PSEUDOHERMAPHRODISM 



339 



prominent mons, the skin rises in a fold, and encircling the phallus, ex- 

 tends downward on either side to form the bifid scrotum or labia major a. 

 No testes or spermatic cords are to be felt anywhere. When the glans is 

 drawn upward, the opening of the urethra is seen at a point correspond- 

 ing to the peno-scrotal junction. From this to the tip of the glans the 

 middle line shows a longitudinal gutter covered by striae of mucosa. 



Fig. 15. Case II. The external genitalia with the labia separated and the phallus 

 raised. The median furrow of mucosa is seen, bearing the urethral opening, represented 

 by a dark spot half-way between the examining fingers and thumbs. Note the entire 

 absence of vagina. (From the Johns Hopkins Hospital Bulletin, February, 1916.) 



The perineum from meatus to anus is smooth and without trace of de- 

 pression. There is nothing to suggest labia minora. An abundance of 

 hair is present, and the skin of the perineal region and adjacent thighs 

 is harsh and coarse. 



There is a definite lack of equilibrium on the part of the superficial 

 vasomotor system. The hands are cold, clammy, and often of dusky hue; 

 the skin of the body shows mottling on cooling, and the patient blushes 

 very readily. All the other reflexes are lively, but there is no cremasteric 

 reflex. 



Rectal examination shows an apparent absence of the prostate, al- 



