Ligatures and Litigations

Eric Lis

It’s easy for games to neglect to relationship between a healer and a patient. Quite honestly, I’ve never been sure if this should be less important in a fantasy setting, or much more. On the one hand, most of the healing in our fantasy games happens via magic – it’s quick, it’s efficient, it’s businesslike, and there doesn’t tend to be a lot of back and forth or getting to know the other person personally. The local cleric probably doesn’t have to ask for a person’s sexual history before using magic to remove a disease, nor do they have to stick a finger into any bodily orifices before casting a cure spell. This is in pretty strong contrast to how it goes in real life, where the relationship may not be at all personable, but it can’t help being intimate. On the other hand, for most people in a fantasy setting, the local healer is probably also their local spiritual leader, which means that even if the healing doesn’t require finding out how much alcohol the person drinks in a week, there’s a good chance that it does involve regular confession of sins, marriage counseling, or the saying of last rites for the relative who died a week earlier.

As it turns out, there’s good historical evidence that the physician-patient relationship in the medieval and Renaissance periods frequently included arguments over money. This was particularly true for apothecaries, who often supplied medications which consisted of rare substances and valuable materials, and whose customers were often exclusively the wealthy and powerful who could afford them (and had the resources to find ways to get out of paying). Perhaps most interestingly (and amusingly), there are surviving court records from the fifteenth century, of an epic legal battle between the Duchess of Norfolk and the king’s apothecary. The court records are a nifty resource for storytellers because they list everything that the apothecary charged his clients for at the time, telling us a huge amount about what was being used as medicine at the time, but they also show something of the psychosocioeconomic side of things by demonstrating 1) just how astronomical a bill could be and 2) how hard someone would fight to get out of paying it.

Purely as an aside, reading the description of the English courts of this era, it sounds as though the nobility of the day was so litigious that they made modern Americans look positively sedate and non-confrontational. This is definitely a potential source of hilarious chaos I’ve never seen reflected or exploited in a fantasy campaign. But anyway…

Based on the surviving records, we don’t actually know if this particular court case was ever settled. There’s a record that the case once failed to be heard because the court couldn’t produce an adequate jury, and then it’s never mentioned again. We don’t know if perhaps it was settled out of court, or if the wheels of justice ground so slowly that both participants died before they had an actual hearing. Either way, it shows a side of the healer’s life that we can easily forget; the apothecary alleged (perhaps falsely… let’s not assume that he was the wronged party) that he had been providing remedies to the Duchess for eight years without being properly paid, a situation difficult to imagine happening to a player’s powerful cleric, but rife with storytelling potential.

As far as this specific historical anecdote goes, the actual medicines used are almost less interesting than the courtroom drama surrounding it. None the less, it seems worth mentioning here, for the benefit of storytellers looking for that bit of verisimilitude they can add to their games. For various and largely unspecified complaints and maladies, the apothecary claimed to have supplied the Duchess with spices (saffron, turmeric, powdered mint, liquorice, cinnamon...), conserves (roses, plums, crabapples…), pills, sugar candies, plasters, waters infused with plant extracts (dragonwort, hyssop, roses, honeysuckle…), powders, and pomanders. One medicine is described as “Mannes fflesshe dryed,” suggesting that mummified human tissue was somehow used. Theriac, an unclear term which often indicated a noxious mixture of all kinds of substances, was provided in at least two forms. The sheer size of this list indicates that the Duchess was willing to consume or use any number of products; if we assume the apothecary’s claims were true, we can’t know if she was a hypochondriac, or if she kept buying medicines after previous ones failed, or if she just had so little care for her wealth that she was willing to spend obscene amounts of money on whatever she felt like. Many of the medicines were probably meant to protect against plague, which might just show that the gentry were willing to pay any price for peace of mind. Medicines and medication overuse may have been very common in the society of the time, for all we know, with lords and ladies consuming priceless cinnamon the way modern people take Tylenol and dietary supplements (that being, without regard for if they do anything). The Duchess was literally ingesting powdered pearls to treat her ills, which pales in comparison to the upper royalty who were apparently consuming crushed gemstones.

The relationship between a healer and a patient can be very complex, and even antagonistic. We can see how, just as fear of malpractice lawsuits has played a role in shaping modern Western medicine, wealthy and powerful patients could exert a certain amount of control over their healers, and may have been able to use the legal system to escape their fees (which might have only been fair, if a lot of the medicines didn’t do anything). Given the incredible costs of magical healing in most fantasy settings, it’s easy to imagine that this could be a problem there as well, although in my experience clerics usually make adventurers pay before they cast any spells, so perhaps it’s a non-issue. For a group of PCs with an interest in political conflict, getting embroiled into a mess like this could provide ample roleplaying opportunities, as well as set up entire households of new allies and antagonists who get embroiled in one way or another. 

More than four years ago, Dr. Eris Lis, M.D., began writing a series of brilliant and informative posts on RPGs through the eyes of a medical professional, and this is the one that appeared here on November 1, 2015. Lis is a physician, gamer, and author of the Skirmisher Publishing LLC OGL sourcebook Insults & Injuries, which is also available for the Pathfinder RPG system