The health center’s report in December 1918 highlights the dilemma: “The outstanding fact, perhaps, is the extreme rapidity with which the epidemic spread after it attained the proportions of an epidemic in the first areas affected. The epidemic became nation-wide in the four or five weeks after it appeared in an epidemic stage in the first localities affected. A fact of scarcely less importance is that the disease reached an epidemic state 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
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