It is not given to everyone to have his maladies made the subject-matter of a published book. Not so Grand Master Perellos (1697 ­ 1720) who lived to see a 104-page volume about his recalcitrant fevers printed in his lifetime.1 It all started with a letter written on February 15, 1708, by Malta's protomedico (Chief Government Medical Officer) Dr Arcangelo Grech2 at the instance of the Grand Master, addressed to the most eminent physician in Sicily, indirectly asking for guidance about the defiant fevers the Grand Master had fallen victim to. The letter, I believe, bears translation and reproduction.peer-reviewe

Bonello, Giovanni

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Malta Medical Journal    Volume 20   Issue 03   September 2008 5Giovanni BonelloHistorical PerspectiveGrand Master Perellos: rheumatic fever and syphilisIt is not given to everyone to have his maladies made the subject-matter of a published book. Not so Grand Master Perellos (1697 – 1720) who lived to see a 104-page volume about his recalcitrant fevers printed in his lifetime.1It all started with a letter written on February 15, 1708, by Malta’s protomedico (Chief Government Medical Officer) Dr Arcangelo Grech2  at the instance of the Grand Master, addressed to the most eminent physician in Sicily, indirectly asking for guidance about the defiant fevers the Grand Master had fallen victim to. The letter, I believe, bears translation and reproduction. ‘His Serene Highness Prince of this island of Malta, aged 71 years (but actually 74) di corpo pricocolo (small in stature?) on the anniversary in which his most joyful election was being celebrated on the seventh of this month, with a great number of knights and vassals gathered in the Palace to extend their congratulations, had felt extremely hot flushes and having left, was shaken by great shivers of cold. On the following day he was assailed by acute pains, first in the heel and later in the knees and right shoulder, for a whole day, with orrore (either stiffening or trembling) all over his back  and high temperature, which persists to this day the ninth day of his infirmity this being of the type, though without the obvious symptoms, of double tertian continuous fever, and a general fatigue, with very clear and colourless urine.‘And, because of the obstacle of high fever (fervore di orgasmo febrile) it was not thought proper at any time to administer any medication, except for one blood letting, in so far as his age and constitution allowed, hoping to procure some metastasis in some noble part, apart from the deposit of internodes. I omit any reference to what is usually done to correct the overabundance of acid exuded, through the appropriate remedies well known to the doctor to whom this brief summary of his medical history is addressed with profound reverence. From Malta, Arcangelo Grech’.3 Don Juan de Acuna, Spanish Governor of Messina and Fra Andrea di Giovanni, the Order’s commander in that city, twisted Dr Bottone’s arm to proceed to Malta to undertake treatment of the distressed Grand Master. Bottone says he was persuaded to go though many obstacles stood in his way, not least his old age and habitual infirmities, the harsh winter season and the state of war which encouraged pirates and enemies to run loose in the canal of Sicily. When Perellos’s letter reached Bottone, the doctor was 67 years old, having been born in Lentini on October 6, 1641. He had been suffering from an extremely painful gout since at least 1692, and was universally recognised as the foremost physician in Sicily. Educated by the Jesuits in Latin and philosophy and in medicine by the university of Palermo under the renowned anatomist Marcello Malpighi, he graduated c. 1665. His reputation spread rapidly, being appointed physician to the Archbishop of Messina Simone Caraffa and subsequently to the Spanish Viceroys Villafranca (1674), Castel Rodrigo (1677) and Santo Strefano (1679).Key wordsGrandmaster, syphilis, rheumatic fever, historyGiovanni Bonello LLDEuropean Court of Human Rights, Strasbourg Malta Medical Journal    Volume 20   Issue 03   September 2008These supervening incumbencies forced him to move to Palermo where Cardinal Portocarrero fell under his spell and recommended him to king Charles II who in 1683 wanted him in Naples. Here he became protomedico under a false name (only Neapolitan doctors could aspire to that post) and for four years occupied the chair of philosophy in the university of the