Hyoscine=Hydro and Morphia

Kai Tiaki : the journal of the nurses of New Zealand, Volume II, Issue 3, 1 July 1909, Page 113

Hyoscine=Hydro and Morphia

Extract from a letter to the Editor on " The Use of Hyoscine-Hydro and Morphia to produce Complete Anaesthesia During Labour."

"To me, this treatment is the most interesting thing since I qualified, and I think its benefits to women ( labouring of child ' will be almost incalculable, second only to forceps and chloroform. The dose I use is an initial one of 1-150 gr. Hyosc, and 1-6 gr. morphia, given hypodermically. This is the nearest I could get to Kroning's dosage, which is hyoscine, 0.00045 gram. (equal to about 1-142 gr.). Kroning found that this began to affect his patients in about half or three-quarters of an hour. He gives a second dose in an hour's time of about 1-400 gr. to 1-200 gr., according to the state of the patient ; subsequent doses, if needed, of the same strength. At St. Helens Hospital we use a rather different dose : beginning with hyoscine, 1-100 gr., and morphia, 1-4 gr., and do not always repeat it. The dosage requires a great deal of experience, and constant supervision to get the best results. My greatest difficulty is that patients respond so differently to the same dose. What will send one sound asleep will have little or no effect on another. This is not mentioned by Kronig. He, however, uses 1 solutions, and I have only used tablets or tabloids, and it is just possible that the quantity of drug in each tabloid may not be quite consistent. However, in a successful case"you can get a state of 'dammer schlaf/ or ' dawning sleep ' and the patient while not quite unconscious, and complaining of her pains, still has no recollection of them next day, and will declare labour to have been painless, or almost so. For instance, I went to see one patient at St. Helens, who was having hyoscine, and she declared she could not stand it another minute, and wouldn't I do something for her ? Next day she greeted me as a stranger, and would not believe she had seen me before. Another patient, who began in the bedroom, in awakening in the Iyabour Ward, looked round with unfeigned astonishment at the white walls, and said : ' They were green last time I looked at them.' She had no recollection of being moved from one room to another. Hyoscine possesses this advantage over chloroform, that it may be given quite early, in the first

stage if desired, and having once been injected the physician need worry about it no further, and can have both his hands free for other duties. I think its effects willfbe farreaching too, in other ways — particularly affecting the use of forceps. Although, in common with any other narcotic, it somewhat lessens the voluntary powers, important at the end of the second stage. The patient is subconscious only instead of unconscious, and can be aroused to at least spasmodic efforts. This small lessening of the voluntary powers may increase slightly the proportion of forceps cases in maternity hospitals, but hyoscine will certainly much diminish it in private practice, when forceps are chiefly used, not because a patient cannot finish the labour unaided, but because she knows there are such things as forceps and chloroform in the world, and cannot see what she is paying a doctor for if she is not to have the benefit of them ! (One has every sympathy with her point of view). " With Hyoscine in private practice, she sleeps between the pains, and does not rouse up very much even then. Her sense of the passage of time is put out of gear ; she doesn't know how long she has been ill — (she cannot remember back half-an-hour). Her pain is deadened, so that she doesn't send for her physician about half-way through the first stage, and weary him with importunings for chloroform ; importunings to which he generally succumbs a long time before he theoretically ought, with the consequence that his patience is exhausted, and his time, and he terminates labour with forcept as soon as conditions ill admit of it. ' ' The only thing I have found at all against it is that the babies are often very sleepy. They do not resent their, arrival into this world jwith the energy they should; and it often takes a lot of slapping and shaking 1 to make them cry lustily. " With regard to the formation of a morphia habit ; Ido not think it is in the least likely. One small dose of morphia, or at most two, isfgiven at a time of physical extremity, when all conditions are so unusual that I think the patient would not associate

the deadening of the pain then, with the possible "deadening of any pain or mental depression she may suffer in an ordinary way. I would as soon expect a cocaine habit after a visit to a dentist who has extracted an eyetooth under that ' dope.' However, I always make a point of telling patients dt is not morphia they're getting, but a brand-

new, very-special drug from Germany. If I am absolutely forced to give it a name, I say it's ' a hydrobromate,' and in spite> of our system of public education, have not yet struck a patient whom this answer failed to satisfy. Faithfully yours, Eleanor h. Baker, M.8., B.Ch., Iy.M. (Christchurch, 26th June, 1909).