Dwale: an anaesthetic from old England

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:

“How to …