capital. His gout however forced him to return to Messina where he settled permanently except, it seems, for his voyage to Malta.4Bottone’s reputation had spread to England, earning him the honour of being the very first Sicilian to be appointed member of the Royal Society in 1697. This signal distinction came about after the disastrous earthquake which devastated Sicily and Malta in 1693. The Royal Society commissioned a scientific report on the event to Malpighi who had however meanwhile left Sicily for Bologna. Malpighi passed on the task to his favourite pupil Bottone who prepared a detailed essay Idea historico-physica de magno Trinacriae terremotu. This so impressed the Royal Society that they appointed Bottone their first Sicilian member. Perellos’s invitation was not the earliest contact by Bottone with Grand Masters of Malta. He recounts in some detail how, still an adolescent, he had come to know Grand Master de Redin who, he says, had died (in 1660) pulmonis et renum inflammatione. During his autopsy, adds Bottone, a large stone had appeared in his right kidney – a calculus in an extremely hard shell, bluish in colour, shiny, similar to a branch of coral. He also knew Grand Master Carafa who died after a long illness (1690) and a huge stone was also discovered in a post mortem. The Sicilian doctor moreoevr mentions the death of Bali (of Santo Stefano) Fra Carlo Valdina who passed away after long suffering and unremitting fever (1645). On his death the doctors extracted from his kidneys various calculi, oval in shape. The text fails to clarify if Bottone was present in Malta in all these deaths, though of some, like Valdina’s, he could only have known second-hand. “When in Malta” Bottone adds, “I heard that more and more often noble knights and inhabitants suffer from calculi”. He attributes this to Maltese conditions – even the best quality spring water gushing out “is channelled through stone conduits and ends clouded by inconspicua corpuscula”. He suggested that all water for internal use should always be purified by boiling and distillation, to dispel spirits and volatile salts, and to allow the dust and mud to settle at the bottom of the distilling vessel.5Bottone gives a very detailed account in Latin of the progress of the disease, the symptoms that developed and the various treatments he prescribed. At first the health of the Grand Master took a dramatic turn for the worse: his life appeared in obvious danger. Those in charge ordered the Last Sacraments, with the concurrence of the highest prelates and knights. Perellos dictated his testamentary disposition.6 Then Bottone administered a large dose of spirit of stag’s antler (spiritus cornu cervi) in saturated volatile salts as a syrup, followed by a small helping of acqua Nocera (a particularly pure mineral water from Nocera once believed to have curative properties) and the patient appeared relieved and quietened down. Follow many pages of meticulous observations on the progress of the patient and various treatments, until his final cure. On April 5, Perellos, now fully recovered, wrote to the Governor of Messina a long letter in Spanish to thank him for contributing tanta parte a la recuperacion de mi salud and praised Dotor Don Domingo Bottoni entrusting him to refer to the Governor viva voce the details of the illness and his recovery.7The trouble with Bottone was not so much his great erudition as his compulsion to show it off. The whole treatise, in convoluted Latin, groans under quotations from philosophers, theologians and of course, professors of medicine, from the most ancient to the contemporaries, like Lazar Rivier from Montpellier, Galen, Hippocrates, Avicenna, Thomas Sydenham, Johannes Guinter, Cous, Antonio Santorelli from Nola, Cornelius Celsius, Athanasius Kircher, Franciscus Vallesius, Richard  Morton and many more. But is it really helpful to know the meditations of St Thomas Aquinas on flatulence and diarrhoea when describing Figure 1: Frontispiece of the 1717 book about the illness of Grand Master PerellosMalta Medical Journal    Volume 20   Issue 03   September 2008 how the sick Grand Master had a colossal evacuation after a touch of Bottone’s special purgatives? He left no occasion slip to prove how up-to-date he kept himself. Again, in line with the thinking of his times, medicine and religion had to appear as one, the doctor being merely a tool in the hands of divinity, fighting, more than natural adversities, the