The widespread adoption of the stethoscope in the mid-nineteenth century provided a more reliable tool for verifying the absence of cardiac activity.

The development of embalming as a standard mortuary practice in the United States — accelerated by the Civil War’s demand for the preservation of bodies for transport — provided a strong additional safeguard, though not a deliberate one.

Waiting mortuaries, where bodies were held for days before burial to allow the beginning of decomposition to confirm actual death, were established in several European cities and advocated by reform-minded physicians in the English-speaking world.

The fear was not entirely imaginary.