Igniting interest and preserving the history of our speciality

The Anaesthesia Heritage Centre is the UK’s leading museum for the history of anaesthesia, analgesia and resuscitation, a unique resource featuring an extensive collection of anaesthetic equipment, an archive and a library. The Heritage Centre’s vision is ‘to link the past with the present and keep alive the history of the specialty through education, information and preserving our heritage’. The team actively engages audiences with a programme of group visits, talks, late events and family activities, and continues to increase outreach opportunities (Figure 1).

In 2021, the Heritage Centre agreed to assess the ‘Foster Collection’; a large collection of anaesthetic equipment housed at St Thomas’ Hospital. This article describes the preservation of these items and their relevance to the modern day. We discuss the challenges faced, funding, and future direction of this project.

The Association’s Collection

The idea that the Association should formally collect historic equipment was raised at the 1935 annual general meeting, and in 1953 a significant personal collection was donated by manufacturer Charles King when he retired. His gift remains central to the current collection at the Association’s headquarters, which now includes over 130,000 items.

Charles King had an interesting personal history. He wanted to attend medical school, however unable to afford it he left school at 14 to become an apprentice at an engineering firm. King served in the First World War and on return set up his own business in medical sales. He sold all kinds of medical supplies, the most notable being his ENT equipment. Working with Ivan Magill, he developed his laryngoscope and helped to manufacture tracheal tubes, connectors and forceps. He produced marketing pamphlets for the equipment, explaining how to use and maintain it.

In 1939, most of King’s company was bought out by the British Oxygen Company. The shop at 34 Devonshire Street was destroyed during the Blitz, and King carried on his business from two parked cars until he moved into an empty shop across the road. American anaesthetist Ralph Waters described it as a “Mecca for anaesthetists worldwide”. King exchanged new equipment for old and built up a collection of historic equipment. The shop stocked supplies, equipment and textbooks, and it was a meeting and networking place for anaesthetists.

Charles Foster, curator and collector

In 1979 Dr Charles Foster was appointed Curator of the Charles King Collection (Figure 2). Foster was a consultant anaesthetist at St Thomas’ Hospital where he started his own equipment collection. Charles Foster’s daughter describes the man behind the collection as “a quiet man…never being the centre of attention but watching proceedings and contributing only when he had something important to say. He loved his work. He was a gentle man in every sense of the word and cared deeply about his patients. He had a good sense of humour. I remember him visiting Spike Milligan who he was anaesthetising the following morning. He was in there for so long, my mother went to see if everything was OK only to be told that he was sitting on Spike’s bed with them both howling with laughter”.

In a 2017 interview for the Heritage Centre’s oral history archive, anaesthetist Dr David Wilkinson recalls sessions with Foster and his equipment at St Thomas’ Hospital during viva preparation for his final examination in the 1970s [1]. Today the Collection contains over 240 items of used medical equipment housed in display cabinets in a corridor of the hospital, of which 40 items are being considered for acquisition by the Heritage Centre.

Many of these items, and the principles underlying their use, would baffle the modern anaesthetist despite the retention of physics in the FRCA curriculum. The ventilators with their complexity of function, housed behind heavy grey boxes, were notably obscure. The apparent randomness of the collection is striking; with at least 15 oxygen/ nitrous oxide administration devices, various pulse meters and a very immobile-looking ‘portable’ suction device. The numerous scratches, scrapes and dents in equipment, perishing rubber and plastic and the leaking of liquid from objects, come together to become a less than eye-catching display. Despite this, it documents physically a one-and-a-half century record of the history and development of our specialty. For example, the EngstrÖm, Cape- Waine, Fazakerley and Blease ventilators plus five other types assist in tracing the evolution of anaesthetic practice since the 1930s. When comparisons are drawn with current anaesthetic equipment, what we have achieved in terms of usability and the positive impact on patient safety is evident.

Life as an anaesthetist in the early 20th Century

Much of the collection represents personal histories of anaesthetists. A portable paediatric anaesthetic case containing a Donald Duck rebreathing bag captivated our interest (Figure 3). Belonging to Dr Sheila Anderson, a founding member of the Association of Paediatric Anaesthesia and a lifelong friend of Sir Ivan Magill, it represents a different era of anaesthetic practice and safety where anaesthetists would have personal responsibility for maintaining their own equipment and would dispose of unused anaesthetic gases at the roadside. The environmental impact had little consideration. The presence in the collection of an equine tracheal tube – apparently a gift to Foster from Magill – is a story lost to time.

The challenges

There are significant responsibilities and challenges with a collection like this, including transportation, storage, handling and preservation, that require careful consideration. We met with Emilia Kingham, a Conservator for UCL, when she undertook a full ‘condition assessment and hazard survey’ of the collection. The main issue is the copious amounts of plastic and rubber in tubing, moulded masks and breathing bags. These are inherently unstable materials, with chemical deterioration of plastic being notoriously difficult to prevent. The PVC contains phthalates, plasticisers that are endocrine disruptors and absorption risk. The most pressing concern, however, is that an oily liquid leaking from one of the objects is likely to contain polychlorinated biphenyls (PCBs), which are carcinogenic and extremely toxic if ignited and the fumes inhaled. Asbestos materials are used in much of the collection, but the risk to health remains low as they are largely encapsulated within the equipment housing. Despite concerns early in the pandemic of ventilator shortages, the use of these items would not have been considered.

Future directions for heritage collections

As with all acquisitions, the centre will consider significance, condition and usability for interpretive or educational purposes, and balance this versus the budgetary, staffing and storage resources required to care for the items adequately.

We hope to use the items that are not acquired by the Heritage Centre in public displays around the hospital to expand knowledge of the anaesthetist’s role and provide resources to educate other healthcare professionals. The continued preservation of the history of our specialty feels as important as ever, not only for posterity, but also as a demonstration of innovation in modern medicine.

Acknowledgements: project funding from Guy’s and St. Thomas’ Foundation

Kate Kanga
ST7 Anaesthetist, Guy’s and St Thomas’ NHS Foundation Trust, London 

Rachel Babic
Clinical Fellow in Anaesthetics, Guy’s and St Thomas’ NHS Foundation Trust, London 

Caroline Hamson
Heritage Manager, Anaesthesia Heritage Centre, Association of Anaesthetists 

Andrew Morley
Consultant Anaesthetist, Guy’s and St Thomas’ NHS Foundation Trust, London 

Twitter: @DrKateKanga

References 

1. Association of Anaesthetists. Dr David Wilkinson: world anaesthesia & the Museum. https://anaesthetists.org/Home/Heritage-centre/Collection/Oral-Histories/Dr-David-Wilkinson-World-Anaesthesia-The-Museum (accessed 7/5/2021).

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