A common theme in the records documenting the relationship of the late medieval medical practitioner with his patient is the latter’s reluctance to settle the physician’s, surgeon’s or apothecary’s bill.
A refusal to pay often lay behind complaints over a practitioner’s incompetence, as the debtor sought to justify his failure to settle his bill by the creditor’s purported failure to provide the promised (or expected) professional services or goods.
The practitioners perhaps worst affected by the non-settlement of bills were the apothecaries, who were particularly vulnerable on account of their long-distance relationship with their customers: whereas the physician or surgeon came into direct contact with a patient, the apothecary who supplied him with remedies did not invariably do so. Many medicinal remedies were luxury goods, made with rare ingredients, including precious metals and pearls, and the profits to be made from wealthy individuals were thus substantial, but so also were the bills run up by members of the gentry and aristocracy, which were often left unpaid for long periods of time.
An interesting example of such a bill accumulated over several years by a fifteenth-century noblewoman, Katherine Neville, Duchess of Norfolk, was disputed in the Westminster court of common pleas in Hilary term 1475. The document in question (edited below) does not merely demonstrate the size of the debt incurred by the duchess to her apothecary, John Clerk, king’s apothecary to Edward IV of England, but itemises the spices, confections and preparations with which he had supplied the lady’s household over a period of eight years from September 1463 to July 1471. It thus gives an indication of the range and quantity of medicinal remedies supplied to a designated patient over a specified period of time. While there is a growing literature on the medieval apothecary and his trade,
documents that detail the treatment prescribed for a specific individual over a clearly defined period remain extremely rare.
Moreover, in keeping with the duchess’s social status, her bill was a large one: according to John Clerk’s claim, she owed £18 18s. 7d. of a total sum of £27 2s. 9
d., at a time when a craftsman or labourer could expect to earn between 3d. and 8d. a day.
Her case thus provides valuable evidence of the full range of remedies consumed by a member of the high aristocracy, and, indeed, of the wider royal family, at the court of the notoriously gluttonous Edward IV, and sheds light on the interplay of the apothecary’s trade with the conspicuous consumption expected of the late medieval aristocracy.
2. John Clerk and his clients
The apothecary John Clerk ranked among the leading members of his trade. He supplied many of the higher nobility, and by letters patent of 17 February 1462 was formally appointed king’s apothecary to Edward IV.
Like many contemporary apothecaries, Clerk was a member of the London Grocers’ Company, and twice (in 1467 and 1475) served as its warden.
He did, however, also cultivate (or at least build up) connexions among the medical establishment. For much of his career he was a parishioner of the London church of St Mary Woolchurch, but by the end of his life he had moved to neighbouring St Stephen’s, Walbrook, a parish where many of London’s medical practitioners became concentrated during the fifteenth century, perhaps an indication of his growing ties in that community.
He was particularly close to Roger Marchall, the royal physician and noted medical writer, who appointed him an executor of his will and for whose children he later provided.
Indeed, Clerk was a man of some learning: he is known to have owned BL, MS Harley 273, a fourteenth-century collection of secular and religious texts, and probably also, as Peter Murray Jones and Tig Lang have argued, BL, MS Harley 1628, which contains – among other texts – the ‘dispensary’ of an apothecary supplying Edward IV and other members of the higher nobility, the very group of individuals who formed Clerk’s customer base.
Clerk survived into the reign of Richard III; although he drafted a will on 8 July 1479, he probably died not long before 15 March 1484, when probate was granted.
The circle of aristocrats and courtiers who patronised the king’s apothecary is illustrated by the ‘dispensary’ in Harley 1628. It included members of the immediate royal family, such as the king’s mother, the Dowager Duchess of York, and his siblings, the Duchess of Burgundy and the Dukes of Clarence and Gloucester, members of the higher and lesser nobility, like the Duke and Duchess of Buckingham, the Countesses of Warwick and Richmond and Lords Dynham and Maltravers, and lesser courtiers like Sir Thomas Montgomery, John Sapcotes, respectively a knight and an esquire of the body to Edward IV, and Thomas Grayson, a yeoman of the king’s chamber.
A striking feature of this list is the number of high-ranking ladies among whom the services of the king’s apothecary were evidently fashionable, and it is plausible that the Duchess of Norfolk was another of his customers.
The absence from the dispensary in Harley 1628 of any mention of the duchess, whose long-running business relationship with John Clerk is documented by the lawsuit of 1475, would seem to render the book’s attribution to John Clerk problematic, but this is not necessarily so. Not only do the personal prescriptions for named individuals contained within constitute an incomplete list of the owner’s clients, but they were added to the manuscript apparently randomly as an afterthought. Furthermore, the few that can be dated with any degree of certainty point to a date of addition between the mid-1470s and mid-1480s.
By this time Clerk and the Duchess of Norfolk may have parted company, perhaps on account of her unpaid bills, which may, indeed, have been one symptom of wider-ranging financial difficulties.
Katherine Neville was born, probably in the first years of the fifteenth century, as daughter of Ralph Neville, first Earl of Westmorland, and his second wife, Joan Beaufort, daughter of John of Gaunt, Duke of Lancaster, by his third wife Katherine Swynford, and was thus a niece of Henry IV and first cousin to Henry V.
The prolific Nevilles were adept at contracting advantageous marriages for their female offspring, and in January 1412 Katherine was married to the young Earl Marshall, John Mowbray (1392–1432), Earl of Nottingham and Norfolk, who came of age the following year. Mowbray’s premature death in October 1432 left Katherine a wealthy widow, and in view of her relative youth it is not surprising that she went on to marry (and survive) three further husbands. The first of these was Sir Thomas Strangways, in the light of his inferior social status perhaps her own choice. Equally, there is no reason to suppose that her third husband, John, Viscount Beaumont, was anything but an agreeable choice to her. They were much of an age, and he too had been widowed rather prematurely, at the age of about thirty-two. When Beaumont was killed while fighting on the Lancastrian side at the battle of Northampton in 1460, Katherine might have expected to settle down to a dignified widowhood, but any intentions she might have had were overthrown by the marriage of her nephew, Edward IV, to Elizabeth Wydeville. The new queen, as is well known, came with a horde of impecunious relatives for whom the king had to provide as best he could. The wealthy dowager duchess was singled out as bride for the queen’s second brother, John Wydeville, a young man in his early twenties. Modern views of the marriage have been coloured by the near-hysterical outrage of the chronicler known as the pseudo-William Worcester, who decried this ‘maritagium diabolicum’,
but we have no way of knowing what relations between the couple were like. What is clear is that Katherine’s family, above all her nephew Richard Neville, Earl of Warwick, but probably also her grandson, John Mowbray (1444–76), Duke of Norfolk, were unimpressed. Norfolk, who was about the same age as his new step-grandfather, had particular reason to feel aggrieved, since Katherine continued to hold a substantial part of the Mowbray estates in dower, and he is unlikely to have disapproved strongly of Wydeville’s summary execution at Warwick’s behest in August 1469.
Katherine for her part lived on for more than a decade. She is last recorded at the coronation of Richard III in 1483, and not heard of thereafter.
Both before and after her short-lived final marriage, Katherine, like other ladies of her social standing, maintained a house in the parish of St Martin in the Fields on the outskirts of London.
Here, she found herself in convenient proximity to the king’s court, when it was based at Westminster or Greenwich, and had easy access to the markets of London. Among other luxury goods, these markets supplied Katherine and her household with a range of medicinal remedies and preventative drugs. We have no way of knowing which and how many suppliers of such goods she patronised, but among them, and perhaps principal among them, was John Clerk.
3. The dispute of 1475
Late medieval English society was highly litigious. Men (and, in some instances, women) took their squabbles over land and property, assaults and other physical offences and payments and contractual obligations to the royal law courts on a regular basis. The records of these courts thus afford valuable insights into a broad range of events and circumstances otherwise hidden from the modern observer. At the same time, the medieval legal records, and above all those of the common law courts, are not without their problems. In the first place, the sheer volume of the surviving materials renders any quantitative analysis, other than on a very modest scale, impractical. Moreover, the surviving record of any individual case is frequently incomplete; verdicts, in particular, are rare. Other difficulties are inherent in the information recorded as well as the manner in which this was done. Crucially, what was documented were allegations and counter-allegations, rather than verified facts, and the procedural inflexibility of the common law meant that complex sets of circumstances needed to be reduced to a simple question that could be pronounced upon by a jury. Moreover, the formulaic way in which events were recorded, in keeping with the requirements of the administrative practices of the law courts, can make it difficult to tease out what had really occurred. Circumstantial detail over and above the standard formulae of the legal record may generally be taken to strengthen the likelihood that there was a factual basis to the events related.
