So far everything is quite simple; but hitherto we have only considered the external mechanism, and we must now further inquire as to the concomitant internal means by which such processes are rendered possible. This brings us face to face with one of the most difficult problems in the whole range of physiology,—the question of the origin of death. As soon as we thoroughly understand the circumstances upon which normal death depends in general, we shall be able to make a further inquiry as to the circumstances which influence its earlier or later appearance, as well as to any functional changes in the organism which may produce such a result. The changes in the organism which result in normal death,—senility so-called,—have been most accurately studied among men. We know that with advancing age certain alterations take place in the tissues, by which their functional activity is diminished; that these changes gradually increase, and finally either lead to direct or so-called normal death, or produce indirect death by rendering the organism incapable of resisting injuries due to external influences. These senile changes have been so well described from the time of Burdach and Bichat to that of Kussmaul, and are so well known, that I need not enter into further details here. In answer to an inquiry as to the causes which induce these changes in the tissues, I can only suggest that the cells which form the vital constituents of tissues are worn out by prolonged use and activity. It is conceivable that the cells might be thus worn out in two ways; either the cells of a tissue remain the same throughout life, or else they are being continually replaced by younger generations of cells, which are themselves cast off in their turn. In the present state of our knowledge the former alternative can hardly be maintained. Millions of blood corpuscles are continually dying and being replaced by new ones. On both the internal and external surfaces of the body countless epithelial cells are being incessantly removed, while new ones arise in their place; the activity of many and probably of all glands is accompanied by a change in their cells, for their secretions consist partly of detached and partly of dissolved cells; it is stated that even the cells of bone, connective tissue, and muscle undergo the same changes, and nervous tissue alone remains, in which it is doubtful whether such a renewal of cells takes place. And yet as regards even this tissue, certain facts are known which indicate a normal, though probably a slow renewal of the histological elements. I believe that one might reasonably defend the statement,—in fact, it has already found advocates,—that the vital processes of the higher (i.e. multicellular) animals are accompanied by a renewal of the morphological elements in most tissues.