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Whenever I find a death record for someone in our family tree, I right away want to find out the cause. Nowadays, when people die of natural causes it is usually cancer, stroke or heart attack. But going back even just a few generations there were more diverse causes of death, possibly because now those conditions can be detected and treated before they become fatal.

My grandmother, Ana Cruz García, had just given birth to a baby girl, Anita, in August of 1916 when she came down with a fever and died. That’s all the information that was passed down, but her death record gave the cause of death as puerperal fever. Also known as childbed fever, it is an infection of some part of the female reproductive organs following childbirth. Nowadays, antibiotics can treat this condition, but giving birth at home in the mountains of barrio Santo Domingo in Peñuelas over a hundred years ago, I doubt that Ana was even seen by a doctor.

Following Ana’s death, her husband (our family patriarch Florencio Rivera Maldonado) fathered eight more children with Otilia Pacheco Arroyo, but only four of them survived into adulthood - Neri, Isidro, Angélica and Delia. There was a set of stillborn babies, a boy and a girl, born around 1931. One little girl, Carmen Lydia, died on December 5, 1937 at just under fifteen months of age. The cause of death was bronco pneumonia.  Another little girl, Aurea Esther, died on August 20, 1941, at almost 2-1/2 years old. I remember Mama Otilia telling me that her beautiful little girl with golden brown curls had died because a jealous neighbor woman had given the tot the evil eye, or “mal de ojo” as it is called in Puerto Rico. However, the official cause of death was gastroenteritis. This is an intestinal infection marked by diarrhea, cramps, nausea, vomiting and fever. 

Gastroenteritis was also the cause of death of Zoraida Rivera Pérez, one of the “secret babies” that I wrote about in the last blog article. She was the biological child of Otilia’s son, Nery and his wife, Emilia Pérez.

 The notes that I had for Florencio Rivera Maldonado recounted three versions of how he died.

1. It was the result of pneumonia caused by a fall.  Broken ribs punctured his lungs.
2. He tripped on a box in the yard, fell and broke his ribs. He went that way to the plaza to buy merchandise to resell. Two or three days later he died.
3. He had a little store that he operated from his house. The coal had been delivered (the coal was made from wood). There was one big piece that was still half wood—not completely made into coal. All the coal was on the ground where it had been delivered in a heap. Florencio got up from his chair and reached up to turn on the radio. Then he swayed backwards and fell, hitting himself on the chunk of coal that was half wood. He never left the house after that. The doctor came to the house. He died a few days later of a ruptured spleen.

The common thread to all three versions is that Florencio fell. Maybe he did break some ribs or maybe he did have a ruptured spleen. But the official cause of death listed on his death certificate is myocarditis – inflammation of the heart muscle, usually caused by a viral infection.

One very common cause of death among children and adults alike in 19^th century Puerto Rico was anemia. The primary cause of these anemia deaths was a rampant hookworm infection, which was prevalent due to poor sanitation and walking barefoot in contaminated soil. Parasites entered the body though the skin and caused severe blood loss. Dr. Bailey K. Ashford, a US Army physician for whom Avenida Ashford in San Juan is named, discovered this through his research. Previously, it had been believed that a nutritional deficiency was the cause of anemia.

Dr. Ashford (1873-1934) was born in Washington D.C. and traveled to Puerto Rico in the military expedition of 1898 during the Spanish-American War. He made Puerto Rico his home, marrying a local woman, María López, with whom he had three children. Anemia had been the leading cause of death in Puerto Rico, accounting for as many as 12,000 deaths a year. Between 1903 and 1904, Dr. Ashford and his colleague Pedro Gutiérrez conducted a campaign that treated 300,000 persons (one-third of the Puerto Rican population at that time), reducing the death rate from anemia by 90 percent.

Two examples of people in our family tree who died of anemia are my great-grandfather, Manuel Alejo Rivera Maldonado in Guayanilla in 1899 and his half-sister Ana María González Maldonado in Guayanilla in 1932.

Reflecting on these stories from our family tree reveals a sad truth about the challenges our ancestors faced. For many of them, the cause of death was not just a medical diagnosis but a reminder of the limited resources and knowledge available at the time. Each condition that claimed a loved one speaks to an era when diseases we now consider preventable or treatable could easily turn fatal.