as," patients often appear to "bear down"
with increased energy. It certainly does not lessen their cooperation
in this respect.

9. We have not observed, nor have we learned of, any cases of inertia
(weak and delayed contractions), post partum hemorrhage, or shock, as
a result of "laughing gas" or "sunrise slumber" analgesia.

10. This method lends itself to perfect control--it may be decreased,
increased, or discontinued, at will; it may be given light now and
heavy at another time; while, at the height of labor, it may be pushed
to the point of complete anesthesia, if desired.

11. We have found "sunrise slumber" (nitrous oxid) analgesia to be the
ideal obstetric anaesthetic, and have adopted it quite to the
exclusion of both chloroform and "twilight sleep." We find that this
form of analgesia has all the advantages of "twilight sleep" without
any of its dangers or disadvantages.

12. A possible objection to the nitrous-oxid method is the cost,
especially in the private home. The average cost in the hospitals
where we are using this method runs about $2.00 for the first hour and
$1.50 for each hour thereafter. This is the cost when using large
tanks of gas, and is, of course, somewhat increased when the smaller
tanks are used in the patient's home.

METHOD OF ADMINISTRATION

Since it was thought best to give the reader some idea of the technic
for the administration of "twilight sleep," it may not be amiss to
explain how "sunrise slumber" is usually employed in labor cases. The
technic is very simple. The administration of the gas is generally
begun about the time the patient begins seriously to complain of the
severity of the second stage pains; although, of course, the gas can
be given during the first stage pains if desired. In the vast majority
of cases, however, we think it is best to encourage the patient to
endure these earlier and lighter pains without resorting to analgesic
procedures.

The form of apparatus used is the same as that employed by dentists
and contains both nitrous oxid and oxygen cylinders. A small nasal
inhaler is best, although the ordinary mouthpiece will do very well.
The gasbag attached to the tank should be kept under low pressure and,
as a pain begins, the patient is told to breathe quietly, keeping the
mouth closed. As a rule this sort of light inhalation serves to
produce the desired analgesic effect. It is not necessary to put the
patient deeply under in order to relieve t