The 1918 outbreak dwarfed the immediately preceding pandemic of 1889 and the subsequent 1957 and 1968 pandemics in mortality and morbidity. In retrospect, much can be learnt about the source, the possibly subterranean spread of virus and the genetic basis of virulence.In the recent pandemics of 1957 and 1968, there were so-called 'herald waves' either in the summer months, or in particular countries up to 6 months before more worldwide outbreaks. These localised outbreaks would lengthen the time available for preparation of new vaccines and stockpiling of antiviral compounds.We present new epidemiological and mortality evidence of early outbreaks of influenza in France, UK, Norway, Germany and USA in the years 1915 to 1917. Certain of these focal outbreaks which had a very high mortality in the young occurred during the winter months, and were respiratory with a heliotrope cyanosis so prominent in the clinical diagnosis in the world outbreak of 1918. Thus, the upturn of influenza activity in Norway in 1916 was associated with an unusual level of mortality in young adults. Similarly, the outbreak at Etaples in France and Aldershot barracks in the UK in 1916-1917 caused mortality in 25-35 year olds. We deduce from an analysis of these outbreaks that early focal outbreaks occurred mainly in Europe and on the balance of probability the Great Pandemic was not initiated in Spain in 1918 but possibly in another European country, either France or England, in 1915, 1916 or 1917.