In general the 1920 recurrence was decidedly milder than the autumn outbreak of 1918. Certain cities, however, suffered severely, particularly Detroit, Milwaukee, Kansas City, Minneapolis and St. Louis. In these the death rate, while the epidemic lasted, was higher than that of 1918. The duration of the epidemic was generally, however, shorter in these cities. Columbus, Ohio, and Indianapolis suffered severely, but to a less extent than the cities just mentioned. In Chicago the death rate was not as high as in the fall of 1918, but it did rise far above the point reached during the 1889–90 outbreak, and the influenza in the last two weeks of January brought the total mortality for that month up to 5,149, the highest mortality in the history of the city with the exception of October, 1918. We have already discussed the recurrent epidemic as it was studied in Detroit. The salient characteristics were a rapid and fairly symmetrical evolution, a shorter duration than in 1918, a lower morbidity with a higher mortality rate, and finally, a smaller total number of deaths than in 1918. The 1920 recurrence was widespread. It was not confined entirely to the large cities. Semi-official reports from small towns and villages show very much the same conditions as were observed in the larger cities. On the whole, however, most communities, both large and small, suffered less severely than in the first spread. The few exceptions to this were distributed over the continent without uniformity. The first among the large cities to show an increase in death rate from the epidemic was Kansas City, in which the mortality first climbed in the week ending January 17th. The following week there was an increased rate in Chicago, New York and Milwaukee, and one week later, Boston, Detroit, San Francisco and Philadelphia were affected. New Orleans was one of the last large cities affected, not showing a definite increase until the week ending February 14th. In contrast to the 1918 pandemic, the influenza of 1920 showed no clearcut direction of spread, and was as in the years following 1889 due, without doubt, to firing up of the pandemic virus as it had been left scattered in many endemic foci throughout the earth. There probably were instances of spread from the larger centers to outlying districts, but there was no continuous spread over large areas. The accompanying table shows clearly that the disease this year commenced in the center of the continent, a fact which would seem to disconnect it entirely from the late epidemics of 1919, occurring in Europe: