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 .  9d . , at a time when a craftsman or labourer could expect to earn between 3d . and 8d .
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 .
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 
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 ( 13921432 ) , 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 ( 144476 ) , 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 .
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 .
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 139139d , 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 . 
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 .
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 .
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 6 lb 7 oz of 
manus christi and a further 12 lb 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 .
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
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 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 8 lb of cordial powders and over 6 lb 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 
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 ] e cankyr in the mouth or in e 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 
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 . 
2d . , 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 .
 this article discusses the medicinal remedies consumed at the court of the yorkist kings of england in the light of a lawsuit in the court of common pleas ( edited in an appendix ) between john clerk , king s apothecary to edward iv , and katherine neville , duchess of norfolk , over the partial non - payment of the apothecary s bills . 
 it argues that the consumption of apothecaries wares in large quantities was not merely a direct result of the excessive diet of the late medieval aristocracy , but in itself represented a facet of the conspicuous consumption inherent in the lifestyle of this particular social class . 
 the remedies supplied by clerk over a period of several years and listed in the legal record are set in the context of contemporary collections of medical recipes , particularly a  dispensary in the british library s harleian collection generally attributed to the king s apothecary . 
Introduction
John Clerk and his clients
The dispute of 1475
Katherine Nevilles medicines
Conclusion