Imagine waking to find that you have mistakenly been buried alive. It is not a likely scenario, but Jan Bondeson says it probably does happen.

There are certain themes of which the interest is all-absorbing, but which are too entirely horrible for the purposes of legitimate fiction." Thus Edgar Allan Poe begins his famous horror yarn The Premature Burial . But Poe's concerns about offending the delicate sensibility of his readers are not reflected in his own work. The sufferings of a person buried or immured alive is one of his favourite literary motifs. What reader of Poe can forget the sufferings of the inappositely named Fortunato, who is walled in by his callous and implacable enemy Montresor; the horror of the teeth extracted from the senseless, sensuous corpse in Bernice ; and the wild shriek from Roderick Usher that greets the appearance of his recently buried sister, dressed in her bloodied shroud and with evidence of a horrible struggle on her emaciated frame: "We have put her living in the tomb!" Readers of these tales may comfort themselves with the notion that Poe must have exaggerated: surely people of the mid-1800s could not have been at risk of being buried alive? But Poe related his fictional world to the medical fears and obsessions of his time. He was both inspired and horrified by the discussions of premature burial that raged in the mid-19th century. Stories about the horrors of premature burial could be found not only in medical journals, but also in newspapers and magazines in Europe and the United States. Compared with such flights of fancy, some by serious medical writers, Poe was a dismal realist.

The English writer John Snart, in his Thesaurus of Horror , published in 1817, tells the tale of gravediggers in Bermondsey churchyard in Surrey, who were exhuming a coffin. They were aghast to behold "a masterpiece of horror! A torn and bloody shroud! Battered forehead! Broken knees and elbows! (Oh God! Oh God! Misericordia!) All, all appeared in view! Even the barbarous prison of the inanimate coffin had, as it were, relented, and, relaxing its cruel grasp, suffering its screws to be torn out, to expose the living inhumation and the ensanguined consequences of the horrid scuffle."

The German medical practitioner Michael Benedict Lessing told a similarly gruesome tale 20 years later. A young Swedish girl had died in a state of advanced pregnancy and was buried in the local churchyard. In the evening, the verger heard pitiful groans from the grave he had filled with earth only a few hours earlier. Coming closer, he thought he could discern the words "God! Jesus! Mercy!" He was a superstitious man, fearful of ghosts, and not daring to examine the grave any further, he ran home to his cottage. It was not until the next day that the verger told the rector of the ghost he had heard. The clergyman was aghast. He reproached the superstitious menial for his tardiness in reporting what he had heard and ordered that the coffin be exhumed. As the coffin was opened, every person present gave a shriek of horror when they saw that the girl had given birth to a child in her coffin.

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Lessing cannot be accused of squeamishness - he describes every detail of the gruesome scene: the confused awakening in the narrow house under ground, the pain and horror of the unnatural childbirth, and the girl's final torture in the unyielding coffin, writhing in blood and excrement.

These gruesome tales are just a sample of many hundreds in a similar vein.

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In 1749, the French physician Jean-Jacques Bruhier claimed that putrefaction was the only certain sign of death and that the ignorance of the medical profession caused many people to be mistakenly declared dead and some to be buried alive. He could back his thesis with impressive case material: no fewer than 56 instances of premature burial or dissection and 125 narrow escapes. His book was widely read in Germany, where the physician Christoph Wilhelm Hufeland shared his concerns. In 1791, Hufeland brought forth a novel suggestion: the construction of Leichenh?user , waiting mortuaries where the corpses could be incubated in a temperate environment until the onset of putrefaction. These mortuaries were built across Germany, most with life-detection apparatus, such as strings that fastened to limbs and connected to a bell.

The two greatest objections to the Leichenh?user were their cost and the fact that many people found them sinister. The alternative was to invent coffins with security devices. In the 1830s, Adolf Gutsmuth invented a coffin that had a long tube connecting the buried box with the world above. Through this tube, air and light could be admitted. The heroic doctor tested his coffin by having himself buried alive in it.

In the second half of the 19th century, the German obsession with security coffins continued and upwards of 30 versions were patented. One had a filter to prevent earth from falling into the face of the prematurely buried person and a lamp that could be lit inside the coffin. Another had a complete air-conditioning system. The crowning touch was that the bell was replaced with a pyrotechnical rocket that was launched through the security tube of the coffin.

Many of these security coffins, however, had glaring design defects. A person enclosed in a normal-sized, airtight coffin would perish within 60 minutes from lack of oxygen. The security coffins that lacked a permanent air supply would thus fulfil their purpose only if the individual regained consciousness quickly. Other security coffins had a permanent air supply and would thus allow inhabitants to survive much longer, but their sensitive mechanisms were positioned where they could easily be triggered by putrefactive changes, resulting in false alarms.

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Were people really buried alive, and were these extreme precautions of any practical use? The reason the life-detection apparatus was finally removed from the German mortuaries in the 1890s was that no apparently dead person had come to life within their walls for many years: indeed, there is not a single verified instance on record. The anti-premature-burial campaigners asserted that as much as one-tenth of humanity was buried alive, but modern forensic science suggests that the findings of corpses and skeletons in strange and macabre attitudes, which inspired so many horror stories about the desperate scuffle in the coffin, were not incompatible with putrefactive changes, or the wounds the result of rodents feeding off the dead body. The build-up of putrefactive gases inside the cadaver can also result in increased intra-abdominal pressure, which, in some instances, is strong enough to expel an unborn child from the womb. But it is impossible to conclude from exhumation findings alone about how many people were buried alive in the 18th and 19th centuries.

There are also numerous instances on record, from the 17th century up to our own time, of people mistakenly being pronounced dead, but later recovering. There are also a few accounts, attested by reliable medical professionals, of people buried alive who recovered in their coffins and called for assistance by knocking on the lid. These few reports are unlikely to represent the total number of premature burials at this time.

Are people still being buried alive? The number of people dying each year, some of them in underdeveloped countries where the legislature for the verification of death resembles that of 19th-century Europe, makes it difficult to answer this question.

In the developed world there are efficient safeguards against premature burial, in particular, an obligatory medical examination. But even this safeguard is fallible in instances of incompetence. In the 1970s, a young Frenchman was declared dead after an overdose and passed through the hands of police, mortuary assistants and undertakers. He gave a groan only when the coffin lid was about to be screwed down. Others may not have been so fortunate.

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Jan Bondeson is professor of rheumatology at the University of Wales College of Medicine and author of Buried Alive , published by W. W. Norton, ?18.95.