he pain.

It is our custom to begin "sunrise slumber" as soon as the uterine
contractions become painful. The earlier the gas is started, the more
oxygen should be used. Two or three inhalations will suffice to take
the "edge" off the earlier and lighter pains. When the pains grow
heavier we use less oxygen and permit three or four deep inhalations
just before a bearing-down pain. At the first suggestion of a
contraction, the patient must begin to inhale the gas; while after the
patient has pulled hard on the traction strops--just as the
contraction pain is passing--she is given an inhalation containing a
larger percentage of oxygen.

At the beginning of a pain, pure nitrous oxid is administered, and the
patient is instructed to breathe deeply and rapidly through the nose.
The gasbags should be about half filled. The mixture of gas and oxygen
must be determined by the severity of the pains and individual
behavior of the patient.

Four to six inhalations of the gas are sufficient to produce the
required analgesia in the average case. Following the first few deep
inspirations through the nose, the patient can be instructed to
breathe through the mouth, while the gas is well diluted with oxygen
and continued until the end of the pain. In this way a satisfactory
analgesia is maintained throughout the "pain" with a minimum of "gas."
The proportion of oxygen used will run from nothing up to ten per
cent. This procedure is repeated with the occurrence of each pain.

The use of the "mask" is just as effective as a nasal inhaler, but
wastes more gas and so is more costly.

When the head is passing the perineum the gas should be pushed to the
point of anesthesia, while the patient's color will suggest the amount
of oxygen to be used as well as serve to control the administration of
the nitrous oxid.

CHLOROFORM AND ETHER

For many years chloroform and ether have been used to alleviate the
pains of women in labor. Valuable as these agents are when deep
anesthesia is required for the carrying out of operative procedures,
they have not proved satisfactory as analgesic agents. If administered
in small quantities at the commencement of a strong uterine
contraction, the patient does not usually inhale sufficient to abolish
pain. She is then apt to be irritated and is certain to insist on
being given a larger quantity. If a sufficient amount be administered
to satisfy the woman, the continued repetition gradually inhibits the