Among all the infectious diseases arising epidemically there is none that can even approach influenza in regard to the extent of its geographic distribution over the earth. It is the world pestilence- as Huxham (1754) described it, the "Morbus omnium maxime epidemicus."

None of the earlier pandemics were nearly so extensively distributed over the entire world as the pandemic of 1889 to 1890.

The enormous development of traffic, especially in travel (traveling influenza patients, convalescents, perhaps also healthy persons), possibly also in merchandise, is chiefly responsible for this.

We must limit ourselves in describing the course of the latest pandemic around the earth to some few especially important landmarks.

It may be regarded as certain that the pandemic of 1889 had its origin in Asia. The first news of the appearance of the pestilence came from Bucham, in the interior of Turkestan, where Heyfelder, medical officer of that section of the Russian railway, recognized the outbreak of an extraordinarily intense influenza epidemic, in the latter part of May or the beginning of June, 1889.

From Turkestan influenza gradually spread through Russia, at first remarkably slowly, as might be expected where traffic is so small. Thus the disease required four months to spread to eastern Russia and Siberia, and five months to reach St. Petersburg.

From Russia and Finland, and especially from St. Petersburg, where the epidemic began in October and reached its acme between the fifteenth and twenty fifth of November, the disease spread like an avalanche over the whole of Europe.

All the localities in Europe affected by influenza were densely populated, and, commercially united with each other as they were, formed new foci for the further spread of the disease in every direction.*

Within Europe the course of epidemics forms a network which it is impossible to unravel.

Even in the middle of November, fourteen days after the recognition of the first influenza cases in St. Petersburg, the first authentic cases were observed in Berlin, Danzig, Breslau, and even in central Germany, Cassel, Chemnitz, Leipsic, and Halle. Paris became infected only a few days later than Berlin (November 17 to 20). Immediately afterward, that is, toward the end of November, the disease broke out in Stockholm, Copenhagen, Vienna, Cracow, Lemberg, and in the German cities of Hamburg, Kiel, Stettin, Bremen, Hannover, Cologne, and Stuttgart,

* The rapidity with which our latest pandemic spread over Germany is shown in the following statistics, which I have compiled from the voluminous tables of P. Friedrich. Of 998 places (towns and villages) spread over the whole of Germany, the first appearance of influenza was noted-

End of October

Beginninf of November

Middle of November

End of November

Beginning of December

Middle of December

End of December

Beginning of January 15 places (?) 12 " (?) 16 " 62 " 103 '" 450 " 307 " 33 "

998 districts.

In the beginning of December Konigsberg, Memel, Munich, Wiirzburg, Weimar, etc., Berne, Geneva, Basel, and Zurich were attacked.

It was not until the second week in December (December 11) that influenza was noted in London, and almost simultaneously it appeared in Brussels; also in Portsmouth, Leith, Hull (imported from Riga), and Inverness (Scotland). In the middle of December it was noted in Hungary and the Balkan States, in Holland, in Innsbruck, and in Venice. In the second half and toward the end of December Italy, Spain and Portugal, Bohemia, Moravia, Siebenburgen, Scotland, Ireland, Athens, and Constantinople became affected. Christiania became affected on December 29, four weeks later than Stockholm. At the end of December we find the disease in Malta, Corfu, Cyprus, and at the same time at the St. Bernard Hospice, at St. Moritz, and at Gibraltar.

Early in its course the disease traversed the Atlantic Ocean, reaching New York and Boston on December 17, from which points the large cities of North America were affected. Nearly six weeks elapsed while the disease was traveling from New York to Hudson Bay, Lake Winnipeg, and Newfoundland. As early as the beginning of January influenza was observed in Canada in Quebec, Montreal, and Halifax.

From Europe influenza reached the north coast of Africa (Egypt and Algeria) early in January, and simultaneously (toward January 7) the most southern point of that continent, the Cape of Good Hope, where the pestilence was conveyed by a ship infected with influenza (the duration of the voyage from London, which was infected on December 10, being twenty days).

In the beginning of January, that is, at the same time as at the Cape of Good Hope, influenza was noted in Trieste, Dalmatia, Sicily, Corsica, Naples, etc., in Antigua (West Indies), Cape Verde, and Persia (Teheran and Tabriz).

By the middle of January the following places were affected: several islands in the West Indian archipelago, Mexico, Honolulu; the interior of Norway, the inhabitants of the Rigi, the Channel Islands, north of Scotland, and the west of England.

Toward the end of January we find influenza in Central America, also in Hong-Kong (a patient leaving London on December 18 at the acme of the disease arrived in Hong-Kong on January 20). From Hong-Kong Colon Bay (China) was infected early in February, though it appears that in both these places the disease was not able to establish itself, since the real epidemic outbreak was first reported in Hong-Kong about the end of February. The numerous contradictory statements that have been made in reference to time and appearance of the first cases of epidemics are to be explained by the fact that the first cases did not take root, This has been noted especially in cases in which the disease has been carried into harbor and coast districts by ships; but also upon the mainland it sometimes requires repeated introduction before developing.

In the beginning of February the following places were affected: Japan (according to the English marine reports), Ceylon, Buenos Aires, Montevideo, Argentine, Rio de Janeiro, Pernambuco, and Guatemala; by the middle of February, Greenland, Scilly Islands, Sierra Leone, and San Francisco.

By the end of February and beginning of March influenza had spread in numerous districts of Farther India, India, China, and thence to Australia (Sydney, Melbourne), New Zealand, and Borneo. About the same time various mountain districts of England (Rieth, Aysgarth, Rishworth, etc.) were affected. We may further briefly note the following districts. From the middle to the end of March Zanzibar, Togo Country, Kamerun, Bermuda, Basutoland, were affected; in the middle of April Hodeida (Arabia), Natal, Bechuanaland, the Azores, Ecuador and Barbados, etc., were attacked. In May the Gold Coast of Africa; in June, Trinidad; in July, Quilim'ane upon the Zambesi, Madagascar, North China, Iceland; in August, Jamaica, St. Helena, Mauritius; in September, Reunion, the Falkland Islands; in October, the Shire plateau in central Africa on the Zambesi. The end of this globe encircling pandemic appears to have been Abyssinia (Shora), in November, and Gilgit, situated in a distant valley of Hindu Kush, in the highlands of Kashmir, in December, 1890.