Sydenstricker in a preliminary report remarks on the fact that the disease reached an epidemic stage in a number of localities in the central, northern, southern and western sections at about the same time as it did in the area along the northeastern coast. “The possibility is suggested, therefore, that sources of infection existed in at least some of the larger population centers, well distributed through the country, some time before the disease appeared as a nation-wide epidemic. The apparent radial spread of the epidemic from certain centers would seem to strengthen this hypothesis. It may also be noted that there is evidence, the collection of which has not yet been completed, pointing to the existence of cases of the disease in various centers, probably widely distributed, weeks before they were definitely recognized as influenza. The possibility that these foci themselves had a common focus is by no means excluded, of course, but there is as yet no conclusive evidence that would warrant the statement that the starting point of the epidemic was Boston or any specific locality.” Dublin, from a study of the statistics of the Metropolitan Life Insurance Company, finds that the virulence of the influenza, as indicated by the mortality rate, was greatest along the Atlantic Coast and became progressively less as it progressed westward. There was one exception. The mortality was high in San Francisco, higher than in other western communities. Dublin believes that quite possibly there was a double infection in San Francisco in the fall of 1918, one coming from the East and of small caliber, while the other came either by way of the Panama Canal or perhaps from Asia. The evidence in favor of two ways is that Dublin finds that the peak of incidence in San Francisco and in some other places on the Pacific Coast occurred sometime in advance of the similar peak at points inland from the coast. This is not brought out in Pearl’s chart, and the latter finds when considering the peak of deaths that the peak for San Francisco was late. The peak in that city, in Oakland, California, and in Los Angeles, was reached on the week ending November 2d. Few cities had as late death peaks. Cleveland and Pittsburgh reached their peak in the same week, St. Paul, Minnesota in the week ending November 16th, and St. Louis, Milwaukee and Grand Rapids not until the week ending December 14th. In the case of Milwaukee and St. Louis these were the high peak dates but they were second peaks. In the former the first peak occurred October 26th and in the latter November 2d. In Grand Rapids the increase in mortality was clearcut by the middle of October, although the peak was not reached until the week ending December 14th. These statistics would indicate that San Francisco was attacked, as evidenced by increase in death reports, relatively late, and at about the time that would be necessary for the disease to be carried across the continent.