PROBLEMS IN OBSTETRICS AND GYNECOLOGY 397 



demonstration. Take, for instance, the relationships of the ovarian 

 fimbria. In some cases its outer end may not reach the ovary, 

 sometimes it may just touch it; sometimes its tip may be imbedded 

 in the ovary; sometimes a considerable extent of the fimbria may 

 lie against the ovary or adherent to it; in some cases there may 

 be a break in its continuity, so that a small outer portion may lie 

 close to the ovary detached from the main part. Marchand has 

 directed attention to the early close relationship between the tubal 

 epithelium and that covering the surface of the ovary, and has 

 pointed out that they are one and the same surface. He believed 

 that in some cases the line of demarkation, instead of being at the 

 end of the ovarian fimbria, might reach over to the lateral portion 

 of the ovary and that from it processes might extend into the 

 cortex of the ovary. The observations of De Sinety and Melassez, 

 in 1878, seemed to establish the correctness of such a view. Other 

 studies, especially those of Whitridge Williams, leave no doubt as 

 to the occasional extension of Miillerian tissue into the ovary. It 

 need not, therefore, be a matter of surprise that small areas are 

 occasionally found in the ovary of pregnancy, presenting the ap- 

 pearance of decidual changes in the connective tissue of the uterine 

 mucosa. 



It must also be mentioned that small localized decidual nodes 

 have also been found in the broad ligaments. I believe that these 

 are also derived from displaced portions of Miillerian tissue, which 

 are quite common, especially in the upper portions of the broad 

 ligaments. Similar areas have also been found under the perito- 

 neum of the pregnant uterus, but this cannot be considered as at 

 all remarkable, since there is no doubt as to the Miillerian nature 

 of the uterus. Rarely they have also been found behind the peri- 

 toneum of the pouch of Douglas, and it is not unlikely that even 

 in this neighborhood may be found small detached Miillerian frag- 

 ments displaced backward in early embryonic life. 



In describing these small decidua-like areas it must be remem- 

 bered that somewhat similar appearances may sometimes result 

 from chronic inflammatory changes in the peritoneum, associated 

 with inclusion of the endothelium and proliferation of the latter. 

 The large cells produced in this manner are usually closely packed 

 and suggest masses of epithelium rather than the looser arrange- 

 ment of multiform anastomosing cells found in the connective- 

 tissue decidual areas. 



The Functions of the Ovary. In addition to furnishing the 

 ovums, it has long been recognized that the ovary exercises an 

 important influence on the body, though the nature of the influ- 

 ence and the changes induced by it have been and still are un- 

 known. Recently, various workers have suggested that the ovaries 