A case containing such detail was that brought by John Clerk against his one-time client Katherine Neville before the justices of common pleas in Hilary term 1475. The case, enrolled in TNA, CP 40/853, rots 139–139d, has not been previously noticed by scholars, and is edited below for the first time. According to Clerk’s complaint, he had supplied to the Duchess of Norfolk spices and medicinal remedies at various times (per diversas vices) during a period of almost eight years from 7 September 1463 to 5 July 1471. For these supplies the duchess still owed him £18 18s. 7d., the balance of a greater sum of £27 2s. 9
d., only part of which she had paid.
The duchess denied that she owed Clerk any such debt, and the matter was committed to trial by jury. On the first possible return date, the sheriffs of London failed to make a return to the writ summoning the jury, and the record of the case ends with a renewed instruction to the same officials to produce a jury in court. The text presents the difficulties characteristic of the common law records of the period: the only known record of the case is its enrolment on the plea roll of the court of common pleas; the two parties’ claims are unsupported by any concrete evidence; and no verdict or other outcome is noted. The case may have been settled out of court, as many such disputes (including litigation between patients and practitioners) were,
or it may simply have petered out. Unless Katherine’s debt to her apothecary was settled by her executors, it may well have been one that Clerk’s own executors had to write off, when he himself died about a year after his unreliable customer. Yet, rather than in the fairly commonplace proceedings for debt, the real interest of the case lies in the list of remedies supplied by Clerk, which can here be linked to an individual aristocratic client, or at least her household.
4. Katherine Neville’s medicines
The medicines which Clerk supplied to the Duchess of Norfolk spanned the full panoply of the apothecary’s wares. They included ‘simples’, or individual herbs and spices like saffron, mace, turmeric, stavesacre, galingale, gentian, powdered mint, liquorice, cinnamon and sandalwood, as well as other dried flowers and herbs, but also more complex concoctions and compound preparations. There were conserves of roses, plums, crabapples and tamarinds, and a quince marmalade. More obviously medicinal preparations included various unspecified pills, sugar candies for the chest, a number of plasters (three of them explicitly for the stomach) and ointments, waters of dragonwort, hyssop, roses and honeysuckle,
powders, fumigations and a pomander, some of them explicitly intended as prophylactics against the pestilence. Finally, there were some rare and costly substances like the half pound of ‘mummy’, glossed as ‘Mannes fflesshe dryed’, and thus probably representing the genuine middle-eastern article,
and composites like ‘Manus Christi’, made from rosewater, sugar and ground pearls,
‘royal paste’, a confection of sugar and honey with ginger, mace and cloves,
and the universal antidote, theriac, which Clerk supplied to the duchess in two varieties, ‘Diatessaron Theriac’ and ‘Great Theriac’, the latter a highly complex preparation requiring four times as many ingredients as even the simpler (but still complicated) diatessaron variety.
While individual herbs and spices and some of the simpler preparations like syrups, waters and ointments formed part of the apothecary’s staple wares and are found, for example, in the inventory of the early fifteenth-century London apothecary John Hexham, and a century later in that of John Amfles (or Amphylys), an apothecary at Bishop’s Lynn in Norfolk,
the rarer substances and more complex pharmaceutical compounds were obviously restricted to the upper end of the market. They covered the same range of remedies which Edward IV consumed in large quantities and which Clerk, and perhaps a few others of his trade, also sold to other members of the aristocracy, and were, as the dispensary in Harley 1628 indicates, often made up specially for each customer.
In type, and in many instances even in name, the composites sold by Clerk nevertheless correspond to standard remedies found in the medical and pharmaceutical tracts of the period, although individual prescriptions could vary. This can be demonstrated by a comparison of some of the recipes found in contemporary collections, like the dispensary in Harley 1628,
or BL, Harley 2378, a composite manuscript or commonplace book of possible East Anglian provenance, some of the contents of which appear to be associated with one Nicholas Spaldyng.
Thus, a wide variety of mixtures of aromatic herbs and flowers could be used in making pomanders,
while different assortments of spices gave distinctive flavours to the draughts described as ‘Hippocras’.
The importance of a client’s income and status is exemplified by the separate recipes in Harley 1628 for ‘dragetum regalis’ and ‘dragetum commune’, and fumigations ‘pro rege’ and ‘commune’.
