‘Dwale’: A Medieval Sleeping Drug in a Seventeenth-Century Receipt Book

Elizabeth K. Hunter

As part of my research into early modern sleep disorders, I have been examining the wide variety of sleep remedies available in England at the time.  Browsing through the manuscript receipt collections at the Wellcome Library in London, I came across one with this unsettling title:

To make a drinke to cause a man to sleepe till hee bee ript

Take 3 spoonfull of the gall of a barrow swine and for a woman of a gelt swine and 3 spoonefull of hemlocke the iuyce and 3 spoonefull of henbane and 3 spoonefull of the wilde nep [bryony] and 3 spoonefull of lettice and 3 spoonefull of popy and 3 spoonefull of eysell [vinegar] and medle them all together and boyle them a little and cloe them in a glasse well stoped and put therein 3 spoonefull to a pottle [half a gallon] of good wine and medle it well together till it bee used and lett him that shalbe cut sitt against a good fire and make him to drinke thereof untill hee bee asleepe and then mayst thou surely carve him and when thou sure hast donne thy cure and wouldest haue him to awake take vinegar and salt and wash his temples therewith and his wound and hee shall awake imeadiately. [Wellcome MS 373, fo. 99r-v]

Figure 1. A patient about to undergo a surgical operation, early 1700s. A man approaches with a cup containing a fortifying or anaesthetic drink. Credit: Wellcome Collection. Public Domain Mark

Rather different from the milk thistle possets and linen-wrapped compresses of rose water and poppy seeds I was used to, this was clearly not a remedy for sleeplessness, but a powerful drug intended to ‘knock’ a patient out who was about to undergo surgery.  It was written down by a woman called Jane Jackson in a book of recipes for physic and surgery she compiled in 1642.

Although the name of the drug does not appear anywhere in the source, upon further investigation I discovered that this is dwale, a recipe that had been in circulation in England since the twelfth century.  The Middle English word dwale (pronounced dwahluh), is derived from Old Norse dwol, dvalar, dvali meaning ‘sleep’ or trance’.  Well known in the medieval period, it is mentioned in famous works of literature, such as The Canterbury Tales and the fourteenth-century poem Piers Plowman.

Dwale was still known about in England in the late sixteenth and early seventeenth centuries, as can be seen from publications from the time.  Thomas Lupton included it in his book of secrets A Thousand Notable Things (1579) – ‘This I had also out of an olde wrytten booke’, he wrote.[1]  More suggestive of use in actual practice is Thomas Bonham’s inclusion of it in his collection of recipes for surgeons, published in 1630, where the ingredients are in Latin.[2]  It is likely that Jane Jackson copied it down from a similar publication.

Figure 2. Illustration of four poisonous plants – (clockwise from top left) hemlock, henbane, autumn crocus and wild lettuce. All except crocus were ingredients in English sleep medicine. Credit: Wellcome Collection. Public Domain Mark

What is striking about dwale is the potentially deadly mixture of poisonous plants with gall and wine.  It is based on ingredients associated with sleep since ancient times – henbane, wild lettuce and the white opium poppy.[3]  The anaesthetist Anthony J. Carter has hypothesised that, at one point, it may also have contained another ‘sleepy’ herb, mandrake.  At some point Bryony, a plant native to England that bears some resemblance to mandrake, has been substituted.[4]

 

While wild lettuce and white poppy were sometimes included in bed-time drinks and possets, henbane and mandrake were considered highly dangerous, and it is very rare to find a sleep recipe that recommends using them in anything other than topical medicine.  Jackson’s version of the recipe also contains the poison hemlock, and Linda Voigts and Robert Hudson found a number of fifteenth-century recipes for dwale that included the even more lethal plant morel (deadly nightshade).[5]  All these plants were considered useful in sleep medicine because they were believed to cool the humours, reducing the temperature in the brain.  Used excessively, however, they could be too effective, causing the body to fall into a lethargy from which the patient would never recover.

The inclusion of dwale in seventeenth-century sources demonstrates the continuity between medieval and early modern sleep medicine, and provides further evidence of the use of poisons in surgical anaesthetics around the world.  We will never know whether Jane Jackson ever attempted to use it to help a patient undergoing surgery, but her interest in copying it down is an indication of the ambitious nature of domestic medicine in relation to surgery (as has been written about by Seth LeJacq).  It is also further evidence of the importance of knowledge of handling poisons in early modern medicine, as discussed on this blog (here and here).  This was particularly important in sleep medicine, in which the ‘coldness’ of the traditional ingredients could be fatal.

