proficient in its use; and that the older methods are probably far
safer for the average physician.

6. That the method requires more care in its administration than can
be expected outside of the hospital in order to avoid the dangers of
fetal asphyxiation--which danger has led not a few obstetricians to
abandon it.

7. That a satisfactory technic is almost impossible of development;
that every patient must be individualized; that the chief dangers are
connected with the over dosage of morphin; that the method is not
adaptable to the general practice of the average doctor.

8. That by prolonging the second stage of labor and by sometimes
giving too much morphin, the number of forceps deliveries is greatly
increased, with their attendant and increased dangers to both mother
and child.

9. That the prospects of passing through labor which may be rendered
painless by artificial methods, tends to produce an attitude of
carelessness and indifference towards those natural methods of living
and other hygienic practices which so greatly contribute to naturally
painless confinements.

10. That this method as sometimes practiced greatly increases the
dangers of a general anesthetic, if such should be found necessary
later on during the labor.

11. That "twilight sleep" is contra-indicated (should not be used) in
the following conditions: primary inertia (abnormally delayed and slow
labor); expected short labor--especially in women who have already
borne children; when the fetal head is known to be large and the
mother's pelvis small; placenta praevia (abnormal placental
attachment); accidental hemorrhage; absent or doubtful fetal heart
beat; when labor is already far advanced; and in threatened
convulsions and eclampsia.

CONCLUSIONS REGARDING TWILIGHT SLEEP

Having presented the evidence both for and against "twilight sleep,"
it may be of assistance to the lay reader to have placed before her
the personal conclusions and working opinions of the authors. We,
therefore, undertake to summarize our present attitude and outline our
practice as follows:

1. "Twilight sleep" as a method of obstetric anesthesia in certain
selected cases and in well-equipped hospitals, and in the hands of
careful and experienced practitioners, has demonstrated that it is a
scientific reality--and has probably come to stay--at least until
better and safer methods of affecting a relatively painless
confinement are discovered; although we ar