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The latter has its origin in a stricture, or in an injury, or in that condition technically known as hypospadias, or in debility. It can be safely said that neither self-indulgence nor spermatorrhoea often leads to permanent sterility.
Adelaide Preville, who was married as a female, and as such lived the last ten years of her life in France, was found on dissection at the Hotel-Dieu to be a man. A man was spoken of in both France and Germany a who passed for many years as a female. He had a cleft scrotum and hypospadias, which caused the deception.
This latter case seems hardly warranted when we consider that men afflicted with hypospadias and epispadias have become fathers. Percy gives the instance of a gentleman whom he had known for some time, whose urethra terminated a little below the frenum, as in other persons, but whose glans bulged quite prominently beyond it, rendering urination in the forward direction impossible.
The Ephemerides speaks of a case of coalition of the bladder with the os pubis and another case of coalition with the omentum. Prochaska mentions vesical fusion with the uterus, and we have already described union with the rectum and intestine. Exstrophy of the bladder is not rare, and is often associated with hypospadias, epispadias, and other malformations of the genitourinary tract.
O'Neill speaks of a case in which the clitoris was five inches long and one inch thick, having a groove in its inferior surface reaching down to an oblique opening in the perineum. The scrotum contained two hard bodies thought to be testicles, and the general appearance was that of hypospadias. Postmortem a complete set of female genitalia was found, although the ovaries were very small.
Some of his observations with regard to genito-urinary surgery are quite as interesting. He even treated congenital anomalies. He suggests cutting of the meatus when narrowed, dilatation of strictures with lead sounds, and even suggests plans of operations to improve the condition in hypospadias.
There seems to be an element of heredity in this malformation, and this allegation is exemplified by Sedgwick, who quotes a case from Heuremann in which a family of females had for generations given birth to males with hypospadias. Belloc mentions a man whose urethra terminated at the base of the frenum who had four sons with the same deformity.
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