be very
easily pulled down and made comfortable for the patient. A folded, clean,
sterile sheet is now placed about the body and extremities and held in
place by a cord around the waist. The opening in the sheet should be in
the right side, as this will allow the assistance being given as needed.
The powerful force of the abdominal muscles is now brought into action;
the force is best utilized with the woman lying on her back.

She should now be encouraged to bear down during the pains and she will be
greatly assisted by pulling on a sheet or long towel tied to the foot of
the bed, or by holding the hand of the nurse. A support for her feet
frequently aids the woman. Pressing low on her back relieves her to some
extent. In the intervals between the pains she should rest, do nothing,
and be perfectly passive. It is now that an anesthetic may be used to
relieve the suffering. She should not be put completely under its
influence for that is not only unnecessary, but injurious. Chloroform when
used should be given on a handkerchief opened and loosely held over the
woman's face, and administered drop by drop on the handkerchief. The
handkerchief should be placed over the face at the beginning of the pain
and be taken away as soon as the pain is stopped. The woman inhales the
chloroform during the pains and their sharpness is blunted. Given in that
way it is not considered dangerous. It should only be pushed to
unconsciousness during a forceps delivery, and even then it is not always
necessary to render the woman unconscious. I have used the forceps without
giving an anesthetic. They should be placed without causing any special
pain, and assist in delivery without causing any more pain when the head
is down low. Of course if the forceps must be used when the head is high
up a greater amount of anesthetic is needed.

Dr. Manton, of Detroit, says:--"The dangers of anesthetics are the same
when employed for obstetric purposes as in surgery, and then use should be
governed by the same rules in each instance." As soon as the head begins
to dilate the vulvar opening, the patient should be turned on her left
side with her knees drawn up and her body lying diagonally across the bed,
with the buttocks close to and parallel with the edge. This position
allows the physician to give better assistance and is no harder for the
patient.

[OBSTETRICS OR MIDWIFERY 533]

The physician with his hands thoroughly sterilized and with a clean
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