A forgotten anaesthetic: Dwale

Victorian surgeons were notorious for speed. Some, like Robert Liston, could amputate a limb in under thirty seconds, relying on sheer precision and nerve. With no anesthesia available, patients endured unimaginable agony while crowds of medical students frequently watched. As pain takes some seconds to fully develop, surgeons raced to finish before agony peaked. Patients were held down by assistants: one at the back, one stabilizing the limb, another gripping the part to be removed.

[Robert Liston (1794-1847) operating]

Some surgeons did give their patients a slug of gin or a spoonful of 'cordial' (syrups containing laudanum) beforehand to numb the pain though these offered minimal analgesia. The first true surgical anesthesia appeared only in the 1840s. Ether was first used surgically by Crawford W. Long in 1842. Then, after its discovery as an anaesthetic in 1847, chloroform, became one of the sedatives available to physicians.

Enter: Dwale
But centuries before the arrival of ether and chloroform, European healers already searched for ways to dull surgical pain. Among the most intriguing solutions was dwale, a potent medieval anesthetic composed of plant extracts whose effects hovered between sedation and poison[1]. Dwale was a dangerous mixture designed to push the body toward sleep while avoiding the fatal edge of toxicity.

In John Gerard's Herball: Or Generall Historie of Plantes (1597) is it called 'Sleeping nightshade'. It provoked a dead sleepe wherein nothynge might awaken.

The word 'dwale' was derived from Middle English dwale (“stupor; deception; delusion, evil”), itself eventually from Old Norse dvala (“sleep; stupor”). Others have derived the word from the French deuil ("grief"), a reference to its fatal properties. Possibly even the modern Dutch word 'dwalen' ("stay; wander") can be traced back to dwale.

Dwale was not a single, fixed recipe. Instead, it was a family of herbal preparations, typically combining ingredients such as henbane, hemlock, mandrake, opium, bile, and vinegar, with wine or ale as a carrier. Many of these plants contain alkaloids capable of inducing drowsiness, delirium, or unconsciousness. Henbane and mandrake, for example, are rich in alkaloids that can suppress sensation, but also trigger hallucinations, respiratory depression, or cardiac failure. Medieval practitioners understood these dangers; surviving manuscripts often warn that the mixture must be prepared with utmost care and administered in small, cautious doses. The recipe was known to monks and (probably) some apothecaries.

The purpose of dwale was simple: to create a state of 'artificial sleep' long enough for a surgeon to perform an operation. In an era when these were performed without modern anesthesia, even partial insensibility offered a profound advantage. Patients who drank dwale might become relaxed, confused, or deeply drowsy, reducing their awareness of pain and making restraint easier.

Dwale was never a reliable anesthetic. Its potency varied wildly depending on plant species, growing conditions, and preparation methods. A dose strong enough to quiet a patient might also stop their breathing. As a result, dwale occupied a precarious place in medical practice: used rarely, cautiously, and often only when the surgeon judged the risk of agony greater than the risk of death.

The knowledge of Dwale petered out with the rise of more scientific anesthesia in the mid‑19th century.

[1] Carter: Dwale: an anaesthetic from old England in British Medical Journal – 1999. See here.