586 HEKBEET M. EVANS 



and intra desquamationem. The recent diagnoses of endometritis, and 

 especially of the so-called interstitial endometritis, have employed as 

 criteria the abnormal presence of polymorphonuclear leukocytes, of lymph- 

 ocytes and of plasma cells (cf. Schonberg, Monch) and Schroeder has 

 shown how serious such infections may be without obliterating the cyclic 

 anatomy. 



B. Time of vitiation. Three means of study could be employed, and 

 as a matter of fact have been employed, in the determination of the time 

 of ovulation in man. First, the study of the exact histological conditions 

 in the uterus and ovary at various times in the menstrual cycle and, 

 .especially, the detection of the approximate time of ovulation by the dis- 

 covery of mature Graafian follicles or of very young corpora lutea which 

 are still in the proliferative stage. Second, the determination of the "con- 

 ception optimum" in pregnancies following a single copulation, it being 

 taken for granted that this means the determination of the time of ovula- 

 tion since a very limited survival of either ova or sperm is postulated. 

 Third, the determination of the age of early human embryos which may be 

 referred to a single copulation and hence the determination of the time of 

 ovulation, the same postulations being made. 



We may discuss briefly the results obtained by these three methods of 

 study. The method of anatomical study of the ovaries has, as far as naked 

 eye inspection of the ovaries is concerned, been carried out by Fraenkel, 

 Villemin, Witas, Halban, Kohler, Delporte and others. These investigators 

 disagree among themselves, Fraenkel, 13 for instance, finding "fresh" cor- 

 pora lutea rather late in the period (eighteenth to nineteenth day), Del- 

 porte at the time of menstruation. As Huge II and R. Meyer have empha- 

 sized, so simple a method, even if carried out with the greatest sare (as it 

 must be admitted Fraenkel has done), is quite inadequate for this task, for 

 deeply seated corpora lutea are notoriously easy to overlook nor can the 

 age of a corpus be estimated with the naked eye. It is obvious that to be 

 decisive, histological serial study of both ovaries should be undertaken and 

 the material should be obtained from cases with a reliable and regular 

 menstrual anamnesis, the supposed period of the cycle being confirmed by 

 histological study of the endometrium. Few, if any, studies with such 

 comprehensive material and such criteria have been carried out. R. Meyer 

 and Huge II have perhaps made the nearest approach to this while 

 careful histological studies have also been made by Schroeder. These 

 painstaking, not to say preeminent students of the subject do not agree 

 among themselves, Schroeder claiming a mid-interval follicular rupture 

 (fourteenth to sixteenth day) while the Berlin observers place a date early 

 in the second week as the usual ovulation time. This disagreement, how- 



13 Fraenkel's latest results are summarized by Fr. Tschirdewhan. In somewhat 

 over three hundred laparotomies forty cases of "fresh corpora lutea" were detected by 

 the method of inspection. Ninety per cent of these occurred later than the mid-intef- 

 menstruum and over half occurred from the eighteenth to twenty-sixth day. 



