Trying to interpret cause of death on a death certificate from 1922
December 24, 2015 3:26 PM   Subscribe

In the course of doing genealogical research, we found a death certificate for a male ancestor in Massachusetts from 1922. The cause of death is "Over stimulation alcoholic resulting heart failure." How do we interpret this? What would this have meant in 1922?
posted by mingshan to Health & Fitness (21 answers total) 1 user marked this as a favorite
Someone who was a known habitual heavy drinker got overstimulated - either just generally excited or worked up about something, or it could have been actual physical labor* of some sort. And then dropped dead.

*Or sex.
posted by Lyn Never at 3:31 PM on December 24, 2015 [1 favorite]

Response by poster: Do you have some historical knowledge of how these terms are used? This was my interpretation too, but I don't know how a doctor would have described what happened at the time.
posted by mingshan at 3:33 PM on December 24, 2015

I don't have access to an OED here, but I'm not convinced that the concept of an alcoholic, meaning a problem drinker, would have been in wide use at that time. I think that alcoholic may have modified stimulation there: the coroner thought the person drank too much that one time and that caused heart failure.
posted by ArbitraryAndCapricious at 3:40 PM on December 24, 2015

I do a lot of genealogy and I also have heart failure, so it was a bit of a shock to me when I first saw "heart failure" as the cause of death on EVERY SINGLE DEATH CERTIFICATE. Before long I figured that, for at least some doctors/coroners at that point, "heart failure" was kind of a go-to. And it's not entirely inaccurate -- just like "lack of oxygen to the brain", everybody who dies ends up with their heart not pumping anymore.

Alcohol can cause or exacerbate what we currently refer to as heart failure, so it's possible that he had that. In that case, it would have meant his heart didn't pump as much blood as necessary. Over stimulation in that case can indeed cause death when you push too far past your heart's capacity to pump.
posted by katemonster at 3:44 PM on December 24, 2015 [3 favorites]

Best answer: Typically during that period they were a lot more euphemistic than this (or put something completely useless down.) The fact that they recorded the alcohol use at all makes me think the whole thing is very straightforward: the guy was presumed drunk and behaving stupidly, then fell over dead (rather than, say, being in a stupor on the floor and dying in place.) They're trying to say it scientifically, rather than trying to save the family from shame.

BTW seriously congratulations on finding a cause of death worthy of the name. I have like eight relatives who died between the 1910 and 1930 census and their COD entries are basically all useless.
posted by SMPA at 3:46 PM on December 24, 2015

It also might have been heart failure resulting from alcohol withdrawal, which is quite possible for a habitual heavy drinker.
posted by banishedimmortal at 3:57 PM on December 24, 2015 [3 favorites]

Prohibition became effective in 1920, and wasn't repealed until 1933.

Poisoning by adulterated alcohol was a huge problem in the 20s, and I wouldn't discount the possibility that he was killed by "bad hooch."
posted by jamjam at 4:49 PM on December 24, 2015 [6 favorites]

Best answer: From looking searching through old journals on google books, it looks like over-stimulated just meant drunk, or inebriated. Here for example is an article from 1879 on "Over-stimulation in women."
posted by interplanetjanet at 5:40 PM on December 24, 2015 [7 favorites]

Best answer: One of the things we found out when doing the family tree is that the people who filled out death certificates were (still are, in some places) elected officials (or their assistants) who do not have to have any medical training. There weren't any standards outside some vaguely standardized definitions of murder or foul play, in which case an investigation would be requested. But a non-suspicious natural death at home was largely guessed at, in a hurry, so the family could plan the funeral.

Heart failure was a pretty standard cause of death in which the decedent just...stopped. Whether it was face-down in the field or fallen off the toilet or just never woke up, unless there was an explanatory injury like drowning or falling and hitting the head, or witnesses to describe some kind of stroke-like behavior or definitive long illness beforehand, heart failure was the go-to.

"Overstimulation" or "exertion" was a common modifier on death certificates then. That's an opinion, for the most part, as is "alcoholic" either meant to mean "person who drank too much" or "ingestion of a significant amount of alcohol". It was sometimes a euphemism, to spare the family an unpleasant situation. It was all at the discretion of whoever was coroner or acting in a similar capacity and might depend on how well he knew the family, his opinion of the decedent, whether he had somewhere else to be, etc.

If you're looking for a standardized dictionary of those terms, there's not one.
posted by Lyn Never at 5:43 PM on December 24, 2015 [1 favorite]

"Heart failure" as an all purpose cause of death is still very common, no matter what may have proceded the stopping of the heart. In the last ten years my mother (years on a kidney machine, kidney transplant in her 50's) officially died of it, as did my brother (car accident left him a quadriplegic for the last three years of his life). If you didn't know details, you certainly couldn't have found it out from the death certificates.
posted by kestralwing at 5:46 PM on December 24, 2015 [1 favorite]

Best answer: Yeah, I'd probably pay less attention to the "heart failure" part and more to the alcohol. I've read a lot of death certificates (albeit from a little before that period), and they can be pretty idiosyncratic. Different people could describe the same thing differently even in the same year ("tuberculosis" vs. "consumption" vs. "phthisis pulmonalis," etc.). Sometimes the certificates themselves are formatted a certain way - like if there are separate places to write "cause of death" and "illness," or "cause of death" and "complication" ( I studied one person whose official cause of death was listed as heart failure, but the "complication" was diphtheria - obviously that's pretty significant in explaining how a 20 year old woman died).

