EFFECTS OF NITROUS OXID
It will not be necessary to compare the favorable and unfavorable claims for nitrous oxid as we did the contentions for and against "twilight sleep." Whatever service "laughing gas" or "sunrise slumber" can render the cause of obstetrics we can accept, knowing full well that, in competent hands, it can do little or no harm; and this we know from the facts herewith recited and from the further fact that we have gained a wide experience with this agent in the practice of both dentistry and surgery. In a general way, the influence of "sunrise slumber" on mother and child may be summarized as follows:
1. It can accomplish its purpose—can quite satisfactorily relieve the mother of severe pain—when employed as an analgesic. It is not necessary to administer the gas to the point of anesthesia except at the height of suffering at the end of the second stage of labor, when the head of the child is passing through the birth canal.
2. This method can be stopped at any moment—the patient ran be brought out from under its influence entirely and almost instantaneously. It is not like a hypodermic injection of a drug which may exert a varying and unknown influence upon the patient, and which, when once given, cannot be recalled.
3. It is a method which may be used in the patient's home just as safely as in a hospital; the only drawback being the inconvenience of transporting the gas-containing cylinders back and forth. This is even now partially overcome by the improved combination gas and oxygen form of apparatus which has been devised.
4. The administration of nitrous oxid analgesia or anesthesia does not interfere with or lessen the uterine contractions or expulsive efforts on the part of the mother—at least not to any appreciable extent.
5. Just as soon as a severe uterine contraction—attended by its severe pain—begins to subside, the gas inhaler is immediately removed, and in a few seconds the patient is again conscious. It is not necessary to keep the patient continuously under the influence of the drug, as in the case of the scopolamin-morphin method of "twilight sleep."
6. This method ("sunrise slumber") is certainly far more safe in ordinary and unskilled hands than the "twilight sleep" procedure. The patient is more safe with this method in the hands of the average doctor or trained nurse.
7. It has been our experience that nitrous oxid in the smaller, interrupted and analgesic doses, actually tends to stimulate the uterine pains and contractions, while at the same time rendering the patient quite oblivious to their presence. When properly administered, the freedom from pain is perfect.
8. Under the influence of "gas," 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.