Appealing to the Republic of Letters: An Autopsy of Anti-venereal Trials in Eighteenth-century Mexico

This study analyses the narrative elements of a little-known report into anti-venereal trials written by an Irish military physician-surgeon, Daniel O'Sullivan (1760–c.1797). It explores the way in which O'Sullivan as the narrator of the Historico-critical report creates medical heroes and anti-heroes as a means to criticise procedures initiated by staff in the Hospital General de San Andrés, Mexico City. The resulting work depicts a much less positive picture of medical trials and hospital authorities in this period than has been recorded to date, and provides a critical and complicated assessment of one of Spain's leading physicians of the nineteenth century, Francisco Javier Balmis (1753–1819).

By this stage, a small and apparently successful trial of the cure had already taken place in the Hospital of San Juan de Dios in Mexico City. 3 Reports indicate that his claims led to a sense of expectation among the medical and clerical authorities in the hospital at the possibility of a home-grown replacement for the usual mercury-based therapies. A claim to possess a new anti-venereal treatment was not, of course, a new phenomenon. That same year an Englishman, Francisco Wates or 'Francisco El Inglés', purporting to be a specialist in treating venereal disease, introduced a cure that included sarsaparilla, warm milk and an emetic of tobacco water. 4 Seven years before Viana's arrival, a virulent polemic over a lizard-based cure for venereal disease had also taken place in the city. The anxiety over the language used in the reports on the lizard cures formed part of a broader context of a new type of reader and consumer of the sciences who increasingly turned to knowledge and scientific practice as a means of defining their role in public life. 5 The historical, 'official' account of the ensuing trials into Viana's remedy, also known as the 'Beato method', in the General Hospital of San Andrés and the hospitals of San Juan de Dios, General, and Pasión in Madrid, has long been based exclusively on the published work by the Valencian surgeon, Francisco Javier Balmis (1753-1819), and to some degree on the minutes from meetings held in San Andrés, and the later reports written by the Protomédico, José Ignacio García Jove. 6 These works have created a picture of a medical community open to testing hypotheses and working to consolidate knowledge; a group largely united despite variance in opinion. 7 According to these accounts the San Andrés trials comprised a variety of stages, each with an increasingly larger cohort of patients. The initial stage involved 20 male patients and 12 female and lasted for one month, during which time they were treated according to Viana's instructions, without the intervention of other medical staff, and to the exclusion of all other medicines. In the second stage, following a meeting of hospital staff and medical authorities wherein the first results were judged inconclusive, the number tested rose to 40 men and 20 women for over a period of two months. Whilst there are occasional references in the notes 3 In 1779, Alonso Núñez Haro y Peralta successfully petitioned to be given responsibility for establishing a hospital in what would become the Hospital General de San Andrés. In 1786 the Viceroy granted him complete control of the running and financing of the hospital. This meant that the hospital was not answerable to the civil authorities for either the administration or financial practices. See Josefina Muriel, Hospitales de la Nueva España: fundaciones de los siglos XVII y XVIII, that suggest a failure to reach unanimous opinion in absolute support of the cure, the hospital authorities concluded that the 'Beato method' was in fact a 'specific' for the treatment of venereal disease, and administered it in place of mercury without further delay. It is clear, however, that a majority of patients were once again opting for the mercurial treatments, which caused the authorities to prohibit the further use of any form of mercury in order to promote their chosen method. 8 Haro y Peralta, convinced of the effectiveness of the cure, commissioned Balmis to bring samples of the Maguey and Begonia plants to Madrid to undertake further trials to persuade the Spanish government of the usefulness of the American discovery. Balmis dutifully travelled to Madrid in 1792 where he undertook a number of trials that led to his publication of the previously mentioned Demostración de las eficaces virtudes (1794).
