The lack of a standardized cause-of-death nomenclature poses certain challenges for historical and demographic research of nineteenth-century mortality trends. Efforts to standardize disease and cause-of-death terminology did not successfully take place on an international level until the late nineteenth century. While many disease terms were in common, their diagnostic applications were not. This study examines the relative impact that standardized nomenclature had on cause-of-death reporting in western Massachusetts from 1850 through 1912. I analyze the effects of one specific international influence on late-nineteenth- and early twentieth-century grammars of death, namely, the organized efforts of European and American medical professionals to instruct physicians in proper nomenclature through explicit references and sanctions in the 1900 International Classification of Diseases (ICD). My analysis focuses on the problematic usage of two diagnostic terms in particular: puerperal fever and inanition. The qualifying instructions for these diseases are particularly important for U.S. studies, because they targeted U.S. physicians for correction and provide further insight into the institutional efforts to effect conventional, diagnostic usage on both an international and a local level. I show that the ICD‘s effect on cause-of-death reporting in Holyoke and Northampton was modest at best. The ICD correctives in question were not unilateral directives from the European medical establishment but in fact originated in the United States. The ICD developed as a collaborative endeavor, enlisting the efforts and interests of participating countries to help create a mechanism for implementing a standardized cause-of-death nomenclature capable of addressing international and local public health concerns.