Even after the unification of Germany in 1871, political power continued to be fragmented. The Bismarckian constitution was superimposed on a collection of previously independent states: it acknowledged their continued existence as historical regions, granted them their own constitutions, state parliaments, and extensive legislative and executive powers. At a regional level, different perceptions of the appropriate role of the state continued to exist, with Prussian centralism contrasting with the laissez-faire amateurism of Bremen and Hamburg. The creation of centralized Reich (German Empire) agencies, such as the Imperial Health Office, failed to guarantee an effective implementation of German Empire decrees, and the administrative structure of individual states remained diverse. Indeed despite increasing pressure to create a uniform nation state and standardized administrative procedures, there were still 25 separate states in 1914. In relation to the structure of medical services and the formulation of medical policy, a significant degree of regional variation persisted into the twentieth century.