Some advocates of the twilight sleep method say that there is less use of the forceps in this method than in normal delivery. At Freiburg, for example, operative delivery has been "reduced" to six or seven per cent. Six per cent., as a matter of truth, is two per cent. above the normal average for forceps delivery in eighteen German maternities. In 95,025 deliveries in these hospitals the average forceps delivery was 4.5 per cent., and some were small teaching hospitals where the forceps were used on any provocation for class demonstration. The twilight sleep method has a much higher operative delivery, and this varies, of course, according to the skill and judgment of the operators. Holmes, one of the first in Chicago to try the newly revived method, says[215] that in July, 1914, before the great war broke out, there were twenty-five malpractice suits pending in one German city as a result of the morphine-scopolamine fad. He quotes a noted obstetrician on this subject: "If you will use the method, have the patient in the best hospital possible, with all the appurtenances requisite for the revival of the child; if you do not know, learn at once the differences between asphyxia, oligoapneia, and narcotic poisoning, and the methods of treating them; get the best and the most reliable product called scopolamine; and then be sure you are in a position to be adequately defended by a lawyer versed in malpractice suits." [215] _American Journal of Obstetrics_, May, 1915. This is the state of the question. Two or three men in the best circumstances say they get one hundred perfect results; other men, equally or far more skilled and in equally favorable circumstances, get one hundred results which are anything but successful, often a disgrace to science, and undoubtedly immoral. They are immoral because they risk human life in an attempt to ease a physiological pain, and this is not a sufficient reason; moreover, these attempts fail oftener than they succeed. The second group of practitioners have no motive except honesty to induce them to make their unfavorable reports of failure. The reports of the two groups are directly contradictory, and the judgment is thus a matter of motives. Testimony from women who have gone through the process is not to be taken into account. They were dazed, and in any case they are not competent to judge a matter which is wholly technical. We know the limitation of morphine and scopolamine and we cannot improve their use. If enough is given to still pain, we take a criminal risk; if we do not give enough to remove the sense of pain, why not use the safer nitrous oxide, ether, and chloroform? If enough morphine and scopolamine are administered early in labor to a multipara, the labor is commonly stopped; if this dosage is given after the pains are developed, the baby is born, as a rule, before they take effect. CHAPTER XXIII VASECTOMY, OR STERILIZATION, BY STATE LAW