FURTHER READING

If you would like to read more about the use of poisons in early modern sleep medicine, see my article “To Cause Sleepe Safe and Shure”  published in Social History of Medicine.

Acknowledgements

This research was funded by a Wellcome Trust Medical Humanities Award “Midnight Vapours: Sleep Disorders in Early Modern England, 1550-1700” [Grant No. 109069/Z/15/Z]



[1] Thomas Lupton, A Thousand Notable Things, of Sundry Sortes (London, 1579), p. 79.

[2] Thomas Bonham, A Chyrugians Closet (London, 1630), pp. 244-245.

[3] Ioanna A. Ramoutsaki, Helen Askitopoulou, Eleni Konsolaki, ‘Pain Relief and Sedation in Roman and Byzantine Texts: Mandragoras Officinarum, Hyoscyamos Niger and Atropa Belladona,’ International Congress Series: The History of Anesthesia, 1242 (2002), 43-50.

[4] Anthony J. Carter, ‘Dwale: An Anaesthetic from Old England,’ British Medical Journal, 319 (1999), 1623-1626, at p. 1624.

[5] Linda E. Voigts and Robert P. Hudson, ‘A Drynke Ϸat Men Callen Dwale to Make a Man to Slepe Whyle Men Keerven Hem: A Surgical Anesthetic from Late Medieval England,’ in Sheila Campbell and David Klausner (eds), Health, Disease and Healing in Medieval Culture (London: Palgrave Macmillan, 1992), pp. 34-56.

Revisiting Jennifer Park’s The Recipes of Cleopatra

Welcome to the August 2020 Edition of the Recipes Project! All month we will be revisiting posts from our archives and exploring the intersections of race, medicine, sexuality, and gender in recipes. First up: we’re delighted to re-post Jennifer Park’s brilliant 2014 piece on the ways that the figure of “Cleopatra” was imagined in early modern Britain. Seen as an expert in medicine, science, surgery, and beauty, this historical figure was placed alongside canonical white men like Galen and Asclepiades. For early modern British readers, “Cleopatra” offered sound medical advice and a sense of respected authority. –AH

By Jennifer Park

In Robert Allott’s edited prose commonplace book, Wits Theater of the Little World (1599), he introduces a section on beauty with this line: “Cleopatra writ a booke of the preseruation of womens beauty.”[1]

Cléopâtre (étude) by Alexandre Cabanel, at the Musée des Beaux-Arts - Béziers. Image available on Wikimedia Commons.
Cléopâtre (étude) by Alexandre Cabanel, at the Musée des Beaux-Arts – Béziers. Image available on Wikimedia Commons.

Today’s post is an introductory foray into the figure of Cleopatra as an apparent source of medical knowledge in early modern England, with recipes that apparently come from the “Book of Cleopatra.” During the time when Shakespeare was believed to have been writing Antony and Cleopatra, Cleopatra’s book was mentioned in a range of early modern works. What’s fascinating about the recipes attributed to Cleopatra is that they appear in a wide range of works, from secrets to cosmetics to surgery and medicine to natural history and the natural sciences.

To provide a brief example, I’ll begin with a few recipes that dealt with the problem of hair loss, found in a work on surgery, as well as in a work on, surprisingly, insects. The first is physician Thomas Bonham’s The Chyrurgian’s Closet (1630), a posthumously published compilation of his medical work.[2] Cleopatra is listed as one of the “Authors of this Worke,” and is referenced in two brief unguent recipes to restore hair growth, a concern explored for the early modern period by Jennifer Evans and for Graeco-Roman antiquity by Laurence Totelin. The first recipe is for greater ease of hair renewal and growth:

Rx. Cort: arundinis, & Spuma nitri, ana {ounce} ss. picis liquida, q. s. f. vng. *. To restore hayre in an inueterate Alopecia [or baldness]. It will be [ B] very profitable daily to shaue the place, and to rub it with a lin|nen cloath, and then to anoint it, by which meanes the hayre will grow with more speed. Cleopatra. [3]

The other is to preserve hair from falling:

Rx. Brassicae aridae, q.s. stampe it cum aq: q.s. vnto the forme of an vng: *. To preserue haire from falling. Cleopatra. [4]

Cleopatra’s expertise in this domain also appears in Thomas Moffet’s work on insects, which was completed in manuscript form in the 1590s and posthumously published. In his section “On the use of Flies”, Moffet mentions a recipe purportedly contained in Cleopatra’s book in which flies are used to treat baldness.

