The condition of the patient's pulse, respiration, pupillary reaction, and the frequency and character of the uterine contractions are constantly watched, to guard against poisoning. Fonyo[206] reported two fatal poisonings by the scopolamine-morphine method as used in surgery. Both were operations for the delivery of women by laparotomy, and in each case the centre of respiration was overwhelmed. In each of these operations only one-hundredth of a grain of scopolamine and one-third of a grain of morphine had been used, but chloroform was administered later. Robinson recently reported the fatal poisoning of a negress by scopolamine, and Chandler of Philadelphia two more where one thirty-third of a grain of scopolamine had been used. One-ninetieth of a grain given hypodermically has caused severe toxic disturbance which lasted for twenty-eight hours, and Root[207] reported a case where one three-hundredth of a grain given by mouth poisoned violently. [206] _Zentralblatt f. Gynäkologie_, September 19, 1914. Leipsic. [207] _Therapeutic Gazette_, vol. ii. In Freiburg, Gauss tests the consciousness of the women about every half hour by showing them some object, and if they remember having seen this object he gives an additional dose of scopolamine. Polak says this memory test is not necessary: even if the patient gives outward evidence of pain by cries and motion, she is apparently but very dimly conscious in his opinion. The progress of the delivery must be constantly watched by repeated extraäbdominal or rectal examinations, following the fetal shoulder as it rotates--and not by vaginal examinations--to avoid sepsis. The fetal heart must be auscultated every half hour at most, between and during the pains. If the child's pulse grows arhythmic or slow between pains, these are bad prognostic signs. All use of the drugs is to be discontinued, and the child is to be delivered at once to save its life, by the most suitable method and route. Polak holds that the solutions of the drugs must be absolutely pure, and that hyoscine cannot be substituted for scopolamine, but that narcophin is no better than morphine: the American preparations have produced delirium. As I have shown, no one can possibly tell the difference between hyoscine and scopolamine, even by chemical analysis. All we can do is to take the druggist's word that the drug at hand was made from _Scopolia_ and not from _Hyoscyamus niger_. It does not make any difference which is the source of the supply.