This chapter describes the circumstances of medical work in Germany. Germany is a federation of States with varying medical conditions, but all subject to the federal Sickness Insurance Act. Medicine, indeed, is one of the chief problems of government, primarily and chiefly owing to Germany's systems of sickness, invalidity, and accident insurance. The public services for the treatment of sickness are becoming unified with those of health welfare work in Germany, but the municipal health office and the child welfare office are related to an extent which varies greatly according to local conditions, personal and other. Puerperal mortality is high, notwithstanding the benefits under the national insurance Acts. Germany was a pioneer in the application of hygiene to school life, and some of the most important advances in school hygiene have been made by German school doctors. The insurance sickness and invalidity associations do a vast amount of anti-tuberculosis work. Sickness insurance is compulsory in Hamburg under Federal law.