Preliminary Draft 
CIVIL AFFAIRS HANDBOOK 
on 
FRANCE 
Section Thirteen 
on 
PUBLIC HEALTH AND SANITATION 
Prepared by 
Office of Strategic Services 
for 
Military Government Division 
Office of the Provost Marshal General 
Preliminary Draft INTRODUCTION 
Purposes of the Civil Affairs Handbook. 
International Law places upon an occupying power the res- 
ponsibility for maintaining civil order in the areas occupied. 
The basic purposes of civil affairs officers are thus (1) 
to assist the Commanding General of the combat units 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 result- 
ing from disorder and (3) to create the conditions which will 
make it possible for civil government to function effectively. 
The preparation of Civil Affairs Handbooks is a part of the 
effort to carry out this obligation as efficiently and humanely 
as is possible. The Handbooks do not deal with planning or policy. 
They are rather ready reference source books of the basic factual 
information needed for planning and policy making. For these rea- 
sons, it should be clear that the data contained in this section 
does not imply any given program of action. 
Revision for Final Publication. 
Significant area information is immediately needed to make 
certain that it is in hand whenever events require it. 
Arrangements were therefore made with the cooperating agen- 
cies to organize all immediately available material in accordance 
with a prepared outline. Hence, this section on Public Health 
and Sanitation in France should be considered a preliminary draft. 
As more detailed or more recent material becomes available, es- 
pecially as to the practice of public health administration on the 
local level, it is to be incorporated into the handbook on France 
as a whole. 
OFFICERS USING THIS MATERIAL ARE REQUESTED TO MAKE SUGGES- 
TIONS AND CRITICISMS INDICATING THE REVISIONS OR ADDITIONS WHICH 
WOULD MAKE THIS MATERIAL MORE USEFUL FOR THEIR PURPOSES. THESE 
CRITICISMS SHOULD BE SENT TO THE CHIEF OF THE SURVEY AND RESEARCH 
SECTION, MILITARY GOVERNMENT DIVISION, P.M.G.O., 2805 MUNITIONS 
BUILDING, WASHINGTON, D. C. (OR PHONE WAR DEPARTMENT EXTENSION 
76370). FRANCE 
PUBLIC HEALTH AND SANITATION 
mis 
Pa£6 
a. Public Health Organization and Services 1 
(1) National Government 1 
(2) Departmental and District Administration 5 
(3) Local Governments 6 
Budget of City of Bordeaux 8 
Budget of City of Lyon 8 
b. Assistance of Private Agencies 10 
c_. Medical and Related Care 10 
(1) Medical Personnel 10 
(2) Hospitals 12 
(3) Stocks of Vaccines, Serums, Drugs, etc. 14 
(4) Status of Vaccination and Immunization 15 
d. Birth, Death, and Disease 16 
(1) Deaths from Principal Causes 16 
(2) Cases and Deaths from Certain Infectious Diseases 18 
(3) Disease Information; Recent Epidemics 18 
e. Sanitation 23 
(1) Departments of Government Supervising Sanitation 23 
(2) Problems and Control Measures 23 
(a) Water Supply 23 
(b) Sewage Disposal 24 
(c) Waste Disposal 24 
(d) Food and Beverage Control 25 
(e) Insect and Rodent Control 25 
(f) Housing, Bathing, and Toilet Facilities 25 
f. Animal Diseases 26 
g. Laws 26 
07 
Selected References . 
Tables 28 
Maps 
I*d«x 
following ■mnffm 
PUBLIC HEALTH AND SANITATION 
FRANCE 
a. Public Health Organization and Services. 
(1) National Government. Until the summer 
of 1940, the central agency in charge of public health 
in France was the Ministers de la Sante publique 
(Ministry of Public Health), Wiich was responsible for 
carrying out all legislative measures covering public 
health and Infectious diseases; social hygiene, including 
campaigns against tuberculosis, cancer, venereal disease; 
medical poor relief; maternal and child welfare; the super- 
vision of physicians, dental surgeons, nurses, midwives 
and pharmacists; the control of drugs, serums, poisons, 
food and drinking water. 
Certain special health services fell within the 
Jurisdiction of departments other than the Ministry of 
Health: the medical services of the army and navy were 
administered by the Ministries of War and Marine, 
respectively; colonial medical services by the Ministry 
of Colonies* The study of epizootic diseases and cer- 
tain questions connected with food and milk were handled 
by a branch of the Ministry of Agriculture. Industrial 
diseases were the concern of the Ministry of Commerce 
and Industry; workshop and factory sanitation, of the 
Ministry of Labor; the medical inspection of school 
children, of the Ministry of Public Instruction. 
The personnel of the Ministry of Health was purely 
administrative, having no technical officers with special 
qualifications in public health or hygiene* Attached to 
the Ministry, however, was a group of technical bureaus 
Imown as the Services oentraux d1hygiene soolale (central 
public health services). These services, wbiciTunder- 
took the technical study of various health questions. 
Included: 
(a) a Central Service for the prevention of venereal 
diseases; 
(b) a Central Nursing Bureau, responsible for all 
questions concerning nurses, social workers, 
visiting nurses; 
(0) an Information Service for the use of public 
health workers; 
(d) a Central Service of Technical Studies for the 
promotion of research work of public health 
Interest; 
(e) a Propaganda Service, which organized national 
health propaganda campaigns and coordinated 
the work of private agencies such as the 
National Anti-Tuberculosis Committee, the 
National Anti-Venereal Disease League, the 
National Anti-Cancer League. 
The Minister of Health could also consult with the 
Cons e11 sup erleur d * hygiene . a purely advisory body 
consisting of representatives of the Ministry of Health 
and other government departments, together with the dean of the Paris Faculty of Medicine, the director or - 
the Paris School of Pharmacy, professors of public 
health of the principal medical schools, and represen- 
tatives of the professions. The Council advised the 
Minister on matters of general health and sanitation, 
epidemic diseases, industrial and professional health, 
food and drinks, the practice of medicine and pharmacy. 
Besides the Supreme Council, there wecee a number of 
specialized advisory committees concerning themselves 
with tuberculosis, venereal disease, cancer, the birth 
rate, etc. 
It will be noted from the Health Ministry’s range 
of activity that in France public health and social 
welfare were on the whole not separate fields. France 
provided public medical relief on a large scale. Under 
the Law of 15 July 1893, every sick person without 
financial resources was entitled to receive free medical 
assistance at home or in a hospital, the cost to be 
carried by the commune, the department or the State, 
depending upon his place of residence. Ot£er law* 
required the commune, department, or State to provide 
assistance and medical care to the aged, infirm or 
incurable; to wounded war veterans; to expectant and 
nursing mothers; to tubercular or mentally ill indigents; 
to children whose parents were dead, had abandoned them, 
or were temporarily or permanently unable to support 
them. In addition, the Law of 5 April 1928 (amended 
in 1929 and again in 1930) provides for a compulsory 
national health insurance system applying to all wage- 
earners whose annual wage is less than 30,000 francs 
($690 at official exchange rate, June 1943)• 
The pre-war public health services of France were 
in theory highly centralized, although during the 1930’s 
centralization was somewhat relaxed, and public health 
services were coming more and more under the control 
of departmental and communal administrations. Respons- 
ibility for the execution of the public health and wel- 
fare laws lay with the departmental prefects, who were 
State officials appointed by the Ministry of the 
Interior to represent all Ministries of the national 
government. Inspectors-general from the Ministry of 
Health visited the departments periodically to make 
certain that the national health laws were being carried 
out, and from time to time conducted nation-wide surveys 
on the condition of particular services. The hospitals, 
hospices for the aged, clinics, dispensaries and other 
services of treatment assistance, were set up within 
the framework of the department or commune. The costs 
of health administration were divided among the State, 
the and the and the Minister of 
Health could exert control over the local services by 
granting or denying financial support from State funds. 
During the 1930*s expenditure on public health and 
social welfare in France increased very considerably, 
and by the end of the decade the appropriation for the 
Ministry of Health amounted to more than 1,600,000,000 
francs. The principal items in the Ministry of Health budget for 1939 (total: Frs. 1,623,449,256) were as 
follows: 
Central administration Frs. 
Assistance in re maternal, 
infant and child care 
Aid to large families 
Aid to families wholly dependent 
on service men 
Care of aged, infirm, incurable 
Free medical care 
Tuberculosis: prophylaxis* 
Aid to tubercular 
Cancer prophylaxis* 
Venereal disease prophylaxis** 
Support of the Insane 
Epidemic control** 
Miscellaneous subsidies*** 
Health and welfare services in 
Alsace and Lorraine 
23,129,300 
175,000,000 
457,000,000 
116,000,000 
316,000,000 
166,000,000 
20,000,000 
46,000,000 
2,500,000 
15,000,000 
208,000,000 
3,796,000 
19,160,000 
42,586,000 
♦ item3~repr©sent State participation in 
support of departmental and communal institu- 
tions, clinics, etc. 
** State subsidy of departmental and communal 
institutions. 
♦♦♦Housing, bacteriological laboratories, national 
charitable institutions, nursing and social 
service schools, state-owned or approved 
thermal establishments, etc. 
In the fall of 1940, and again in 1942, the Vichy 
regime passed laws altering the administratiaiand 
organization of the public health services in France. 
responsible government department is the Secretariat 
d*Etat & la Famllle et It la Sante (Secretariat of 
State for family and health), wbloh coordinates all 
health services, public and private. 
Under the new laws, the country is divided ineo 
twenty sanitary regions. In each region there is a 
director, who directs all services pertaining to domestic 
welfare and health and is responsible to the Secretary 
of State for Health. Each regional director of domestic 
welfare and health is assisted by one or several 
inspectors-general of health, medical inspectors, 
inspeotors-general of domestic and child welfare, 
administrative inspectors of public charities, and 
various deputy-inspectors. The regional directors and 
Inspeotors-general are appointed by decree. The other 
inspectors are selected by the Secretary of State on 
the basis of competitive examination. 
The Vichy scheme of organization gives the regional 
directors dictatorial powers in administering the health 
and welfare services of their regions. They power 
to control and regulate all medical and sanitary estab- 
lishments, agencies and services, both public and pri- 
vate, within their districts, including all personal 
services, professional and otherwise, and the appoint- 
ment of all personnel concerned with maintaining public 
health and hygiene. TVlth the new regional organization, the former 
departmental services of hygiene inspection, the ser- 
vices of the municipal bureaus of hygiene, the maritime 
and air sanitary services, the frontier sanitary posts, 
and the departmental services of inspection of public 
assistance were discontinued* 
This organization of the public health administra- 
tion is of German inspiration and has primarily a politl 
cal purpose. It has left practically untouched the 
basic laws applying to health end medical assistance, 
as well as the social and health insurance system (the 
wage limit for which has been raised and the qualifica- 
tions for which have been simplified). There is, as 
under the Republic, an advisory Hygiene Council concern- 
ing itself particularly with "social ills." This is 
apparently a new body (the old Supreme Council of 
Public Hygiene seems to have been in abeyance since 
1940), composed of 100 members appointed for three 
years and grouped in six commissions. is 
at the disposition of the legislative authorities for 
advice on; maternity and childhood, tuberculosis, 
venereal disease, cancer, alcoholism, health education. 
Note on the health administration of ports and frontiers 
To protect the population against the introduction 
of diseases by sea, the French coast was, up to the 
summer of 1940, divided into five sanitary districts 
administered by the service maritime sanitaire (maritime 
sanitary service), which was directly under the Ministry 
of Health. Each district was supervised by a medical 
director with his headquarters at the most important 
port in the area. These coastal health services were 
responsible for controlling infectious diseases, for 
immunization, for the disinfection and fumigation of 
vessels. The coastal sanitary districts, with their 
headquarters, were: 
1) Departments of Pas-de-Calais and Nord; head- 
quarters; Dunkirk; 
2) departments of Calvados, Eure, Manohe, Seine- 
Inf erieure, Somme; headquarters: Le H^iVre; 
3) departments of Cotes-du-Nord, 
Ille-et-Vllaine, Vendee, Loire-Inferieure, 
Morbihan; headquarters; St. Nazaire; 
4) departments of Landes, Gironde, Charente- 
Inferieure; headquarters; Pauillac; 
5) departments of Alpes-Maritlmes, Gard, Eerault, 
Aude, Pyrenees-Orlentales, Corsica, Var, 
Bouches-du-RhBne; headquarters; Marseille. 
After the war of 1914-181 sanitary services were 
also organized at the land frontiers of France, with 
special posts for the medical examination and, if 
necessary, disinfection of Immigrants. Since the fall of France and the German occupa- 
tion of most of the French coastal area, these services 
have been discontinued. 
(2) Departmental and District Administration 
(pre-Vichy). The prefects of the ninety departments 
of France were responsible for all public health ser- 
vices within their respective departments and for the 
appointment of all public health personnel* In each 
department the prefectxwas assisted by an advisory body 
known as the Conseil departemental d*hygifene (depart- 
mental health council), consisting of three doctors of 
medicine (of whom one naval or military medical officer), 
a pharmacist, an engineer, an architect and a veterinary 
surgeon* Each of the 281 arrondlssements into which the 
departments are divided was defined as a conscription 
sanltaire (sanitary district) and possessed a commission 
sanltaife (sanitary commission) presided over by the 
sub-prefect and Including a doctor of medicine, an 
architect or other representative of the professions, 
and a veterinary surgeon. 
It was up to the prefect to establish a sanitary 
code, which was drafted by the departmental health 
inspector in consultation with the health council, to 
put into effect the national health regulations within 
the department. The mayors of the communes were expected 
to carry out these regulations under the supervision 
of the prefect and his health inspector. 
