epigastrium, pelvis and lumbo-sacral area, are bad sleepers, talk suicide and may attempt it in a half-hearted way. If asked why they wish to end their lives they may say that "they have been ill so long they cannot endure the agony any longer"; they may say their “heads are all wrong," that "something occurred inside their heads," that "everything went round and got mixed up together"; that "something came down and covered their brains and they have no feeling about anything at all”; that "they know that they will end in the asylum," that "they must end their lives before they are 33." If the agitation be extreme and topophobia be present, a spectacular attempt at suicide will almost surely be made, but generally speaking the more talk there is of death the less likely is an attempt. In conversion hysteria the patient frequently speaks of death but is careful not to make even a half-hearted attempt at selfdestruction. When asked why they wish to end their lives they may say because their "illness makes life not worth living." Cases of phobia and of obsession speak of death and making an end of it all because of their difficulties, but they do not talk of death convincingly; they toy with the idea.

The anxious hysteric is the most dangerously near to suicide of all the psychoneurotics, and cases are frequently cited of poisonous doses of drugs being taken, and drowning attempts made, but these patients differ from the truly impulsive suicide in telling about what they have taken. The self-preservative instinct asserts itself, and it is noticed that drowning attempts are made when people are there to save them and often in shallow water. Anxiety hysteria is, as we know, due to psychic conflict, and the measure of agitation present is an index of the tendency to death and corresponds to the agitation in melancholia, only on a higher plane, that is to say in a more complex, highly-evolved, inhibited and controlled field of mental function. There has been no regression to Narcissism in anxiety hysteria, but the conflict and repression prevent, by conative deviation, the investment of objects with sufficient instinct interest. Nevertheless the hysteric has a large narcissistic element in his make-up, or, more precisely, he has an abnormal proportion of instinct interest deviated to phantasies of himself, and so there is reduced intensity in cognition of objects. This is what C. G. Jung implies by the word 'introverted.'

The idea of death present in obsessions does not become a tendency to death because the obsession is, like the physical symptom in conversion hysteria, a compromise by displacement or a solution of a conflict; and, moreover, the obsessional neurotic has very much the same zest in life

as the normal individual, except that his experience of life and reality is impoverished by the affect transferred to an act or a thought which is cut off and unassociated with his other acts and thoughts. It is probable that his talk about death is attributable, therefore, to the same fundamental cause which has been assumed to be the basis of the other psychoneuroses, but in obsessions it is not a strong or persistent idea.

Reference has been made to a tendency to death in agitated anxious hysteria, and it may be asked can this tendency become an impulse? It can and does if regression occurs. Anxiety hysteria tends to pass to conversion hysteria, or, if regression occurs, to manic depressive insanity; and in the latter event in the depressed phase the tendency becomes an impulse.

If then the facts are that in the psychoneuroses death is present as an obsessive idea, and sometimes as a tendency, and in certain of the psychoses there are impulses to death; and if the idea of, tendency to, and impulse to death arise from unpleasure, from tension of accumulated affect; what is the significance of death to these patients?

It has a totally different significance to that which it has to a normal individual functioning in the Reality Principle. For the latter it is the inevitable end of human life. To the neurotic it is equivalent to quiescence, a quiescent resolution of the affective excitement; he does not consider its consequences for other people, or in any way confront it objectively. It is an alternative solution of the problem of how to dispose of excitement from dynamic instinct.

Death is envisaged by the neurotic as a sleep and a forgetting, an escape from what he calls "the pressure of life," and the meaning of it as connoting the total extinction of the individual's activity is not envisaged at all. So that to the neurotic death is like sleep, and the tendency to it is an effort by the organism to restore the quiescent equilibrium; in other words, it has no reality for the neurotic but is an activity of the Pleasure Principle.

The physiological changes that accompany these psychological states are not marked so far as clinical observations can detect them. There are changes in the function of the endocrine glands, both in the activity of secretion and the relation between the autocoids one with another. Experimental proof of the nature of these changes is difficult. There has been repeated experimental proof by Pavlov and others that psychic influences promote or inhibit physiological secretions, for example, the flow of gastric juice; that the thymus gland and the pituitary body influence the development of the sexual glands, that under psychic

influences the suprarenal bodies increase the secretion of adrenalin into the circulation. Nearer to our purpose, it is known that a hyperactive thyroid gland produces a syndrome resembling anxiety hysteria, except that in this syndrome of exophthalmic goitre the death tendency is not present, whereas in anxiety hysteria it is. Then apart from experimental proof there has been a good deal of speculation recently on the influence of the endocrine glands on individual behaviour. Dr Crichton Miller at the Glasgow meeting of the British Medical Association, in 1923, sought to associate the activity of certain endocrine glands with types of personality; a hyperactive thyroid with the creative artistic type, the hyperactive pituitary body with the will to power individual of the Napoleon type, the hyperactive suprarenal with the extrovert man of action of the British Naval Officer type. He did not speculate on the correlation between hyperactive sex glands and any type; had he done so we might have expected lovers, lunatics, and poets, to have been correlated! Physiologists now assume that the internal secretion of the interstitial cells of the testes and ovaries works against or is balanced by the internal secretion of the thyroid gland and suprarenal capsule. The presence of sex gland secretion has not been detected in the blood. As regards the evidence afforded by the nervous system, evidence by no means clear or complete, it is supposed that a hyperactive sex gland secretion acts on the vagus nerve and produces the condition of vagotonus. And the question arises, is the hyperactivity of the sex glands and the condition of vagotonus in the physiological sphere definitely related to psychic repression and the death tendency? On this subject I will quote from Eppinger and Hess.

