Education And Debate

Dwale: an anaesthetic from old England

BMJ 1999; 319 doi: http://dx.doi.org/10.1136/bmj.319.7225.1623 (Published 18 December 1999) Cite this as: BMJ 1999;319:1623
  1. Anthony J Carter, consultant anaesthetist
  1. Department of Anaesthetics, North Staffordshire Hospital, Stoke on Trent ST4 6QG

    I'll imitate the pities of old surgeons

    To this lost limb, who ere they show their art

    Cast one asleep, then cut the diseased part.

    Thomas Middleton (1570-1627), Women beware Women

    Before the advent of general anaesthesia, it is generally believed, a patient undergoing an operation could have expected little in the way of support other than from the bottle or from an ability to “bite the bullet.” But there is compelling evidence of an earlier age of anaesthesia. Descriptions of anaesthetics based on mixtures of medicinal herbs have been found in manuscripts dating from before Roman times until well into the Middle Ages. Most originated in regions of southern Europe where the relevant herbs grew naturally. A typical one, dated 800 AD, from the Benedictine monastery at Monte Cassino in southern Italy, used a mixture of opium, henbane, mulberry juice, lettuce, hemlock, mandragora, and ivy.1

    There is no evidence to suggest that similar recipes existed in the British Isles at that time.2 However, in 1992, an extensive study succeeded in identifying a large number of similar recipes in late medieval (12th-15th century) English manuscripts.3 All identified the anaesthetic, a drink, by the name dwale. A typical manuscript (fig 1), translated into modern English, reads:

    Summary points

    Although general anaesthesia is little more than 150 years old, the use of medicinal herbs to render patients unconscious before surgery goes back to Roman times

    Recent studies have identified a large number of recipes for a herbal anaesthetic known as dwale, written in medieval English

    These include two groups of ingredients, the harmless and ineffectual—bile, lettuce, vinegar, and bryony root—and the powerful and dangerous—hemlock, opium, and henbane

    In spite of its dangers, dwale was widely known about, and would have been administered by ordinary housewives, caring for loved ones

    “How to …

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