The departmental organization was required by 
national law to include bureaus for the administration 
or supervision of: free medical care and other forms 
of obligatory public assistance, food and drug control, 
epidemic control, the practice of medicine and pharmacy, 
the enforcement of building and sanitation laws — as 
well as for the collection of vital statistics. Each 
department was required to maintain a departmental 
smallpox vaccination service and a disinfection service 
with at least one post in each sanitary district, able 
to meet demands for service within six hours. 
Up to 1935 the departments were not required to 
have technically-trained health personnel (outside of 
the memberb of the advisory commissions). In that year, 
however, the appointment of full-time departmental health 
inspectors was made compulsory. Inspectors and deputy- 
inspectors, who had to be physicians, were recruited by 
competition, and were required to have a diploma in 
public health from one of the medical faculties giving 
public health courses (Paris, Lyon, Nancy, Montpellier, 
Algiers). 
Outside of the services required by the national 
laws^departmental health organization was not uniform 
throughout France. Many of the departments set up 
offices d*hygiene sooiale (public health bureaus) as 
an outgrowth of the anti-tuberculosis legislation of 
1916 and 1919 and of the work of private welfare 
agencies. In some departments these bureaus limited 
their activities to tuberculosis control; in others, 
where the direction of the "public health bureau" and 
that of the departmental health inspection service were in the same hands, they undertook extensive social 
hygiene work in cooperation with the departmental health 
authorities. 
In a certain number of departments, full-time 
medeolna de ciroonscription or district health officers, 
were appointed to work under the departmental inspector. 
Sometimes there were several such officers in a district, 
each one specializing in a particular field — tuber- 
culosis, venereal disease, medical inspection of schools, 
etc.; in other cases, one medical officer handled the 
various aspects of district health. Some sanitary 
districts had also a special service of medical personnel 
to study epidemic diseases and to initiate control 
measures in case of any epidemic outbreak. 
All departments had anti-tuberculosis organizations: 
sometimes these were part of the departmental health 
service; sometimes they were private agencies working 
closely with the departmental authorities, 'Whether its 
anti-tuberculosis organization was public or private, 
each department had at least one dispensary which 
maintained a consulting clinic, facilitated admission 
into sanitoria for tubercular patients and carried on 
an educational campaign. 
. Many departments set up health centers which in- 
cluded consulting clinics not only for tuberculosis, 
but also for child care, cancer, venereal disease. 
Many also had visiting nurses, specializing in tuber- 
culosis or in child care, attached to the office of the 
public health inspector. Finally, some departmental 
health organizations established general medical and 
bacteriological laboratories, supported by State subsidies. 
Little information on departmental expenditures for 
public health is available. Departmental budgets for 
public health and assistance totaled fra, 1,440,022,213* 
of which frs. 82,851,609 was for public health. 
With the Vichy governments laws on public health 
organization (see pp. 5-4), the former administrative 
set-up of the departments was discontinued. 
(3) Local Governments. Under the basic 
public health law of 10 February 1902, the mayors of 
the 38,000 communes (which vary in size from less than 
500 population to nearly 1,000,000 — and in the case 
of Paris nearly 3,000,000) were made responsible for 
enforcing the national health regulations. The depart- 
mental administration had to draft a sanitary code and 
to provide smallpox vaccination and disinfection services, 
but beyond these services the matter of public health 
and sanitation was left largely up to the mayors. The 
law required them to carry out the measures of the 
departmental sanitary code with reference to the noti- 
fication and control of infectious diseases, the sani- 
tation of buildings and private thoroughfares,'the purity 
of drinking water, and the disposal of garbage. The law of 1902 did not require technically- 
trained personnel to enforce the sanitary codes in 
communes of less than 20,000 population* In small 
rural towns and villages, unless they were located in 
departments with district health inspectors, the health 
regulations were likely to remain a dead letter, although 
their enforcement probably improved after the appoint- 
ment of departmental health inspectors became compulsory* 
The mayors could, after due process of law, impose severe 
penalties, including expropriation, for violation of 
the sanitary laws, but in practice the judicial procedure: 
were so complicated that penalties were seldom carried 
out. The law of 1902 also provided that if the mortality 
in any commune exceeded during three consecutive years 
the mean mortality for the country as a whole, the pre- 
fect should instruct the departmental health council 
to investigate the causes and to frame measures for 
improvement* Here again, however, the provision was 
seldom carried out. 
Towns of more than 20,000 population, as well as 
medicinal watering places of more than 2,000 population, 
were required to establish Bureaux municipauxd1hygiene, 
or municipal health offices, under the direction of the 
departmental health inspector. Smaller communes could 
be directed by the prefect to establish inter-communal 
health bureaus* The heads of these bureaus were appointed 
by the Supreme Health Council, but were not required to 
have medical training. The municipal health offices 
were not organized according to any uniform plan* The 
larger centers had well-organized and -equipped offices 
with staffs of qualified physicians and health visitors, 
but in the smaller towns the bureau directors were likely 
to be part-time medical men or even persons not medically 
qualified. 
The law of 10 February 1902 required the municipal 
health offices to enforce and adminisfer the national 
regulations concerning vaccination, disinfection, and 
control of infectious diseases; sanitation of buildings, 
hotels, boarding houses, drinking water, streets, sewers, 
garbage disposal. The larger towns went beyond these 
requirements and took onchlld care — including often 
establishment of municipal nurseries; control of milk 
for babies; medical Inspection of school children; 
venereal disease prophylaxis and treatment. In a few 
towns the health bureaus handled the administration of 
free medical care. A few health bureaus took care of 
food control, inspecting slaughter houses and wholesale 
markets and supervising the quality of milk (although 
this inspection was usually carried out by the municipal 
veterinary service). 
There are no figures available on the aggregate 
expenditure of communes for health purposes. The follow 
ing extracts from the 1937 budgets of the cities of 
Bordeaux (pop. 253,343) and Lyon (pop. 570,622), both of 
which had extensive municipal public health services, 
will give some idea of the amount and division of local 
health expenditures. Budget of the City of Bordeaux for 1937 
Public assistance and social welfare 
Frs. 16,448,951*05 
including: free medical care Frs. 9,700,000 
aid to aged, infirm, 
incurable 3,750,000 
maternal and child care, 
subsidies to private 
charitable 
Institutions 1,150,000 
Public health and protection of children 
1,795,909-80 
including: medical inspection of 
schools, maintenance of 
five anti-tuberculosis 
dispensaries, two anti- 
venereal disease dis- 
pensaries; smallpox, 
diphtheria and rabies 
vaccination services 
Frs, 18,244,860.85 
Bureau d’hygiene: general administration 
(salaries of director, assistant director, 
medical inspectors, building inspectors, 
municipal laboratory, etc,) Frs. 914,252 
City*s share of cost of child welfare 
(orphans and others without support) 1,400,000 
City’s share of cost of indigent insane 4,700,000 
City’s share of cost of care of aged, infirm, 
incurable 15,632,564 
City’s share in aid to large families 30,000 
City’s share in aid to expectant and nursing 
mothers 374,638 
Birth bounties 100,000 
Care and treatment of subnormal children 126,772 
Cost of transporting indigents to and from 
hospitals 20,000 
Orphan placement service 70,000 
Cost of free medical care of city’s indigents 
in public hospitals 15,840,000 
Cost of free medical care of city’s indigents 
in private hospitals 1,500,000 
Health Budget of the City of Lyon for 1937 Night medical and pharmaceutical service Frs. 
77,724 
Maintenance of city institutions {orphans, 
aged, incurable, incapacitated workers; 
municipal lodging house) 
1,849,537 
City institutions for mothers and infants 
(unmarried mothers* home; day and full- 
time nurseries, municipal restaurants for 
nursing mothers, free milk for infants) 
2,198,843 
Subsidies: anti-tuberculosis dispensary) 
anti-rabies service ) 
of the Instltut bactirlologique 
93.150 
Frs. 45,113,219 
I«yon has its own municipal garbage-incinerator and 
slaughterhouse; inspection is under those departments. 
The City of Paris had a special regime, both as 
to municipal administration and as to the organization 
of public health. Public assistance, home care, all 
hospitals and hospices, were administered by an auto- 
nomous body called the Administration ginfaale de 
publlque. The dirfeotor of the Assistance 
Wblique was appointed by the Minister of Health of 
the Republic* He was assisted by a supervisory council 
composed of delegates from the Municipal Council of 
Paris, representatives of the main judicial and adminis- 
trative bodies in the city and distinguished members 
of the professions. 
The Assistance publique administered free medical 
care, assistance to abandoned children and to the aged 
and infirm; it ran pre-natal and post-natal clinics and 
various other consulting services (e.g. cancer, tuber- 
oulosis); it collaborated with the Office public d"hygiene 
of the Department of the Seine on anti-tuberoulosis 
and anti-cancer work; maintained rest homes, Insane 
asylums, sanatoria (some of these at the seashore or 
in the mountains); it handled unemployment relief. By 
agreement with the communes outside of Paris but within 
the department of the Seine, it oared for their indigent 
sick. 
The public assistance administration drew its funds 
from: revenues from capital and real estate; an annual 
subsidy from the city which amounted in the late 1930*s 
to more than 500,000,000 francs; special subsidies from 
the city for building or modernizing hospitals; payments 
by patients insured through the national social insurance 
system; payments by the State, the Department of the 
Seine and by communes outside of Paris for the care of 
non-Parisian patients in Paris hospitals. The 1940 
budget of the Assistance publlque. as projected, was 
988,957,025 francs (which included 417,760,000 francs 
for unemployment relief). J2, Assistance of Private Agencies. There are 
a large number of very active private charitable and 
health organizations, among them the Associations 
d’hygiene soolale (social hygiene associations) and 
ITEeHed Cross Society, both of them widely distributed 
throughout the country. There are also a number of 
important health groups specializing in particular fields 
and operating in elose touch with the national and local 
health authorities. The most notable of these are: 
Comlte national de defense oontre la tuberculosa, 
which carries on educational campaigns, helps subsidize 
dispensaries and sanatoria and has a school to train 
visiting nurses. In practically every department there 
is a committee affiliated with the Comlte national; 
usually these are known as Comit4s departernentaux 
d’hyglene soolale etde lutte antItuberouleusaT The 
departmental health inspector is often a member of 
the board or even secretary of the committee. The 
departmental committees collaborate with the«depart- 
mental health authorities; may have their own dispen- 
saries, if there is not an Office d’hygiene soolale 
attached to the prefect’s office. 
Comite national de 1’enfance. which interests itself 
especially in the prevention of tuberculosis in children; 
and the Oeuvre du placement des Tout-Petits, which 
places the infants of tubercular parents in healthy 
foster-families• 
Institut prophylactlque. which carries on eduoa- 
tional campaigns In the field” of venereal disease, does 
research and dispensaries; Llgue national oontre 
le peril venerlen, in the same field. Both of these 
agencies work in close touch with the Central Service 
for the Prevention of Venereal Disease of the Health 
Ministry. 
Llgue francalse oontre le cancer, which is primarily 
a propaganda agency. 
The American Friends1 Service Committee (known 
since the severing of diplomatic relations as the Seoours 
Quaker) and the Unitarian Service Committee have included 
some medical assistance in their welfare work in the 
former unoccupied zone. The two groups together, at 
least up to November 1942, provided a visiting-nurse 
service in some villages of southern France otherwise 
deprived of medical care. 
o. Medical and Related Care. 
(X) Medical Personnel. In 1937 there were 
some 27,400 physicians in France, of whom over 6,800 
were in Paris. Over 400 of the total number were engaged 
full-time in public health work in the departments or 
communes; another 500 were part-time physicians in social 
hygiene dispensaries. Is Impossible even to estimate bow many physicians 
there are in France at the present time. All French 
doctors were subject to call for military service upon 
the outbreak of the war. Many are now war prisoners 
in Germany, while others have been requisitioned, as 
have nurses, pharmacists, and dentists, for service there 
along with French industrial workers. All reports since 
the Armistice indicate a severe shortage of medical personnel. 
For the most part, French physicians were well trained 
up to the war, although American medical opinion seems to 
consider their standards of practice not up to those of 
the United States. No physician might practice anywhere 
in the Republic without a State diploma, which was conferred 
after examination at the end of a five-year medical course. 
The most notable characteristic of the French medical 
curriculum was a compulsory training in diagnosis and 
practice dn the hospitals and clinics which lasted the 
full five years along with theoretical studies. There 
were nine medical Faculties in France and fifteen Schools 
of Medicine (of which eleven were preparatory — that is, 
offering only the first three years). The fifth year had 
to be spent at one of the nine Faculties or (pre-1940) 
with permission of the Faculty, it could be spent abroad. 
There were 1,650 medical students in 1937; in 1942 there 
were more than 3,000, although Jewish and foreign students 
had practically been eliminated. Early in 1943 the Vichy 
government introduced a law reducing the number of medical 
students. 
It is worth recalling that French medical research 
has contributed Immeasurably to medicine throughout 
world; Pasteur, Pierre and Marie Curie, Irene and Frederic 
Joliot-Curie are only a few of the great names. 
On August 16, 1940, a new law was passed regulating 
the practice of medicine. Another new law, passed October 
16, 1940, instituted an "Ordre des Medecins" (Order of 
Physicians). The purpose of both laws was primarily 
political, tending to place medical practice under the con- 
trol of the State. Apparently, however, the Vichy govern- 
ment has not been able to control the Order of Physicians 
to its satisfaction. It is reported that the government 
ordered home attention given to war invalids only by 
physicians approved by the secretariat-general for ex- 
service men, and that at least one departmental council 
of the Order of Physicians protested this "stage in the 
process of state control." On August 14, 1942, the Govern- 
ment introduced a law to coordinate all health services 
and facilities, public and private, under the Secretariat 
of State for Family and Health, thus evidently strengthen- 
ing its control over physicians. 
