392 The Uterus 



hangs against or through the os uteri as a polypus. It is a source of 

 constant irritation, and the muscular wall of the uterus, in its attempts 

 to expel it, undergoes hypertrophy, like the left ventricle in aortic 

 obstruction or the bladder in prostatic disease. 



The cervix is nearly an inch long, and ends in a transverse 

 aperture, something like the mouth of a tench, os tinea;. On account 

 of the backward slope of the cervix, the anterior lip is also inferior ; it 

 is also the larger, and is the first seen through the vaginal speculum. 

 The upper part of the cervix has a slight serous covering behind, but 

 none in front, as shown on p. 389. 



The cavity of the cervix is fusiform, opening above by the 

 os internum, and into the vagina by the os externum or os tincae. 

 The mucous membrane in the cavity of the cervix is arranged in a 

 longitudinal and transverse pleat to allow for dilatation during preg- 

 nancy. 



The epithelium of the interior of the cervix is columnar ciliated, 

 but that upon the outside is, like the epithelium of the rest of the 

 vaginal cavity, squamous. 



Sometimes the squamous epithelium on the cervix ends quite 

 abruptly, being replaced by crops of projecting and close-set filiform 

 papillae. To the touch these patches are soft and velvety, and through 

 the speculum they appear florid and pathological. They may be 

 called phantom ulcers, and they deserve not that amount of personal 

 attention and treatment which are at times so assiduously bestowed 

 upon them. They are not the result of disease ; but when the surface 

 is persistently rubbed with lunar caustic a genuine ulceration is easily 

 made. 



During pregnancy the cervix grows broad and soft, and is drawn 

 up from the cavity of the vagina, the os tineas being blocked by a plug 

 of mucus. From chronic disease it is at times enormously hypertro- 

 phied. Stricture of the neck may cause dysmenorrhcea and sterility ; 

 it may be dilated by graduated sounds. Dilatation may also be so 

 thoroughly effected as to allow complete introspection of the uterus, 

 and the enucleation of large tumours. The cervix is often the seat of 

 epithelioma which may extend to the body of the uterus, the vagina, 

 bladder, or rectum, so that faeces and urine escape by the vulva. It is 

 of the columnar variety. In the early stage the cervix maybe con- 

 veniently amputated by the dcraseur, but, later on, if operation be still 

 justifiable, the entire uterus and its appendages should be taken away, 

 cither with or without abdominal section. 



The presence of cancer of the cervix does not necessarily prevent 

 conception, but if the disease be advanced natural delivery at the 

 full time is almost impossible. In such circumstances the abdomen 

 is opened through the linea alba, and the supra-vaginal part of the 

 uterus, with the fcetus, ovaries, and tubes, are removed ; this is Porrtfs 

 operation. 