It could be that in this case "over stimulation alcoholic" means refers to stimulation from alcohol, or that the person was an alcohol who had a heart attack. It could be, as was suggested above, that the person drank industrial grade alcohol or a derivative during prohibition and died, as was common at the time (fun fact: this is related to why we have denatured alcohol). Hopefully a historian with much more experience can weigh in, but in the meantime, take into account how old this person was when they died and other factors like that that can give you some clues about what that cause of death means here.
posted by teponaztli at 6:58 PM on December 24, 2015

Best answer: I've probably read 10,000 death certificates from 1900-1930.

All I can say is I'd look for newspaper articles from the time. Even a blurb will shed more light than analyzing this phrasing.
posted by ReluctantViking at 8:20 PM on December 24, 2015 [4 favorites]

Best answer: I don't think being a doctor is going to really help me interpret this, but I'm suspecting alcohol withdrawal as well. Severe alcohol withdrawal can cause seizures and death, although the mechanism isn't really heart failure per se, but my impression is that any cause of death on a death certificate from that time period probably isn't physiologically accurate anyway except in a minority of cases, because there wasn't a great understanding of pathophysiology of many diseases at that time. Alcohol withdrawal is definitely a state of agitation and so that's how I thought the "overstimulation" would tie in.

My first thought on reading the description was of wet beriberi, heart failure that comes from thiamine deficiency, or straight up alcoholic cardiomyopathy, which is heart failure due to direct toxic effects of alcohol on the heart. Not sure how well established any of that was at the time the certificate was written (although the second link suggests that wet beriberi was a known entity but alcoholic cardiomyopathy was not).
posted by treehorn+bunny at 8:46 PM on December 24, 2015 [2 favorites]

Concerning the OED, their earliest citation re: "resulting from or associated with excessive consumption of alcohol (ethanol) or alcoholism," is from 1830, and re: "addicted to alcohol (ethanol), affected with alcoholism; showing the effect of habitually drinking alcohol; (also) under the influence of alcohol, inebriated," is from 1845.

Just passing on some OED on general principle.
posted by mr. digits at 9:20 PM on December 24, 2015 [5 favorites]

This sounds like the sort of death that may have got a mention in a local newspaper.
posted by intensitymultiply at 9:39 PM on December 24, 2015

Was this person elderly? My elderly relative actually died this was a few years ago. He was 101 and outside on a hot day gardening, at the end he had a beer instead of water and the dehydration and exertion triggered a heart attack.
posted by pairofshades at 12:12 AM on December 25, 2015

Best answer: > Concerning the OED, their earliest citation re: "resulting from or associated with excessive consumption of alcohol (ethanol) or alcoholism," is from 1830, and re: "addicted to alcohol (ethanol), affected with alcoholism; showing the effect of habitually drinking alcohol; (also) under the influence of alcohol, inebriated," is from 1845.

Those are for adjective use; just for completion's sake, the earliest noun use ("A person who is addicted to alcoholic drink; one suffering from alcoholism") is from 1852: Sc. Temperance Rev. Apr. 177/2 "O ye blessed alcoholics, how I envy you! while this cold clay of mine receives no such consolation." (It greatly surprises me that it goes back that far.)

That said, I'm reasonably sure this is the adjective, modifying the preceding noun; a more filled-out version would read "Overstimulation, alcoholic, resulting in heart failure." And I agree that there's not much to be gleaned from this except that alcohol was somehow involved.
posted by languagehat at 8:45 AM on December 25, 2015

Given the variety of experience levels of folks filling out death certificates 100 years ago, my first thought was that it's a more refined version of "he said 'hey, y'all, watch this!' and handed a friend his beer."
posted by The Almighty Mommy Goddess at 12:15 PM on December 25, 2015

Response by poster: Thanks for all these helpful answers! The man in question was in his early 40s, and the family lore is that he committed suicide. He and his immediate family were poor, immigrant mill workers. We also found out today that they owned a large metal vessel that they used for making their own alcohol.

Only the index of death certificates was available at the town hall. It sounds like it may be worthwhile to track down a copy of the actual death certificate in Boston and check the BPL for newspaper articles.
posted by mingshan at 4:13 PM on December 25, 2015 [1 favorite]

(Please post back if you do! Following along because now I'm curious!)
posted by [insert clever name here] at 10:07 PM on December 25, 2015

Response by poster: New details keep coming out from members of the extended family. We just heard yesterday that the man in question had possibly shot himself. We were able to figure out who filed the death certificate -- it was an undertaker that was located in the same ethnic neighborhood in which they lived. Our new theory, which we probably will never be able to prove, is that he shot himself and the undertaker put in a different cause of death to spare the family embarrassment and allow them to have a Christian funeral.
posted by mingshan at 6:15 AM on December 28, 2015

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