As to medical personnel other than physicians, the 
following figures are available for the pre-war period; 
Surgeon-dentists: 8,558 in 1936 
Pharmacists: 12,931 in 1938 
Midwives: 11,286 in 1938 
(figure includes Algeria) 
who because of their 
training, might qualify 
as nursing aides. There seem to be no recent figures on the number of 
nurses. At the end of 1928 there were about 24,000 graduate 
nurses, including 11,750 lay nurses, 8,000 nurses belonging 
to religious orders, 1,600 psychiatric nurses, as well as 
visiting nurses for child care and tuberculosis. As the 
number of graduates had been increasing steadily since the 
institution of a State nursing diploma in 1922, this num- 
ber must have been considerably larger by the outbreak of 
the war. 
Surgeon-dentists, midwives, and pharmacists, as well 
as physicians, are required to have a State diploma in 
order to practice. The dental training course is five years, 
and the course in pharmacy of the same length. Pharmacies 
are inspected annually by trained inspectors of the 
Ministry of Agriculture. Midwives must have two years* 
training leading up to their diploma, including apprentice- 
ship in obstetrics in a hospital. 
(2) Hospitals. According to the latest avail- 
able official figures, in 1933 there were in FrAnoe 2,062 
public hospitals and hospices (l.e. institutions for the 
aged, infirm, and incurable) with a total of 260,969 beds. 
The hospitals and hospices were distributed as follows: 
Hospitals: Paris 42 
Departments 238 
280 
Hospices: Paris 20 
Departments 550 
570 
Combined hospice** 
hospitals; Paris 7 
Departments 1 >205 
1,212 
Beds were divided among civilians, military, aged- 
inf irm-lncurable, and "assisted children" (i.e. children 
receiving State aid) as follows: 
Civilians: Paris 
26,278 
100.275 
Departments 
126,553 
Military: Paris 
Departments 
0 
12.511 
Aged-infirm:Paris 
12,612 
-39.129 
Department s 
107,741 
"Assisted 
children" :Paris 
1,965 
12.19? 
Departments 
HEOTSi|28 
14,164 In 1937, in addition to the public hospitals and 
hospices, there were in Paris thirty-seven independent 
establishments approved and directly supervised by the 
Administration de publique; that is, 
they had a semi-public status. These were specialized 
clinics, hospitals maintained by religious orders, etc. 
The number of beds, in these Institutions is not available, 
nor is the number of such institutions outside of Paris. 
In addition, there were, in 1937, 122 privately-owned 
"oliniques" — small hospitals and nursing homes, mater- 
nity hospitals, or establishments for the treatment of 
nervous disorders or for retarded children — in Paris, and 
63 in the departments. Here again, the total number of beds 
is not known. Each department has at least one hospital 
within its borders," or one available to it. Many of these 
hospitals, especially in the large cities, are modern, and 
before the war were well equipped. In many towns there 
were also well-equipped church hospitals. 
In 1928, the most recent year for which figures are 
available, there were 96 sanatoria for pulmonary tubercu- 
losis, with 9,358 beds; 36 of these were publicly-owned. 
Most French hospitals and hospices are "public estab- 
lishments," enjoying an autonomous legal status distinct 
from the State, the department, or the commune — though 
within the framework of the latter. A public hospital or 
hospice, up to 1940, was created by decree of the Consell 
d'etat. In all communes except Paris, which had a special 
regime, the hospitals were administered by an administrative 
commission presided over by the mayor. The commission 
appointed the secretary, the superintendent, the medical 
and surgical staff, but might not recall them without the 
approval of the prefect of the department. The receiver 
of the hospital was appointed by the prefect on nomination 
by the Commission and might be removed only by the Minister 
of Health. 
Hospital funds come from: revenue from capital or 
real estate; gifts and legacies; patients (the cost of their 
care being paid by the State, the department, or the commune 
when they are entitled to free medical assistance); State, 
departmental, or communal subsidies; miscellaneous funds, 
as from pari-mutuel. Vben a commune has not a hospital or 
hospice of its own, or has inadequate hospital facilities, 
it may arrange, after consultation with the administrative 
commission and the prefect, to have its ill or aged eared 
for in a private establishment. 
In Paris, at least up to 1940, all hospices and hospi 
tals were administered by the Administration de 
lfA33 istanoe publique (see p. 9). 
Since the passage in 1940 of laws changing the public 
health organization, all hospitals, public or private, like 
other health services, are controlled by the directors of 
health and welfare of the regions in which they are located 
(see p. 3). 
As of November 1942 the German occupying authorities 
were reported to have requisitioned the following Paris 
hospitals: Beaujon, La Piti£, comprising some 3,300 beds. Beaujon is the newest and best-equipped, 
hospital in Paris (opened 1935), Lariboisl&re and La Pitie 
are among the largest and most recently modernized. 
Hospital space is reported to be very short in Paris and 
probably will be found so throughout Prance. Many 
hospitals may, of course, no longer be operating due to 
shortage of personnel and supplies or to the destruction 
of physical facilities. 
All Paris hospitals suffer from severe transport 
difficulties. There are almost no ambulances. Patients 
are brought to the hospitals with the help of the Police 
first aid. For the return journey, they are grouped in 
the same ambulance, which makes a round like a motor bus. 
Undoubtedly hospitals elsewhere in France have the same 
problems• 
X-ray equipment, both public and private, was widely 
distributed throughout France before the war. Most of it 
was of French, German, or American manufacture„ There 
were many portable units, operating on the currents 
generally available (110 or 115 volts, 3-phase, 50-cycle 
alternating current). It is possible that much of this 
equipment has been requisitioned by the German occupying 
forces. 
Throughout France, there are large numbers of board- 
ing schools, public buildings, hotels, and chateaus that 
might suitably be converted for use as hospitals, provided 
that adequate water and toilet facilities could be installed. 
(3) Stocks of Vaccines, Serums, Drugs, etc. 
Since the fall of France, an acute shortage of medical 
and surgical supplies and equipment has developed. It 
has been reported that the Germans confiscated much ortho- 
pedic and surgical equipment. 
Many drugs, chemicals, and other basic supplies are 
unobtainable or critically low. Druggists are supplied on 
a quota basis, according to the size of their clientele, 
and often get less than 1# of their needs. Doctors in mak- 
ing out prescriptions usually give three or four alternatives 
for every ingredient. Research is going on to determine how 
far substitutes may be used. 
The lack is most seriously felt in the following drugs: 
caffein, theobromin, bismuth, salts, iodine, camphor, boric 
acid and derivatives, vaseline, quinine, opium and its 
alkaloids, glycerin, saccharine, lanolin, cod liver oil, 
starch, glucose, mustard meal, lactose, tartaric and citric 
acids, insulin, opotherapio products, and many alkaloids 
and chemical and vegetable products. Sulfa drugs are only 
occasionally purchasable. Anesthetics in general are 
lacking. Still other missing drugs are digitalis, calcium, 
and phosphorus. The Germans have confiscated all supplies 
of radium. It is reported that stocks of vaccines are 
being used up, and the institutions making them are few in 
number. There is also an acute shortage of medicated alcohol, 
and of bandages and surgical dressings, those available 
being of poor quality. However, it is reliably reported 
that the American Hospital at Neuilly has developed a new 
product called "dermophane" to replace ordinary dressings 
for wounds and burns. This new cellophane material is 
said to reduce the amount of pus formation ordinarily 
expected by nine-tenths, and to eliminate excrescences 
after healing. The dressing can be placed directly on 
the wound, after wetting, without the use of any tanning 
material or grease, and can be changed without causing pain. 
It is possible that the product may be useful for internal 
wounds in the lungs and larynx. 
From the information available, it is apparent that 
any military forces in France would be obliged to supply 
all of their own medical and surgical supplies and equip- 
ment necessary for the care and treatment of troops, as 
well as all serums, vaccines, and other biologicals. 
(4) Status of Vaccination and Immunization. 
Under the basic public health law of 10 February 1902, 
smallpox vaccination is compulsory in France for all child- 
ren under one year, with revaccination during the eleventh 
and twenty-first years. In case of war, public calamity 
or epidemic, smallpox vaccination can be made obligatory 
by ordinance of the prefects for sill those who cannot prove 
a successful vaccination within the preceding five years. 
This was done early in 1942 in Paris, where an outbreak 
of smallpox was checked by intensive vaccination. Every 
department is required to provide free vaccination service. 
The manufacture of the vaccine was, and presumably still is, 
limited by law to the Academy of Medicine and to a small 
number of laboratories under State supervision. 
Anti-typhoid vaccination has been compulsory in the 
armed forces since 1914. In November 1940, typhoid ahd para- 
typhoid injections became obligatory for adolescents enter- 
ing youth camps and for all persons between ten and thirty 
in any area menaced by epidemic. Reports from France indi- 
cate that these edicts were actually carried out, and that 
as early as August 1940 vaccination field crews were being 
sent out from the Pasteur Institute into threatened regions. 
Inoculation against diphtheria was made compulsory 
for school children in 1931* but was widely practiced 
before that. Since November 1940, anti-tetanus injections 
have been compulsory with diphtheria vaccinations for 
children under fourteen; early in 1943 both these vaccina- 
tions were due to be made compulsory for persons of all 
ages. In some areas, it has been reported that the entire 
population has been inoculated against tetanus, typhoid, and 
typhus. Before the war, the immunization of new-born infants 
against tuberculosis with B.C.G. was very widely practiced. 
This is probably still the case, since the Secretariat for 
Health is conducting a vigorous campaign against tubercu- 
losis. But it has been reported, in connection with the 
whole field of immunization, that stocks of vaccines are 
being used up, and the institutions making them are few in 
number. 4. Birth, Death, and Disease. 
(1) In 1935, 1936, and 1937, latest years for 
which figures are available, the total number of deaths in 
France, from all causes, was 658,379, 642,313, and 623,502, 
respectively. In the same years, the total births amounted 
to 662,456, 630,059, and 616,863, respectively. 
The birth and death rates for the five years before 
the war are given below. It will be noted immediately 
that in the years 1935 to 1939, the death rate slightly 
exceeded the birth rate. The French birth rate has been 
declining steadily since the last war — and indeed the 
population has remained practically stationary since 1881. 
Birth rate Death rate (per 1,000) 
1935 15.3 15.7 
1936 15.0 15.3 
1937 14.7 15.0 
1938 14.6 15.4 
1939* ’ 14.6 15:3** 
* Provisional figures. 
** Excluding war losses. 
By the first quarter of 1942 the death rate in Paris 
had reached 22.2 per 1,000; in the same quarter of 1938, 
the Paris death rate had been 15.6 per 1,000. The Vichy 
radio in August 1942 mentioned that deaths in Paris in 
the first half of the year had exceeded births by 20$. No 
birth or mortality figures appear to have been published 
for the country as a whole, but it may be assumed that the 
increase in the death rate is general. The causes are 
undernourishment — food rations insufficient to afford 
protection against disease; inadequate clothing and shoes; 
inadequate supplies of coal and wood for heating; overcrowded 
living quarters; disorganization of the health and medical 
services. 
Deaths from Principal Causes. 1935 and 1936 
1221 mk 
Senility* 83,857 80,947 
Diseases of the heart 64,989 64,809 
Other diseases of the circu- 
latory system 14,317 13,781 
Cerebral hemorrhage, cerebral 
embolism, thrombosis 49,800 48,475 
Other diseases of the nervous system 15,855 14,948 
Tuberculosis of the respiratory 
system 44,658 43,161 
Cancer and other malignant tumors 39,762 40,220 
Pneumonia 28,502 28,251 
*French law apparently does not absolutely require a certi- 
ficate of the cause of death. As the French Penal Code 
prescribes severe penalties for medical practitioners who 
divulge information obtained in the course of practice, 
some French physicians object to certifying the causes of 
deaths of their patients. Moreover, in rural areas, veri- 
fication of the fact and certification of the cause of 
(Footnpte continued on following page) Deaths from Principal Causes. 1935 and 1936 (continued) 
1935 1936 
Other diseases of the respiratory 
system, TB excepted 37,545 35,812 
Nephritis 18,845 18,623 
Diseases of the liver and biliary passages 12,303 12,161 
Other diseases of the digestive system 12,633 12,333 
Congenital debility and malformations, 
premature birth, diseases of early 
infancy 12,930 12,130 
Status of birth control; 
Birth control has long been practiced extensively in 
France, as is indicated by the contrast between the relatively 
high marriage rate and low birth rate: 
Marriages per 1,000 Births per 1,000 
1935 13.6 15.2 
1936 13.4 15.0 
1937 13.1 14.7 
as compared with the marriage and birth rates in the same 
years in the United States: 
1935 
1936 
1937 
10,41 
10.70 
11.20 
17.0 
16.8 
17.1 
Contraception is, however, a matter of purely Individual 
concern. There are no birth control clinics, private or 
public, nor any organizations conducting educational campaigns, 
French law forbids propaganda or publicity concerning birth 
control. Abortion is illegal. The State and a number of 
private agencies, both under the Bepublio and under the 
present Government, have done everything possible in the 
way of propaganda, subsidies to large families, birth 
bouaties, etc., to encourage an increase in the birth rate. 
footnote continued from preceding page) 
death are often made by non-medical persons. Hence the large 
number of deaths attributed to ”senility,”or to "natural” or "ill- 
defined" causes. In 1935 and 1936, 129,553 and 131,709 deaths, 
respectively, were listed with the cause "not specified or ill- 
defined.” Thus important specific causes, such as tuberculosis, 
bronchitis, or cancer, may have been hidden by inclusion in these 
groups. (2) Number of cases and deaths from certain 
infectious diseases: 
1938* 1937* 1936 1935 
Cases Cases Cases Deaths Cases Deaths 
Typhoid and 
paratyphoid 
fever** 4,120 5,868 4,202 1,052 4,203 1,071 
Undulant fever*** 554 484 436 *** 405 *** 
Measles 37,487 26,791 31,076 1,010 18,413 721 
Scarlet fever 18,731 18,728 18,748 279 19,090 326 
Diphtheria 16,800 19,187 16,264 1,325 17,431 1,605 
Dysentery*** 73 129 50 *** 45 *** 
Acute polio- 
myelitis*** 788 592 366 *** 502 *** 
Cerebro-splnal 
meningitis 408 452 328 *** 388 *** 
Plague 0 0 0 0 0 0 
Smallpox {incl. 
some ohiokenpox) 2 5 273 10 428 15 
Typhus fever 1 1 4 H 1 5 
* Causes of death for 1937 and 1938 are not available, 
** The number of oases of typhoid and paratyphoid fevers may 
be low; it is suggested that a mortality rate as high as 
25$ for these diseases is unlikely, 
*** No deaths are given under these diseases, which may mean 
that no cases ended fatally, or, more likely, that the 
deaths from these causes are lumped in the statistics 
under "other infectious or parasitic diseases." 