The extensive list of Katherine’s medicines illustrates the degree to which the medical treatment of the late medieval aristocracy was part of the conspicuous consumption that characterised the lives of that class more generally. Thus, the remedies supplied to the duchess, a member of the very highest echelons of society, indeed, a great-aunt of the king and the sister-in-law of his queen, included some rare and expensive substances, and in substantial quantities. If Katherine’s medicines containing pearls were not in the same league as the concoction requiring sapphires, emeralds, coral, pearls, gold and silver prepared for her cousin Margaret, Duchess of Burgundy (arguably one of the wealthiest princesses of her day),
they were still beyond the reach of most of her contemporaries, and in the years of their association Clerk claimed to have supplied to her no less than 6lb 7oz of ‘Manus Christi’ and a further 12lb of unspecified ‘confections of pearls’. Equally, the duchess was supplied with the universal antidote, theriac, not only in its more common diatessaron variety, but also with the more complex and costly ‘Great Theriac’.
If less pricy by comparison, many of the individual spices and substances supplied by the apothecary were still expensive luxury goods imported by foreign, mostly Italian, merchants. This was true not only of the apparently genuine ‘mummy’, but also of exotic spices like cinnamon, mace, cloves, sandalwood, ginger and rhubarb,
and also of sugar, of which the duchess purchased the very best quality, made from the third cut of the sugar cane.
With the exception of the few instances where Clerk’s plea explicitly stated the purpose of a particular remedy, it is only occasionally possible to hazard a guess at the ailments for which particular preparations were prescribed, or, indeed, to be certain that Katherine was the only recipient (prophylactics against the plague might well have been shared with other members of her household). At the heart of medieval medical theory lay the concept of humoral balance, which could be disturbed by a variety of factors, principally relating to diet. Most of the ailments likely to afflict a patient were, therefore, attributed to an excess or deficiency of at least one of the four humours, which medication, along with dietary adjustments and supplements, aimed to redress. Allowing for financial circumstances, a remarkably wide range of herbs, spices, minerals and other animal and vegetable substances were employed in complex combinations to restore equilibrium according to the personal needs of each individual.
Particularly ‘noble’ ingredients, such as precious metals, pearls and gemstones, were prized for their perfect equilibrium by those who could afford them; those further down the economic scale had to make do with less perfect substitutes.
Retrospective diagnosis is further complicated by the fact that a number of very different conditions could be ascribed to the over-production or lack of one specific humour: an excess of black bile, the melancholic humour, could, for example, result in depression, various skin diseases, digestive problems or, in extreme cases, cancer or leprosy.
In some instances, however, it is possible to hazard a guess as to the purpose of a particular ‘simple’ or combination of ingredients, either because it was explicitly stated, or on account of the cumulative evidence of multiple remedies pointing to the same condition.
Not surprisingly, prophylactics against the plague featured large. On at least two and perhaps three occasions during the period covered by Clerk’s claims was the capital struck by epidemics. In the autumn of 1464 the Westminster law courts were suspended on account of the disease which had been rife since the previous year; three years later another plague struck during a meeting of parliament, claiming the lives of several lords and members of the Commons, and there was a further, more serious, outbreak in 1471.
The Edwardian court consumed supposed preventatives in considerable quantities. The dispensatory in Harley 1628 included recipes for waters, electuaries and powders against the pestilence, as well as prescriptions for remedies specifically provided for the king.
For Katherine, John Clerk similarly provided fumigations and a pomander, intended as protection from the miasmatic air thought to carry and spread the epidemic,
more than 8lb of cordial powders and over 6lb of waters explicitly against the disease, and, of course, the aforementioned theriac, the universal antidote particularly prescribed for the pestilence.
A few of Katherine’s medicines allow for some conclusions as to the state of her health. A number of the substances that Clerk supplied may point to the results of a lifetime of consuming the rich diet of a late medieval aristocrat.
There was a disjuncture between the recommendations of the late medieval regimina santitatis, the contemporary popularity of which is attested by the numerous surviving examples, and the active behaviour of the upper classes in the face of their physicians’ best efforts.
Under the terms of Edward IV’s household ordinances, the king’s physician was required to attend him at meal times and oversee his diet; the monarch, however, was – as contemporaries recorded – ‘most immoderate’ in his eating and drinking, and was even in the habit of taking emetics ‘for the delight of gorging his stomach once more’.
If gluttony was a particular characteristic of the late Edwardian court, it was merely an exaggerated example of noble standards of living in the period.
Sweetmeats, combined with the sweetened wines that were becoming increasingly popular in the fifteenth century were a common feature of the diet of noble ladies in the period. Thus in 1450 the citizens of Exeter plied Edward IV’s future mother-in-law, Jacquetta, Lady Rivers and Dowager Duchess of Bedford, with sugared wafers, spiced buns and various types of wine,
and the physician attending Honor, Lady Lisle, early in Henry VIII’s reign was probably not alone in advising his mistress against late-night snacks and recommending a moderate diet.
