Evening star., 1936-02-16

the direction of obstetrical anesthesia
would be an objectionable defiance
Of the Divine purpose.
The najor"y Of the medical pro-
fession, Of course, has not shared
this view, but every approach has
been rendered difficult by serious OBJ
stacles inherent in the birth process
itself. The mother must be an active
agent-although not necessarily con-
sciously active. Whatever drug is
used must be one which will eliminate
or reduce pain without inhibiting the
automatic and necessary muscular
contractions which are an essential
part of the mechanism of child birth.
Twilight Sleep" Abandoned.
One drug at one time widely used
In obstetrics was scopolamine. an
alkaloid derivative from poisonous
plant Of the potato family. Mixed
with other drugs, this was the basis
of the so-called twilight Sleep" which
was widely publicized 20 years ago
and now has passed almost entirely
out Of use. Scopolamine is extremely
poisonous, does not actually kill pain.
and only when skillfully administered
inathe right proportions with other
drugs does it produce forgetfulness.
Faced with these facts, Drs. Kane
and Roth started systematic search
for a drug Of the lowest possible
poisonous effect which would cause
the least possible excitement of the
HAffAnf houn tho aacf
both mother and child and at the
same time reduce pain to minimum.
They hit upon paraldehyde. It long
had been used in medical practice as
o hypnotic and to quiet victims of
delirium tremens.
At the outset, although paraldehyde
produced about the degree of light
unconsciousness required, and was
relatively safe to use, there were
various drawbacks. For one thing, it
was not retained easily.
Experiments with various mixtures
showed this drawback could be over
come by slight admixture of benzyl
alcohol, a mild local anesthetic.
The paraldehyde- -benzyl alcohol
analgesiac-amnesiac is the basic one
used in these cases. In cases where
1t Is not alone sufficient mild doses
OF other anesthetics-such as NOR
phtne or ethylene gas-are given at
the crucial moments of the child
birth process. This is the practice
today without paraldehyde, but, with
1t, the other drugs can be given in
much less toxic doses and less fire.
quently.
Not Perfect Analgesiac.
Drs. Kane and Roth do not assert
paraldehyde is a complete analge-
siac-but their experiences demon
strate it approaches about as near
being such as is possible in the child
birth process without interfering with
necessary functions. 1t seems to COM
bine the properties of both types of
obstetrical anesthetics. AS an anal
gesiac it reduces pain almost to the
minimum necessary in obstetrics. As
an amnesiac, it causes total forget
fulness.
The mixture Is administered when
the first labor pains are reported
and usually produces sleep within 80
to so minutes. Hence, it is a failure
In those cases where the childbirth
process is very rapid, being confined
to less than an hour. This is some
times the case with first births.
As q rule, the labor pains are much
longer, however. so that the initial
pains actually are of relatively little
consequence. Within Is to 80 minutes,
as rule, the prospective mother is
sound asleep. If she Is not, a slight
dose of morphine may be given at
the end of 30 minutes, and at the
end of an hour another paraldehyde-
benzyl alcohol treatment. These pro-
cedures, however, seldom are neces-
sary, for the sleep starts In half an
hour and continues for several hours
before it is necessary to administer
the mixture again. The second ad-
ministration can be made while the
patient still is under the effects OF the
nrst. This can be continued indefi-
nitely, so long as labor continues.
Evidence OF Activity.
says ~ report py sDF6. haue 4uo
Roth: "The patient sleeps soundly,
perhaps stirring with each pain. In
many cases the only evidence OF
uterine activity is the seeing or feel
ing ef the contractions by the OBJ
server. As the effect of the drug be-
gins to- wear OF the patient becomes
slightly restless and may complain Of
discomfort, but falls asleep immedi-:
ately after each pain. At this time
the injection Is repeated"
Only ut the final brief stage Of Che
birth process is mild dose Of more
powerful anesthetic given, such as
ether 0r ethylene. This is what now
a done without the basal anesthetic.
says ths report: .Tile patients tls-
ually sslsep soundly Tor six or eght