French law requires that the health authorities (i.e. 
the prefect and sub-prefect in a department, the mayor of 
a town or village, the prefect of police in Paris) be 
notified without delay of cases of the following diseases: 
typhoid and paratyphoid fevers, typhus, smallpox, scarlet 
fever, measles, diphtheria, military fever, cholera, plague, 
yellow fever, dysentery, puerperal fever, ophthalmia, 
cerebro-spinal meningitis, acute poliomyelitis, trachoma, 
undulant fever, leprosy. 
But notification is optional for a number of important 
diseases — pulmonary tuberculosis, whooping cough, influenza, 
pneumonia, erysipelas, mumps, scurvy. Figures for the number 
of oases are therefore not available. Deaths ascribed to 
some of these in 1935 and 1936; 
i$21 mk 
Pulmonary tuberculosis 
Influenza 
Pneumonia 
Ttiooping cough 
Malaria 
44,658 
7,677 
28,502 
8 36 
163 
43,161 
4,487 
28,251 
1,220 
120 
(3) Disease Information; Recent Epidemics* The 
most widespread of all communicable diseases in France is 
pulmonary tuberculosis, which was reported as causing the 
death of 44,658 persons in 1935 and of 43,161 in 1936 — 
or over 6$ of all deaths. Due to the incomplete notifica- 
tion system, these figures are probably understated. Tuberculosis was most prevalent in rural communities, 
in the Alps, and in Brittany and No many. In cities, the 
tuberculosis death rates were highest in Nantes, Le Havre, 
and Rouen, 
Before the war, headwaywas being made against tuber- 
culosis. Since the fall of France, the disease has increased 
heavily. Reports vary greatly as to Just how great the 
Increase is. One source estimated that the number of danger- 
ous cases had increased from 550,000 before the war to 
1,000,000 at the present time; according to this source, 
those affected are mostly men and women between 50 and 60, 
whose old lesions decalcify due to lack of proper diet. 
The French radio has stated that in the regions of France 
devastated by war, 60% of the children show tubercular 
tendencies. Many of the war prisoners returning from Ger- 
many have developed the disease while in prison camp. It 
is reported that cases tend to be galloping, some 
ending fatally in a few weeks, and many serious forms of 
tuberculosis are found among the farming population. 
At the end of 1942 the Government at Vichy inaugurated 
an intensified campaign against tuberculosis. It was 
announced that anti-tuberculosis dispensaries were being 
equipped with modern technical equipment and specialized 
personnel, and that mobile units were to be formed. It is 
not known how successful the campaign may have been, in 
view of the shortage of equipment in France. 
It is probable that the increase in tuberculosis is 
not particularly important for military operations. The 
danger of infection becomes of consequence only over a pro- 
tracted period of time, and principally through the use of 
native kitchen help. 
Since the fall of France, there has been a progressive 
and rapid decline in. the health of the nation. Most French- 
men suffer from severe undernourishment, and there are 
reports of losses of weight among adults of as much as 30 
or 40 pounds and even more. The present conditions of 
overcrowding, and the shortage of shelter, food, clothing, 
fuel, sanitary facilities, and medical care have resulted 
in the spread of disease and constitute a fertile field for 
the development of epidemics. 
Typhoid fever and paratyphoid fever, which are endemic 
throughout France especially in the port cities, have be- 
come apparently epidemic in parts of southern France. 
Before the war, the infection was largely shJp-bome, but 
other sources of infection are shell-fish, milk, vegetables 
grown in unhygienic conditions, and contaminated water. 
In the fall of 1940 the Government gave the Pasteur Insti- 
tute a free hand in immunizing the population, and typhoid 
injections were made compulsory in regions threatened by 
epidemic. However, there were a number of reports, in the 
latter part of 1942, of typhoid epidemics in and around 
Lyon, Montpellier, ToulonPont-du-Las, the department of 
Dordogne. There were also severed reports of typhoid in 
refugee and internment camps. 
Influenza, meningitis, and infectious Jaundice have 
also been reported as epidemic. An outbreak of smallpox 
occurred in Paris, but was checked by intensive vaccination: reports gave a total of 132 oases in the former occupied 
zone from February to November 1942. Diphtheria is endemic 
and in localized areas is epidemic. Malaria is endemic 
in the entire French coastal region and in the low country 
of northern France, The Germans have apparently allowed 
control measures to lapse, so that malaria-carrying mosqui- 
toes have probably multiplied. 
Reports in 1942 indicated the presence of epidemic 
(louse-borne) typhus fever and endemic (flea-borne) typhus 
fever throughout France. There are known to have been 97 
oases in the occupied, and 138 in the former unoccupied 
zones during 1942, In addition to typhus, trench fever 
and relapsing fever are prevalent• Echinococcus has ap- 
peared occasionally, and may become more frequent. One 
report stated that some villages of occupied France had 
flown black flags from church steeples to indicate the 
presence of plague. 
There has been an increase in the incidence of minor 
infectious diseases: measles, whooping cough, scarlet 
fever — as well as Influenza — due to lowered resistance 
among the undernourished population. Skin infections are 
common: in particular, impetigo and scabies. 
Mthin recent years a few deaths from leprosy, anthrax, 
rabies, and trachoma have been reported, but it is not 
considered that these diseases will be of special import- 
ance to troops in France. In 1934* two deaths from yellow 
fever were reported in Paris, but it is believed that they 
were imported oases, and did not develop the disease in 
France proper. 
Venereal disease is reported to be widespread among 
German troops, in spite of strong measures by the occupy- 
ing authorities. The number of cases among French prosti- 
tutes has increased greatly, A system of cards is used 
for control, but white cards are distributed fraudulently 
to infected persons, and re-inspection is not sufficiently 
frequent to make the evidence of the cards reliable. The 
director of the Instltut prophylactlque has been quoted as 
stating that venereal infections among Frenchmen have 
trebled in the last three years and that 5,000,000 are 
suffering from syphilis at the present time. It was an- 
nounced at the end of 1942 that Marshal Petain would shortly 
sign a decree making treatment compulsory for infected per- 
sons, and that venereal disease clinics would be modernized 
and improved. 
Insects and rodents: 
In general, the insects and animals important to man 
are the same in France as in the United States. Their 
relative importance as carriers of disease is, however, 
altered by the present disorganization of the social, 
economic, health, and sanitary structures in France, 
Due to overcrowding, lack of soap, and poor sanitary 
conditions, lousiness is common. The common body louse 
is the vector of epidemic typhus fever, trench fever, and 
relapsing fever. Mosquitoes are widely distributed throughout France, They are most common in the coastal regions, 
in the low country of Northern France, and in the Loire 
River Valley, where malaria is endemic. Though malaria 
has been well controlled in the past, the incidence of 
this disease may, under present conditions, increase to 
the point of being important to military forces in the 
regions mentioned. 
Because of the large pet and rat population, fleas 
are universally distributed throughout France. The rat 
flea is the vector of endemic typhus fever and plague. 
The former disease is endemic in all regions; the latter 
is probably of no consequence at the present time although 
there has been one report of plague in some villages of 
Northern France. The common house fly abounds, and is 
capable of carrying infected material from filth and fecal 
matter to the food of man. 
Rats are encountered everywhere in France, and in many 
regions are known to harbor the causative organisms of 
infectious Jaundice. 
In the southern provinces ticks are prevalent and 
transmit a tick-borne form of typhus fever. 
Below is a list of principal disease-bearing insects 
to be found in France at the present time. 
Insect 
Disease 
L. bacoti (tropical rat mite) 
(thought to be restricted to 
southern Europe, but has 
been found in Hamburg) 
May carry endemic typhus 
P. humanus (or corporis) 
P. vestimenti (body louse) 
Epidemic typhus, trench 
fever, relapsing fever. 
P. humanus humanus, or 
P. capitis (head louse) 
Possible vector of epidemic 
typhus and trench fever- 
Aedes maculipennis messeae 
(principal fresh-water 
vector of malaria north 
of Alps) 
Malaria 
"s 
Aedes maculipennls atroparvus 
(principal salt-water or 
brackish water vector of 
malaria north of Alps. 
Also enters houses.) 
Malaria — responsible for 
"house malaria" of winter 
months. 
Aedes plumbeus 
Minor vector of malaria and 
vicious biter. 
Aedes aegypti 
(mostly in south of France 
but also in north) 
Dengue, yellow feverv 
F. papatasli (mostly in south- 
ern France but has been found 
as far north as Paris) 
Vector of sandfly fever or 
3-day fever, Oriental sore. 
and dumdum fever. Insect 
Disease 
S. reptans oolumbaozense 
(Goblatz fly) 
Not carriers of disease, but 
in April and May of certain 
years may be so numerous and 
serious a pest as to inter- 
fere with military operations. 
Bloodsuckers• 
F. canlcularls and 
F. soalaris 
May cause urinary myiasis - 
Musca domestlea 
Transmits by mechanical means: 
typhoid, paratyphoid, bacillary 
dysentery, amebic dysentery, 
cholera, eggs of parasitic 
worms. 
Musea autumnalis 
As above. 
Musca stabulans 
Accidental infection with 
myiasis. 
Stomoxys calcltrans 
May transmit blood diseases; 
feeds on men and animals* 
Sarcophaga Haemorrhoidalls 
May transmit intestinal 
myiasis. 
Green-bottle flies 
May cause cutaneous myiasis. 
Sometimes breed in wounds. 
Black bow-flies 
May cause cutaneous myiasis. 
Hypoderma bovis 
Occasionally produces cutan- 
eous myiasis and ophthalmo- 
myiasis in humans. 
(oriental rat flea) 
(mostly in southern Europe 
but occasionally in France) 
Principal vector of endemic 
typhus and plague . 
P. irritans 
Possible vector of plague • 
C. oanis and C« fells 
Possible vector of plague* 
N. fasoiatus (European rat flea) 
Vector of plague and 
endemic typhus. 
Leptopsylla 
(coastal regions of France) 
Weak vector of plague • 
Ants of all sorts 
May carry pathogenic bacteria 
on bodies if they are of those 
which frequent garbage, etc. 
L. tredeolmgutlatus 
(black widow spider) 
(probably mostly in southern 
France — prevalent about 
privies) e. Sanitation. 
(1) Departments of Government Supervising Sanita- 
tion. Up to 1946, sanitation was mainly tbe responsibility 
of the Ministry of Health. On the loeal level, the national 
sanitary laws regarding drinking water, sewage, garbage, 
building, etc., were supposed to be carried out by the mayor 
and communal officials, under the supervision of the prefect 
and the departmental health inspector, and of the district 
health officers, if any. (See paragraph a.(3).) Pre- 
sumably these services are now under the regional health 
inspectors. 
Food and drug control is the responsibility of the 
ministry of Agriculture, and is carried out locally by the 
veterinary inspectors of the departments and the market 
Inspectors and the police in the communes. Legislation is 
concerned largely with the repression of fraud and misre- 
presentation and with the elimination of poisonous substances 
in food or drugs intended for human consumption. However, 
the cities have municipal meat inspection serviced, under 
the supervision of the departmental veterinarian, as well as 
an inspection service in the markets to control spoilage of 
foods coming from outside the municipality. 
(2) Problems and Control Measures. 
(a) Water Supply. There are abundant supplies 
of crude water throughout France• Springs are plentiful, 
particularly in the Vosges, Jura, Alps, Pyrenees, and the 
Massif Central. Many of them are highly mineralized; their 
water is bottled and distributed widely throughout France, 
forming an important element in the supply of drinking water. 
It should be noted, however, that in southern France and the 
Mediterranean coastal lowland, wells and small streams fre- 
quently dry up in the summer, making the matter of water 
supply a critical one. Along the Atlantic coast, the German 
Todt Organization is reported to have drilled additional 
wells for industrial use. 
The water supply in most cities and large towns is 
potable, although in some instances, as in Marseille, the 
supplies are notoriously bad and are sometimes the cause of 
epidemics of water-borne diseases. The practice of chlorina- 
tion seems not to be universally accepted in France, and most 
communes rely upon water sources considered free from contami 
nation, employing slow sand or gravel as'the only method of 
treatment. Mien water supplies are chlorinated, this treat- 
ment is most commonly accomplished by "Javellisation” or 
"Verdunlsatlon." It is reported that ozone is used in the 
treatment of the water supply in about 90 French communes. 
It should also be noted that large cities and industrial 
communes frequently have dual water supplies — one for 
domestic use and the other for industrial or other purposes. 
Mater in many smaller towns and villages is obtained 
from municipal springs or wells and is transported by various 
means (Jugs, pitchers, etc.) to the place of use. Communal water supply systems, where they exist, often serve only 
public buildings, business houses and the larger hotels. 