The current study seeks to highlight the problems inherent in privileging successes above failures in our understanding of the past. In other words, to recognise the validity of the path of 'bad medicine' tackled by David Wootton, who has argued that: We know how to write about histories of discovery and progress, but not how to write histories of stasis, of delay, of digression. We know how to write about the delight of discovery, but not about attachment to the old and resistance to the new. We know how to write about successful treatments and lives saved, but not about worthless therapies and lives lost. … Because we only know how to tell one half of the story, the story we could tell is so obviously unsatisfactory that … we usually choose not to tell it. 9 An increasing number of critical studies into Spanish American medicine and science in the early modern period are moving beyond the need to merely highlight the continent's contribution to world knowledge, and instead dig deeper into the complexities of reception, rejection, promotion, development, and exchange that necessitate recognition of the negative with the positive, and consider errors and failure as well as successes. 10 With this in mind, I will argue for the importance of including in the historical narrative a long neglected report into the trials written by a contemporary Irish physician-surgeon, Daniel  paints a contrasting picture of a hospital system wherein the exercise of power and authority led to corruption, the misrepresentation of medical data and, in some cases, death, and illustrates the strategies adopted in a struggle to succeed within particular structures of authority and patronage. I have chosen to refer to this document as an 'unofficial' report for two main reasons. First, unlike the sources that have formed our understanding of these events to date, it did not receive recognition from or endorsement by any of the Mexican authorities; furthermore, there is no evidence to indicate that they had any knowledge of its existence. Secondly, despite the fact that it was commissioned by the Royal Academy of Medicine in Madrid, it has remained almost completely untouched and unstudied by scholars since the end of the eighteenth century. 12 For the purposes of this article I shall focus on the interplay between O'Sullivan, the creation of his Relación, and the concept of the international republic of letters of the late eighteenth century as a potential mediator for medical disputes. By setting the Relación within this context I hope to highlight the importance of understanding the literary aspects of such medico-scientific texts and explore particularly the means by which authors, such as O'Sullivan, persuade and even manipulate their audience, both real and imagined. This study will engage with O'Sullivan's attempt to promote himself as a reliable narrator by appealing to core ideals within the republic, thus establishing a platform for agreement with the reader. It focuses on two narrative strategies in particular: the employment of contrasting narrative voices within the text, and the creation of enlightened medical heroes with their constituent anti-heroes, such as his depiction of Francisco Javier Balmis. 13 Key to this approach is O'Sullivan's interest in, and pursuit of, a recognised place in the republic of letters with its constituent value system.
In its ideal form, the republic of letters, was a 'realm of talent and of thought'; an international, metaphysical, and intellectual community built upon the ideal of the promotion and exchange of knowledge across geographical, religious, and social boundaries. 14 In many senses it was a forerunner of today's virtual communities whereby individuals sought to increase and share knowledge as well as attain recognition whilst separated by sometimes vast geographical distances. It can be understood as a potentially non-hierarchical space characterised by a particular 'attitude', where the 'practices of intellectual sociability and discourse … were grounded in cultural and epistemological assumptions shared by those who Documental, Fol. 40, leg. 14c, doc. 67. The use of underlining is presented as in original manuscript, spelling and typography are also as in the original document, translations from the Spanish are my own. 12  Autopsy of anti-venereal trials in eighteenth-century Mexico considered themselves to be citizens of that republic'. 15 These shared assumptions included the importance of links formed by 'mutual assistance' and obligation, above and beyond the work of institutions. 16 Goodman has also argued that in addition to the idea of a 'pseudo-Gemeinschaft' of the 'scientific community', the project of the Enlightenment had given its citizens 'a greater sense of identity, a greater sense of their own autonomy and high status within their society' built upon ideals of reciprocity, intellectual cooperation, cosmopolitanism and fidelity to the truth. 17 As Daston indicated, at the heart of this republic lay the ideal of: an elite confraternity distinguished by merit in literature, scholarship, and science; by near total freedom of expression …; by equality among members, in defiance of rank and birth; and by tolerance-tolerance that was emphatically religious and incidentally national. 18 Such sentiments were, in reality, often at odds with the fact that these same individuals were also competing for intellectual accolades and peer approval, with the institutes and academies playing a key role in judging merits and all the ensuing problems these processes entailed. 19 This world, as Grafton has remarked, formed a 'palimpsest of people, books, and objects in motion', 20 offering potential for a migrant physician in search of career advances in the late eighteenth century.

