ep" injections are not started until the patient is
in the stage of active labor. The initial injection consists of the
proper dose of scopolamin and morphin (or some of their derivatives),
while the patient's pupils, pulse, and respiration are carefully
noted, as also are the character of the uterine contractions and the
character of the fetal heart action.

Usually within an hour, a second dose of scopolamin is given, while
the application of so-called "memory tests" serves to indicate whether
it is advisable to administer additional injections. Some leading
advocates of this method claim that the majority of the unfavorable
results attendant upon "twilight sleep" are the direct result of
failure to control the dosage of the drug by these "memory tests;" and
they call attention to the large percentage of "painlessness" as proof
of probable overdosing. If the patient's memory is clear and she is
not yet under the influence of the drug, a third dose is soon given.
If, however, the patient is in a state of amnesia (lack of memory),
this third injection is not commonly given until about one hour after
the second injection. The amount of amnesia present is used as a guide
for repeated injections at intervals of one to one and a half hours.
As a rule, the morphin is not repeated.

It must be evident that the success of such a method of anesthesia
must depend entirely upon thoroughgoing personal supervision of the
individual patient by a properly trained and experienced physician;
and it is for just these reasons that "twilight sleep" is destined to
remain largely a hospital procedure for a long time to come.

Experience has shown that those cases of "twilight sleep" that are not
under the influence of scopolamin over five or six hours do vastly
better than those under a longer time. When employed too long before
labor this method seems to favor inertia and thus tends to increase
the number of forceps deliveries.

The number of injections may run from one to a dozen or more, and
patients have come through without accident with fifteen or more
doses, running over a period of twenty-four hours.

THE CLAIMS OF "TWILIGHT SLEEP"

While "twilight sleep" as a method of anesthesia is not altogether
new, many of the claims made for it by recent advocates are more or
less new; and, to enable the reader clearly to comprehend both the
advantages and disadvantages of this method, both the favorable and
unfavorable facts and cont