In March 1937 only a little over a third of the 38,000 
communes in France possessed a public supply of drinking 
water, and from these sources the average available daily 
quantity was about 65.6 gallons per commune. In most rural 
communities water is obtained from individual wells which 
are usually open-topped and subject to pollution. Little 
care is taken with the location of the well with reference 
to barns, latrines, fertilizer stores, etc. In the case 
of rivers, human drinking water is frequently taken from 
animal watering places. Underground streams and other sub- 
terranean bodies of water lie near the surface, and thus 
are subject to contamination. French law requires the cover- 
ing of wells and prohibits dumping near springs and streams, 
but the law is not well enforced. 
Under present conditions in France, no source of water 
supply should be considered safe until all facilities have 
been thoroughly investigated and approved by proper military 
personnel. 
(b) Sewage Disposal. In 1933» 80$ of the towns 
of more than 5,000 inhabitants had sewage systems, but these 
were of varying merit and often obsolete. Not more than 25$ 
of these towns had adequate sewage services. In communities 
of less than 5,000, the proportion of adequate sewage ser- 
vices was estimated at between 1$ and 12$, according to the 
region. 
The sewage systems of the large French cities are in 
the main efficient. But disposal by dilution is still not 
widely used in France; even large towns still have septic 
tanks. In small towns and villages, cesspools connected 
with bacterial filter-beds or humus nitrification beds are 
common. The residue from these beds is often used on culti- 
vated land. In rural districts, latrines, usually quite’ 
unsanitary, are in common use; the night soil frequently is 
saved and stored with stable manure to be used as fertilizer. 
Throughout France, sidewalk and building-corner urinals are 
common; these convenience stations are never screened and 
are usually filthy; their effluent is discharged into a drain, 
gutter, sewer, or sometimes a nearby stream. 
(o) Waste Disposal. There is no uniformity in 
the matter of garbage disposal in France. In large cities, 
as a rule, garbage collection is carried out by the munici- 
pality. Some communes turn over the problem to private gar- 
bage collectors. And many communes, especially small ones 
in rural areas, have no organized garbage collection service 
at all, leaving it up to the individual householder to bury 
or otherwise dispose of his own waste. In some places, 
garbage is thrown into the streets and collected irregularly. 
In Paris, and in most towns of over 2,000 population, 
up to the war, garbage was collected daily. Householders 
were supposed to keep it in closed receptacles, although 
this regulation was by no means always carried out to the 
letter. Of Paris garbage, 56$ (in 1934) was incinerated in municipal incinerators, 31% was sold as fertilizer, either 
as was or after treatment. Outside of Paris itself many 
communes, even in the Paris area, simply dumped their gar- 
bage or made it available to farmers for fertilizer. Other 
cities — e.g. — Toulouse — also had incinerators; still 
others {Cannes, Avignon, Aix-en-Provence) maintained scien- 
tific fermentation plants to transform garbage into salable 
fertilizer; and others still had scientific dumps (e.g, 
Paris-Plage), the garbage being treated with chemical to 
discourage flies and rats, to fill in swamps and waste 
areas for future cultivation. 
It ia possible that where garbage collection services 
existed, they may have become disorganized due to wartime 
conditions, the lack of gasoline of horses for trucks, etc. 
(d) Food and Beverage Control. Under a law 
of 1st August 1905 and subsequent decrees, the purity of 
foods and drugs is, at least in theory, carefully controlled. 
Misrepresentation and fraud, the manufacture and «ale of 
products harmful to man or animals, is liable to severe 
punishment. Public markets and slaughterhouses are subject 
to inspection by municipal Inspectors, who may confiscate 
any spoiled, poisonous or fraudulent food product. Slaughter- 
houses must be maintained in sanitary conditions; the muni- 
cipality may require the inspection and stamping of meat 
slaughtered outside its own slaughterhouses. The depart- 
mental veterinarian is responsible for the supervision of 
animals, the control of animal diseases, etc, in his depart- 
ment. In view of the acute shortage of food in France at 
present, especially in the cities, it will probably be 
found that the inspection services have broken down. 
The chief danger to food in France before 1940 was 
contamination by insects, especially the house fly which 
is a notorious carrier of filth. The normal French whole- 
sale market or slaughterhouse has no protection whatsoever 
against flies and frequently is a breeding place. The same 
applies to many retail markets. 
Milk is customarily not pasteurized and may be found 
to be polluted. The French as a rule boil it before con- 
sumption. Dairy herds are inspected (since 1935) for tuber- 
culosis, but treatment is voluntary. It was estimated 
before the war that one-fifth or more of the dairy herd 
suffered from tuberculosis. As in the case of all food 
products, the supply of milk is severely limited. 
(e) Insect and Rodent Control: for prevalence 
of disease-carrying insects, etc,, see paragraph d, (1) 
(disease information). 
(f) Housing. Bathing, and Toilet Facilities. 
There are no very recent figures on the amount or condition 
of housing in France. In 192? the Ministry of Labor esti- 
mated that there was a shortage of 1,000,000 dwelling units, 
of vhich 250,000 were needed to replace downright slums. 
Since then some 200,000 low-cost dwelling units have been 
built, but little if any slum-clearance has taken place. 
gisirwiriB Since the fall of France there have been repeated reports 
of overcrowding, due — among other reasons — to the 
requisitioning of many buildings by the occupying troops 
and, in northern France, to destruction during military 
operations. Before 1914, S,4$ of the dwellings in the 
Paris region were classed as unsanitary; in provincial cities 
like Lyon, Marseille and Lille the proportion of unsanitary 
buildings was as high as 20 or 30 percent. There is no 
reason to suppose that this situation has improved in th© 
past quarter-century, since French municipalities tended 
not to enforce the expropriation and destruction of unsani- 
tary buildings. 
Outside of the better hotels and modern residential 
quarters of large cities and resorts, bathing and toilet 
facilities are limited. Except for quite recent installa- 
tions, French plumbing is likely to be decidedly ineffi- 
cient. Many houses even in large towns have no bathrooms, 
and in small towns many houses have no running water. In 
rural areas latrines, often quite unsanitary, are usually 
the only toilet facility. (See also e. (2)(b) sewage 
disposal.) 
f. Animal Diseases. There is little information 
available, tfithln recent years a few deaths from anthrax 
and rabies have been reported, but it is not considered 
that these will be of importance to troops in France. An 
epidemic of chicken pest is reported to have ravaged the 
poultry flocks in Alsace in the spring of 1942, but it was 
checked by quarantine measures of the occupying authorities. 
Hoof-and-mouth disease was imported from Morocco in 1937, 
but was controlled, and has not been reported since. 
French departments are required to maintain anti-rabies 
services and veterinary services, although their operation 
has probably been cut down by shortage of personnel and 
equipment. The animal population has also been consider- 
ably reduced, by the shortage of fodder and by German 
requisitions. 
g, Laws. The principal laws concerning public 
healtbrand sanitation have been covered in the preceding 
paragraphs. Texts of the most important laws up to 1930 
will be found in the Annexes (appendices) of L*hygiene 
publlque en France (Paris, 1930). The texts ot all public 
health laws and regulations from 1930 to 1940 are collected 
in the semi-annual Bulletin du Ministers de la Sant<i Publlque. SELECTED REFERENCES 
Naval Intelligence Division, B.R. 503 A, Geographical Handbook 
Series, FRANCE, Volume II, History and Administration 
(Great September 19^2), pp, 233-253* 
Survey of France prepared under the direction of the Chief of 
Staff by the Military Intelligence Service, War Department 
General Staff* 
League of Nations, Annual Epidemiological Reports 
✓ N \ 
Conseil Superieur de 1'Hygiene publique de France, L*hygiene 
publique en France (Paris, 1930)* 
Jacques Parisot, Le Developpement de 1'Hygiene en France 
(Nancy,1933)* 
Jean Pillu. L!organization de 1'Administration generale de 
1'Assistance publique S~Paris (Paris 1934). TABLES 
I. Municipal Water Supplies. 
II. Hospitals, 1933* 
III. Medical Personnel, 193&& 1937. 
IV. Mortality by Cause, France & United States. TABLE NO. I 
MUNICIPAL WATER SUPPLIES IN FRANCE 
AMIENS: Municipal} wells and springs at Pont de Metz about 6 kilometers (3*7 miles) 
Trom the city. The water is ordinarily conducted through iron pipes by grav- 
ity, but pumps are sometimes used to increase the supply. 
ANGERS; Municipal} Loire River} slow sand filtration. The impounding reservoirs 
have a capacity of 6,000 cubic meters (1,585*000 U, S. gallons). The water 
is said to leave a nonadhering scale in boilers. 
AURILLACt Municipal} Springs of Velzic in the valley of the Jordanne River about 
6-172 miles from the city. The discharge varies from 26 to 32 gallons per 
second according to the season. It is conveyed to the city through iron 
conduits. Two impounding reservoirs have a combined capacity of 6,200 cubic 
meters (1,61*0,000 U. S, gallons). No treatment. 
BESANCON; Municipal, Three sources of supply: (a) Infiltration gallery 130 meters 
(1*27 feet) long at Arcier} (b) Rain water collected in concrete pipes in the 
forest at Aglans, 11 kilometers (6,8 miles) from the city} (c) wells 6 meters 
(20 feet) deep in alluvial soil 50 meters (161* feet) from the bank of the 
Doubs River, Arcier water treated with ”Javelle water”} water from alluvial 
soil is slow sand-filtered), Five reservoirs have a total capacity of 9*800 
cubic meters (2,6 million U, S, gallons). 
CAEN: Springs of Moulines, 23 kilometers (ll* miles) from the city. The water is 
impounded in two reservoirs with a combined capacity of 11,000 cubic meters 
(2,906,000 U, S. gallons). It is said to form deposits in boilers and pipes. 
GABORS: Municipal; springs at Fontaine des Chartreux; no treatment. Collecting 
reservoirs have a capacity of 5,000 cubic meters (1,321,000 U. S. gallons), 
The water is calcareous but is said to leave no deposits in pipes; is suit- 
able for use in boilers. 
CALAIS: Societe General des Eaux de Calais} 16 artesian wells from 1*0 to 60 meters 
(131 to 197 feet) deep in the communal forest of Quines about five miles south 
of the city. Three reservoirs which are metal tanks, store 5*200 cubic meters 
(1,371*,000 U. S, gallons) of water. No treatment. No deposit is formed in 
cold water pipes, but it is reported that it forms in hot water pipes. 
CHATEAUROUX: Municipal; three springs: Fontaine Bovry, Fontaine des Religieuses, 
and Fontaine du Jardin, Combined flow is 68 liters per second (1,552,000 
U. S. gallons per day). No treatment. The water is said to form a scale 
in boilers but does not corrode nor leave deposits in pipes. 
CHERBOURG: Municipal} Divette River. The water is impounded in the La Fauconniere 
Reservoir and then filtered through sand. The maximum available supply is 
6,000 cubic meters (1,585*000 u, S. gallons) per day. The French Naval Arsenal 
at Cherbourg also obtains its supply from the Divette River in the Quincam- 
poix Valley about one mile from Cherbourg, Water intended for drinking pur- 
poses at the arsenal is sterilized by heat. The city water is reported to 
cause no corrosion of boilers or pipes. 
CLERMONT-FERRAND: Municipal; three springs and River Allier, Marpou and Huhn 
Springs supply an impounding reservoir with a capacity of 2,000 cubic meters 
(528,000 U, S, gallons), Les Combes Spring is directly connected with the 
distribution system. Industrial water is supplied from the River Allier and 
stored in two impounding reservoirs with a combined capacity of 1*,500 cubic 
meters (1,200,000 U, S. gallons). 
CONCARNEAU: Municipal; wells; slow sand-filtration; capacity of reservoirs is 1,000 
cubic meters (261*,000 U. S, gallons). DIEPPE: Supply obtained from spring at Gouffre in the valley of the Scie at St, 
Aubin-sur Scie, about six kilometers (3,7 miles) from the city. The water 
is conveyed to Dieppe by gravity through an underground gallery. No treatment. 
DIJON: Three springs; Rosoir and Ste. Fey which are the property of Dijon, and Chat, 
which is owned by the French Government, These springs are in the valley of 
the Suzon River about 18 kilometers (11 miles) from the city. They furnish 
about 100,000 cubic meters (26 million U, S, gallons) per day in winter, but 
only 5,000 cubic meters (1,320,000 U, S, gallons) in dry weather. At such 
times, an auxiliary supply is obtained from Monceuil Spring in the valley of 
the Ouche River, Both supplies are said to deposit lime in pipes and boilers. 
Hardness varies from 210 to 230 parts per million. The water is sterilized 
with ”Javelle water” at times. 
PIHARD: Municipal; lakes, La Garde and Le Moulin Neuf, in the communes of La Rich- 
ardais and Pleurheit. The supply is treated with alum and filtered through 
slow sand filters. The total reservoir capacity is ll|7,000 cubic meters (39 
million U, S, gallons). 
D0UARNENE2: Municipal; wells 7 kilometers (U,3 miles) from the city; no treat- 
ment. The capacity of the reservoirs is 1,500 cubic meters (3,960,000 U, S, 
gallons)• 
DUNKERQUE (Dunkirk): Societe des Eaux de Dunkerque; artesian wells in chalk strata 
ai Houlle in the Pas-de Calais. No treatment. There are two reservoirs with 
a capacity of 5,000 cubic meters (1,321,000 U. S. gallons) each for emergency 
use, but no reservoirs for ordinary use. The water is hard and leaves deposits 
in pipes and boilers. 
FOUGERES: Municipal; wells four meters (13 feet) deep; no treatment. 
GRENOBLE: Municipal; infiltration galleries in post-glacial alluvium in the region 
of Rochefort about 12 kilometers (7.5 miles) from Grenoble in the basin of the 
Gresse and Drac Rivers, The flow is about 1,100 liters per second (25,106,000 
U, S, gallons per day). The water is reported to form deposits in boilers and 
pipes, but is non-corrosive. 