O'Sullivan and the Republic of Letters
Born in County Cork, Ireland, O'Sullivan followed in the steps of many young Catholic Irishmen before him, studying Mathematics, Philosophy and Theology at the University of Toulouse, France, in the 1770s. 21 In 1780 and following his tonsure, he matriculated in Medicine at Toulouse, and, much in the manner of medical students of the time, spent the following five to six years travelling to study at various schools and hospitals in Paris, Montpellier, London, Glasgow, Edinburgh, and Dublin. 22  The Relación was not, however, O'Sullivan's first attempt to rally the interest of the literary republic. In 1789 he had sought limited literary success with an application to publish a literary journal, the Censor Literario ò Revisor Critico (The Literary Censor or Critical Reviewer). In a manner typical of the publications of the period, he promised a periodical that would highlight all that was beneficial in literature, commerce, agriculture, science, and arts. His application for exclusive rights to the periodical and all income thence deriving received a mixed response from the Spanish authorities. Whilst he was offered muted support to facilitate this project, he was not granted the full economic benefits in the initial stages. The 23 Archivo Histórico de la Facultad de Medicine, Universidad Autónoma de México (AHFM-UNAM), leg. 2, exp. 6. Whilst not wishing to detract from valuable examples of Spanish medical practice in this period, we should, of course, note that he makes these claims to the excellence of medical training Spain in a document requesting certain privileges within that same Empire, and should therefore also be understood within the context of self-promotion. response to his application noted three main concerns: doubts as to the fluency and purity of his Spanish; lack of German language ability, indicating that he could not offer the public any insights into that increasingly important language; and lastly, it was feared that the works printed in the languages in which he was proficient (English and French) would contain errors or ideas relating to doctrine that were not admissible on Spanish soil, necessitating constant vigilance of the content of the proposed publication. 28 It is not clear whether O'Sullivan ever received word that he had gained consent to publish, as the statement of limited and censored approval was granted only days after he had already set sail for Veracruz with the Spanish army.
Once in Mexico, the language in O'Sullivan's applications for various posts, just as in his Relación, suggests a general flexible sense of identity built upon the ideals of the pursuit of knowledge based on reasoned, impartial and critical thinking. This polymorphous approach to identity claims within the republic of letters reflects the migrant path to survival and indicates the particular importance of appealing to those powers and institutions perceived to best further an individual's career, whichever the nation. For an individual in O'Sullivan's situation, the recognition afforded by corresponding membership to a distant and reputable institution such as the Academy of Medicine held potential in a competitive local environment, and for his future should he return to the Peninsula as he seemed to have planned. 29 Over the course of the seven to eight years he lived in Mexico, he consciously cultivated connections with various centres of knowledge including the Botanical Gardens and the Royal Pontifical University. For the most part, however, his later applications for recognised positions were unsuccessful. 30 Although O'Sullivan claims that his lack of success in career progression within Mexico was due to the opposition he had voiced to the Beato method trials, it is also possible that he had fallen victim to ongoing antagonism among various institutions and suffered simply from being a 'foreigner'. 31 In the case of the treatment offered to venereal patients in the Hospital of San Andrés, or more precisely, the lack thereof, it is clear that by 1792 he had decided to appeal beyond the local authorities in the person of the Viceroy and turn to his trans-Atlantic connections in the hope that the case would be 28  brought to the highest court in the empire, that of Charles IV of Spain. The means by which he worked to persuade his reader is the subject to which we now turn.

Promoting Reliability: The Narrator and the Reader
The Relación that forms the focal point of this article was one of three reports that O'Sullivan submitted at the behest of the Royal Academy of Medicine. 32 In the concluding section of the last of these, the 'Carta cirular' (Circular letter), directed to his friend O'Scanlan in 1793, O'Sullivan states that he had undertaken all that behoved an hombre de bien (honest man) and Christian philosopher using all possible means compatible with a prudent approach, in order to confront the 'torrent of ignorance' and the 'stumbling blocks to progress' in matters that dealt with the life and health of the citizens. 33 Despite his intention to write a report on the initial trials in 1791 he explains the delay of nearly two years as he bemoans: But my friend, time, which consumes everything, had weakened this good intention, setting obstacles in the path to completion; the duties inseparable to this sorry profession which we have both embraced; the little joy that can be gained from working in a country where ignorance, charlatanry, inferiority and deceit play such a key role against honour, talent, education, and truth; the desire to distance myself entirely from an issue that has brought me little more than open persecution, … have made me postpone and nearly forget my original aim to deal with this matter. 34 The request from the Royal Academy in April 1792 seems to have woken him once more from the 'state of indifference' into which he had fallen, turning again with enthusiasm to the task at hand. 35 O'Sullivan can now sense that the doors to the international knowledge network have opened to him, bringing him a step closer to institutional recognition and the possibilities of reciprocity therein, claiming that: Yes Sir, knowing the current advanced state of Medicine in Madrid, having received news of so many individuals in whom exact philosophy and healthy criticism is evident, knowing at last that there is a Royal Academy of medicine facilitating gatherings of men who are learned, expert, and trained in observation, who, on the basis of their reflections, have reached the zenith of philosophy, which is the art of doubting, under the scrutiny of such highly qualified men, I did not fear the success of such a cure whose temporary effects are only capable of deceiving the ignorant or incautious. 36 bien' also carries significance as an enlightened man. 34 Ibid., n.p. 35 Ibid., n.p. To date, I have found no trace of the April 1792 letter, or a further letter on the matter written by O'Scanlan in June 1792. 36 Ibid., n.p. court of Madrid. His language appeals to the enlightened institution from the perspective of one who shares their goals and aspirations on a scientific and philosophical level but is trapped in a world that is not of his making.
