Yvette Guilbert, in her novel the “Demi-vieilles,”[162] describes in a picturesque manner the pangs of a woman at the climacteric age. Let us quote a few lines: “They try to remain young, hide the gradual onset of their ugliness, and look for a chance to taste of love again. They cry out for the past, for even while they fight against time they cannot detain it in its course.” This description, however, does not apply only to the majority of middle-aged women, but more especially to professional beauties. Footnote 162: Quoted after Professor Kisch. It can be seen from these considerations how necessary it is for a woman who has frequent pregnancies to observe the rules of hygiene. That these produce excellent results we have proved. We know of a score of ladies of the aristocratic and wealthy classes who, though having six or even seven children, look none the worse. A certain Austrian archduchess still remains a beautiful woman, in spite of her eight children and the fact that she is a grandmother. Such examples may be frequent in old families with this hereditary tendency. Though the bearing of many children can hasten old age, yet, on the other hand some women, after the birth of their first child, become better and fresher looking. We can see this especially in girls of twenty or more who, having appeared somewhat withered before marriage, begin to bloom afresh after the birth of the first child. Increased activity of the ovaries and thyroid is the explanation of this phenomenon. As already mentioned, the thyroid takes an active part in ovarian changes. In a young girl of fourteen, just previous to menstruation and puberty, we may find a swelling of the thyroid gland. During menstruation we can often see a distinct enlargement of the thyroid, and at the same time certain nervous symptoms such as are usually connected with thyroid change. Increased activity of the thyroid during pregnancy is shown by a swelling of the gland, often causing a regular goiter, and, at the same time, not infrequently by the typical symptoms of exophthalmic goiter. Lactation is also dependent upon thyroid activity. After prolonged lactation there is an exhaustion of thyroid activity; and, on the other hand, by giving thyroid extract we can increase the flow of milk. The swelling of the thyroid in the above conditions can be explained by the greater demand for thyroid secretion, and that this hyperactivity occurs is also shown by the observations of the early writers on myxœdema. Morvan, Ord, and Combe found that myxœdema was frequently caused by numerous pregnancies, especially if associated with prolonged lactation.