LE PUY: Municipal; springs in the region of Vourzae, a few miles from the city. 
One reservoir has a capacity of 3,000 cubic meters (793*000 U, S, gallons). 
The water is said to form no scale in boilers nor deposits in pipes and is 
not corrosive in boilers and pipes. 
LILLE; Municipal, Springs at Einmerin, Ancoisne, Houplin, and Seclin, Water is 
collected in aqueducts and conducted to three reservoirs with a combined capa- 
city of cubic meters (8,321,000 U, S, gallons). It is treated with 
calcium hypochlorite but not filtered. The city also owns an additional 
supply known as the Arbonnoise supply which is utilized only for industrial 
purposes. The spring water is said to form scale in boilers and leaves de- 
posits in pipes but causes no corrosion. 
GUERET: Municipal; supply collected in a reservoir after filtering through sub- 
soil; reservoir capacity is 700 cubic meters (185,000 U, S, gallons); no treat- 
ment, The water is clear and is said to cause no deposits. 
LA ROCHELLE: Municipal, Water is collected in three galleries located at Varaize, 
Le Vivier and Lafond, respectively. The total volume supplied per 2J4. hours 
is about 282,500 cubic feet (2,113,000 U, S, gallons). Other galleries were 
being constructed (1921;) to bring a larger supply to the city, the total 
available supply then being about 700,000 cubic feet (5*236,000 U, S, gallons). 
The water is calcareous and unless treated it leaves deposits in boilers and 
pipes. LE HAVRE: Springs at St. Laurent de Brevedent and Radicatel, 12 kilometers 
(7*5 miles) and 3h kilometers (21 miles) from the city, respectively. 
The total discharge of the two springs is about 39,i|00 cubic meters 
(10,1* million U, S. gallons) per day. Reservoir capacity is 15,000 cubic 
meters (7,7 million U, S, gallons). 
LIMOGES: Municipal; supply obtained from regions of La Crouzille and Puy Ber- 
brand. No treatment. It is collected in three impounding reservoirs which 
have a total capacity of 12,000 cubic meters (3,170,000 U. S. gallons). 
The water is said to form scale in boilers and leave deposits in pipes, 
and causes some corrosion in boilers. 
LOUDEAC: source not given; capacity of reservoir 500 cubic meters 
(132,000 U, S, gallons); no treatment. 
LYONS; Municipal, The supply comes from galleries, basins and wells dug on the 
banks of the Rhone immediately above Lyons in the communes of Caluire, 
Cuire, and Villeurbanne, There are two galleries, two basins and 30 walls 
on the right bank of the Rhone and 95 filtrating wells on the left bank. 
All the water comes from the Rhone River and filters through about 20 meters 
(66 feet) of sand and gravel to the wells and galleries. Sterilized with 
"Javelle water". It is said to form no deposits in pipes or boilers. 
MARSEILLE: Municipal; River Durance near Cadenet, 83 kilometers (52 miles) 
from the city. The aqueduct which conducts the water to the city delivers 
on an average 12,000 liters per second (271* million U. S. gallons per day). 
The water is clarified by standing in a settling basin of 3,000,000 cubic 
meters (792,510,000 U. S, gallons) capacity, and passes to the mains without 
further treatment. It is said to form scale in boilers but does not cause 
much corrosion. 
MAYENNE: Municipal; artificial lakes in suburbs of city and Mayenne River; no 
treatment; capacity of reservoirs is 600 cubic meters (159,000 U. S, gallons). 
The water from the lakes is slightly turbid after storm. River water has a 
yellow color and is said to be corrosive when used in boilers. 
MILLAU: Municipal; Mere de Dieu Springs and River Tarn, Tarn water is stored in 
the Troussy Reservoir, 
MONTPELLIER: River Le Lez near Berriassien; no treatment except sedimentation in 
reservoirs; ten reservoirs with total capacity of 6,100 cubic meters 
(1,611,000 U, S, gallons). 
MULHOUSE: Three wells 70 to 110 meters (230 to 3&1 feet) deep and one spring, all 
situated on municipal property; total yield about 7,000 cubic meters (1,81*9*000 
U. S, gallons) per day; two reservoirs 'with combined capacity of 1,700 
cubic meters (1*1*9,000 U, S. gallons). The water is reported to form heavy scale 
in boilers. 
NANCY: Municipal; two separate supplies; one is from the Moselle River which is 
used for industrial purposes; and numerous springs near Nancy which furnish 
water for drinking purposes. There is no general distribution system for the 
spring water but it is conducted to fountains about 300 meters (981: feet) 
apart, located in the streets, from which it is carried in individual con- 
tainers, The river water is stored in a reservoir with a capacity of 
21:,000 cubic meters (6,31:0,000 U. S, gallons). 
BORDEAUX: Municipal; springs. The springs of Budos and Taillan Ul and 12 
”kilometers (25 and 7*5 miles) from the city, respectively, have a combined 
flow of 670 liters per second (15,292,000 U, S. gallons per day). The 
water from each spring is conducted through masonry aqueducts to the city 
and stored in two reservoirs with a combined capacity of 16,1*00 cubic meters 
(h,332,000 U, S, gallons)• No treatment. The water is said to leave no 
deposits in pipes or boilers nor cause corrosion. BQULOGNE-SUR-MER: Municipal, but operated by La Gorapagnie Generale des Eaux; 
two springs, one at Tingry and the other at Molinet about six miles from 
the city, the combined flow of these springs is about 7,000 cubic meters 
(1,850,000 U. S, gallons) per day. Water from other small springs forms 
an emergency supply. The present supply (1921;) is inadequate and steps 
are being taken to obtain water from additional sources. The water is 
derived from chalk and is consequently hard, leaving deposits in pipes 
and boilers, > f 
SPURGES: Municipal; two wells 5 meters (16 feet) deep and one well 30 meters 
(9B feet) deep in the St, Outrille district; four reservoirs with total 
capacity 6f 6,800 cubic meters (1,796,000 U* S, gallons). The water is 
said to leave calcareous deposits in pipes. 
BREST: f£ldm Rivfer:, Treated by filtration. 
NANTES: Municipal; Loire River; slow sand filtration. The capacity of the im- 
pounding reservoirs is 20,000 cubic meters (^,280,000 U, S, gallons)* 
The water leaves a nonadhering deposit in boilers. 
NEVERS: Municipal; eight collecting wells in sand alluvium along the Loire River; 
wells are 7*75 meters (25 feet) deep and two meters (6,6 feet) in diameter; 
no treatment. Daily draft of wells is I;,000 cubic meters (1,057,000 U. S, 
gallons). The water is said to form deposits in pipes but does not corrode ' 
boilers. 
NICE: Municipally owned but leased to the Compagnie Generale des Eaux for 
1 operation. There are two sources of supply, Sainte Ihecle Spring in the 
valley of the Pal Hon furnishing one-third, and the Vesubu River two- 
thirds, The spring water is brought to the city in enclosed masonry 
conduits. River water passes through an open canal for 35 kilometers 
• • (22 miles) and filtered through sand. Both supplies are sterilized with 
Ozone before passing into the mains. The sterilized water is used only 
'* for domestic consumption, A separate system exists which furnishes river 
water for industrial and public service purposes. This water is not 
sterilized. The daily consumption is 80 gallons of drinking water and 
90 gallons of unfiltered water per capita. Water is also supplied to 
towns between Villefranche and Monton. 
PARIS: Municipally owned but leased to private companies for operation; in- 
" 'dependent systems of distribution, the "private system" furnishing spring 
water and filtered river water for drinking purposes and the system supply- 
ing raw river water for industrial and general use. Spring water is brought 
to Paris through five aqueducts: the Dhuys aqueduct, 8l miles long, from 
Pargny-la-Dhuys, Ij. to 6 million gallons per day; the aqueduct of the Vanne, 
108 miles long, 26 to 31 million gallons per day; the aqueduct of the Avre, 
63 miles long, from Rueil la Gadeliere, 16 to 29 million gallons per day; 
the aqueduct of the Loing and Lumain, U5 miles long, from Monttgny-sur-Loing, 
21 to 26 million gallons per day; and the aqueduct of the Voulzie under 
construction in 1921;, 28 miles long, from Provins to Moret where it Joins 
* the aqueduct of the Loing and Lumain, about 26 million gallons per day. The 
total available supply of spring water is estimated at from 92 to 118 mil- 
lion gallons per day depending on the season. Another project under con- 
sideration would furnish about 250 million gallons per day from wells in the 
valley of the Loire between Gien and Nevers. This project was authorized 
in 1931. 
The spring water supply is supplemented by filtered water from the Marne 
and Seine Rivers, Two pumping and filtration plants, one on each river, 
are capable of furnishing a total of 53 million gallons per day. This 
supply is treated either with ozone or hypochlorite of lime. 
Water for industrial and general purposes is pumped from the Villete, Marne 
and Seine Rivers by numerous pumping plants. The combined capacity of these 
plants is from 175*000 to 200,000 U, S, gallons per day. The total capacity of the seven reservoirs that impound spring water for 
the "private system" is 599,190 cubic meters (158,290,000 U, S. gallons); 
the capacity of the eight reservoirs that impound river water is 187,393 
cubic meters (l*9*50i*>000 U. S, gallons). 
Each street in Paris is provided with two systems of canalisation, one for 
drinking water ("private system") and the other for river water. Ninety- 
four per cent of these canalizations are placed in the municipal sewers, 
A special system supplies water for fire fighting. 
The filtered river water is said to form deposits in pipes, but neither 
spring nor river water has any corrosive action on lead pipes. 
QUIMPERLE: Municipal; wells four meters (13 feet) deep; no treatment. Capacity 
of reservoirs is 1,000 cubic meters (261*,000 U. S. gallons). The water is 
said to cause no corrosion. 
RENNES: Municipal; La Loysance and La Minette Rivers; no treatment. Capacity 
o7 reservoirs is 62,000 cubic meters (16,1*00,000 U. S. gallons). The water 
is said to be noncorrosive. 
RQANNEt Municipal; source not known. 
ROUBAIX and TOURCOING* The supply is owned Jointly by these two cities. There 
are two sources of supply, the River lys which is used for industrial pur- 
poses, and spring water for drinking purposes. The river water is filtered 
through sand and gravel, but the spring water is untreated. The river 
water reservoir has a capacity of 11,000 cubic meters (2,906,000 U* S, 
gallons). Both supplies are derived from calcareous formations and are 
consequently hard. 
ROUEN* Municipal; springs. About 75 per emit of the supply comes from springs 
at Fontaine-sous-Preaux and the remainder from Darnetal, The water is 
sterilized with "Javelle water". 
ST. ETIENNE: Municipal; Fur an and Lignon Rivers. Water from the Fur an River, 
used chiefly for drinking purposes, is impounded in two reservoirs with a 
total capacity of 2,970,000 cubic meters (785 million U* S. gallons). A 
dam near Lapteon in the Lignon River impounds 5*500,000 cubic meters 
(1,1*53 million U* S, gallons), from which water flows through an aqueduct 
5l* kilometers (3l* miles) long to the city* No treatment of either supply* 
Water from the Lignon River is said to be slightly colored and corrosive 
in boilers* 
ST. MALO* Municipal; lake reservoir of Sainte Suzanne, 250,000 cubic meters 
capacity (66 million U, S. gallons); slow sand filtration. 
PERIGUEUX: Municipal; springs at Le Toulon about two kilometers (1*2 miles) from 
the city* near the right bank of L’Isle Creek* The water is impounded in two 
reservoirs with a total capacity of 7,500 cubic meters (2 million U* S, 
gallons) and distributed without treatment or filtration* The water is 
calcareous and produces scale in boilers and leaves deposits in pipes* 
POITIERS8 Municipal; collecting wells about 10 meters (33 feet) deep in the 
district of Lovasseau* The water is conducted to Poitiers by gravity through 
a pipe line 2k kilometers (15 miles) long. The water is hard and is said 
to produce deposits in pipes and form scale in boilers* 
SAINT NAZAIRE-SUR-LOIRE: Municipal; supply from La Grande Briere (peat bog); 
slow sand filtration. Total reservoir capacity is 2 million cubic meters 
(528 million U. S. gallons)* The water is said to cause no corrosion* SAMUR: Loire River, For character of Loire River, see Nantes, which is 
"" *75 miles down stream. 
STRASBOURG; Municipal; five wells a few miles from the city near the Rhine 
rSTverT The underground reservoir at Oberhausbergen contains 16,660 cubic 
meters (li,li00,000 U. S. gallons). Rapid sand filtration. The water is hard 
and forms scale in boilers, but causes very little corrosion. 
TOULOUSE: Clavefont Springs and two infiltration galleries which receive 
water from the Garonne River. Water from one of the galleries is filtered 
through sand; none of the supply is treated chemically. 
TOURCOING: (See ROUBAIX, and also RONCQ) 
TOURS: Cher River; total reservoir capacity 28,000 cubic meters (7,1*00,000 
tf. S, gallons). 
VALENCIENNES: Municipal; spring water is collected in galleries in the 
region lying between Aulnoge and Marly, One reservoir of U00 cubic meters 
(106,000 U. S, gallons) capacity stores the supply. Treatment consists 
of addition of ”Javelle water”. The water forms scale in boilers and leaves 
deposits in pipes. 
RONCQ: Waterworks supply water for industries of towns of Roubaix-Tourcoing. 
~¥ater is drawn from river heavily polluted with industrial effluents. 
Following method of treatment has been found satisfactory: Water is settled 
for 2 hours, then treated with ferric sulfate and a hypochlorite in 2 
coagulation tanks, with detention periods of 1 hr, and 1/2 hr. It is 
passed through filter at 10 cm, per sq. m, per hr, and through a second 
filter at f? cm. per sq, m. per hr. 
