AN ANALYSIS OF THE 1875-1877 SCARLET FEVER EPIDEMIC OF CAPE BRETON ISLAND, NOVA SCOTIA ___________________________________________________________ A Dissertation presented to the Faculty of the Graduate School University of Missouri-Columbia ___________________________________________________________ In Partial Fulfillment Of the Requirements for the Degree Doctor of Philosophy ___________________________________________________________ by JOSEPH MACLEAN PARISH Dr. Lisa Sattenspiel, Dissertation Supervisor DECEMBER 2004 © Copyright by Joseph MacLean Parish 2004 All Rights Reserved Dedication This dissertation is dedicated to the people of Cape Breton and in particular the people of Chéticamp, both past and present. Your enduring spirits, your pioneering efforts and your selfless approach to life stand out amongst all peoples. Without these qualities in you and your ancestors, none of this would have been possible. Acknowledgements I would first like to thank my fiancée Demmarest who has been a constant source of support throughout the process of creating this dissertation and endured my stress with me every step of the way. I will never forget your patience and selflessness. My mother Ginny was a steady source of encouragement and strength since my arrival in Missouri so shortly after the passing of my father. Your love knows no bounds mom. I would also like to thank my close friends who have believed in me throughout my entire academic “career” and supported my choices including, in no particular order, Mickey ‘G’, Alexis Dolphin, Rhonda Bathurst, Michael Pierce, Jason Organ and Ahmed Abu-Dalou. I owe special thanks to my aunt and uncle, Muriel and Earl “Curly” Gray of Sydney, Nova Scotia, and my cousins Wallace, Carole, Crystal and Michelle AuCoin and Auguste Deveaux of Chéticamp, Nova Scotia for being my gracious hosts numerous times throughout the years of my research. My advisor, Lisa Sattenspiel, who spent many long hours correcting drafts, also deserves many thanks for all her hard work and knowledge throughout my time at Missouri. My committee members, Ann Herring, Ray Wood, Bob Benfer and Richard Bienvenu all deserve many thanks for wading through the dissertation and offering their much appreciated suggestions. The Life Sciences Program at the University of Missouri-Columbia and the Social Sciences and Humanities Research Council of Canada are graciously thanked for their financial support. The Department of Anthropology at Mizzou provided me with several greatly appreciated teaching positions over the years for which I am also grateful. The Graduate Professional Council, Graduate Student Council and the Graduate School at the University of Missouri and the Canadian ii Association for Physical Anthropology all provided me with travel funds for some professional meetings over the years. Finally, the staffs of the Beaton Institute at the University College of Cape Breton in Sydney, Nova Scotia and of Les Trois Pignons/La Société Saint-Pierre in Chéticamp, Nova Scotia were all extremely helpful in letting my research run as smoothly as possible. Thank you all. iii TABLE OF CONTENTS ACKNOWLEDGEMENTS ……………………………………………………… ii LIST OF FIGURES ………………………………………………………………. vii LIST OF TABLES ……………………………………………………………….. ix ABSTRACT ……………………………………………………………………… xi Chapter 1. INTRODUCTION ……………………………………………….. 1 2. THE PEOPLE AND HISTORY OF CAPE BRETON ISLAND ……………………………………………………... 11 The Aboriginal Inhabitants, the Mi’kmaqs The Acadians The Scots The 19th Century Cultural Landscape: Cape Breton After The Expulsion 3. THE BIOLOGY OF STREPTOCOCCAL INFECTIONS ………. 34 Streptococcus Pyogenes: A Brief Introduction to its Biology and Symptoms of the Infections It Causes The Implications of Scarlet Fever as a Manifestation of Streptococcus pyogenes 4. MEDICINE IN THE 19TH CENTURY …………………………… 47 Science and Medicine in the 19th Century Determining Causes of Death in the Historic Record Cape Breton’s Medical Situation in 1875-1877 iv 5. PREVIOUS STUDIES OF SCARLET FEVER EPIDEMICS …… 64 The Scarlet Fever Pandemic of 1825-1885 Scarlet Fever and General Streptococcal Epidemics in the Literature 6. DISEASE MODELING THEORY ………………………………. 91 Models and Their Uses Types of Models The SIR Epidemic Model The SICR Epidemic Model Applying the Data to the Model and the Remaining Rates The Random Features of the Model 7. THE CAPE BRETON SAMPLE ………………………………… 123 Introduction to the Data Set Summary of the Data Set and Accompanying Maps Identifying Scarlet Fever and Other Causes of Death from the Historic Record 8. METHODS OF ANALYSIS ……………………………………… 145 Identifying Cultural Groups in the Historic Record Geographic Plotting Determining the Presence and Extent of Streptococcal Mortality in Cape Breton Sensitivity Analysis from Modeling v 9. RESULTS AND ANALYSIS …………………………………….. 