The purpose of this paper is to report a series of clinical observations having to do with the prognostication of death in the presence of serious organic disease. These observations are based on the premise that there is an unconscious awareness on the part of the patient of his impending death and that this is reacted to with anxiety which may be repressed. The anxiety, however, is often betrayed by various clinical signs which the alert physician can recognize and use in making a prognosis and planning management.
There are references in the psychiatric and psychoanalytic literature describing unconscious psychologic reactions to organic disease. Freud1 quotes Aristotle as concluding that "dreams may very well betray to a physician the first signs of some bodily change which has not been observed in waking." He also quotes Hippocrates1,2 and more recent writers who vouched for the diagnostic value of dreams.