machinations of the evil one. A physician intervened by giving a small pull in the tug-of-war between God and the devil. All this makes for very heavy reading, and ensured that everyone immediately forgot Bottone’s book the day after publication. Not even Dr Paul Cassar refers to it.The Sicilian’s main works remain his treatise on fire (1692), on the earthquake (1693), but, most of all, his very last book following the deadly plague of Marseilles: Preserve salutevoli contro il contagioso malore of 1721. He espouses the 1649 corpuscular theory of Giovanni Alfonso Borelli: the action of the sun and of atmospheric agents releases from the soil “pestiferous germs”; these spread in the air and carry the disease. Plague does not effect animals but can be carried and transmitted by them. His most valid contribution, though based on a flawed syllogism, remains his insistence on personal and public hygiene, the cleanliness of buildings, roads, drains, watercourses and stagnant waters. Perellos survived his life-threatening rheumatic fevers, but, all the same faced other major health problems attributed, by diplomatic gossips, to his venereal disease. The wittiest and most observant of them all, the envoy Giacomo Capello, in the secret report he forwarded to Venice in 1716, had a lot to say about Perellos, and none of it particularly endearing. From his name to his habits, to his tastes, to his debauchery, to his stinginess. Before becoming Grand Master he simply went by as an undistinguished Perellos, but on election he fancifully added y Roccaful because that surname commands some respect in France. He brokered his election to the grand-mastership relying on the usual simony (the commerce in sacred positions or objects). He favoured rabidly pro-French and anti-Venetian policies. Capello describes the manoeuvres by which Perellos secured the grand-mastership. He had a miserable income and depended on a (Maltese?) merchant for maintenance. In order to buy votes he embezzled 30,000 scudi from the fund for the redemption of slaves. Had his bid to become Grand Master failed, he would have been ruined as he was in no position to return the ill-gotten bribe money.  He exercised no authority at all over knights of the Grand Cross, who laughed at him behind his back, nor on the population, as anyone who wanted to escape his jurisdiction just became a cleric of the bishop or a patentee of the Inquisitor. That simple.To avoid expense Perellos never went to the country (San Anton and Verdala castle) but spent all his afternoons in a miserabile orticello near Marina Gate, over which there is a gabinetto vitriato (a glass-walled balcony) wretchedly furnished. He gets up very early, goes to several masses, and almost always wears a ceremonial wig (he probably introduced its use in Malta).  To save money he retains no foreign correspondents and keeps himself more or less informed of European affairs only by borrowing from others - not subscribing to – foreign printed broadsheets. A weak person, he goes by first impressions. If caught unawares, he cuts short by flying into a rage; if prepared, he defends himself properly. Mostly he was fond of the vile canaglia (the lowest classes) and protected corsairs because they paid well: ten per cent Figure 2: The mercury treatment for syphilis in the 18th centuryFigure 3: Legend Portrait of Grandmaster Raimond Perellos8 Malta Medical Journal    Volume 20   Issue 03   September 2008of the loot, however immorally obtained. His very strained relations with the Papacy depend on the fact that Rome sides with those assassinated rather than with their assassins. Bad monarchs, Capello adds, deserve worse counsellors, and in this Perellos was well served by the uditore Goris  (Gaspare? Antonio?)from Siena. His most vocal opponent was the Portuguese bali Emanuel (Vilhena, his successor after Zondadari) who often drove him to despair and sometimes to tears.  