n]
Plate 57.--Figure 13.

Fig. 14, Plate 57, exhibits the form of a congenital epispadias, in
which the urethra is seen to open on the dorsal surface of the prepuce
at the median line. The glans appears cleft and deformed. The meatus is
deficient at its usual place. The prepuce at the dorsum is in part
deficient, and bound to the glans around the abnormal orifice.

[Illustration]
Plate 57.--Figure 14.

Fig. 15, Plate 57, represents in section a state of the parts in which
the urethra opened externally by one fistulous aperture, a, behind the
scrotum; and by another, b, in front of the scrotum. At the latter place
the canal beneath the penis became imperforate for an inch in extent.
Parts of catheters are seen to enter the urethra through the fistulous
openings a b; and another instrument, c, is seen to pass by the proper
meatus into the urethra as far as the point where this portion of the
canal fails to communicate with the other. The under part of the scrotum
presents a cleft corresponding with the situation of the scrotal septum.
This state of the urinary passage may be the effect either of congenital
deficiency or of disease. When caused by disease, the chief features in
its history, taking these in the order of their occurrence, are, 1st, a
stricture in the anterior part of the urethra; 2ndly, a rupture of this
canal behind the stricture; 3rdly, the formation (on an abscess opening
externally) of a fistulous communication between the canal and the
surface of some part of the perinaeum; 4thly, the habitual escape of the
urine by the false aperture; 5thly, the obliteration of the canal to a
greater or less extent anterior to the stricture; 6thly, the parts
situated near the urethral fistula become so consolidated and confused
that it is difficult in some and impossible in many cases to find the
situation of the urethra, either by external examination or by means of
the catheter passed into the canal. The original seat of the stricture
becomes so masked by the surrounding disease, and the stricture itself,
even if found by any chance, is generally of so impassable a kind, that
it must be confessed there are few operations in surgery more irksome to
a looker-on than is the fruitless effort made, in such a state of the
parts, by a hand without a guide, to pass perforce a blunt pointed
instrument like a catheter into the bladder. In some instances the
stricture is slightly pervious, the urine passing in small qua