Title page of Thomas Moffett's work on insects, posthumously published. Image available on Wikimedia Commons.
Title page of Thomas Moffett’s work on insects, posthumously published. Image available on Wikimedia Commons.

For Galen out of Saranus, Ascle|piades, Cleopatra, and others, hath taken many Medicines against the disease called Alopecia or the Foxes evill; and he useth them either by themselves or mingled with other things. For so it is written in Cleopatra’s Book de Ornatu. Take five grains of the heads of Flies, beat and rub them on the head affected with this disease, and it will certainly cure it. [5] 

[Nam Galenus é Sarano, Asclepiade, Cleopatra, & aliis, medicamenta contra alopeciam exscripsit: iisdénique nunc solis nunc mixtis usus est. Sic enim in libro Cleopatrae de ornatu scribitur: R. muscarum capita.g.v. contere et affrica capiti alopeciâ laboranti, & certò sanabitur.] [6]

That Thomas Bonham and Thomas Moffet, who practiced medicine around the turn of the seventeenth century, both reference Cleopatra for these hair-related remedies establishes that they took for granted Cleopatra’s perceived expertise in this area.

Cleopatra’s medical knowledge primarily passed into early modern use through the work of Galen, the Greek physician whose work on the four humors would form the foundation of early modern medical beliefs about the body. Laurence Totelin, for example, provides an example of a recipe in Galen’s work, excerpted from “Cleopatra’s Cosmetics”. The figure of Cleopatra closer to her time was, it turns out, a figure closely associated with cosmetics, gynaecology, and alchemy. That Shakespeare’s Cleopatra—Cleopatra VII, former Queen of Egypt—was probably not the actual author of these receipts seems not to have mattered much for their transmission. Totelin documents a few such Greek cosmetic recipes that used her name and convincingly reads Cleopatra in early Greek medical writings as an example of medical authors claiming famous women as an authority for gynaecological and cosmetic remedies. The attribution of Cleopatra as the author or source of recipes in the early modern period is, I suspect, the inheritance of this practice put into use in posterity. Since the beginning, then, it seems that Cleopatra’s reputation has exceeded her.

What we get is a female figure whose relationship to medicine and to recipe-culture throughout the centuries was quite different from that of the early modern woman. Rather than having to develop and prove expertise in culinary, medical, and pharmacological knowledge by experimenting with receipts, as early modern women did, Cleopatra in the early modern period was already held to be a figure of medical authority. During a time when women were carving a place for themselves in the domain of household physic, Cleopatra may have been a shining example of a woman memorialized through her recipes as evidence of her medical expertise.

[1] Robert Allott, Wits Theater of the Little World (1599),75v.

[2] Thomas Bonham, The Chyrurgians Closet, or, An Antidotarie Chyrurgicall (1630).

[3] Bonham, 283.

[4] Bonham, 283.

[5] Translation quoted in John Uri Lloyd, “Ancient Therapeutics,” The Eclectic Medical Journal 76.4 (1916), 177.

[6] Thomas Moffet, Insectorum, sive, Minimorum animalium theatrum (1634), 71.

Pain, poison, and surgery in fourteenth-century China

Yi-Li Wu

It’s hard to set a compound fracture when the patient is in so much pain that he won’t let you touch him. For such situations, the Chinese doctor Wei Yilin (1277-1347) recommended giving the patient a dose of “numbing medicine” (ma yao).  This would make him “fall into a stupor,” after which the doctor could carry out the needed surgical procedures: “using a knife to cut open [flesh], or using scissors to cut away the sharp ends of bone.” Numbing medicine was also useful when extracting arrowheads from bones, Wei said, enabling the practitioner to “use iron tongs to pull it out, or use an auger to bore open [the bone] and thus extract it.” More generally, Wei recommended using numbing medicines for all fractures and dislocation, for it would allow the doctor to manipulate the patient’s body at will.