But he has no fear of being dethroned as, during his long rule he had appointed 50 Grand Crosses by personal prerogative and these would support him whatever. The Grand Master gives 50 scudi daily in alms, but ostentatiously and at two soldi per person. How far better if instead of alms from ill-gotten piracy, he were to ransom the poor Christians enslaved by the Turks and passing through Malta on French ships? Perellos resplended through ignorance, but is very cunning nonetheless, vainglorious, stubborn, cruel, and would never let go of a penny. He increased import duties enormously by 30,000 scudi a year, all to the detriment of the poor, acting through a doganiere scelerato.Capello underlines Perellos’s mania for women, a trait which still persisted in 1716 when the Grand Master was 80 years old. He always splashed on perfume profusely, and the ladies of the city visited him daily. He served them hot chocolate and confectionery, flirting vacuously with them. They spent their time with him all busily running down their husbands, and he made it a point always to take their side. He cannot resist womanizing, and keeps a young girl as mistress across the Palace, after having ditched his previous concubine (Donna Florinda) with a gift of a house and other presents. To everyone’s outrage, he still carried on subsidising her wretched relatives of the lowest social orders (gran canaglia). Those who needed favours from the Grand Master contrived for his young lover to plead on their behalf. All this lechery, Capello adds, resulted in intractable venereal disease. The Grand Master was now paralysed by the repeated treatment for syphilis – the inunction with mercury. He still looked strong considering his paralysis, having undergone the inunction far too many times: that is, absorbed mercury over and over again “in consequence of his excessive chastity” Capello comments, with less than relaxed sarcasm. An astrologer on a visit to Malta seeing the Grand Master exclaimed ‘this is a sack of bones, crammed with disease and vendetta’.8Rubbing the body with mercury salves and remaining extremely long in oven temperature had long been the universally accepted remedy against syphilis and other venereal ailments. The benefits of the treatment were questionable; its devastating side effects were not. The only alternative, guaicum, a wood from the West Indies enjoyed a blaze of popularity for its alleged anti-venereal curative powers.9 Whether guaicum did anything for the patient is debatable, but for its importers it did a lot. Its agent in Italy died leaving a fortune of three million gold florins. Peruvian bark (cinchona) the basis of quinine, was also experimented – less aggressive than mercury but probably useless. It may or may not be coincidental that Bottone, though never mentioning syphilis by name, prescribed Cortex Peruviana to Perellos.10A reputable bibliography of the Order of Malta11 records a book on the last days and death of Perellos.12 Hard as I tried, I could not get hold of a copy. I looked for it at the National Library in Malta and at the central archives of the Order in Rome, with no result. A search in Florence and Siena proved equally useless. The information this book presumably contains would have rounded this feature off quite nicely. Capello’s hatchet job notwithstanding, Perellos ranks with the better Grand Masters. He spent fortunes on constructing handsome buildings and embellishments – both the St John and the Palace tapestries were his gifts. Equally importantly, he revolutionised the thinking behind the Order’s fortifications, opting for the new advanced French engineering model, after years of Italian primacy. Overall, a ruler with a positive balance sheet. References1 Domenico Bottone, Febris rheumaticae malignae quam … D. Raymundus Perellos, Messina, 1717. 2 For Dr Arcangelo Grech v. Paul Cassar, Medical History of Malta, London, 1964, p. 483; Giovanni Bonello, Histories of Malta, Vol. VIII, Malta, 2007, p. 90, 97, 100. 3 Bottone, op. cit., pp. 13 – 15. 4 Dizionario Biografico degli Italiani, Istituto Treccani, sub voce. 5 Bottone, op. cit , pp. 46 – 52. 6 Ibid., pp. 53 – 55.7 Ibid., pp. 73 – 75.8 Victor Mallia-Milanes , Descrittione di Malta, Malta, 1988, pp. 83 – 87. 9 Kenneth F. Kiple,  Plague, Pox and Pestilence, London, 1997, p. 112.10 Bottone, op. cit., pp. 69 – 70.11 Ferdinand de Hellwald,   Bibliographie Méthodique, Rome, 1885, p. 144. 12 Relatione della morte del Gran Maestro Fra. D. Raimundo Perellos, Siena, Francesco Quinza, 1720.

Arcangelo Grech v. Paul Cassar, Medical History of Malta,

Bibliographie Méthodique,

Dizionario Biografico degli Italiani, Istituto Treccani, sub voce.

Pox and Pestilence,

Relatione della morte del Gran Maestro Fra. D. Raimundo Perellos,

Grand Master Perellos : rheumatic fever and syphilis

https://www.um.edu.mt/library/oar/bitstream/handle/123456789/893/2008.Vol20.Issue3.A7.pdf?sequence=1&isAllowed=y

Grand Master Perellos : rheumatic fever and syphilis

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