TO DIE SO FAR FROM DIXIE: MODELING EPIDEMIC DYSENTERY IN A CIVIL WAR PRISON CAMP _______________________________________ A Dissertation presented to the Faculty of the Graduate School at the University of Missouri-Columbia _______________________________________________________ In Partial Fulfillment of the Requirements for the Degree Doctor of Philosophy _____________________________________________________ by REBECCA SHATTUCK LANDER Dr. Lisa Sattenspiel, Dissertation Supervisor DECEMBER 2015 The undersigned, appointed by the dean of the Graduate School, have examined the dissertation entitled TO DIE SO FAR FROM DIXIE: MODELING EPIDEMIC DYSENTERY IN A CIVIL WAR PRISON CAMP presented by Rebecca Shattuck Lander, a candidate for the degree of Doctor of Philosophy, and hereby certify that, in their opinion, it is worthy of acceptance. Professor Lisa Sattenspiel Professor Gregory Blomquist Professor Mary Shenk Professor Allison Kabel ACKNOWLEDGEMENTS This research would never have become successful without the aid and support of many friends, family, and colleagues over the years. My advisor, mentor, and friend, Dr. Lisa Sattenspiel, played perhaps the greatest role in helping me to conceptualize, plan, and execute this project. I deeply appreciate her ongoing support and encouragement through the research and writing process. My thanks also go to my dissertation committee members, Dr. Gregory Blomquist, Dr. Allison Kabel, and Dr. Mary Shenk for their patience, time, and helpful critiques. Additionally, I am grateful to Debbie Allen and Dr. Mark Hannink, and the MU Life Sciences Fellowship Program, for providing me with outstanding funding and research opportunities during my first four years – without the financial support provided by the program, I could never have been as successful in my research. I would also like to express my appreciation to Erin Miller and Jessica Dimka for their insight and help during the model development process. Finally, my love and thanks to family and friends who have been supportive through the whole stretch of my doctoral education: my compatriots in the Department of Anthropology, especially Liz McCarthy, Rachel Munds, and Shilo Bender; my parents, Chuck and Marilyn Shattuck; my sister, Titina; and my loving husband Sean. This is for you. ii TABLE OF CONTENTS ACKNOWLEDGEMENTS ................................................................................................................ ii TABLE OF CONTENTS ................................................................................................................... iii LIST OF FIGURES ........................................................................................................................... vi LIST OF TABLES ............................................................................................................................ viii ABSTRACT ...................................................................................................................................... ix Chapter 1: Introduction ................................................................................................................ 1 Chapter 2: Sickness and Health in the Civil War ....................................................................... 7 Environment and Disease Transmission ......................................................................... 9 Understanding and treatment of illnesses .................................................................... 11 Managing infectious disease in the military ................................................................. 15 Diarrheal and nutritional diseases among the troops .................................................. 19 Civil War Medicine in the Context of This Research ..................................................... 23 Chapter 3: Dysentery .................................................................................................................. 24 Dysentery as a Modern Concern ................................................................................... 26 Dysentery in the Civil War ............................................................................................. 30 Chapter 4: History and Health at Camp Douglas, Illinois ....................................................... 33 Setting the Stage: Prison Camps during the Civil War .................................................. 33 Camp Douglas, Chicago, and Public Perception ............................................................ 35 The Prison ...................................................................................................................... 39 Daily Life and Prisoners’ Experiences ............................................................................ 41 “Inexcusably Inhuman”: Sanitation Challenges ............................................................ 45 Nutrition among the Confederate prisoners ................................................................ 47 Disease-related Morbidity and Mortality ..................................................................... 49 Chapter 5: Agent-Based Modeling in Anthropology and Epidemiology .............................. 53 iii Mathematical and Statistical Modeling in Anthropology ............................................. 54 Agent-Based Modeling .................................................................................................. 57 Applications of Agent-Based Models ............................................................................ 61 Mathematical and Agent-Based Modeling of Dysentery .............................................. 64 Chapter 6: Methods .................................................................................................................... 66 Historic Sources and Reconstruction of the Camp Environment .................................. 67 Developing an Agent-Based Model ............................................................................... 71 The Model Space ....................................................................................................... 73 Agent Movement .......................................................................................................... 78 Movement Energy ..................................................................................................... 85 Disease Methods ........................................................................................................... 87 Contamination of Food.............................................................................................. 91 Mortality .................................................................................................................... 92 Data Collection and Model Validation .......................................................................... 93 Model Analyses ............................................................................................................. 95 Research Aim 1: Assess the Influence of Asymptomatic Carriers ............................. 96 Research Aim 2: Examine Grouping Behaviors and the Timing of Infection ............ 96 Research Aim 3: Explore the Impact of Population Density .................................... 98 Chapter 7: Sensitivity Analyses and Simulation Results ........................................................ 99 General Model Trends ................................................................................................... 99 Results of Sensitivity Analyses .................................................................................... 105 Latent Period ........................................................................................................... 108 Infectious Period ..................................................................................................... 111 Carrier Probability ................................................................................................... 114 Population Density and Population Size ................................................................. 116 Clustering .................................................................................................................... 120 Patterns of infection early in the model ................................................................. 121 Chapter 8: Discussion and Conclusions .................................................................................. 127 Application of model results to understanding the impacts of crowding .................. 128 iv The Impact of Asymptomatic Carriers ...................................................................... 132 General Model Trends ................................................................................................. 133 Early Model Behavior .............................................................................................. 138 Group Movement and the Timing of Infection ....................................................... 140 Implications and Applications ..................................................................................... 142 Conclusions.................................................................................................................. 145 Bibliography ............................................................................................................................... 147 APPENDIX A: Instructions to Access the Model Code .......................................................... 163 Vita .............................................................................................................................................