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Historical mortality analysis is often confounded by changing disease environments, diagnostic criteria, and terminology. Recorded causes of death are shaped by these local and historical contexts. We analyze changing literal causes of death during the shift from miasmatic to germ theories of disease using death records from two Massachusetts towns for selected years spanning 1850 to 1912. This analysis demonstrates that (1) International Classification of Diseases (ICD) classifications aredoi:10.1017/s0145553200012761 fatcat:v4l4r2tc6jeu5ozzrmi2afgnku