HYPOSPADIAS.
Where the deficiency in the floor of the urethra is confined to that part of it which traverses the glans, the case will require no interference unless there should be a constriction or stricture at the outlet of the passage which may require dilatation or incision and muco-cutaneous suture. Where the deformity exists in the penile portion of the urethra there is usually much curving of the penis, and urination causes great discomfort from the direction in which the stream flows; it will be neces sary to remedy the arching of the penis by a deep and free incision made in a transverse direction across the median groove. By extending the organ and suturing the margins of the wound in the vertical direction the penis becomes straight. Afterwards a new floor for the urethra may be made by dissecting a flap from the cutaneous covering of the lower part of the penis or scrotum.
When the floor of the urethra is absent as far as the perineum the condition resembles that which is seen in sonic Australian tribes. The writer exhibited, many years ago, a specimen of artificial hypospadias which he found in an aboriginal of the interior of Australia. He ascer
tained from an explorer that at least one tribe in the centre of that Continent performs the serious operation of slitting the male urethra open from the glans backwards, through the perineum towards the bladder, evidently with the view of preventing procreation. A careful examination of the specimen proves to what extent the most serious plastic operations may be carried out when recovery follows a barbarous mutilation undertaken without anatomical knowledge, and performed with the crudest of instruments, and without the slightest conception of the necessity of aseptic methods.
The treatment of the congenital variety of this perineo-scrotal hypo spadias which simulates hermaphroditism can only be carried out by a very elaborate and extensive series of plastic operations which seldom prove successful. As the determination of sex is often impossible in these cases it is a wise rule to bring up the child on the supposition of its belonging to the male sex, and not to attempt surgical interference with the deformity.