Even more potent than infectious diseases in producing old age are the results of degenerative changes in the ovaries. The effects of castration have already been mentioned. Much in the same way do those causes act which exhaust the internal secretion of the ovaries, e.g., many pregnancies, or sexual excesses. We must take into consideration the fact that, as shown by many authors, the different ductless glands are altered during pregnancy (Launois,[161] Guieysse, etc.). Many mothers of large families look old before their time, as do also many of those who lead a professedly immoral life. Even in young girls we can see the consequences of such deteriorating agencies in hypertrophy of the mammæ, developing in very short time, and also a tendency to deposition of fat on the abdomen, which becomes pendulous in women who have had many children. The features of women who indulge in sexual excesses undergo a striking change even in early life. They become coarse, bloated, less sharply defined, and the cheeks and chin become fat and flabby. Indeed we have often been struck by the great resemblance of such a face to that of an early stage of myxœdema, a condition due to deficiency of thyroid secretion, which in turn, as shown by Sajous, influences other ductless glands. The effects of numerous pregnancies are far more marked if lactation is prolonged. Footnote 161: Launois et Mulon: “Hypophyse et femme enceinte,” Société de biologie, p. 448, 21 mars, 1903; and Thèse à la Faculté des Sciences, 30 juin, 1904. Not all women after many pregnancies, or after unduly frequent sexual intercourse, will show symptoms of premature senility, as much depends on heredity and also on the surroundings in which they live. Certainly if they live in precarious circumstances, as do the poorer women of the working classes in many European countries, especially Germany and Austria, where these women perform hard bodily work and are badly fed, and have much sorrow and care, they will soon appear old; and women looking like matrons at thirty are of common occurence in the lower classes of these countries. But this is seen also in the women of southern Europe, although they do not work so hard. This is due to the fact that in southern countries girls reach puberty early and are married very young, in the East often at the age of twelve. Thus, sexual activity begins earlier and ends much sooner. Its end, of course, means the beginning of old age. As soon as retrograde changes commence in the ovaries, the summer of a woman’s life is over; and, just as summer is sometimes prolonged into autumn, so at this period of her life may she still retain strong sexual desire. Happy the woman whose heart, as well as her ovaries, undergoes a senile involution, for there is nothing more terrible for a formerly beautiful woman than to see her charms wane while her heart remains young.