The water supply for the following cities is chlorinated by the 
Verdunisation method: Lyons, Rheims, Carcassonne, Ligny-en-Barrois, Bar-le- 
Duc, and Aix-les-Bains, TABLE NO. II 
HOSPITALS IN FRANCE - 1933 
Beds ” 
Department 
Number of 
hospitals 
Number 
of Beds 
Civil- 
J”"3 w 
H* 
ck 
Military 
Infirm 
aged & 
incur- 
ables 
Children 
Staff 
Total 
1. 
Ain 
35 
795 
112 
557 
99 
311 
1,871* 
2, 
Aisne . • • • • 
35 
1,209 
11*6 
1,092 
330 
398 
3,175 
3. 
Allier • • • • • 
25 
1,262 
258 
908 
281* 
1*28 
3,U*0 
1*. 
Alpes (Basses-) • 
• 
17 
1*12 
16 
357 
52 
121* 
961 
5. 
Alpes (Hautes-) • 
• 
7 
299 
52 
177 
32 
121* 
681* 
6. 
Alpes-LIaritimes • 
• 
25 
1,932 
256 
51*5 
72 
229 
3,031* 
7. 
Ardeche • • • • • 
17 
372 
32 
51*0 
53 
205 
1,202 
8. 
Ardennes • • • • 
12 
691 
57 
71*3 
88 
21*1* 
1,823 
9. 
Ariege • • • • • 
12 
1*21* 
63 
359 
18 
86 
950 
10. 
Aube • 
15 
379 
30 
ia5 
35 
178 
1,037 
11. 
Aude •••••• 
9 
703 
101 
577 
90 
179 
1,650 
12. 
Aveyron .... 
12 
600 
65 
51*5 
77 
171* 
1,1*61 
13. 
BslTort • • • • 
• 
1 
188 
- 
- 
- 
ia 
229 
ll*. 
Bouches—du-Rhone 
• 
28 
2,985 
165 
1,671* 
15 
1*35 
5,271* 
15. 
Calvados • • • • 
21 
869 
909 
1,059 
236 
251* 
3,327 
16. 
Cental 
18 
286 
- 
598 
25 
132 
i,oia 
17. 
Charente • • • • 
12 
613 
Ill 
1*93 
161 
181 
1,559 
18. 
Charent e-I nf eri eure 
9 
1,131 
111 
526 
153 
107 
2,338 
19. 
Cher •••••• 
22 
1*26 
2 
559 
85 
159 
1,231 
20. 
Correze • • • • • 
H* 
1*09 
157 
327 
29 
119 
1,01a 
21. 
Corse . 
3 
216 
- 
51* 
10 
65 
31*5 
22. 
Cote d*0r * . , , 
26 
1,559 
296 
627 
189 
1*61* 
3,135 
23. 
Cotes du Nord • • 
• 
13 
831* 
173 
991* 
71* 
300 
2,375 
21*. 
Creuse • • • • • 
13 
212 
9 
103 
21* 
78 
736 
25. 
Dordogne • • • • 
32 
559 
118 
275 
79 
136 
1,167 
26. 
Doubs •••••• 
H* 
765 
335 
293 
76 
338 
1,807 
27. 
Drome •••••• 
13 
682 
151 
61*3 
61* 
207 
1,71*7 
28. 
Eure •••••• 
21 
1,175 
123 
1,113 
97 
380 
2,888 
29. 
Eure-ct-Loire , , 
• 
26 
897 
162 
587 
30 
315 
1,991 
30. 
Finistere .... 
25 
1,069 
61 
1,195 
306 
551 
3,182 
31. 
Card •••••• 
21* 
960 
133 
91*9 
118 
1*32 
2,592 
32. 
Garonne (Haute) . 
♦ 
13 
910 
- 
886 
56 
50 
1,902 
33. 
Gers 
15 
368 
60 
1*26 
133 
181 
1,11*8 
3l*. 
Gironde • • • • • 
20 
2,791* 
1*9 
1,175 
152 
952 
5,122 
35. 
Herault • • • • • 
30 
i ,9ia 
3i*7 
1,588 
191 
1*65 
1*,532 
36. 
Ille-ct-Vilaine • 
• 
26 
1.525 
52 
1,998 
209 
1*78 
It, 262 
37. 
Indre •••••• 
16 
553 
73 
365 
83 
195 
1,269 
38. 
Indre-et-Loire . 
• 
16 
1,573 
238 
805 
108 
31*3 
3,067 
39. 
Isere ••.... 
32 
2,103 
no 
697 
ia 
785 
3,736 
1*0. 
Jura ..•••• 
16 
610 
1*5 
233 
12 
206 
1,106 
ia. 
Landes • • • • • 
H* 
398 
51* 
337 
38 
121 
91*8 
1*2. 
Loir-et-Cher , , 
• 
13 
626 
59 
739 
167 
21*7 
1,838 
1*3. 
Loire •••••• 
ia 
2,392 
10I* 
1,663 
21*5 
787 
5,191 
1*1*. 
Loire (Haute) • « 
• 
23 
iao 
7 
797 
58 
216 
1,1*88 
1*5. 
Loir e-Inferieure 
• 
21 
1,729 
li* 
1,530 
11*7 
711* 
1*,131* 
1*6. 
Loiret • • • • • 
25 
1,079 
168 
1,181 
206 
527 
3,161 
1*7. 
Lot ...•••• 
2 
162 
36 
159 
12 
60 
1*29 
1*8. 
Lot-et-Garonne • 
• 
21 
371 
17 
397 
H* 
161 
960 
1*9. 
Lozere • • • • • 
10 
106 
26 
200 
9 
73 
iai* 
50. 
Maine-et-Loire • 
• 
1*8 
1,225 
228 
1,735 
260 
698 
1*,H*6 
51. 
Manche • • • • • 
30 
1,079 
76 
1,221* 
1*77 
31*6 
3,202 Hospitals 
Number of1 'Beds 
(Continued) 
Department 
Number of 
hospitals 
Number of Beds 
Civil- 
ians {2 
p. 
r» 
Military 
Infirm 
aged & 
incur- 
ables 
Children 
Staff 
Total 
52. 
Marne ...... 
20 
881t 
802 
1,663 
619 
625 
1,623 
53. 
Marne (Haute) • • 
# 
11 
513 
155 
536 
16 
201 
1,121 
51. 
Mayenne • • • • • 
29 
736 
39 
1,011 
208 
282 
2,276 
55. 
Meurth&-et-Moselle 
27 
2,11*7 
111 
2,062 
512 
1,153 
6,018 
56. 
Meuse •••••• 
15 
51t9 
167 
678 
160 
271 
2,128 
57. 
Morblhan • • • • 
15 
980 
117 
1,136 
117 
115 
2,795 
58. 
Moselle ..... 
35 
2,001 
77 
1,11*5 
175 
715 
l*,ll*3 
59. 
Nievre • . • • • 
lit 
598 
91 
196 
115 
207 
1,51(0 
60. 
Nord •••••• 
101* 
it, 716 
151 
8,625 
828 
1,925 
16,278 
61. 
Oise •••••• 
30 
929 
211 
1,319 
226 
378 
3,093 
62. 
Ome •••••• 
17 
931 
90 
820 
no 
297 
2,251 
63. 
Pas-de-Calais . . 
• 
2lt 
1,798 
100 
2,517 
211 
521* 
5,183 
61. 
Puy-de-Dome ... 
• 
30 
1,191 
251 
1,502 
255 
227 
3,126 
65. 
Pyrenees (Basses) 
• 
13 
698 
116 
120 
13 
271 
1,551 
66. 
Pyrenees (Hautes) 
• 
6 
381 
112 
268 
52 
96 
939 
67. 
Pyrenees-Orientales 
13 
532 
92 
301 
192 
76 
1,196 
68. 
Rhin (Bas-) ... 
• 
37 
3,380 
198 
1,300 
190 
1,197 
6,565 
69. 
Rhin (Haut-) • . 
• 
51t 
2,829 
32 
2,119 
318 
1,079 
6,677 
70. 
Rhone •»•••• 
30 
6,076 
20 
2,939 
302 
1,397 
10,731* 
71. 
Saone (Haute) • • 
• 
6 
328 
79 
H2 
22 
139 
710 
72. 
Saone-et—Loire , 
• 
31 
979 
261 
739 
181 
363 
2,529 
73. 
Sarthe • • • • • 
37 
783 
171 
1,017 
70 
168 
2,509 
71. 
Savoie • • • • • 
12 
773 
91 
661 
10 
190 
1,728 
75. 
Savoie (Haute). . 
• 
lit 
838 
86 
270 
39 
221 
1,1*57 
(Paris). . 
• 
69 
26,278 
- 
12,612 
1,965 
1,669 
1*2,521* 
76. 
Seine (Banlieue). 
• 
19 
- 
18 
2,110 
- 
109 
2,567 
77. 
Seine-Inferieure 
• 
11 
3,786 
359 
3,263 
289 
1,511* 
9,2n 
78. 
Seine-eb-Marne . 
• 
25 
1,156 
211 
1,11*1* 
77 
1*79 
3,100 
79. 
Seine-et-Oise . • 
• 
ItO 
3,715 
102 
1,809 
98 
1,065 
6,789 
80. 
Sevres (Deux-). • 
• 
17 
815 
107 
610 
18 
288 
1,928 
81. 
Some •••••• 
31 
1,155 
108 
1,723 
238 
612 
3,866 
82. 
Tarn •••••• 
7 
130 
105 
532 
116 
132 
1,315 
83. 
Tarn-et-Garonne . 
• 
13 
it22 
132 
353 
13 
170 
1,120 
81. 
Var ••••••• 
29 
879 
litO 
711 
•158 
302 
2,223 
85. 
Vaucluse • • • • 
59 
1,317 
118 
1,083 
19 
112 
3,009 
86. 
Vendee • • • • • 
20 
711 
«6 
731 
90 
323 
2,027 
87. 
Vienne 
11 
700 
388 
583 
133 
203 
2,007 
88, 
Vienne (Haute-) . 
• 
9 
695 
182 
785 
12 
263 
1,967 
89. 
Vosges • • • • • 
29 
1,213 
187 
1,516 
no 
156 
3,182 
90. 
Tonne •••••• 
22 
718 
136 
189 
12 
208 
1,593 
Totals: (90 de- 
partments) 
2,062 126,553 
12,511 
101,711 
11,161 
36,613 
291,612  
MEDICAL PERSONNEL IN FRANCE 
Detailed for 1936 — Totals for1937. 
Departments 
(Same as counties) 
(1) 
rH on 
g fe 
•H +J 
tj o 
® o 
S T3 
Surgeon 
dentists 
Midwives 
Departments 
Medical 
doctors 
Surgeon 
dentists 
Midwives 
Ain 
161 
29 
184 
Lot. 
87 
11 
43 
Aisne 
221 
15 
42 
Lot-et-Garonne , 
• 
• 
140 
34 
89 
Allier. ....... 
321 
62 
113 
Lozere 
33 
7 
21 
Alpes (Basses), , , 
51 
15 
24 
Maine-et-Loire . 
• 
• 
249 
63 
230 
Alpes (Haute) ... 
AO 
15 
27 
Manche 
• 
184 
46 
41 
Alpes-Maritime. , . 
602 
213 
105 
Marne 
49 
54 
112 
Ardeche 
88 
18 
48 
Marne (Haute). , 
• 
• 
97 
21 
105 
Ardennes 
120 
26 
91 
Mayenne 
96 
16' 
53 
Ariege 
70 
14 
55 
Meurthe-et-Mo se1ie 
284 
104 
138 
Aube 
143 
36 
52 
Meuse 
1100 
19 
115 
Aude 
197 
28 
83 
Morbihan .... 
178 
27 
108 
Aveyron 
140 
35 
63 
Moselle 
225 
132 
336 
Belfort 
49 
20 
40 
Nlevre 
117 
34 
45 
Bouche s-du-Rhone, , 
sa 
282 
273 
Nord 
996 
283 
386 
Calvados 
208 
63 
80 
Oise 
193 
49 
65 
Cental 
88 
21 
21 
Orne 
138 
24 
25 
Charente, 
151 
42 
78 
Pas-de-Calais, , 
• 
• 
438 
124 
257 
Charente-Inferieure 
255 
56 
106 
Pay-de-Dome, . , 
393 
69 
196 
Cher 
IAS 
34 
61 
Pyrenees (Basses 
). 
• 
310 
90 
129 
Correze 
126 
28 
88 
Pyrenees (Hautes] 
. 
• 
116 
32 
79 
Corse 
116 
19 
31 
Pyrenees (Orientales, 
163 
40 
94 
Cote-d'Or 
204 
57 
124 
Rhin (Bas-), , , 
454 
238 
373 
Cotes du-Nord . . , 
188 
37 
31 
Rhin (Haut-) . . 
• 
• 
226 
142 
318 
Creuse 
99 
18 
46 
Rhone 
765 
281 
243 
Dordogne 
188 
48 
81 
Saone (Haute-) , 
• 
• 
98 
30 
106 
Doubs 
144 
43 
153 
Saone-et-Loire , 
• 
• 
245 
116 
215 
Drome 
151 
42 
66 
Sarthe 
185 
51 
73 
Eure 
175 
60 
43 
Savoie 
122 
40 
72 
Eure-et-Loir, , . , 
124 
30 
84 
Savoie (Haute-). 
• 
• 
144 
80 
113 
Finistere 
260 
57 
159 
Seine 
5,940 
2,505 
1,082 
Card 
225 
52 
100 
Seine-Inferieure 
• 
• 
459 
117 
147 
Garonne (Haute-), . 
