In his report Polak says he has had no failures; the patients had no recollection of the labor; in the first series of fifty-one the children showed no sign of asphyxiation or even cyanosis except in two cases. In this first series one patient had a long second stage and the child had to be resuscitated. There were, he said, no post-partum hemorrhages; no low forceps; the placentas were delivered without difficulty; none of the women showed signs of tire or exhaustion the next day; in fact, they were better off than the women who have normal labor. This report is different from that made by other men just as competent, and in exactly the same circumstances; even Gauss confesses many failures. The lay journals say Gauss had no failures, but he himself should know. In April, 1915, I was told in New York City that there had been no failures there, yet in May, Dr. Broadhead, professor of obstetrics at the Postgraduate School of Medicine in that city, after observing seventy-two cases confessed[208] several failures where the child was concerned. One Catholic woman, a member of the executive committee in a Twilight Sleep League of married and unmarried women, was killed in Brooklyn by the method in the summer of 1915.
Dr. Charles M. Green, professor of obstetrics in Harvard University, tells us:[209] "My own observations, published in 1903, led me at the time to favor this therapeutic means of producing the 'Twilight Sleep,' and removing the consciousness of pain, or at least preventing all remembrance of it. I have long since abandoned this agent, however, for two reasons: First, because it has apparently been the cause, occasionally, of fetal asphyxia. Second, because the effect of the drug on the mother is often uncertain, and unless used with great care may cause unfavorable or dangerous results. Moreover, we have other and safer measures for the relief of pain in labor. So I have given up teaching the use of scopolamine in my lectures."
Dr. Williams, professor of obstetrics in Johns Hopkins University, and the author of a book on obstetrics which is very valuable, says:[210] "We have used the scopolamine treatment of childbirth in two separate series of cases at the Johns Hopkins Hospital, but in neither series were the results satisfactory, nor did they in any way approach the claims made for the treatment. We expect to do more with it next year." In the fourth edition of his Obstetrics, published in 1917, he thinks that the twilight sleep method will fall into disuse, or at least that its use will be restricted to a small group of neurotic patients. From his experience, he says, the method is not adapted for private practice.
Dr. Hirst, professor of obstetrics in the University of Pennsylvania, tried the scopolamine treatment in the maternity hospital of the university in about 300 cases at three different times. He tried it first in 1903, but he found that if sufficient morphine is given to abolish pain there is danger of hemorrhage in the mother and of asphyxia in the child. At a meeting of the Obstetrical Society of Philadelphia[211] Hirst, commenting on a paper by Polak, said: "I am sorry to say I cannot agree with my friend Dr. Polak in his conclusions ... I had to discontinue morphia and scopolamine because there were too many cases of post-partum hemorrhage, too many cases in which forceps had to be used, too many asphyxiated babies. So I am not an enthusiast for 'twilight sleep.'"
Dr. Joseph B. De Lee, professor of obstetrics in the Northwestern University Medical School, Chicago, and the author of a book on obstetrics which is now one of the best we have in English, tells us[212] that the impressions he received from studying ten cases of childbirth in Professor Krönig's clinic at Freiburg were "decidedly unfavorable to the method of 'Twilight Sleep.'" In all the ten cases, he testifies, the birth pains were weakened, and labor prolonged—in two instances for forty-eight hours. In three cases pituitrin, which is in itself a dangerous drug to use before the uterus has been almost emptied, had to be given to save the child from imminent asphyxia. In five of the cases forceps had to be used owing to the paralyzing effects of the drug, and all these forceps cases were extensively lacerated. Several of the women became so delirious and violent that ether had to be used to quiet them, with the result that the infants were born "narcotized and asphyxiated to a degree." One child had convulsions for several days.
The complete failure in these ten cases is so obvious as to be a scandal, although De Lee does not say so. He abandoned the use of the method twelve years ago, and in 1913 he visited the maternities at Berlin, Vienna, Munich, and Heidelberg, and found that all had tried the method and had rejected it.
Several so-called detoxicated substitutes for morphine, like "tocanalgine" and "analgine," have been tried; but these turned out to be morphine, and to be equal in strength to morphine as we ordinarily have it. These were the drugs that were advocated in the Cosmopolitan Magazine as "having nothing to do with the morphine-scopolamine treatment originating some years ago in Freiburg." They are morphine treacherously disguised, and the assertions in the Cosmopolitan were never retracted when attention was called to the untruth by the Journal of the American Medical Association. In the American Journal of Obstetrics for May, 1915, is a full description of these drugs (page 772).
Dr. Joseph Baer reported[213] sixty cases of the morphine-scopolamine treatment at the Michael Reese Maternity Hospital in Chicago, and his results were diametrically opposed to those Dr. Polak himself obtains. The rooms used were large, and had cork-lined sound-proof walls and doors; obstetricians and specially trained nurses were present day and night. The circumstances, then, were the best that could be had.
He used Merck's scopolamine at first, and later a solution made up after the formula of Straub of Freiburg, which is more stable. His doses of morphine were from one-eighth to one-fourth of a grain; Gauss uses one-eighth to one-sixth of a grain; Polak, as much as three-fourths of a grain of narcophin for his first dose.
Baer's series ended on February 5, 1915, and of his sixty cases only five were successful. Three of the successful cases received one-fiftieth of a grain of scopolamine in all, and some of the unsuccessful cases got as high as one-sixteenth of a grain, with only wild delirium as a result.