A Letter to the Publisher from Mr Bussiere, F. R. S. concerning a Triple Bladder, etc.

V. A Letter to the Publisher from Mr Bussiere, F. R. S. Concerning a triple Bladder, &c. According to my promise, I send you the description and figure of the triple Bladder which you saw lately, at a meeting of the Royal Society; it is so extraordinary a case, that I do not question but it will be very acceptable to you. There is indeed some account of a double Bladder found in the body of some men; as for instance, that which was found in the body of the famous and learned Casaubon; but there is none of three Urinary Bladders in the body of a man. I do not say however that the same case might not have been in some others, but there is no mention made as yet in any Author that I know; the opening of dead bodies is too much neglected; and I do not question but if Physicians were a little more careful to search, or cause to be searched in the bodies of them that dye of extraordinary distempers, they would find sometimes, that which they attribute to the alteration of the blood or humour, dependeth meerly on an extraordinary conformation of parts. This triple Bladder found in the body of the late Mr Booth will be a proof thereof; but before I give the description of it, I think it necessary to give you an account of the Symptoms which that Gentleman did undergo by the conformation of his Bladder, and of the cause of his death. In his best health, he could not make his water in a full and continual stream, the Urine running out but by little and little, and with great efforts of inspiration, chiefly when there was but little quantity of it in the Bladder. Bladder, which did fatigue him very much, though the passing of the Urine through the neck of the Bladder was not painful; except the two or three last years of his life, because of a thick Mucus, which then discharged with the Urine. That Mucus growing in greater quantity of late, made him apprehensive it had been caused by a Stone in his Bladder; upon such thoughts he apply'd himself to one, in order to be searched by him, who accordingly introducing his Catheter, and meeting with some resistance in the Urethra, did force the Catheter through the Membranes, and made such dilaceration in them, that the Patient lost immediately a great quantity of Blood; which bleeding continuing for ten days, without his seeking for any help, brought him under very great torments, by reason the blood being grumulous in the Urethra, could not be forced out but by very violent efforts and acute pain, which caused a mortification in the part, of which he dyed. The next day after his death, I did open the body, in presence of Drs Dames, Chamberlain, Woodward, Mr Bernard the Chirurgeon, and several others; in which the natural Urinary Bladder was found lying on the left side of the Pelvis upon the Ilium Bone, then searching what should be the cause of such unnatural situation, we did find one large and round bag, lying under the Pubis upon the Rectum, filling up all the cavity of the Hypogaster; then in order to examine the thing more exactly, I did dissect the Penis and the Rectum, and having taken them out of the Body, and laid them down upon a Table, the first thing I did was to lay open the Urethra, to examine whether there was any carnosity, as the Surgeon who first introduced the Catheter had suspected; but there was none: and that Ductus was as plain and found as could be, except the dilaceration which the Catheter had made in it; then having introduced a Conductor into the Bladder, I divided it quite; and first it was observed, that the round bag, which was made up of two Bladders, or rather two Cystis's, divided one from the other only by a Membrane, that which was next to the true Bladder was something bigger than the Bladder, the other which was lying on the right side being much lesser; each of these two Cystis's had its orifice open in the neck of the natural Bladder, which was longer than it is naturally, as you may see in the Figure. None of the Ureters were inserted into any of these Cystis's, but they were inserted into the neck of the true Bladder, by the orifices of the two Cystis's, insomuch that the Urine could be equally received by them and the Bladder. Secondly, It was observed that the glandules of the true Bladder were extraordinarily big and red, that colour being, very likely, the effect of the inflammation caused by the dilaceration of the Urethra. I have oftentimes observed that a thick Mucus, which runneth out of the Bladder, and which some think to be the matter of an Impostume or Ulcer in the Kidneys, is only produced by those glandules of the Bladder grown scrophulous, when that Mucus groweth thick and clammy, it causeth the same pain on the neck of the Bladder as if it were a Stone. The glandules of the great Cystis were very sensible, but very small, they were not at all sensible in the smaller Cystis. Now it is easie by the description of these Bladders, to give a reason of the symptoms that Gentleman did undergo, for by the situation of the great Cystis, it is plain that the Water could not come out but by the force of the inspiration, its own Muscles being not able to force it out, and consequently could not come out but but by little and little; and these efforts of inspiration were to be the greater when there was but little quantity of Urine, because it required greater force to make it ascend from the bottom of the Cystis, which could not be done but with great labour and fatigue. The pain which he did suffer in the late years of his life, was caused by the thickness of the Mucus running out of the glandules of his Bladder, his Kidneys being very good and sound. Explanation of the Characters in the Figure. A A the body of the true Bladder, 1, 2, 3, 4, 5, 6, its glandules. B B the great Cystis. C C the smaller Cystis, 1, 2, 3, its wrinkles. D part of the true Bladder overturned: E the neck of the Bladder. F F F F the two Urethra's. G the insertion of the Spermatick Vessels in the Urethra. H H the Prostates. I I Vesiculae Seminales. K K Vasa Deferentia. L the Urethra. M M the erectores Muscles. N the Penis.