"...the most terrifying question of all may be just how much horror the human mind can stand and still maintain a wakeful, staring, unrelenting sanity."

Just how much sanity would you have left if you were buried alive? People used to have a very real fear that they might be declared dead and be buried while still alive. Whether true or not, the fear of it happening was very real. It was historically the Europeans who were most troubled by the prospect of premature burial, and while being buried alive was something that horrified some Americans, in Europe it became the fashionable fear with many determined people set to find a cure for the fear. And it was not fear alone that motivated people but the fact that graveyard excavations at the time revealed that nearly 2 percent of those buried before the advent of embalming were buried alive.

Some inventions that were put into practice were signaling devices from the coffin in the grave to the world outside. Some were bells, flags, and even lights that could be activated from inside the coffin if the poor unfortunate soul actually was not dead. The most common device was a bell mounted above the grave with a string or rope running down into a pipe and into the coffin, to be rung upon waking. The problem with levers, ropes, or stings were the false alarms due to the decomposing bodies swelling or shifting and triggering the alarms.

Physicians in the 18th and 19th centuries were aware that in the plague or cholera epidemics, the sheer volume of bodies might mean that victims might not be individually diagnosed, and death might only be apparent. The Danish physician Jacques-Bénigne Winslow began his 1740 thesis with the solemn words, "Death is certain, since it is inevitable, but also uncertain, since its diagnosis is sometimes fallible." Since he thought that absence of heartbeat and respiration were insufficient indicators of death; he only accepted the onset of putrefaction as infallible. Then the practice of waiting 12 to 24 hours before burying the body became a standard practice throughout Europe. And in 1787, the French doctor Francois Thiérry wrote a book stating that most people didn't die for a while after the cessation of the evidence of life, and he suggested that all recently dead people be watched in special waiting mortuaries until the inarguable putrefaction started. It was the Germans who caught on to this idea, with communities proudly building houses for the dead. Bodies would, by law, come to the institution, stick around until putrefaction was documented, and then be released for burial. The facilities permitted families to visit, and even charged for sightseers, although the smell was awful. The houses, even with the support of law, got few takers, and it was never documented that even one occupant woke up.

Embalming did not become common in the United States until the late 19th century. One of the sales pitches that undertakers made in favor of embalming was that one could be sure that an embalmed loved one was actually dead and would not be buried alive.

The fear of premature burial did have some positive effect on medical practices and with the public's increasing trust in medical evaluations, and with embalming becoming common, the fears mostly have faded away. But it still makes great stories for books and movies. Because deep down, we all fear being buried alive.