In the same month that the disease broke out in Scotland it appeared in Spain. The Inspector General of Health in that country reported that an epidemic of the disease began at Madrid in the last half of May, 1918, at a period when there was an unusually large gathering of people in the city. Within a short time it had spread rapidly through all the provinces. The increase in death rate became marked on the 27th of May and reached its peak on the 31st, at which time the rate was twice that of the average annual death rate for that period of the year. During the following week there was some oscillation around the peak and then the curve fell away. The epidemic was particularly severe at Madrid, Badajoz, and Seville. It was mild at Barcelona. MacNeal remarks: “In Spain the disease appeared in epidemic form about the middle of May and this outbreak received great publicity, sufficient to lead to the popular appellation of Spanish influenza. The very rapid and extensive spread of the disease in Spain would indicate that it had been introduced from without rather than transformed from the endemic state in that country. This also appears to accord with the view of those who have studied the epidemic in Spain.” Filtzos reports that influenza first appeared in Greece toward the end of May, 1918. The symptoms were slight and the people who were attacked suffered for three or four days with fever, accompanied by nervous symptoms. It was called at the time “Spanish Fever”. Beginning with September the epidemic became worse and caused a considerable rise in mortality. Complications with bronchopneumonia appeared. The decrease in incidence began toward the middle of December, 1918. According to Benjafield, the pandemic first commenced in the Egyptian Expeditionary Force in May, 1918, but the maximum incidence was not reached until September and October. The cases during the earlier period of the epidemic were on the whole mild in type and of short duration, only a very small proportion being complicated by bronchopneumonia. The epidemic continued from November, through February, 1919, but the number of cases showed a marked decrease during the last two months. The month of June saw the spread into England which we have already described, and the continuation from the German West front back into the enemy territory. Rose reports that on the 3d of June, 1918, in Strasbourg the first cases of influenza were reported in his hospital and that by the 15th of the month the disease was practically epidemic. Wachter in reporting cases from Frankfurt a. M. says that the cases of influenza in that city appeared from the beginning of June, 1918. Schmorl remarks that influenza became epidemic in Dresden in the beginning of July, 1918. According to Koepchen, the disease was epidemic in Bonn the 25th of June.