Today’s Bitter-Tasting Yet Truly Morbid Fact!
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.
There is no evidence to suggest that similar recipes existed in the British Isles at that time. However, in 1992, an extensive study succeeded in identifying a large number of similar recipes in late medieval (12th-15th century) English manuscripts. All identified the anaesthetic, a drink, by the name dwale. A typical manuscript, translated into modern English, reads:
How to make a drink that men call dwale to make a man sleep whilst men cut him: take three spoonfuls of the gall [bile] of a barrow swine [boar] for a man, and for a woman of a gilt [sow], three spoonfuls of hemlock juice, three spoonfuls of wild neep [bryony], three spoonfuls of lettuce, three spoonfuls of pape [opium], three spoonfuls of henbane, and three spoonfuls of eysyl [vinegar], and mix them all together and boil them a little and put them in a glass vessel well stopped and put thereof three spoonfuls into a potel of good wine and mix it well together.
When it is needed, let him that shall be cut sit against a good fire and make him drink thereof until he fall asleep and then you may safely cut him, and when you have done your cure and will have him awake, take vinegar and salt and wash well his temples and his cheekbones and he shall awake immediately.
In addition to alcohol, the ingredients in dwale are, in order of their listing, bile, hemlock, bryony, lettuce, opium, henbane, and vinegar… The seven ingredients in the dwale recipe can be divided into two broad groups, those in the first group being harmless and ineffectual (bile, lettuce, vinegar, and bryony root), and those in the second being powerful and dangerous (hemlock, opium, and henbane). Ingesting as little as 1 ml of hemlock juice can prove fatal; 3.5 ml opium (normal concentration 4-12% morphine alkaloids) would come close to, or exceed, the fatal dose of around 300 mg, and a similar volume of henbane (normally 0.25-0.5% concentration) would contain 8.75-17.5 mg of hyoscine alkaloids, enough to kill a child. The alcohol in the wine itself cannot be ignored.
However, dwale might not have been quite as dangerous as would at first sight appear. Medicinal herbs grown in northern countries are less potent than those grown in sunnier regions. As their potency is greatest when herbs are freshly collected, much would have been lost in the boiling and storage that the recipe calls for.
Most importantly, the recipe only asks him that “shall be cut” to drink until he falls asleep. A potel (2.276 litres) is the equivalent today of three bottles of wine. It seems most unlikely that the patient would have drunk this entire amount, particularly as the presence of bile and vinegar in the mixture would have given it a bitter taste. The amount consumed would have been enormously variable, and it is this variability in dose that would have made dwale so dangerously unpredictable.
What a Hangover…
Culled from: National Institute of Health
Vintage Ophthalmological Images Du Jour!
Colored woodcuts from George Bartisch’s Ophthalmodouleia, published 1583.
A woman with an enlarged and protruding eyeball and a man with sutured eyelids.
A man with metal clamps on his upper eyelids, perhaps to hold them open, and a man with metal clamps hanging from his upper eyelids, perhaps to close them down.
Culled from: Crucial Interventions: An Illustrated Treatise on the Principles & Practice of Nineteenth-Century Surgery