Hektoen International

A Journal of Medical Humanities

Fear of being buried alive

Howard Fischer
Uppsala, Sweden

Cremation eliminates all danger of being buried alive.”
– “Short reasons for cremation,” an Australian pamphlet, c. 1900

A diagram of a safety coffin with a signal flag. Crop of Wellcome Collection image. CC BY 4.0

It has been said that one of our most common fears is being buried alive.1 Someone is mistakenly thought dead, placed in a coffin, and buried. We will not discuss other forms of alive burials, such as deliberate punishment, torture, or execution.

The Greek physician Galen (129–216) described patients with a fear of being buried alive,2 or taphophobia, from the Greek taphos, a grave. By the end of the nineteenth century, 700 cases of live (or “premature”) burial had been documented,3 and fear was widespread. Cases were reported4,5 in the UK, France, Italy, the US, Austria, Spain, Russia, and in the Netherlands, where the rate of premature burial was estimated at five per 1,000 burials (in 1830) and in France at two per 1,000 burials. The countries with the highest risk of premature burial, according to an 1896 book, were France, Spain, Portugal, and India. The Jewish practice of burial within twenty-four hours of death was also considered a cause of premature burial.6 During the Second World War and the war in Vietnam, estimates of premature burial were as high as four percent.7

Edgar Allan Poe (1809–1849), writing in the middle of the nineteenth century, used the theme of being buried alive in three short stories. “Premature Burial” (1844) was about the fear of being buried alive; “The Fall of the House of Usher” (1839) and “A Cask of Amontillado” (1846) were about murder by premature burial.8 Some well-known individuals who feared premature burial were George Washington (1732–1799), who requested that his body not be buried until three days after his death, composer Frédéric Chopin (1810–1849) who requested that his heart be cut out of his chest post mortem, and Alfred Nobel (1833–1896), who asked that major arteries in his body be incised before his burial.9 Others requested to be decapitated after death.

Why were living people incorrectly thought dead? Some were victims of medication overdose, with slowed pulse and inapparent respiration; others were comatose, or in a state of catalepsy. Catalepsy is a condition characterized by rigidity, fixed posture, slowed vital signs, and decreased pain sensitivity. It may be seen in Parkinson’s disease, epilepsy, and cocaine withdrawal.10 Sometimes a “dead” person “came back to life” when the coffin was accidentally dropped, when grave robbers attempted to steal jewelry from the “corpse” or remove the body itself, or when a dissection or autopsy was started. An undetected premature burial resulted in the horrible death of the victim from asphyxiation, dehydration, starvation, or hypothermia.11

Methods of preventing premature burial included the obvious approach of delaying burial (as George Washington had requested) or cremation. Inventors created “safety coffins,” in which the occupant could stay alive and signal his condition. Periscope-like air inlets allowed air from above ground to enter the coffin. The coffin’s occupant could activate bells or flags to indicate he was alive. Some burial vaults were equipped with an escape hatch. Coffins were constructed with a viewing window so that observers above ground could look through a hole in the gravesite into the coffin. By 1895, some coffins had a fan to provide ventilation, as well as a battery-powered alarm. A 1995 casket was equipped with a “survival kit,” consisting of an oxygen tank, a flashlight, and a system for two-way communication with the outside.12,13

The nineteenth-century physician had several techniques to verify death, including observing the absence of respiration, pulse, heart sounds, pupillary reaction to light, and a pain reaction to electric shock. The most reliable indicator was “putrefaction” (decomposition), indicated by a greenish discoloration of the abdominal skin.14

In the UK there was no requirement for an after-death examination by a physician. Only a report of a death was mandated. By 1836, a physician was required to “certify” a death but was still not required to examine the body. Cremation began as a method for disposal of corpses in 1885 in the UK. Only in the late 1930s did a compulsory medical examination become required before pronouncing an individual dead.15

Today’s physicians, like their predecessors, check vital signs and the pupillary reaction to light. They look for a corneal reflex (blinking of the eyelids after touching the cornea with a wisp of cotton), and a gag reflex. The Bárány (vestibular stimulation) test consists of injecting water into the external auditory canal and looking for eye movements. Lack of reaction may indicate brainstem death. An electroencephalogram and a cerebral blood flow study will indicate the presence or absence of brain activity. The risk of premature burial is “tiny” if these tests show no brain function.16

Physicians still report cases of elderly or dying patients afraid of being buried alive.17,18 A number of US states and at least three other countries have seen patients declared dead later showing signs of life in a funeral home, as recently as 2023. Some of these people were declared dead by nursing staff in nursing homes or in an “Alzheimer care center.” In some US states, nurses are legally permitted to pronounce a person dead under certain circumstances. One Michigan woman was incorrectly pronounced dead by paramedics, who may pronounce a death in certain jurisdictions, and a South African woman was found to be alive after being pronounced dead at the scene of a car wreck.

In New York state, unless there is a local law that requires otherwise, anyone may make a pronouncement of death, including emergency medical technicians, police, and firemen.19


  1. “Premature burial.” Wikipedia.
  2. Mark Polizzotto and Peter Martin. “Buried alive: An unusual problem at the end of life.” Journal of Palliative Care 22(2), 2006.
  3. “Buried alive in Brooklyn!” The Brownstone Detectives, October 14, 2020.
  4. William Tebb and Edward Vollum. Premature Burial and How it May be Prevented: With Special Reference to Trance Catalepsy and Other Forms of Suspended Animation. London: Swan Sonnenschein and Co., Lim., 1896.
  5. Franz Hartman. Buried Alive: An Examination into the Occult Causes of Apparent Death, Trance, and Catalepsy. Boston: Occult Publishing Co, 1895.
  6. Tebb and Vollum, Premature Burial.
  7. Sam Silverman. “Buried alive.” Encyclopedia.com. https://www.encyclopedia.com/social-sciences/encyclopedias-almanacs-transcripts-and-maps/buried-alive.
  8. Silverman, Buried Alive.
  9. “Taphophobia.” Wikipedia.
  10. “Catalepsy.” Wikipedia.
  11. “Premature burial.” Wikipedia.
  12. Lawrence Tarazano. “People feared being buried alive so much that they invented these special safety coffins.” Smithsonian Magazine.
  13. Barbara Mikkelson. “Have people been buried alive?” Snopes, June 9, 1999. https://www.snopes.com/fact-check/just-dying-to-get-out/.
  14. Tebb and Vollum, Premature Burial.
  15. Brian Parsons. “Premature burial and the undertakers.” Interdisciplinary Perpectives on Mortality and its Timings, September 20, 2017.
  16. Caitlin Doughty. “What are the chances of being buried alive?” Literary Hub, October 9, 2019.
  17. Samuel Fanous and Shaun O’Keeffe. “Not yet dead and buried! Three cases of taphopobia in older people.” European Geriatric Medicine, 6(3), 2015.
  18. Emily Schmall. “A patient declared dead is found in a body bag gasping for air.” New York Times, February 5, 2023.
  19. New York State Department of Health. “Technical notes.” https://www.health.ny.gov/statistics/vital_statistics/2009/technote.htm.

HOWARD FISCHER, M.D., was a professor of pediatrics at Wayne State University School of Medicine, Detroit, Michigan.

Highlighted in Frontispiece Volume 15, Issue 4 – Fall 2023

Spring 2023



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