394 GYNECOLOGY 



such a large size. The wall of the follicle external to the membrana 

 granulosa does not present a two-layer arrangement; there is no 

 rupture of the follicle; there is no formation of a corpus luteum; 

 the ovum is invaded by phagocytic cells. In adult life, also, it is to 

 be noted that, beside the follicles which rupture, there are others 

 which may develop to a certain extent and then undergo retrograde 

 changes before rupture occurs. The ovum may increase, a yellow 

 body may form, owing to the development of lutein cells in the 

 theca interna. Then the ovum and surrounding epithelium degen- 

 erate and are absorbed, along with the liquor folliculi. The explana- 

 tion of such a process is not always certain.- In some cases it appears 

 to be due to chronic inflammatory changes in the ovary, but it is 

 probably also due to other causes of which we are ignorant. 



Regarding the bursting of the follicle there is a difference of 

 opinion. Most authorities hold that the ovarian tissue, being greatly 

 thinned at the most projecting point, is gradually ruptured by the 

 increase in intrafollicular pressure resulting from the accumula- 

 tion of liquor folliculi. Nagel, however, holds that owing to an 

 increase in the thickness of the inner layer of theca folliculi, to the 

 swelling of its cells with lutein particles and to its becoming arranged 

 in a wavy manner, pressure is made on the follicle contents from 

 without, and that. they are forced in the direction of least resist- 

 ance, viz., outward toward the surface of the ovary. 



Clark holds that rupture is due to changes in the circulatory 

 conditions in the ovary. Owing to the marked engorgement of the 

 organ, tension is increased and the follicular contents are forced 

 to the surface. The vessels lying external to the folicle at the bulg- 

 ing portion are compressed, and consequently necrosis and disin- 

 tegration of the tissue take place. Pari passu with the develop- 

 ment of the lutein cells there is fatty degeneration in the cells of 

 the stratum granulosum and in those of the discus proligerus. This 

 enables the ovum to escape easily from the cells surrounding it. 



The formation of the corpus luteum has given rise to consider- 

 able discussion. Some workers still hold firmly that it is a deriva- 

 tive of the membrana granulosa. The majority hold, however, that 

 it is developed from the inner part of theca folliculi, which is re- 

 garded as a cellular layer of the connective-tissue stroma of the 

 ovary. 



Of great interest is the observation recently made by Stoeckel, 

 Pick, and others, that, occasionally, corpus luteum cells may not 

 undergo their normal growth and retrogression within the limits 

 of the follicle, but may wander outward into the ovarian stroma 

 and even undergo atypic proliferation. I have occasionally noted 

 this wandering, though not to a great distance; in some instances 

 the cells contained abundant dark pigment apparently derived 



