[Reprinted from the American Gynaecological and Obstetrical Journal 
for July, 1895.] 
THE PUERPERIUM. 
Nova Goa, Portuguese India, April 18, 1895. 
To the Editor of the American Gynecological and Obstetrical Journal : 
Sir : I desire to bring to the notice of my confreres a few cases in 
which diseases were cut short by simple means, in order that those 
who have more considerable practice may try them and compare the 
results. 
1. After-pains due to Retroflexion.-Mrs. C, aged twenty-one, on 
the second day of her third confinement complained of very severe 
after-pains which did not yield to various medicines, and even to 
quinine in large doses. Vaginal examination revealed retroflexion of 
the uterus, which was reduced by laying the patient on her face, and 
the pains stopped, but on changing the position they recurred. The 
former decubitus having been therefore maintained for three consecu- 
tive days, allowing the patient to occasionally lie on her sides, she 
was completely cured. 
2. Retention of Placenta due to Tough Membranes.-Mrs. P., aged 
twenty-five, had the membranes left untouched during her first and 
second labors until they protruded through the vulva, and the pla- 
centa had to be detached by Crede's method. In her third labor 
they were ruptured just before the full dilatation of the os to prevent 
uterine fatigue, and the third stage of the labor was normal. 
3. Inflammation of the Breast treated by Suction.-Mrs. P., aged 
twenty-six, on the thirteenth day of her third confinement had a se- 
vere pain in the right breast attended with fever and spontaneous 
flow of milk. In spite of fomentations, the symptoms became worse, 
the increase of fever being preceded by a chill. The flow of milk 
stopped, the breast enlarged, a portion of it, of a pyramidal shape' 
being indurated and tender. By oral suction at the nipple about two 
tablespoonfuls of blood were drawn at about 11 a. m. on the follow- 
ing day, and all the symptoms gradually disappeared, so that by the 
evening the gland regained its natural size and functions. 
4. Puerperal Inflammation arrested by expressing the Blood out.- 
Mrs. N., aged thirty-five, on the second day of her fifth confinement 
Copyright, 1895, BY J- ©• Emmet, M. D. Viviato Joao Pinto. M. D. 
2 
lost the child ; on the fourth had pain in the hypogastric region, 
fever, and diminution of lochial discharge. Being worse on the fol- 
lowing day, it was resolved to apply leeches, but on finding by palpa- 
tion the uterus enlarged, it was held after Crede's method of extract- 
ing the placenta, and about three ounces of blood were drawn by 
gentle compression and the patient improved rapidly. 
This case and the preceding one show that timely application of 
vacuum and compression avoided local depletion by other means. 
5. Post-partum Hemorrhage due to Suckling.-Mrs. A., aged thirty- 
three, of nervous temperament, had a laceration onshore than half of 
the neck of the uterus in her fourth labor due .to meddlesome inter- 
ference of the midwife, which bled profusely when the newborn child 
was put to the breast on the second day. The haemorrhage was stopped 
by suitable means. When it was found that suckling induced the 
bleeding it was discontinued for two days, and on again taking the 
child to the breast there was no haemorrhage. 
This case shows that in women of nervous temperament suckling 
produces haemorrhage when there is much laceration, as noticed above. 
Viviato Joao Pinto, M. D., 
Professor of Anatomy in the Medico-chirurgical School of Nova Goa.