every means to retain the membranes intact, but that is when protection for the child is needed for sometime longer.  If the suffering is very severe, during this stage, fifteen grains of chloral hydrate, well diluted with water, may be given every fifteen or thirty minutes until sixty grains have been given. (This medicine should never be given to a person with heart trouble).  I find one drop doses of the tincture of Gelsemium every fifteen to thirty minutes of benefit, especially if the womb does not dilate well, or the patient is very nervous.  The patient may receive and can receive light nourishment during this stage.

[532 Mothers’ remedies]

Management of the Second Stage.—­After the rupture of the membranes the labor proceeds faster and a termination may be expected within a reasonable time.  There is a short lull in the pains, usually, after the waters have escaped and during this time the patient should remove her clothing and put on a night dress, and to prevent its being soiled roll it well up under the arms and retain it there.  After labor it can be very easily pulled down and made comfortable for the patient.  A folded, clean, sterile sheet is now placed about the body and extremities and held in place by a cord around the waist.  The opening in the sheet should be in the right side, as this will allow the assistance being given as needed.  The powerful force of the abdominal muscles is now brought into action; the force is best utilized with the woman lying on her back.

She should now be encouraged to bear down during the pains and she will be greatly assisted by pulling on a sheet or long towel tied to the foot of the bed, or by holding the hand of the nurse.  A support for her feet frequently aids the woman.  Pressing low on her back relieves her to some extent.  In the intervals between the pains she should rest, do nothing, and be perfectly passive.  It is now that an anesthetic may be used to relieve the suffering.  She should not be put completely under its influence for that is not only unnecessary, but injurious.  Chloroform when used should be given on a handkerchief opened and loosely held over the woman’s face, and administered drop by drop on the handkerchief.  The handkerchief should be placed over the face at the beginning of the pain and be taken away as soon as the pain is stopped.  The woman inhales the chloroform during the pains and their sharpness is blunted.  Given in that way it is not considered dangerous.  It should only be pushed to unconsciousness during a forceps delivery, and even then it is not always necessary to render the woman unconscious.  I have used the forceps without giving an anesthetic.  They should be placed without causing any special pain, and assist in delivery without causing any more pain when the head is down low.  Of course if the forceps must be used when the head is high up a greater amount of anesthetic is needed.