Wei’s preferred numbing medicine was “Wild Aconite Powder” (cao wu san), and he detailed the recipe in his influential compendium, Efficacious Formulas of a Hereditary Medical Family (Shiyi dexiao fang), completed in 1337 and printed by the Imperial Medical Academy of the Yuan dynasty (1271-1368). In his preface, Wei affirmed that medical formulas were the foundation of medicine and that a doctor’s ability to cure depended on his ability to use these tools skillfully. Wei’s family had practiced medicine for five generations, and he synthesized their knowledge with that of other doctors to produce a comprehensive treatise encompassing internal medicine; the diseases of women and children; eye diseases; illnesses of the mouth, teeth, and throat; ulcers and swellings; and diseases caused by invasions of “wind” (ailments with sudden onset, including febrile epidemics and paralytic strokes). Numbing medicine appeared in Wei’s chapters on bone setting and weapon wounds.

Wei’s Wild Aconite Powder is the earliest datable recipe that I have found for surgical anesthesia in a Chinese text, and it is a valuable window onto practices that were largely transmitted orally, whether in medical families or from master to disciple.  Dynastic histories relate that the legendary doctor Hua Tuo (110-207) employed a formula called mafeisan  to render his patients insensible prior to cutting them, even opening up their abdomens to excise rotting flesh and noxious accumulations. Some scholars have hypothesized that mafeisan (literally “hemp-boil-powder) may have contained morphine or cannabis (ma), but its ingredients remain a mystery.  A text attributed to the twelfth-century physician Dou Cai (ca. 1146) recommended using a mixture of powdered cannabis and datura flowers (shan qie zi, also called man tuo luo hua) to put patients to sleep prior to moxibustion treatments, which in this text could involve a hundred or more cones of burning mugwort placed directly on the patient’s skin.  Wei Yilin’s recipe provides important additional textual evidence for a tradition of anesthetic formulas based on toxic plants, one that was clearly in circulation long before he wrote it down.

At least as far back as the Divine Farmer’s Classic of Materia Medica (3rd c.), medical authors had described aconite as highly toxic (for contemporary Roman views of aconite, see blogpost by Molly Jones-Lewis). In the right hands, however, aconite was a powerful drug, and part of the Chinese practice of using poisons to cure (see blogpost by Yan Liu).  Warm and acrid, aconite could drive out pathogenic wind and cold from the body, break up stagnant accumulations, and invigorate the body’s vitalities. In the language of Chinese yin-yang cosmology, it nourished yang—all that was active, heating, external, and ascending. The main aconite root was considered more toxic than the subsidiary roots (designated by the separate name fu zi, “appended offspring”), and the wild form was more potent than the cultivated variety.

Images of toxic medicinal plants from China’s most celebrated pharmacological work, Li Shizhen (1518-93), Compendium of Materia Medica (author’s preface dated 1590). Woodblock edition of 1603. Wild aconite is the middle image in the top row. Cultivated aconite (main and subsidiary roots) are in the bottom right corner. Image credit: National Library of China. Posted on-line at the World Digital Library.
Images of toxic medicinal plants from China’s most celebrated pharmacological work, Li Shizhen (1518-93), Compendium of Materia Medica (author’s preface dated 1590). Woodblock edition of 1603. Wild aconite is the middle image in the top row. Cultivated aconite (main and subsidiary roots) are in the bottom right corner. Image credit: National Library of China. Posted on-line at the World Digital Library.

Wei’s numbing recipe consisted of 13 plant ingredients, including the main roots of both wild and cultivated (Sichuanese) aconite, along with drugs known as good for treating wounds:

Young fruit of the honey locust (zhu yao zao jiao)
Momordica seeds (mu bie zi)
Tripterygium (zi jin pi)
Dahurian angelica (bai zhi)
Pinellia (ban xia)
Lindera (wu yao)
Sichuanese lovage (chuan xiong)
Aralia (tu dang gui)
Sichuanese aconite (chuan wu)
Five taels each[1]

Star anise (bo shang hui xiang)
“Sit-grasp” plant (zuo ru), simmered in wine until hot
Wild aconite (cao wu)
Two taels each

Costus (mu xiang), three mace

Combine the above ingredients. Without pre-roasting, make into a powder. In all cases of crushed or broken or dislocated bones, use two mace, mixed into high quality red liquor.

