The living dead aren't just characters in low-budget horror movies, according to a new book that details the history of premature burial and the technology used to detect death.

Buried Alive author Jan Bondeson's macabre history book includes urban legends and old-wives' tales along with a complete survey of death-discovery technology -– all delivered with a quietly wry sense of humor. "Medical historians have largely chosen to ignore the question of the reliability of the criteria for determining life or death and there is very little scholarly work done in this area," said Bondeson, 38, a professor at the Wales College of Medicine.

Bondeson's book fully explores the various methods that were used in the past to make sure someone was really, not just "apparently," dead.

Administering enemas of tobacco smoke to the suspected dead had a strong following among many members of the medical profession in the 17th and 18th centuries.

Other doctors preferred to insert hot pokers into various orifices, pinch nipples with pliers, and vigorously yank on the tongue of a presumed corpse in order to ascertain that their patients were quite dead.

Tongue-pulling became so popular that a device was created to automate the procedure. The suggested modus operandi was to clamp the maybe-dead person's tongue to the machine and then turn a crank that rapidly moved the tongue in and out of the patient's mouth.

This procedure had to be continued for at least three hours, doctors believed, so a village's most-easily amused person was usually assigned to the task.

Although some were reputed to have been restored to life during these medically sanctioned tortures (sadly, no reports on their response to being pinched, penetrated and pulled has survived), many doctors felt that the only true sign of death was putrefaction.

They advised that anyone who was presumed to be dead should be placed in a very warm place and observed for signs of decomposition before burial.

Since few people fancied the idea of watching their loved ones rot, in the late 18th century France and Germany embarked upon the wide-scale construction of "vitae dubiae asylums" –- hospitals for the "doubtful dead," also known as waiting mortuaries.

Here, corpses were placed in an environment that would encourage them to decompose rapidly but were also optimistically supplied with a string that, when gently yanked, would signal their resurrection.

Unfortunately, real corpses have a disconcerting but natural tendency to twitch and writhe, so the mortuaries were often filled with the strident sound of alarm bells.

The alarm systems were soon discontinued but the mortuaries remained in business until the mid-1800s.

"Waiting mortuaries are a 'damned' chapter of history which we are not supposed to know about," writes Bondeson, who found this part of his research the most disturbing.

The general populace was never thrilled about using what were commonly known as death hospitals, Bondeson said, despite dire warnings that if their loved ones woke up gibbering and shrieking in a coffin, the reluctant family had no one but themselves to blame.

Happily a new option was soon available -- the "security coffin."

Security coffins allowed the not-dead person to release themselves from the confines of the grave, or to alert cemetery watchmen with bells, horns or flags, all designed to be easily activated by a presumably traumatized person enclosed in a dark coffin.

But, Bondeson points out that here again the user-friendly interface had a serious drawback -- the natural changes experienced by a real corpse in a coffin trigged the alarms and led to many "distressing scenes in cemeteries, with bells ringing and little flags waving" -- so security coffins soon fell out of favor.

Bondeson said that current medical science still doesn't offer fail-proof methods of determining death in every case.

And the blithe assumption that live burials don't happen in the 21st century due to the use of embalming isn't necessarily true, said Bondeson. Embalming is not required by law in most cases.

And people are increasingly choosing not to have their loved ones embalmed, said Manhattan funeral director Joseph Riclan.

"The Federal Trade Commission's consumer guide to funerals clearly points out that embalming is not always legally required, and that people can save hundreds of dollars by not having their loved ones embalmed. So many people are choosing to decline this service," Riclan said.

Riclan doesn't think that refusing embalming services will increase the danger of being buried alive. "We rely on medical statements, typically brain-activity tests, to determine death now," Riclan said. "Embalming is more for the family, so they'll have a nice final memory of their loved one."

But the absolute best way to avoid being buried alive is to avoid taking a drug overdose when outside in cold weather, a combination that too closely mimics the signs of death, said Bondeson, who believes that it's quite likely that a few people are still waking up in buried coffins.