Friday, May 3, 2013

Is That Really The Cause Of Death?

When you read a cause of death on an early death record (in Michigan, any time prior to August 29, 1897) you might want to take it with a grain of salt. [1] Like early birth records (Why Early MI Birth Records are Unreliable) early Michigan death records aren't necessarily trustworthy because the source of the information is. . . well, unknown. Local supervisors/assessors were supposed to collect the information once per year. For this reason alone it is wise to be skeptical of the information. Here are some more:
  1. With the passage of time, memories fade so information provided up to a year after the event could be wrong.
  2. The source of the assessor's information is unknown. It could have come from a family member, a neighbor or even the assessor's own recollection. [2]
  3. The assessor's information could have sustained an error when the county clerk transcribed it for the state returns.
In addition to these concerns, we may not want to completely trust the listed cause of death on death returns and even early death certificates because:
  1. Medical terminology, being generally unfamiliar to the layman, could be misunderstood by the family and an incorrect cause of death passed along to the assessor. “Such, for example, as 'fits,' 'chronic,' 'rash,' 'sore inside,' 'yaller ganders' (by which is meant jaundice!), etc., etc., are very common.” [3]
  2. Even if the information provided to the assessor was accurately conveyed, there was no guarantee that the person who originally “determined” the cause of death had any knowledge of medicine or physiology.
After the introduction of the death certificate system, not only should all deaths in Michigan have been recorded, but we should also know who provided the cause of death. According to state regulations “The physician who attended the deceased person during his last illness shall fill out the medical certificate of cause of death. . . In case of death without the attendance of a physician, or if it shall appear probable that the deceased person came to his death by unlawful or suspicious means, the registrar shall refer the certificate to the health officer or coroner for immediate investigation . . . Provided, That when the health officer is not a physician, and only in such case, the registrar is authorized to insert the facts relating to the cause of death from statements of relatives or other competent testimony.” [4]

The new system also, for the most part, eliminated the county-level transcription process because the original physicians' certificates of death were supposed to be sent to the state. [5] However, some cities including Detroit and Grand Rapids did not wish to comply and thus provided “exact transcripts.” [5] “The undesirability of transcripts of any kind, however, is shown by the fact that the returns from these cities, the largest in the State and which should be the most satisfactory, are not so in point of fact. Errors of copying are made and not noted by a careful comparison; essential items of the statement of cause of death are omitted when the copyist cannot make out the physician's statement; and as a whole no certified statement, however neatly executed, is as valuable as the original would have been.” [5] I'm not sure how long it took for all localities in Michigan to provide the original death certificates to the state.

So, the good news is that once death certificates were required we have an idea of where the information on cause of death originated because now we have a name. We can only hope that whoever provided the information actually received adequate medical training. However, prior to August 1897 in Michigan and in other localities where we have no idea where cause of death information came from, we can make no assumptions about the source.

A few years ago I read “The Poisoner's Handbook” by Deborah Blum. She described the situation in New York City when there was no requirement that the coroner be a physician or have any medical training whatsoever. As a result, between 1898 and 1915, this elected position was filled by individuals whose occupations included saloonkeeper, milkman, plumber and carpenter, among others. [6] If an auctioneer, for example, has the final say on a cause of death, how can we place any confidence in that assessment? I don't know how prevalent this situation was throughout the country or if it was largely confined to big cities. Either way, it may be best to consider the information on cause of death with some skepticism unless you know who provided it. One more thing to consider is that even if the cause of death was determined by someone with medical training we don't know the quality of that training. If physicians in the 1800s believed that teething caused diarrhea, convulsions and even death (Rethinking Teething Deaths) how much can one trust the accuracy of that cause of death.

  1. Secretary of State of Michigan. Thirty-Second Annual Report of the Secretary of State on the Registration of Births And Deaths Marriages And Divorces in Michigan For The Year 1898. (Lansing, Michigan: Robert Smith Printing Co, 1900), v.
  2. Secretary of State of Michigan. Thirty-Second Annual Report . . . 1898., clix.
  3. Secretary of State of Michigan. Twenty-Eighth Annual Report Relating To The Registry And Return Of Births, Marriages And Deaths in Michigan For The Year 1894. (Lansing, Michigan: Robert Smith Printing Co, 1897), xi.
  4. Secretary of State of Michigan. Twenty-Ninth Annual Report Relating To The Registry And Return Of Births, Marriages And Deaths in Michigan For The Year 1895. (Lansing, Michigan: Robert Smith Printing Co, 1897), xviii.
  5. Secretary of State of Michigan. Thirty-Second Annual Report . . . 1898., lxxii.
  6. Deborah Blum, The Poisoner's Handbook. Murder And The Birth Of Forensic Medicine In Jazz Age New York, (New York, The Penguin Press, 2010), 20.

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