Wei most likely learned this formula from his great-uncle Zimei, a specialist in bonesetting and wounds. Its local origins are also suggested by its use of zuo ru, literally “sit-grasp”, a toxic plant whose botanical identity is unclear. However, according to the eighteenth-century Gazetteer of Jiangxi (Jiangxi tong zhi), sit-grasp was native to Jiangxi, Wei’s home province, and was used by indigenes to treat injuries from blows and falls.  While classical pharmacology focused on the curative effects of aconite, Wei’s anesthetic relied on aconite’s ability to stupefy and numb, while curbing its ability to kill. If an initial dose failed to make the patient go under, Wei said, the doctor could carefully administer additional doses of wild aconite, sit-grasp herb and the datura flower.

Additional images of toxic medicinal plants from Li Shizhen, Compendium of Materia Medica. Sit-grasp herb is in the middle of the top row, and datura flower in the middle of the bottom. Image credit: National Library of China. Posted on-line at the World Digital Library.
Additional images of toxic medicinal plants from Li Shizhen, Compendium of Materia Medica. Sit-grasp herb is in the middle of the top row, and datura flower in the middle of the bottom. Image credit: National Library of China. Posted on-line at the World Digital Library.

In subsequent centuries, as medical texts proliferated, we find additional examples of numbing medicines that employed aconite, datura, and other toxic plants, employed when setting bones and draining abscesses, and to numb injured flesh before repairing tears and lacerations to ears, noses, lips, and scrotums.  Such manual and surgical therapies are an integral part of the history of healing in China.

Yi-Li Wu is a Center Associate of the Lieberthal-Rogel Center for Chinese Studies at the University of Michigan, Ann Arbor (US) and an affiliated researcher of EASTmedicine, University of Westminster, London (UK).  She earned a Ph.D. in history from Yale University and was previously a history professor at Albion College (USA) for 13 years.  Her publications include Reproducing Women: Medicine, Metaphor, and Childbirth in Late Imperial China (University of California Press, 2010) and articles on medical illustration, forensic medicine, and Chinese views of Western anatomical science.  She is currently completing a book on the history of wound medicine in China.

Acknowledgements
This research was funded by the Wellcome Trust Medical Humanities Award “Beyond Tradition: Ways of Knowing and Styles of Practice in East Asian Medicines, 1000 to the present” (097918/Z/11/Z). I am also grateful to Lorraine Wilcox for directing me to the work of Dou Cai.

*****

[1] The weight of the tael (Ch. liang) has varied over time, but during Wei’s lifetime would have been equivalent to 40 grams.  A mace (Ch. qian) is one-tenth of a tael.

‘This one is good’: Recipes, Testing and Lay Practitioners in Early German Print

By Tillmann Taape

Title illustration from Brunschwig’s Small book of distillation. © Wellcome Images

Having recently finished my doctoral thesis on the printed works of Hieronymus Brunschwig, which have previously featured on the Recipes Blog (here and here), I am delighted to contribute to this series of posts on testing and trying (for an overview, see our re-posted summary of the Testing Drugs and Trying Cures conference). What better opportunity to share how it all came together, and reflect on the role of recipes and testing in the narrative.

Hieronymus Brunschwig (c.1450–c.1530), a surgeon and apothecary from Strasbourg, wrote the first printed books on surgery and distillation. In my thesis, Hieronymus Brunschwig and the Making of Vernacular Medical Knowledge in Early German Print, I read these uncommonly practical and technical books alongside records from the Strasbourg archives, about the craft guilds and medical practice. This allows us to make sense of Brunschwig’s practical vernacular medicine in relation to local intellectual trends, different forms of healing, the local milieu of guilds and artisans, and early German print culture.

Brunschwig’s first book was the Cirurgia of 1497, the first surgical manual in print. This, of course, was an opportunity to codify and re-define surgery. Brunschwig revives the medieval tradition of what Michael McVaugh has termed rational surgery (i.e. a learned as well as a practical art), to educate trainee surgeons and to present their discipline as a respectable and useful trade. Emphasising the need for skilled hands as well as a working knowledge of the human body, Brunschwig defends surgery on two fronts: against learned physicians’ rhetoric of superiority, and against other craftsmen’s deep-seated anxieties about occupations which were in contact with sick and dead bodies.

