Labor is well established, the os is dilated to the size of a fifty-cent piece, more or less, and the contractions and general condition indicate that there is to be no cessation of symptoms until your patient is delivered.

She is begging you to do something for her. You have made out your diagnosis and reassured your patient, but now the severity of her symptoms is such that she feels that she must have help. You have the reputation of using chloroform, and she would not be satisfied unless you did use chloroform. You are waiting for the right psychological moment - she has patiently endured her sufferings, and feels that she can hold out no longer without help that she has not received. You have assured her that she is doing well, that every indication is for a safe delivery, and that you are going to use chloroform, so that she will not suffer. The urgency of the occasion grows more imperative and you decide to make another digital examination.

As this is completed, say, "All right, madam, be patient and bear strong and hard to the next pain, and just as that leaves you I will give you chloroform, so that you will get well under its influence by the time another contraction comes, and you will not suffer any more."

Just as the contraction has expended its energy, synchronously with the first inspiration after a long bearing down, shake about thirty drops of chloroform upon a handkerchief in a paper cone or which you have placed in a tumbler, and, placing that close over her nose and mouth, suggest to her strongly, "Breathe this down now, and go to sleep." She takes a deep inspiration, and you quickly and strongly suggest, "Breathe it in again, and now again, away down deep."

The three deep inspirations from the thirty drops of chloroform administered in this way at this particular moment have sufficient physiological effect to annihilate completely the receding contraction, and these three deep inspirations in succession, together with the physiological effect of the chloroform, secure the thorough relaxation of your patient. She is now in a receptive condition, and you must quickly, but emphatically and distinctly, follow this up with your suggestions to get her into a deeper suggestible condition or into a hypnotic state.

So, removing the cone or glass about two inches from her nose, you proceed to suggest, "Now, go to sleep, sleep, sleep, sleep. Now you feel quiet all over. Your muscles are relaxed. Everything is dark to you. You do not hear anything but my voice. You are drowsy and sleepy, s-o-o-o-o sleepy. You feel the sleep coming over you. You are going to sleep, sleep, sleep, sleep. By the time I count ten you will be fast asleep. One, two, three, four, five, six, seven, eight, nine, ten, and you are asleep, fast asleep. By the time I count five you will be sound and dead asleep. One two, three, four, five, and you are asleep, fast asleep, sound asleep, dead asleep, and you will not awaken now until I tell you. Every second your sleep becomes sounder and sounder, and deeper and deeper. You will not hear anything, or feel anything, or know anything, except what I tell you. Sleep on quietly now until I awaken you."

Your patient is now in a deeper condition of suggestibility, but you want to take an additional precaution to secure more thorough relaxation, so, without the addition of more chloroform, you bring the cone or glass closer to her nose and suggest, "Breathe deeply, deeper yet, once again away down deep. There, now, you are thoroughly relaxed."

Then, stroking her forehead gently, make suggestions about as follows: "Sleep on quietly. Now your nerves are getting steady, and quiet, and strong - steady, and quiet, and strong all over. By the time I count ten the last bit of nervousness will be gone, and your nerves will be steady, and quiet, and strong all over. One, two, three, four, five, six, seven, eight, nine, ten, and your nerves are steady, and quiet, and strong all over."

"Now, on account of the sedative effect of the chloroform upon you, you feel all pain, or aching, or soreness, or hurting about your abdomen, or back, or womb going away; you are getting easier and easier, and by the time I count five you will be perfectly easy and not suffer any more. One, two, three, four, five, and you are perfectly easy.

"Now your labor will be regular and normal; you will labor hard, but will feel no pain. Your contractions will be strong, the mouth of your womb will dilate and open easier, but you will feel no pain.

"Sleep on, and when the next contraction comes reach up your hands, and bear down strong and long, but you will feel only a pressure - you will not experience any pain."

As the contraction again becomes evident, say to your patient, "Bear down hard now; it will not hurt you. That is fine; stronger yet, more yet. There, now, take more chloroform and go into a deeper sleep."