This appeal to commonality of interest links us directly to the idea of the reliable author. In their study of narrative structure, Herman and Vervaeck outline the fundamental fact that the success of 'the reliability and the quality of reading depend on the similarity between the implied author's ideology and the ideology of the reader'. 37 In the most direct sense then, O'Sullivan's readership comprised the élite that formed the Royal Academy of Medicine who commissioned the report. The final success of his claim within the institution is evidenced by the fact that he was offered corresponding membership in October 1793 on the basis of his work. 38 We find further direct allusion to this group of ideal readers in his concluding appeal in the Relación: The reports to the Royal Academy of Medicine and the Madrid Royal Protomedicato will put an end to these disorders that have lasted for too long. If, distinguished professors, you who have dedicated your studies and countless efforts to the alleviation and conservation of the public, you who know no other language than the truth, … in conclusion, you, whose consummate science, practice, and insight, prevent you from being deceived by illusions; you, worthy successors of the family of Asclepius, will have compassion on the afflictions of this unhappy public and lay their pitiful groans at the compassionate feet of the throne; you, wise companions who do honour to the medical profession, will pour out the consoling balm of health on the open wounds anxious to receive it, and add to the many glorious titles by which you are distinguished in society, that of Protectors and Consolers of the helpless poor. 39 The tone of the address is, of course, laudatory as he is appealing to their higher senses for the acceptance and promotion of his account. His words hint at the desire for the content of the report to reach the highest echelons of power through appeal to the king and, therefore, a wider circulation outside of the Academy and among the educated elite. The structure of his text must, then, seek to match the ideology of the implied reader in terms of enlightened ideals that honour the medical profession. That said, he also gives his reader a reason to continue through the introduction of various narrative hooks. The methods he employs to achieve this latter goal range from the accessible format of the report-77 folios, divided into 26 reasonably short, numbered sections and a final conclusion-to the choice of content for each section. 40  of the hospital with an outline of the history of venereal disease and its many treatments, to an assessment of literature charting the reoccurring practice of charlatanry, and a detailed account of the various stages of the Beato method trials. Within the chronological pattern, the events of the trials are driven forward by the insertion of a critico-satirical analysis of the main characters, their motivations and actions. As the plot thickens in terms of the levels of deceit and manipulation, O'Sullivan introduces little 'cliff hangers' at the end of each section, drawing the reader into the story and promising a denouement that never truly materialises as the outcome of the action is still ongoing at the time of writing.
From the outset, he prepares his reader to accept certain premises in the unfolding account through the inclusion of three specific quotations on the title page taken from Virgil, Cicero and Horace. His appeal to the authority of classical texts draws the reader's attention to three central factors relating to the narrator: first, a forewarning of the disturbing content of the narrative that lay ahead and his key involvement in these events, 'Quaeque Ypse miserrima vidi … et quorum pars magna fui'; 41 second, the resulting sense of responsibility to account for what had happened, 'Quis nescit primam hanc esse Historiae legem, ne quid falsi dicere audeat; deinceipsne quid veri non audeat'; 42 and finally, the qualities of character of the narrative's 'hero' and homme ilustré in the face of all opposition: Yustum et tenacem propositi Virum / Non Civirem Ardor prava jubentium, / Non Vultus instantis, Tiranni / mente quatit solida / Si fractus illabatur orbis, / Ympavidum ferient Ruinae. 43 The reader is thereby made aware that terrible events have taken place and that the account that follows is linked to a source that embodies all that is truthful; a narrator certain in his perceptions as a result of experience that has come at great personal cost. The underlying suggestion is, therefore, that the reader may trust the narrator who indicates his critical awareness of these judgements and bases his account not only on the act of 'seeing' as 'eyewitness' but also 'perceiving' through the use of reason. A further interesting area of study lies in the potential import of O'Sullivan's choice of classical texts and the significance of their original contexts in regard to his observations of the eighteenth-century trials. Such a discussion will take place within the larger project from which the current study is taken but is not possible here.