Among his prescriptions were occasional small quantities of marmalade, in lieu of heavier treats, and this may also have been the purpose of the ‘chardequynse’ and perhaps of the preserves of roses, plums, crabapples and tamarinds purchased from Clerk by Katherine. A common cordial taken as a digestive at the end of a probably excessive meal was the spiced wine known as ‘Hippocras’, after the celebrated Ancient Greek physician Hippocrates.
John Clerk sold the latter to Katherine by the gallon as a ‘potion’, and the owner of Harley 1628 supplied hippocras spiced with cinnamon to her sister Cecily, Duchess of York,
while the Exeter citizens rounded off Jacquetta of Luxembourg’s entertainment with a supply of hippocras made from red wine sweetened with sugar and spiced with cinnamon, ginger and long pepper.
Other remedies supplied to the Duchess of Norfolk that may point to digestive or related problems were the various plasters for the stomach,
while the preparations for the patient’s liver may also have been necessitated by the effects of an aristocratic diet, including (from a modern perspective) the regular consumption of large quantities of rich wines.
Nor was the king alone in ignoring his long-suffering physicians’ advice. The exasperated tone of Lady Lisle’s physician speaks vividly of her reluctance to follow his instructions, while some decades earlier the refusal of one of the canons of Gisburn priory in Yorkshire to forsake ‘unwholesome food’ and follow a regimen prescribed by his physician was pleaded in court as a justification for the practitioner’s failure to effect a cure.
Finally, there were among Katherine’s medicines some individual remedies that may point to specific complaints: there were the sugar candies for the chest; the stavesacre, also referred to as ‘Lice-bane’ or ‘Lousewort’, a plant known for its properties in combating body lice,
which was also recommended as a remedy for the toothache;
cinnamon, which as well as being prescribed for digestive problems was thought to heal diseased gums;
water of honeysuckle, which was said to ‘[sle] þe cankyr in the mouth or in þe body’;
and, along with waters against the pestilence, John Clerk also supplied similar preparations against the itch (pruritus).
The case of the Duchess of Norfolk’s dispute with her apothecary and the list of the remedies he supplied provide a vivid illustration of a number of aspects of the relationship of the late medieval aristocracy with the medical professionals of their day. In conjunction with other medical manuscripts of the period, it confirms the centrality of two concerns: the fear of epidemic disease on the one hand, and the need to combat the effects of an immoderate diet on the other. Whereas the physician of the period was concerned with preserving his patient’s health, to the aristocrat a rich diet formed part of the conspicuous consumption that was expected of him by contemporary norms, and one that he was reluctant to forego. Thus, late medieval physicians industriously drew up dietary regimina for their patients, which they – as exemplified by the obdurate canon of Gisburn – promptly ignored, only to blame their hapless medical attendants for the ill effects they suffered as a result.
At best, the late medieval nobleman or woman might be persuaded to moderate their indulgence by swallowing marginally less harmful foodstuffs designed to assist their digestion, such as Katherine Neville’s ‘chardequynse’ or the late-night marmalade recommended by Lady’s Lisle physician. Contemporary medical theory itself subscribed to an element of conspicuous consumption in attributing particularly beneficial qualities to costly substances such as gold, pearls and precious stones, which apothecaries ground into compound medicines for those who could afford them.
A side effect of the aristocratic lifestyle could be a chronic shortage of ready money; in contemporary terms, the Duchess of Norfolk’s tardiness in paying her apothecary’s bills was not particularly unusual. Medical practitioners, as Carole Rawcliffe has demonstrated, frequently had to wait for extended periods before their bills were settled,
and among the worst culprits was the king himself. Thus, by May 1475, Edward IV alone owed to Clerk the substantial sum of £283 6s. 2
d., which he would never pay; in lieu of settlement the apothecary had to be content with an exemption from the payment of customs on goods shipped from the port of London.
Nor was John Clerk alone in having to pursue the ageing Duchess of Norfolk for outstanding debts. About the same time, the Luccese merchant Humphrey Gentille was seeking payment of bills run up in Sir John Wydeville’s lifetime,
while the executors of the London brewer John Tattershall sought £26 for 156 barrels of ale at 3s. 4d. per barrel.
If the disappearance from the plea rolls of Clerk’s lawsuit against Katherine Neville raises the possibility that they negotiated a settlement out of court, the evidence of the duchess’s other creditors rounding on her, along with her absence from the list of later customers of the king’s apothecary in the dispensary in Harley 1628, may suggest that they parted company on less than amicable terms.