452 
92 
138 
Seine-et-Marne , 
• 
• 
247 
117 
67 
Gers 
112 
10 
73 
Seine-etrOise .. 
• 
• 
760 
504 
334 
Gironde 
716 
229 
272 
Sevres (Deux). , 
• 
• 
139 
34 
84 
Herault 
436 
56 
152 
Somme 
234 
72 
96 
Ille-et-vilaine , , 
287 
42 
76 
Tarn 
155 
38 
38 
Indre 
134 
23 
52 
Tarn-et-Garonne. 
• 
• 
101 
19 
41 
Indre-et-Loire, . , 
240 
53 
100 
Var 
315 
85 
117 
Isere 
247 
124 
169 
Vaucluse .... 
168 
67 
75 
Jura, 
102 
32 
122 
Vendee 
201 
26 
213 
Landes 
188 
42 
88 
Vienne 
150 
34 
130 
Loir-et-Cher. , , , 
124 
33 
65 
Vienne (Haute-). 
• 
• 
188 
54 
149 
Loire 
290 
105 
187 
Vosges 
152 
29 
107 
Loire (Haute-). . , 
83 
22 
50 
Yonne 
159 
53 
40 
Loire-Inferieure,., 
427 
88 
198 
Grand Total 
Lolret 
188 
51 
72 
1936 
— 
3,2.930 
8-55S 
11.286 
Grand Total 
(2) 
1937 
27.427 
9JJL7-... 
. lit m 
(1) Not including military doctors. 
(2) Not including 112 Officee of health. TABIZ NO. IV 
MORTALITY BY CAUSE IN FRANCE AND THE UNITED STATES 
(Rates per 100,000 inhabitants) 
mm— 
mTMTSTmS” 
Cause of Death 
Deaths 
1935 1936 
Rates 
1935 1936 
Deaths 
1936 1937 
Rates 
1936 1937 
Typhoid paratyphoid , 
1,071 
1,052 
2.6 
2.5 
3,182 
2,743 
2.5 
2.1 
Typhus fever 
5 
n 
0.0 
0.0 
115 
134 
0.1 
0.1 
Smallpox 
15 
10 
0.0 
0.0 
35 
34 
0.0 
0.0 
Measles ....... 
721 
1,010 
1.7 
2.4 
1,267 
1,501 
1.0 
1.2 
Scarlet fever .... 
326 
279 
0.8 
0.7 
2,493 
1,824 
1.9 
1.4 
Whooping cough, . . , 
836 
1,220 
2.0 
2.9 
2,666 
4,981 
2.1 
3.9 
Diphtheria 
1,605 
1,325 
3.8 
3.2 
3,065 
2,637 
2.4 
2.0 
Influenza 
7,677 
4,487 
18.3 
10.7 
33,811 
38,005 
26.3 
29.4 
Plague 
Tuberculosis of the 
0.0 
0.0 
0.0 
0.0 
0.1 
0.1 
0.0 
0.0 
respiratory system. 
Other forms of tuber- 
44,658 
43,161 
106.5 
103.0 
65,043 
63,330 
50.6 
49.0 
culosis 
6,792 
6,319 
16.2 
15.1 
6,484 
5,994 
5.0 
4.6 
Syphilis 
266 
296 
0.6 
0.7 
12,612 
13,221 
9.8 
10.2 
Malaria 
Other infectious or 
163 
120 
0.4 
0.3 
3,943 
2,729 
3.1 
2.1 
parasitic diseases. 
4,978 
4,628 
11.9 
11.0 
14,081 
12,825 
11.0 
9.9 
Acute poliomyelitis . 
Cerebrospinal menin- 
(Bracketed figures for U.S. 
included in "Other” immed- 
( 780 
( 1,461 
( 0.6 
( 1.1 
gitis 
Cancer and other 
lately above) 
(3,020 
( 2,208 
( 2.4 
( 1.7 
malignant tumors, , 
Tumors, non-malig- 
nant, or nature 
39,762 
40,229 
94.8 
96.0 142,613 
144,774 
111.0 
112.0 
not specified ... 
Chronic rheumatism 
4,291 
4,038 
10.2 
9.6 
6,513 
6,383 
5.1 
4.9 
and gout 
347 
336 
0.8 
0.8 
1,830 
1,751 
1.4 
1.4 
Diabetes mellitus , , 
Alcoholism (acute or 
4,558 
4,291 
10;9 
10.2 
30,406 
30,587 
23.7 
23.7 
chronic) 1,182 
Other general diseases 
and.chronic poison- 
1,107 
2.8 
2.6 
3,714 
3,305 
2.9 
2.6 
ings 
Progressive locomotor 
ataxia and general 
3.775 
3,786 
9.0 
9.0 
23,781 
22,940 
18.5 
17.7 
paralysis of insane 
Cerebral hemorrhage, 
cerebral embolism 
1,817 
1,689 
4.3 
4.0 
5,453 
5,055 
4.2 
3.9 
and thrombosis. , , 
Other diseases of 
nervous system and 
organs of special 
49,800 
48,474 
118.7 
115.7 116,562 
111,753 
90.8 
86.5 
sense 
15,855 
14,948 
37.8 
35.7 
21.523 
19,445 
16.8 
15.0 
Diseases of the heart 64,989 
Other diseases of cir- 
64,809 
155.0 
154.6 3a,350 
346,401 
265.8 
268.0 
culatory system . , 
14,317 
13,781 
34.1 
32.9 
30,325 
29,181 
23.6 
22.6 
Bronchitis 
7,192 
6,881 
17.1 
16.4 
4,342 
3,980 
3.4 
3.1 
Pneumonias. 
Other diseases of 
the respiratory 
system (tuberculos- 
28,502 
28,251 
68.0 
67.4 119,378 
110,009 
93.0 
85.1 
is excepted), . . , 
Diarrhea and enter- 
37,545 
35,812 
89.5 
85.4 
11,200 
10,592 
8.7 
8.2 
itis 
6,676 
5,410 
15.9 
12.9 
20,951 
18,925 
16.3 
14.6 
(Same-under 2 yrs.) 
• 
• 
• 
• 
15,612 
14,406 
7.3 
6.5 KlOTWSi 
MORTALITY BY CAUSE IN FRANCE AND THE. UNITED STATES 
(contO 
FRANCE 
UNITED STATES 
Deaths 
1935 1936 
M§£ 
1935 i936 
&e£thg 
1936 1937 
Rates 
1936 1937 
Appendicitis ... * 
1,639 
1,604 
3.9 
3.8 
16,480 
15,340 
12,8 
11.9 
Diseases of liver 
and biliary pas- 
sages 
12,303 
12,161 
29.3 
29.0 
21,149 
21,170 
16,5 
16.4 
Other diseases of 
digestive system , 
12,633 
12,333 
30.1 
29.4 
34,996 
33,941 
27.2 
26.3 
Nephritis 
18,845 
18,623 
44.9 
44.3 
106,865 
102,877 
83.2 
79.6 
Other diseases of 
genito-urinary 
system 
4,314 
4,389 
10.3 
10.5 
20,014 
19,642 
15.6 
15.2 
Puerperal septicemia* 
529 
397 
0.8 
0.6 
4,506 
3,644 
2.1 
1.7 
Other diseases of 
pregnancy, child- 
birth and the puer- 
peral state. . . , 
959 
910 
1.3 
1.4 
7,676 
7,125 
3,6 
3.2 
Diseases of the skin 
and cellular tissue 
and of bones and or- 
gans of locomotion 
1,545 
1,483 
3.7 
3.5 
3,691 
3,349 
2.9 
2,6 
Congenital debility, 
malformations, pre- 
mature birth, other 
diseases of early 
infancy * 
12,930 
12,130 
20.2 
19.2 
63,854 
63,349 
29.8 
28.8 
Senility 
83,857 
80,947 
199.9 
193.1 
11,367 
9,904 
8.9 
7.7 
Suicide 
8,430 
8,185 
20.1 
19.5 
18,294 
19,294 
14.2 
14.9 
Homicide ...... 
514 
466 
1.2 
1.1 
10,232 
9,811 
8.0 
7.6 
Violent and accidental 
deaths (suicide and 
homicide excepted) 20,607 
19,220 
49.1 
45.9 
110,249 
105,348 
85.8 
81.5 
Cause of death not 
specified or ill 
defined 
129,553 
131,709 
308.9 
314.3 
21,111 
20,593 
16.4 
15.9 
Total: 
658,379 
642,318 1569.8 1532.6 
1,479,228 1,450,427 
1151.8 
1122.1 
♦Rates per 1,000 living births, 
Rannort Enidemioloelcme Annuel - League of Nations, Geneva, 1939. MAPS 
Average Actual Temperatures (graph). 
Average Annual Rainfall. 
Density of Population. 
Pluviometrlcal Fractions. 
The departments of France. 
Regional division, 1941. SHOWING AVERAGE ANNUAL RAINFALL OF FRANCE (AFTER ANGOT) 
Average actual Temperatures. Fahrenhefc 
RE II. TYMDIL T1MPRA1W GMfIS. 
motf. : m mctfomlockal sutrmi at mnuin 
UCS OBI TIE HKM GWClfO TO Tltt EAST or TIC WRWWW DENSITY OF POPULATION BY ARROND1SSEMENTS 
(Based on the Census figures for 1926) 
Erratum : T/ir nrrondissement of Rouen has a density between 101 and 300, not 71-100. 
FIG. 8. THE GRAPHS INDICATE PLUVIOMKTRICAL FRACTIONS (iflXI 
angot) for each month, in thousandths of the total annual 
RAINFALL, FOR TYPICAL DEPARTMENTS 
1 Pu *** I Ardennes m Haate-Ssvofe « — «- * - 
2 Seine-InKrieurs 9 Haute-Marne 16 Cmn t\ UmWttcInmaT 
™ «*£*?* M a3T 
4 J'Wiwr® ii liukt j9 Dordooe «« iii« ■ nit 
s >s Char I, CStoP U 
f ij?1*®" . *3 SsJawt-Loirt so Aidtds ,* Ate HbMm 
7 Selne-et-Oise Haute-SaAne u in ft* The departments of France 
except Corsica REGIONAL DIVISION 
194.1 
Armistice Line 
Regional boundary 
Departmental boundary 
Regional division, 1941 im 
PUBLIC HEALTH 
FRANCE 
Administration Generale de 
1'Assistance Publique. 13 
Administration 
local... •••••••• ••••••••••6 
national. ••••••••• ••••••1 
American Friends1 Service 
Committee.•••••••••••••••••••••*10 
Animal diseases.. •••••.••26 
Anti-tuberculosis organization.....6 
Assistance publique 
(see Paris) x 
Associations d‘hygiene sociale....10 
Birth Control.•••••••••••..••••.••17 
Birth & death rates.•••••.•••••••.16 
Bordeaux.••••••••••••••••••..••••••8 
Budget.••••••.•••••••••••^•••••••3,8 
Bureaux municipaux d'hygiene.......? 
Comite National ...... 10 
Comite National de Defense 
Contre la Tuberculose 
(see Comite National) 
Commission Sanitaire 
(see Departmental & district 
administration) 
Conscription sanitaire 
(see Departmental & district 
admini s trati on) 
Conseil Departemental d*Hygiene 
(see Departmental & district 
administration) 
Conseil Superieur 11 
Death, Causes of••••••16,17,18,38,39 
Death rates 
(see also Birth & death rates) 
causes. •• •••• ...16 
Departmental & district 
administration..••••••• •••••5 
Drugs H*,15 
Epidemics. 18,19,26 
Fleas 
(see Insects) 
Fly 
(see Insects) 
Food & beverage control...........25 
Fronti ers •••••• •••••••••••••1* 
Health centers.. ••••••• 6 
Health Officer 
(see Medecin) 
Hospices •••••••• .12 
Hospitals 12, li*,35,36 
administration •••• .13 
finance., ...13 
equipment. Ii*,l5 
Housing, bathing & toilet ••••25 
Immunization 
(see Vaccination) 
Infectious diseases. .18-20 
(see also Death,Causes of), 
Insects ,..20,22,2^ 
Institut prophylactique...........10 
Laboratories,.6 
Law of 1902 ...6,7,1^ 
Laws,. ...26 
Ligue Francaise centre 
le Cancer...... 10 
Ligup National centre le 
Peril Venerien. 10 
Louse 
(see Insects) 
Lyon..... 
Maritime sanitary service..........!* 
Mayors .....6 
Medecins de circonscription 
(district health officers)..••••.6 
Medical research. •••••• .11 
Ministere de la Sante 
Publique . . .1 
Mosquitoes 
(see Insects) 
Offices d'Hygidne Sociale 
(see Departmental & district 
administration) 
Ordre des Medecins 11 
Paris 9 
Personnel .5,6 
medical. •••••••• .10,11,37 
Population. .1*2 
Ports. •••• ••••!* 
Prefect,,., • ••• •••••••1**5 
Rainfall 1*1,1*2 
Rats 
(see Rodents) 
Regional organizations ...........3,1* 
Rodents,.•••• ••••••••20,22,25 
Sanitary code.... .5,6,7 
Sanitation, supervision 23 
Secretariat a la^ 
Famille et a la Sante .,3 
Serums ...U*,l5 
Service Centraux d*Hygiene 
Sociale.-. ••••••• . .1 
Sewage disposal 21* 
Special death services. ....I 
Temperatures ••••••••••••••••1*1 
Ticks 
(see Insects) 
Tuberculosis. .... .1,3,1*,5,6,10,13,19 
Unitarian Service Committee....•••10 
Vaccination & Immunization.....15,19 
Vaccines, drugs. .......Ii*,l5 
Venereal disease ............20 
Waste disposal.•••••••••••••••••••21* 
Water supply.... ...23,2l*,29,3l* 
Welfare, public..•••••••••••••••.2,3 
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