716 STRUCTURE OF THE OS AND CERVIX UTERI. 
while, on the other hand, where the contracted parts are 
soft and very much thickened, acute disease will commonly 
be found accompanying the stricture. 
Ascertaining the presence or absence of actual disease is a 
point of great importance before giving a decided opinion as 
to the propriety of operating by incision. A mere stricture, 
whether hard or soft, of the passage between the vagina and 
the body of the uterus is not necessarily to be considered a 
disease, but may be simply an abnormal (perhaps congenital) 
condition of the part. 
The passage between the vagina and uterus comprises the 
os uteri, cervix uteri, and os internum, and in permanent 
stricture of this passage the whole of these component parts 
may be affected, or, at times, only one or other of them. It 
is most common to find the os and cervix uteri affected to¬ 
gether ; seldom the os uteri by itself; and least common of 
all in the lower animals the os internum. 
A medical practitioner recently informed me that he very 
often found the os internum contracted, even after the os and 
cervix uteri had given way to the full extent. In such cases 
the uterus, with its contents, is forced as a whole down to the 
external opening, and thus brings the contracted os internum, 
generally a very delicate membrane in such cases, into view 
—which the practitioner ruptures with his finger-nail or 
divides with a scissors. 
As it is not necessary to enter minutely into the anatomy 
of the parts under discussion, suffice to say that the ana¬ 
tomical structure of the cervix uteri is very similar to that of 
the uterus itself, with the exception of its having a greater 
amount of connective tissue and far greater supply of mucous 
follicles and crypts, and several distinctly formed rugae or 
folds longitudinal and transverse. 
In hard stricture these transverse rugae or folds appear 
generally to be transformed into a compact unyielding fibro¬ 
cartilaginous material. In one very severe case I found six 
of these hardened unyielding transverse rugae or folds between 
the os uteri and os internum. 
In soft stricture, without any actual disease being present, 
the contraction is generally confined to the os and the vaginal 
portion of the cervix uteri. 
In cases of complicated stricture, or, in other words, stric¬ 
ture accompanied with some active disease, it will often be 
found that the stricture is merely the concomitant effect of 
the disease, and such causative disease will almost invariably 
prove to be either ulcerative, scirrhous, really cancerous, or 
fungous in its nature. 