163 Differences in the Effects of the Epidemic on the Two Major Ethnic Groups Differences by Ethnicity or Differences by Occupation? Geographic Mapping of Epidemic Cases Computer-based Model 10. DISCUSSION, CONCLUSIONS AND FUTURE DIRECTIONS ………………………………………………... 201 REFERENCES CITED …………………………………………………………... 216 VITA ……………………………………………………………………………… 225 vi LIST OF FIGURES Figure Page 2.1 Cape Breton Island with the counties and some of the major towns noted …………………………………………………… 12 4.1 Map of Cape Breton Island showing the counties and major towns …………………………………………….......... 61 5.1 (A) Annual scarlet fever deaths in England and Wales, 1849-1893 (ordinate). (B) National wheat prices (shillings; ordinate). Marked falling trend in both series after 1875 ……. 79 6.1 The progression of the SIR disease model compartments ……….. 104 6.2 The addition of a carrier compartment to the SIR model creating the SICR model ………………………………………………. 107 6.3 The expanded SICR including births and deaths ………………… 108 6.4 The part of the model showing the maturation flows from juveniles to adults ……………………………………………. 110 7.1 Map of Cape Breton Island showing the four counties ………….. 126 8.1 A map of the 1871 census subdistricts approximated from Hornsby’s (1992) Figures 3.5 and 6.5 of the 1851 and 1891 census subdistricts and the 1871 list of census subdistricts contained in the Canada Dominion Bureau of Statistics (1876) census summary tables ……………………………………….. 158 9.1 Population pyramid of Judique and Chéticamp based on the 1871 census …………………………………………………... 171 vii 9.2 Death rates of Acadians and Scots for all other causes of death, 1875-1877 ……………………………………………………. 175 9.3 Death rates of Acadians and Scots for all streptococcal causes of death, 1875-1877 …………………………………………….. 176 9.4 Map of Cape Breton Island with the census subdistricts outlined shown with a graphic representation of their corresponding deaths from all categories of streptococcal infection ………… 191 9.5 Graph showing the effects of altering the type of person who is the initial or index case for the epidemic …………………….. 193 9.6 Graph showing the effects of altering the transmission rate (tau) …………………………………………………………... 195 9.7 Graph showing the effects of altering the scarlet fever death rate that affects juvenile infectives ……………………………….. 196 9.8 Graph showing the effects of altering the interaction modifier …. 198 9.9 Graph depicting the percentage of total carriers in the population and the percentage of those carriers who are juveniles ……… 199 viii LIST OF TABLES Table Page 4.1 Number of physicians and surgeons in Cape Breton Island in 1871 ………………………………………………………….. 59 6.1 The combination of just two factors in modeling can produce many more than two compartment boxes ……………………. 101 6.2 The κ values per unit time for the different groups that can infect a susceptible ………………………………………………….. 119 8.1 The most commonly misspelled Acadian surnames and their most common Anglicized versions …………………………... 149 8.2 Numbers of dead and living by ethnicity ………………………… 154 8.3 Other manifestations of S. pyogenes ……………………………… 159 9.1 Ethnicity of all 1864-1877 dead, 1871 census of the living, scarlet fever dead of 1875-1877, all other possible strep deaths of 1875-1877 and total of both scarlet fever and other possible strep deaths of 1875-1877 …………………………………….. 164 9.2 Comparison of all possible streptococcal deaths to deaths from all other Causes during 1875-1877 …………………………… 166 9.3 Comparison of all possible streptococcal deaths to the living population from the 1871 census ……………………………... 166 9.4 Comparion of 1875-1877 “scarlet fever” deaths to deaths from all other causes for those years ……………………………….. 167 9.5 Comparison of 1875-1877 “scarlet fever” deaths to the living population from the 1871 census …………………………….. 167 ix 9.6 Deaths within an ethnic group reporting an “unknown” cause of death ………………………………………………………….. 168 9.7 1871 census living and 1864-1877 vital register dead by age category and ethnicity ………………………………………... 173 9.8 Population density within households for the sub-districts of Judique and Chéticamp based on the 1871 census summary tables (Canada Dominion Bureau of Statistics, 1876) ……….. 179 9.9 Comparison of ethnicity to household type for those who died of all possible streptococcal causes from 1875-1877 …………… 182 9.10 Percentages of ethnic groups by household types for the combined populations of Judique and Chéticamp based on the 1871 censuses of those sub-districts ………………………………... 184 9.11 Household types by ethnic groups for the combined populations of Judique and Chéticamp based on the 1871 censuses of those sub-districts …………………………………………………… 186 9.12 Scarlet fever deaths for each ethnic group by household type for all counties of Cape