Sir James Y Simpson and London's "conservative and so curiously prejudiced" Dr Ramsbotham.

The history of medicine division of the National Library of Medicine has in its manuscripts collection a body of correspondence that vividly describes the strong views held by James Y Simpson in espousing the use of obstetric anaesthesia. The collection consists of 31 letters written by Simpson, mostly from Edinburgh, to the London obstetrician Francis Henry Ramsbotham during the years 1844-53 (many of them composed at the bedside of women about to be delivered), drafts or copies of 15 letters sent to Simpson by Dr Ramsbotham, and several other holographs addressed to Ramsbotham. Despite the unfavourable circumstances under which Simpson wrote many of his letters and the poor legibility of the drafts and copies, the research condition of the material on the whole is surprisingly satisfactory. The theme of the collection is the use of chloroform anaesthesia in childbirth. Surgical anaesthesia, ether, was discovered in the United States and first publicly demonstrated by William T G Morton at the Massachusetts General Hospital in October 1846; it was used first in obstetrics by Simpson in January 1847. Dissatisfied with many of the properties of ether-it was bulky and inflammable, induction was slow, and the lightly anaesthetised patient was liable to vomit-Simpson sought an alternative and soon discovered the anaesthetic properties of chloroform.' In November 1847 Simpson introduced chloroform anaesthesia in obstetrics, and the practice spread quickly in Scotland. In England, however, its acceptance was slower, and clearly evident throughout this collection of correspondence is Simpson's message that London medicine is unreasonably conservative and distantly behind the more advanced practices of Scotland. In fact, in his letter to Ramsbotham dated 1 December 1846-even before the subject of obstetric anaesthesia had become an issue-Simpson, in his straightforward manner, suggests that London therapeutics may be somewhat slack: