9. That the method is of special value in sensitive, high-strung, nervous women of the "higher classes," who so habitually shun the rigors of child bearing—especially in the instance of their first child.
10. That the action of scopolamin is chiefly upon the central nervous system—the cerebrum—that it diminishes the perception of pain without apparently decreasing the contractile power of the uterus; labor may, therefore, proceed with little or no interruption, while the patient is quite oblivious to the accompanying pains.
11. That the physical and nervous exhaustion is quite entirely eliminated—especially in the case of the first labor—that patients who have had this method of anesthesia appear refreshed and quite themselves even the first day after labor.
12. That there is decidedly less "trauma" (appreciable injury) to the nervous system and therefore less "shock;" and that all this saving of nervous strain tends greatly to hasten convalescence.
13. And, finally, that "twilight sleep" does not interfere with the carrying out of any other therapeutic measures which may be deemed necessary for a successful termination of the labor.
DANGERS OF TWILIGHT SLEEP
While we are recounting the real and supposed advantages of "twilight sleep"—especially in certain selected cases—it will be wise to pause long enough to give the same careful consideration to the known and reputed dangers and drawbacks which are thought to attend this method of anesthesia in connection with labor cases.
We desire to state that these expressions, both for and against "twilight sleep," are not merely representative of our own experience and attitude; but that they also represent, as far as we are able to judge at the time of this writing, the consensus of opinion on the part of the most reliable and experienced observers and practitioners who have used and studied this method in both this country and Europe. The dangers and difficulties of "twilight sleep" may be summarized as follows:
1. That this method tends to weaken the mental resistance of many women; to lessen their natural courage and to decrease that commendable fortitude which is such a valuable feature of the character endowment of the normal woman.
2. That "twilight sleep" is essentially a hospital method and is, therefore, inaccessible to the vast majority of women belonging to the middle and lower classes of society, as well as to those women who live in rural communities.