IIERMAPIIRODITISM. 



691 



Malformed males have been more often mis- 

 taken for females than the reverse. The varieties 

 of malformation in persons actually male, that 

 are liable to lead to mistakes with regard to 

 their true sex, appear to be, 1st, extrophy or 

 extroversion of the urinary bladder; 2d, ad- 

 hesion of the inferior surface of the penis to 

 the scrotum ; and 3d, and principally, fissure 

 of the inferior part of the urethra and of the 

 scrotum and perinaeum. 



1. Extroversion of the urinary bladder. 

 For a full description of this malformation we 

 must refer to the articles BLADDER and MON- 

 STROSITY. This malformation is known to 

 occur more frequently in the male than in the 

 female, and when present in the former it has 

 occasionally given rise to a supposition of her- 

 maphroditism, the red fungous mass formed 

 by the mucous membrane of the protruded 

 posterior wall of the bladder, and situated 

 above the pubis, having been mistaken for the 

 female vulva, an error which has probably 

 been the more readily committed from the 

 uterus and seminal ducts, and sometimes also, 

 as in an instance described by A. Fraenkel,* a 

 part of the intestinal canal opening upon the 

 surface of the exposed portion of bladder. In 

 some instances of this malformation occurring 

 in man, the external male sexual organs are 

 very imperfectly formed, or can scarcely be 

 said to be at all present. In other cases the 

 scrotum is of the natural form, with the two 

 testicles in it; and the penis is of considerable 

 size, though almost always fissured on its upper 

 surface from the epispadic or open state of the 

 urethra. 



An example of supposed hermaphroditic 

 malformation briefly described by Rueffe,f 

 which seems referable to this variety will be 

 sufficient to illustrate it. " In the year 1519 

 an hermaphrodite or androgynus," he remarks, 

 " was born at Zurich, perfectly formed from 

 the umbilicus upwards, but having at this part 

 a red mass of flesh, beneath which were the 

 female genitals, and also under and in their 

 normal situation those of the male." 



2. Adhesion of tlie inferior surface of the 

 penis to the scrotum by a band of integuments. 



This state of parts has occasionally given 

 rise to the idea of hermaphroditism, the penis 

 being so bound down as not to admit of erec- 

 tion, and the urine passing in a direction 

 downwards, so as to imitate the flow of it from 

 the female parts. 



In a boy of seven years of age regarding 

 whom Brand I was consulted, the penis was 

 confined in this manner to the scrotum by 

 abnormal adhesions. He had been baptized 

 and reared as a girl, but by a slight incision 

 the adherent organ was liberated, and the 

 parents were convinced of the mistake that they 

 had committed in regard to the sex of their 

 child. The difficulty of determining the true 



* De Organorum Generationis Deform. Rarissi- 

 ma, Berlin, 1825, with a plate. 



t De Conceptu et Generatione Hominis, p. 44. 



$ Case of a boy who had been mistaken for a 

 girl. London, 1788. 



sex of the boy was increased by the testicles 

 not having descended into the scrotum. 



Wrisberg* mentions two similar instances 

 in persons of the respective ages of nineteen 

 and forty-six. He relieved the adherent penis 

 in the first case by operation. 



3. Fissure of the inferior part of the ure- 

 thra, perineum, fyc. This species of mal- 

 formation, which has perhaps more frequently 

 than any other given rise to the idea of the 

 person affected with it being the subject of 

 hermaphroditism, evidently consists in an arrest 

 of the development of the external male sexual 

 parts. 



At an early stage of the development of the 

 embryo, the various central sexual organs are, 

 like all the other single organs situated on the 

 median line of the body, found to be composed 

 of two separate and similar halves, divided 

 from each other by a vertical fissure, which, 

 after the originally blind extremity of the intes- 

 tinal canal has opened upon the perinaeum, 

 forms a common aperture or cloaca for the 

 intestinal canal, and also for the urinary and 

 genital apparatus, both of which are, in their 

 primary origin, prolongations from the lower 

 part of that canal. After a time, (about the 

 second month in the human embryo,) the 

 opposite sides of this cloaca gradually approxi- 

 mate, and throw out two corresponding folds, 

 which by their union constitute a septum that 

 separates the rectum from the canal or portion 

 of the fissure, that still remains common to 

 the urinary and generative organs ; and, in the 

 same way, by two similar and more anterior 

 folds, the urethra of the female, and the pelvic 

 portion of that of the male is subsequently 

 produced. After this in the female the process 

 of median reunion does not proceed further, 

 and the primary perinaeal fissure remains, form- 

 ing the vulva ana vagina. In the male, how- 

 ever, the development, when normal, goes on 

 to a greater extent, and the sides of the opening 

 become so far united as ultimately to leave only 

 the comparatively contracted canal of the urethra 

 to serve as a common passage for both the 

 internal urinary and genital organs; and the 

 situation of the line of junction of the opposite 

 sides of the original perinaeal cleft remains still 

 marked out in the adult, by the raphe existing 

 in the median line of the scrotum. The two 

 lateral parts of the female clitoris unite together 

 into one solid body, having on its under sur- 

 face a slight groove or channel, indicative of 

 the line of conjunction of its two component 

 parts ; and the urethra is left to open at the 

 root of this iraperforated organ. In the male, 

 on the contrary, the two primitive halves of 

 the penis, consolidated together at an early 

 stage along the course of their upper surfaces, 

 come, in the progress of development, to unite 

 inferiorly in such a manner with one another as 

 to form a tubular prolongation of the pelvic 

 portion of the canal of the urethra, which is 

 gradually extended forwards along the body of 

 the penis and ultimately through its glans. 



Many of the malformations to which the 



* Comment. Med. &c. Arg. p. 534. 

 2 z 2 



