151 ‘ 
474 
392 
82 
87,774 
2,613 
939 
65,304 
2,302 
1,556 
1,905 
11,348 
1,807 45 
Number of 
deaths 
Causes of death 
0, Disease of the circulatory organs 
38, Pericarditis 
39, Acute endocarditis 
40, Chronic valvular inflammation and 
valvular defects 
41, Myocardial disease 
42, Coronary artery disease and angina 
pectori s 
43, Other heart diseases 
44, Aneurysm 
45, Arteriosolorosis and gangrene 
46, Other diseases of the circulatory organs 
H. Diseases of the respiratory organs 
47, Bronchitis 
48, Fulmonitis 
49, Pleurisy 
50, Other diseases of the respiratory system 
1. Diseases of the digestive organs 
51, Stomach and duodenal ulcers 
52, Oastro-enteritis (under 2 years old) 
53, Gastro-enteritis and intestinal ulcers 
(2 or more years old) 
54, Appendicitis 
55, Hernia and intestinal obstructions 
56, Cirrhosis of the liver 
57, Gallstones and other liver and gallbladder 
diseases 
58, Other diseases of the digestive organs 
J. Diseases of the uro-genital system 
59, Nephritis 
50. Other kidney diseases 
61. Urinary calculi 
62, Bladder diseases 
63, Diseases of the ureters 
64, Diseases of the prostate gland 
65. Non-venereal genital diseases 
K. Illnosses of pregnancy, delivery and puemerium 
66. Afebrile abortion and illnesses of pregnancy 
57, Natal and postnatal metrorrhagia 
68. Febrile abortions and puerperal fever 
69. Toxomias of pregnancy 
70. Other accidents at pregnancy, delivery and 
puerperium 
L. Diseases of the skin and subcutaneum 
M. Diseases of the locomotor system 
N. Congenital malformations (not counting 
still birth) 
133,054 
531 
444 
13,879 
46,963 
19,971 
19,400 
134 
26,804 
4,328 
87,123 
11,142 
59,368 
3,099 
13,514 
50.032 
5,064 
8,731 
2,849 
5,499 
6,514 
4,244 
8,252 
8,879 
25.168 
11,985 
2.802 
866 
2,433 
137 
5,438 
1,507 
6,074 
751 
567 
2,358 
808 
1,590 
3.403 
1,894 
5.197 Number of 
deaths 
Causes of death 
O, Diseases of the newborn except for still birth 
71, Congenital debility 
72, Premature births 
73, Birth injuries (live births) 
74, Other illnesses in children under 3 months 
P. Senility 
Q, Additional causes of death 
75, Suicide 
76, Homocide and manslaughter 
77, Accidental death 
78, Violent deaths (unclassified) 
79, Deaths from war and execution in war 
80, Legal execution 
R. Sudden death (cause undetermined) 
TOTAL 
38,931 
15,912 
16,520 
4,705 
1,794 
71.542 
49.375 
19,288 
785 
28,916 
328 
0 
58 
14.461 
795.793 47 
32 
APPENDIX 8. BIBTH AND DEATH RATES. OEHMANY. 1937 
Live ‘births 
Still births 
Deaths (excluding still births) 
Surplus of births over deaths 
Still births per 100 legitimate births 
Births per 1000 inhabitants (not includ- 
ing still births) 
Deaths per 1000 inhabitants (not includ- 
ing still births) 
1.275.212 
31,262 
793,192 
482,020 
2.4 
18.8 
11.7 48 
1937 
1938 
1937 
1938 
Diphtheria 
146.733 
149,424 
5,387 
5,286 
Scarlet fever 
117.544 
114,243 
819 
759 
Pulmonary tuher- 
63.570 
60,420 
33,236 
30,623 
culosi8 
Skin tuberculosis 
1.042 
1,039 
_ 
Other forms of 
—— 
——— 
3,132 
tuberculosis 
Epidemic meningitis 
1,574 
1,826 
780 
842 
Encephalitis lethargica 291 
287 
162 
160 
Acute anterior 
2.723 
5,757 
323 
527 
poliomyelitis 
Trachoma 
697 
533 
Typhoid fever 
3,051 
2.945 
301 
338 
Paratyphoid fever 
3,755 
3,210 
1,08 
126 
Dysentery 
7,245 
5,265 
181 
161 
Bacterial food- 
— 
—— 
_ — _ 
poisoning 
Puerperal fever 
3,402 
2,991 
671 
548 
Puerperal fever after 
3,015 
2,862 
438 
344 
miscarriage 
Dog bites by animals 
80 
112 
1 
— 
suspected as rabid 
Anthrax 
90 
84 
7 
12 
Psittacosis 
22 
37 
6 
6 
Incidence Mortality 
APPENDIX 9. INFECTIOUS DISEASES IN GERMANY 
1937-1942 33 49 
1939 
1940 
1941 
1942 
1939 
1940 
1941 
1942 
Diphtheria 
174,014 
174,052 
204,918 
280.731 
7,560 
3,500 
9,607 
14,764 
Scarlet fever 
152,606 
159,597 
279,117 
401,907 
1,275 
1,700 
3,233 
4,454 
Whooping cough 
83,416 
133,479 
107,543 
88,306 
939 
1,373 
1,335 
1,028 
Pulmonary and laryn- 
77,687 
98,062 
117,558 
127,248 
33,423 
42,989 
49,653 
53,999 
geal tuberculosis 
Skin tuberculosis 
1,873 
1,667 
1,909 
1,840 
— 
— 
— 
— 
Other forms of 
6,620 
9.779 
15,512 
17,033 
3,475 
4,867 
5,636 
6,101 
tuberculosis 
Cerebrospinal men- 
6,232 
7,211 
4,767 
2,765 
2,415 
2,089 
1,367 
947 
ing.it i s 
Encephalitis lethargica 536 
786 
658 
426 
296 
295 
294 
236 
Acute anterior 
4,115 
2,149 
5,306 
3,932 
373 
230 
573 
413 
poliomyelitis 
Trachoma 
774 
5,586 
9,196 
8,554 
— 
— 
— 
— 
Typhoid fever 
4,108 
9.163 
7,723 
16.403 
499 
971 
805 
1,622 
Paratyphoid fever 
3.893 
4,197 
4,883 
6,078 
144 
183 
156 
187 
Dysentery 
6,408 
24,458 
10,330 
15,137 
230 
1,497 
672 
1.872 
Bacterial food- 
2,330 
3,158 
2,255 
1,940 
66 
121 
84 
83 
poisoning 
Weil's disease 
141 
84 
90 
103 
28 
17 
17 
5 
Puerperal fever 
3,267 
3.552 
2,876 
2,161 
759 
777 
635 
330 
Puerperal fever after 
* 2,280 
1,930 
1,936 
1,590 
338 
317 
330 
355 
miscarriage 
Anthrax 
85 
92 
52 
33 
9 
15 
3 
2 
Dog bites by animals 
354 
2,099 
1,136 
781 
— 
18 
6 
3 
suspected as rabid 
Psittacosis 
25 
30 
17 
6 
3 
4 
1 
2 
Bang's disease 
327 
264 
229 
202 
7 
9 
10 
1 
Malaria 
-.<0\iS Ur, ■ 
344 
422 
1,607 
711 
6 
3 
3 
3 
Incidence Mortality 
APPBSDIX 9 (G01TT1D) 50 
RBSIRICTED 
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