Here you put about twenty drops of chloroform on the handkerchief in the cone or glass and make a few additional suggestions about as follows: "Sleep, sleep, sleep, sleep, breathe deeply, sleep soundly. Now sleep on quietly until the next contraction, and then don't wake up - just reach up your hands and bear down, but sleep on."

As this contraction recedes you give about ten drops more of chloroform and make a few additional suggestions.

By that time your patient is sufficiently amenable to suggestion to the extent that I have frequently had patients go two hours in labor without more than the slightest complaint, getting them to relax thoroughly after each contraction and making a few additional suggestions.

Toward the latter part of the second stage of labor, with the last two or three expulsive pains, it is best that you give chloroform at the beginning of the contraction for its physiological effect, using it freely and effectively, as it enables you to manipulate the head and perineum, and render such assistance as best to prevent laceration.

I have yet to see the first case of post-partum hemorrhage in a case where suggestion was used, though I have always followed the expulsion of the child with my left hand and grasped the fundus of the uterus after Crede's method. Post-partum hemorrhage is largely a nervous phenomenon, and properly directing and controlling the psychic factor is a safeguard against it, though I never neglect any other precaution, and consequently I have never had any trouble on this score.

A rigid os indicates an irritable involuntary nervous system, and it rapidly disappears when the psychic factor is properly directed as above outlined. Your success will be in direct ratio to the extent to which you secure thorough relaxation of the patient and properly make suggestions.

The patient need not necessarily be asleep; a merely partial subconscious condition is attended with excellent results, provided you have the confidence and co-operation of your patient, and this it is your privilege to gain very quickly after you enter the room.

A nervous physician is undoubtedly a menace to the welfare of an obstetric patient, for nervousness begets nervousness and fear begets fear. Self-control and self-confidence on the part of the accoucheur carry, all unconsciously, a wonderfully helpful influence.

Don't neglect any other therapeutic resource. An obstetric patient of mine had two sisters, each of whom died of eclampsia in her first labor. The effect of such a family record was most depressing upon her. During the last weeks of pregnancy I saw her every few days, and assured her positively that the treatment on which I had her would prevent any such occurrence. She was a plethoric, full-blooded woman, and the secundines were removed with practically no hemorrhage at all. A severe headache, extreme nervousness, and rapid, full pulse which followed required not only large doses of veratrum hypodermatically, but free bleeding also, as well as suggestion in the form of reassurance, persuasion, and encouragement, with large doses of calomel and jalap.

To a patient who had aborted after four months, and had considerable hemorrhage and was almost pulseless, I suggested strongly and loudly, upon making an examination, "You will be all right. Be brave, madam; you will have no trouble, etc.," though I proceeded to clear and pack her uterus.

In a case of twins I "chloroformed" my pol administered by inhalation and suggestion, and used forceps on the first child and internal version on the second with perfect success.

Ten drops of chloroform given to a patient after each contraction while she is thoroughly relaxed, passive, eyes closed, and breathing rhythmically through her mouth, and suggestions made in a monotone, conversational way, to quiet nervousness and render the patient conscious that something was being done for her, is attended with excellent results without any farther effort to induce hypnosis.

The confidence of the patient in her physician can be considerably augmented by properly directing the psychic factor in obstetrics, and the welfare and safety of the patient are rendered far more certain.

In a case of an abortion at five months, before the expulsion of the uterine contents, which was attended with much hemorrhage, I packed the vagina and put on T-bandage, hypnotized the patient, made appropriate suggestions, and went away, returning in three hours to find that the patient had been easy, but upon removal of the packing both fetus and secundines came away together.

A patient who once has the assistance of a physician who properly directs the psychic factor will instinctively feel that she has never before had the right attention in her previous confinements.

A number of physicians of my acquaintance have been able to execute successfully the above described methods greatly to the satisfaction of themselves and patient.

Your success in obstetrics, as in all other classes of work, will be in direct ratio to the integrity and stability of your patient's nerve and brain plasm on the one hand, and your ability to present suggestion properly on the other.

The ideas suggested in this chapter are of value to the individual physician in direct ratio to his ability to appropriate and use them.