After offering some examples of events that are interesting because they are true, such as the Lisbon Earthquake and the London Plague, the narrator adds that false accounts that attempt to imitate such horrors are abominable. He observes that his examples are fascinating because of the extent of the damage but explains that individual stories of suffering are often far more intense while thanking God that large groups never suffer as much as some individuals have. He states that being buried alive is one example of intense suffering that sometimes occurs when a person temporarily loses his vital signs, and he asks where the soul goes during that moment of near-death.
He then provides examples of people who have been buried alive, including a Congressman's wife, who appeared to die and was placed in the family vault for three years before they again opened the vault to realize belatedly that the wife must have revived after her funeral and managed to escape her coffin. She apparently tried to call for help by banging on the door of the vault, but her burial shroud caught on some ironwork, and she consequently died on that spot. The narrator also tells of the wealthy Victorine Lafourcade who was wooed by the poor Parisian journalist Julien Bossuet. She rejected him in favor of Monsieur Renelle, who treated her badly and caused her to die, at which point she was buried. The lover visited her grave and realized that she had actually been buried alive, and he revived her, after which they fled to America. When they returned twenty years later, Renelle tried to claim her, but a tribunal decided that the husband's authority no longer existed.
The narrator then tells of an artillery officer who received a concussion and apparently died. Two days after his hasty funeral, a peasant heard him struggling, and they uncovered his grave and took him to a hospital, where he revived and told of his experiences. He had swooned but was preserved by the air in the soil above his head, and when he heard a crowd above him, he woke up and became aware of his situation. The patient began to recover but died from a medical experiment involving a galvanic battery. Conversely, the galvanic battery is the giver of life when Edward Stapleton dies of typhus fever. His friends do not receive official permission for a postmortem, so they dig up the corpse and they manage to revive him with an electric shock. He claims afterward that he never really died but was unable to speak during the autopsy.
Having established that premature burials sometimes occur, the narrator explains that the stifling lack of air and fear of death combines with claustrophobia, darkness, and silence to form a terrifying ordeal that does not occur anywhere else on Earth. The narrator confirms this observation with a story from his own experience. He has a history of catalepsy, and whenever he has a fit, he lies senseless in a trance where his muscles barely move. The state closely resembles death, but most of the time the onset of the condition is gradual, so that the sufferer's friends are aware of his catalepsy. The narrator's case is textbook, and he generally either slowly goes into a swoon and suddenly recovers or becomes immediately cataleptic and wakes slowly. Otherwise his health is good, although he tends to wake from sleep in a state of confusion.
In all of the narrator's experiences, he suffers no physical harm but begins to dream of death and premature burial. In one case, during a cataleptic trance, he hears a voice telling him to sit up before it speaks to him of the agonies of night and death. It asks him how he can sleep so peacefully when so many of the dead do not rest easily. Because of this, the narrator becomes increasingly nervous and confines himself to the presence of friends for fear that he will be deemed dead. His increasing paranoia leads him even to suspect his friends of unreliability, despite their reassurances, and he arranges for his family vault to be stocked with food and water and to have a lever with which to open the door.
Despite the narrator's precautions, at one point he wakes slowly from catalepsy. Keeping his eyes closed, he is filled with terror at his suspicion that he is in a coffin. When he opens his eyes, he sees nothing and tries unsuccessfully to scream. He flails his arms, striking wood above his face. He tries to open the lid with the provisions he has made for his coffin, but finds nothing and, smelling dirt, concludes that he must have fallen among strangers and awoken in a regular grave. He screams successfully, only to have four people shake him enough to make him remember where he is.
The narrator remembers that near Richmond, Virginia, he and a friend had been on the banks of the James River when a storm overtook them. They chose to stay on board a small sloop anchored on the river, and the narrator had been asleep in one of the ship's tiny sleeping berths. He had imagined in the sluggishness of awakening that he was in a grave, and the men who found him were unloading the ship's cargo of topsoil, which had provided the smell of dirt. The experience is terrible but shakes the narrator out of his fear of death and burials, and the catalepsy ceases as the narrator becomes more active and less fretful. He concludes that imagination is sometimes unhealthy and that man must ignore the darker possibilities of the world in order to survive.
In contrast with the majority of Poe's stories, which involve a first-person narrator describing their contact with situations of Gothic horror, "The Premature Burial" deals with the psychological effects of the frightening experiences of others on an ordinary person who in the end faces only imagined suffering. The story consists of a number of grisly anecdotes about people who undergo premature burial, and Poe purposely leads the reader to believe that having provided precedents of premature burial and the story of his own foreboding dreams, the narrator will conclude by launching into his own corroborating account. Instead, the atmosphere of apprehension that the narrator creates turns into relief and ridicule instead of true terror as the narrator describes waking up in a boat and thinking he is in a grave.
The sheer anticlimax and embarrassment of the boat incident shakes both the reader and the narrator out of preoccupation with impending death. The narrator realizes that to worry constantly about death is in itself something of a premature burial, providing a double meaning to Poe's name for the story. The narrator notes that his experience with premature burial is false but still as emotionally intense as the real occurrence because of his fear. At the same time, he indicates that prior to the events on the boat, his crippling anxiety had caused him to cease to leave the house except in the company of friends, at whom he constantly fretted. The narrator is unable to truly live his life because of his fear, and in this sense, he has prematurely buried himself.
A clever feature of Poe's prose is that throughout the story, he subtly foreshadows the unexpected ending in ways that seem at first to add to the grim atmosphere of the narrator's account. The narrator provides details of how he was prone to waking up in a slow, confused manner similar to some of his awakenings from catalepsy at such a point that the reader is too busy thinking about the possibilities for premature burial during catalepsy to worry about a point of comparison with sleep. In addition, the narrator's opening lines about how horrible it is to invent calamities such as the London Plague when they have already occurred in history are misleading. The narrator leads the reader to assume that he says these words because he wants the reader to believe his story, but in reality, he is suggesting that the inventions of the human imagination in the areas of death and destruction are unnecessary and counterproductive.
In order to satirize the narrator's concerns about death, Poe includes several humorous elements in the story, particularly during the narrator's anecdote concerning the boat. Four men interrupt the narrator's panicked scream by asking him, "What do you mean by yowling in that ere kind of style, like a cattymount?" The comical accents and gruff voices provide a relieving element of normality that has thus far been lacking in the narrator's tale, as does their unceremonious shaking of the sufferer. In the words of the fourth man, the narrator's heartfelt shriek that "resounded through the realms of the subterranean Night" turns into a wildcat's yowl, an amusing and much less disturbing sound. The earthy men who are coincidentally moving topsoil off a boat provide a foil for the nervous narrator and his otherworldly thoughts, and unlike in stories such as "Ligeia," in this story the eerie does not overcome the normal.
In addition to the humorous elements within "The Premature Burial," the fictional nature of the narrator's account becomes a source for irony in itself. The narrator states that although man has a natural interest in death, these themes are "entirely horrible for the purposes of legitimate fiction," and these words become the moral of the narrator's tale of fear while simultaneously reminding the reader that the story is fictional. Poe's usual oeuvre is to depict men in exactly the type of terrifying situation that the narrator abhors as only compounding the psychological effect of mortality. By having his narrator begin a story in this manner, Poe satirizes his own role in shaping the fears of the ordinary people that are represented by his main character.