The Relación is, in fact, peppered with the juxtaposition of images of light and dark, sight and blindness, reality versus pretence, all resonant of reason and unreason respectively as he plays to the enlightened concepts of serving the public good. 44 The emphasis on true sight and the practice of reason or informed sceptical analysis builds upon an autoptic rhetorical structure wherein the report becomes an autopsy of medical practices and a veritable dissection of the private interests of those involved in the trials. 45 The overlap between medical and historical terminology is highlighted by Catherine Darbo-Peschanski's explanation that: autopsy or personal visual experience, which is implicit in the very etymology of the word historiē /a, [is] directly derived from the noun histō r, itself derived from the root *wid meaning 'see' and which also gives the verb oida, 'I know.' Just as histō r means 'the one who knows because he has seen'…, so historiē would be, or would prepare one for, a knowledge founded more specifically on visual observation … 46 The role of the witness in laying bare the truth in classical historical accounts is similarly echoed in Guido Schepens's study of the Roman historian Ammianus, whose approach, he argues, was a, '… "classic" formulation of the method of personal inquiry in history: it envisages veritas as the result of a process of research and evaluation (scrutari) through autopsy or the careful interrogation of participants in the events'. 47 For O'Sullivan, the play of visual language and references to classical texts alludes to a continuation of the tradition of Renaissance emphasis on firsthand reporting in historiographical writing. Both Pagden and Greenblatt, building on de Certeau's commentary to Montaigne's 'Of Cannibals', have noted the use of the autoptic imagination as a key element in early modern accounts of the New World. 48 Pagden asserts that the use of first person utterances, 'I saw', 'I heard', etc., are 'an appeal to the authority of the eye witness, to the privileged understanding which those present at an event have over all those who have only read or been told about it'. 49 If we follow Greenblatt's argument that 'the eyewitness possesses the truth and can simply present it: he who has not seen for himself must persuade', then O'Sullivan's presence at the trials and his personal interaction with the main characters is in itself a strong foundation on which to base his reliability in the mind of the early modern reader. 50 Furthermore, O'Sullivan adds the emerging late eighteenth-century rhetoric of the trained 'philosophical' traveller or observer promoted by such as Raynal's Histoire philosophique et politique (1770) and Adam Smith's The Wealth of Nations (1776). 51 The idea of anatomical scrutiny, or the detailed interrogation of all the constituent parts, is a central theme on which he bases his approach: In history, the facts are like the bones of the skeleton; the chronological order and the natural transition from one subject to another form the joints and the ligaments that bind them; the accidents, small circumstances, with their effects and consequences, are the vessels, membranes, muscles, and other elements that form the natural contour and make History's body beautiful; the truth forms its character, and critical ability provides the senses. But this body with all these requisite parts is still no more than a cadaver, to bring it to life we need to express the particular interests, and the secret passions of the actors, these are the nerves, this the vital principle that sets the whole machine in movement. This is the most difficult aspect of the role of the Historian, and more so if he is dealing with contemporary events. 52 The difficulties of dealing with live and sensitive issues (the passions and interests) come clearly to the fore in his allusion to the nervous system alongside a recognition that none of the other elements make sense without an attempt to understand these factors. Should the reader have forgotten the numerous struggles the narrator has experienced, we are brought back to consider his initial warnings from the title page and the responsibility that results from such knowledge. O'Sullivan's narrative techniques therefore consciously frame the information he provides and turns the reader's gaze in a particular direction, one of which was the creation of the 'hero' and the 'anti-hero'.