A surgeon treating an abdominal wound. Hieronymus Brunschwig, Dis ist das Buoch der Cirurgia (Strasbourg, 1497). © Wellcome Images.

The later books on distillation, published in 1500 and 1512, open up to a wider readership, including not only medical artisans such as surgeons or apothecaries, but also the ‘common man’ – a middling social layer of literate citizens, householders and other lay practitioners. This new kind of medical reader, as I have discussed in a previous post and elsewhere, is emblematised in the figure of the ‘striped layman’ which appears in numerous woodcut illustrations throughout Brunschwig’s works.

A conspicuously stripy student, from Brunschwig’s Cirurgia (1497). © Wellcome Images

Many of the recipes and instructions in the distillation books are adjusted for this type of reader. They start from scratch and are rich in technical details which are not found elsewhere in print or, to my knowledge, in manuscript. Although Brunschwig engages with complex ideas about the nature of matter and its manipulation, such as John of Rupescissa’s notion of a ‘quintessence’ in all things, he re-works them into manageable, pedestrian remedies. Rather than pursuing Rupescissa’s heavenly panacea, Brunschwig uses distillation to produce a type of middle-class quintessences: although earth-bound and imperfect, they were reliable and effective remedies in the hands of laypeople.

Detailed woodcut images of distillation apparatus and instructions for its use. Brunschwig, Liber de arte distillandi de simplicibus (Strasbourg, 1500). © Wellcome Images.

One overarching theme of my thesis is the artisan’s approach to understanding and manipulating nature. For a craftsman with no Latin, Brunschwig mined a surprising amount of knowledge from texts. But more importantly, I argue, he knew things through direct physical engagement with bodies, materials and technical processes. His books are full of instructions to probe wounds, check temperature by touch, inspect colour changes in the alembic, and smell or taste distilled remedies. His expertise was located as much in the body and its senses as in books.

Nonetheless, writing was a powerful tool for recording and communicating practical insights. From cautionary tales of exploding alembics to heroic accounts of successful cures, Brunschwig emphasises his own experience as a source of knowledge. The German term he uses for this type of knowledge, erfarung, is related to fahren, meaning ‘to travel’. In the early sixteenth century, it denoted a way of experiencing the world through one’s own senses, by moving through it or simply being in it in an active, attentive manner. Erfarung was compared, often unfavourably, to spiritual contemplation and introspection. Over time, however, doctors and students of nature such as Paracelsus came to see personal erfarung as the necessary labour of insight rather than a sinful distraction. The Book of Nature, they insisted, should be read with one’s feet. Brunschwig’s emphasis on his own and others’ erfarung was thus part of a larger vernacular culture of experiential knowledge, as well as learned debates about experientia which have often been the focus of historical accounts of a medical empiricism developing in the early modern period.

Recipes played a major part in Brunschwig’s codification of experiential medical knowledge. Some, as I have shown in a previous post, were presented in Latin pharmaceutical jargon likely unknown to laypeople. These recipes were closed to readers, who were meant to copy them out on a piece of paper and hand them to an apothecary who would manufacture the remedy according to his art and his experience. Although the great majority of recipes are in German, some of these are also presented as tried and tested, by Brunschwig himself or others, and do not call for ‘tweaking’ on the part of readers.

Other recipes, however, give alternative ingredients or leave the exact composition up to the practitioner’s judgment. Many recipes come without the author’s seal of approval, and their sheer number makes it seem unlikely that Brunschwig could have tested each one. Such ‘open’ recipes leave room for improvisation and testing. The ongoing work of erfarung runs on into readers’ own practice, and often spills out into the margins of Brunschwig’s printed books. In many surviving copies, early modern healers from different walks of life marked recipes with a magisterial probatum est, or a simple vernacular note such as ‘this one is good’.

In some of the earliest medical works in print, Brunschwig addresses a readership of lay healers and ‘common men’ which would come to represent a significant portion of the early German print market. Through his use of recipes embedded within a culture of erfarung, he involved his vernacular readers in a continued effort of empirical trying and testing.

Pursuing the themes of recipes and artisanal knowledge, I am delighted to be joining the Making and Knowing Project at Columbia University this summer, and look forward to sharing our work on making, testing, and trying, which has previously featured on this blog.

 

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