"In subjects sensitive to pilocarpine, the tone of the whole autonomic system is raised, clinically this constitutional hypertonicity gives rise to gastric hyperacidity, physiological bradycardia, slight respiratory arhythmia, eosinophilia, spastic constipation, a tendency to hyperidrosis and salivation. This condition is vagotonia and readily passes beyond physiological limits. Vagotonia gives rise to the lymphatic, arthritic and exudative diatheses in children, and to vaso dilation."

I will also quote from Dr David Orr's appendix to the public Morrison lecture, 1920, by Dr R. G. Row: "The vagus nerve is closely related to the thymolymphatic system. Resection of the vagus is followed by acute yellow atrophy of the thymus, especially of its cortex, by atrophy of the lymphatic follicles of the spleen, atrophy of the cortical substance of the ovaries and testes and by lymphatic leucopenia. Hence the internal secretion of these organs is in a great measure regulated by the vagus."

Again "Emotion is a most important factor in the genesis of the sympathetic neuroses; and even within physiological limits psychic states can determine changes in the endocrine-sympathetic mechanism. It is common to observe after fear or mental suffering the rapid development of chlorosis, Addison's Disease, hemicrania, renal neurosis, nervous diabetes, hyperidrosis, angina pectoris, angio-neurotic eruptions."

Now the opposite condition of vagotonia is characterised by tachycardia hyperthermia, rapid metabolism, gastro-intestinal atony, diminished secretion of sweat and saliva and vaso-constriction; the psychoneuroses and manic-depressive insanity present a mixture of these two groups of symptoms, but undoubtedly depression and the death idea is associated most markedly with vagotonic symptoms. It has not yet been experimentally proved that these symptoms are correlated with an oversecretion of the sex glands. There has been no isolation of the sex gland autocoid from the circulation. Clinically there is observed apparent deficiency in, and so overpowering of, the compensatory secretions of the adrenals, thyroid and pituitary, or of some of them, producing the condition named vagotonia; and vagotonia is observed to occur in some individuals at certain epochs in their life history, namely at prepuberty and at the climacteric. It is at these epochs that the psychoses, dementia praecox and melancholia, occur respectively, and these psychic states are associated with impulses to death: these epochs are also associated with an increment of sex impulses, and if there be no satisfactory discharge of the activity of these increased impulses a psychic state of dread or anxiety arises; if the organism fails to adjust its balance of function, it tends to a pathological state.

We observe the idea of death, the tendency to death and an impulse to death present in these states and ascribe it psychologically to tension from unexpended excitement or withheld affect, and physiologically to an alteration in the secretion of the endocrine glands.

It may be profitable now to consider this remarkable phenomenon of an organism seeking its own death from the standpoint of Biology.

Some recent experiments on the unicellular organism by Woodruffe and others have demonstrated the facts (a) that the unicellular organism will live indefinitely and continue to multiply indefinitely if the nutrient medium in which it lives is periodically renewed; (b) that if the nutrient material is not renewed the organism dies, apparently from the products of its own metabolism.

These demonstrated facts, which are inconsistent with the theory of Weismann that the unicellular organism and its products are immortal,

place the unicellular organism in line with the multicellular organism with a sexual cycle, and from them the inference may be drawn that there is a natural tendency in protoplasm to death except in that plasm modified as germ plasm; if so modified, the plasm tends to union with a similarly modified plasm and there follows from this union a fresh growth of plasm, a new generation, containing within its organism both soma plasm with a life-death rhythm and germ plasm with a reproductive rhythm.

Biology only admits two great hormonic drifts or tendencies in the organism, one to self-preservation, the other to reproduction, if both these tendencies are satisfied the individual lives a complete biological life. If it succeeds in preserving its own life for death at the normal period of the life rhythm of the species, then its germ plasm together with the soma plasm dies; if it reproduces, its soma plasm dies but its germ plasm lives.

From the biological standpoint the individual who has an impulse to death is no longer activated by one of the two "hormonic" drifts, namely the self-preservative, and is therefore activated by the other only, the sexual or reproductive.

This conception of the death tendency in neurotics may be now resumed in terms of Psychology, Physiology and Biology; psychologically as a psychic tension from failure of investment of the objects of perception with instinct interest, and failure of instinct interest to invest psychic substitutes for perceived objects, so that the excitement cannot find outlet in real ends or in substituted or imagined ends; physiologically as a change in the balance between the hormones or autocoids, which acting through the nervous system keep the organism adjusted to external and internal stimuli; biologically as a failure in the activity of one of the two great tendencies in the animal organism, a tendency essential to life and to adjustment to the environment.

Acknowledgments are due to the following authors for material extracted from their writings:

EPPINGER and HESS. D. Orr's appendix to the 1920 Morrison Lecture.

R. G. Row. Morrison Lecture, 1920.

J. DREVER. Instinct in Man, p. 140.

S. FREUD. Introductory Lectures on Psychoanalysis, p. 356.

D. ORR. Appendix to 1920 Morrison Lecture.

C. SPEARMAN. Nature of Intelligence, p. 135.

C. G. JUNG. Psychology of the Unconscious, p. 37.