The Creation of the Medical Hero and Anti-hero
It is important to recognise texts such as O'Sullivan's as examples of literature in the broader sense, especially when taken within the context of his literary ambitions in the republic of letters. As part of the structural strategies employed to engage the reader, O'Sullivan creates a narrative that moves between the extradiegetic and homodiegetic. That is, on some occasions the narrator stands above the events he narrates (extradeigetic), but as part of the autoptic imagination he must show that he has also experienced them and is a player in them (homodiegetic). Such an approach means that although at times the character of 'Dr O'Sullivan' in the third person is not visible, he is continually present in the text as the omniscient narrator. The homodiegetic narrator, as an involved character, situates himself in a central role in the action (autodiegetic), whilst the extradiegetic narrator is a distanced, impartial observer (allodiegetic). 53 This method facilitates O'Sullivan's conception of the role of the historian and the reliable, detached, and disinterested voice that stands outside of the action, providing the balanced, critical assessment whilst also promoting the immediacy and reliability of the eye-witness, allowing him to underline his personal efforts in the struggle for the public good. We find this exemplified in the confrontation 51  between O'Sullivan and the proponents of the Beato Method when the cure is first discussed among the hospital staff: The Beato's claims and the certificates of authenticity he provided in no way persuaded Dr O'Sullivan … he added that no charlatan had ever presented himself before the public without a thousand statements supporting the benefits of his secrets. … These are the reasons, said Dr O'Sullivan, 'that led me to withhold judgement in this matter, and do not permit me to continue with you, esteemed gentlemen, in the hopes I see you have formed; only experience can overturn my decision and no one would be happier than I should it be proven, for no one could be more completely convinced of the value of a method that at so little cost could destroy cito tuto et jucunde 54 this scourge of humanity; I would go as far as to say that if as few as half the claims made by the Beato were confirmed, the cure would, for me, be a most valuable invention, and I do not doubt that the Public would gain much good from it. But however much I wish it to be true I am even more aware of the deceit should it be false, and as a result I am ever more aware of the need to stay undecided until experience makes the decision clear.' 55 Both the extradiegetic narrator and the homodiegetic narrator are present. The use of indirect speech when preparing the broader setting of the confrontation and direct speech with the inclusion of quotation marks serves to bring the reader's focus to key arguments. This strategy emphasises his role as the detached, disinterested observer withholding personal opinion and following the route of trial and experience as the basis of scientific practice. The opposite is then inferred of his opponents. The criticism is, of course, that they have already reached their conclusions about the veracity of the cure without waiting for the outcomes of the trial-the lack of proper scepticism. He thus stands out from his opponents and his words are given greater bearing through the repetition of first person utterances. The narrator's use of direct and indirect speech as a means of consciousness representation should lead the reader to question the 'relationship between representing agent and the one who is being represented'. 56 The introduction of quoted monologue in direct form reveals a character's thoughts and allows the narrator to 'cover up his presence' but also opens up the possibility that he is manipulating the reader who cannot necessarily verify whether or not the words were spoken in exactly such a way or with such clear intent as portrayed in the text. 57 O'Sullivan often follows a two-pronged approach to questioning the reliability of his opponents. The first step is to outline moral or character weakness and then to build on this to question their ability to reason and work for the common good, and a lack of objectivity. This is evident from the opening section of the Relación, in which he lists the physicians, surgeons and administrative staff in each area of the hospital. Included in the lists of staff in the Venereal wards we find 'Dr Don Daniel O'Sullivan of the Universities of Toulouse, Montpellier, and Edinburgh' (highlighting his European education and links), followed by a note, wherein the reader is told that: 54 'Cito tuto et jucunde' (quickly, safely, pleasantly). 55  The former Chief Surgeon of this Department [Venereal Disease], Don Francisco Balmis, had been forced by the Lord Viceroy to obey the repeated Royal Orders issued as a result of his wife's pleas that he return to Spain. … the Archbishop proposed the provisional appointment, of Doctor O'Sullivan to the post, who had been highly recommended and of whom His Excellency had formed a most favourable opinion. Although for various reasons this newly arrived physician did not consider it to be noble employment, he gladly accepted the post as much in recognition of the Lord Archbishop's good intentions as out of an intention to dispel the belief that the treatment for Venereal disease and the use of Mercury were the purview of surgeons, and that the physicians did not understand such matters … 58 The characterisation of Balmis in this extract and in what follows stands in clear contrast to the portrayal available in the majority of scholarship on this prominent Valencian surgeon, and later physician. Known largely for his role in the Royal Philanthropic Vaccine Expedition of the nineteenth century, sponsored by Charles IV, the focus on the importance and successes of this venture has often created a view of Balmis that overlooks the shadier aspects to his career trajectory. 59 Fêted in the epic poetry of his time and celebrated still for his role in the fight against smallpox, this later success has led many to read the Demostraciones eficaces (1794) in the belief that he was present during the Mexican trials and a key player in the discovery of the cure. 60 Little, if any, mention is ever made of his role in promoting a cure that was eventually discredited. 61 If we return to Wootton's critique that we 'know how to write about successful treatments and lives saved, but not about worthless therapies and lives lost', then the insights provided by O'Sullivan into this key figure of the Spanish nineteenth century should surely go some way toward addressing such lacunae. 62 The image of the desperate Spanish surgeon sent scuttling back to Spain to appease the unremitting demands of his wife, allows O'Sullivan to present himself by contrast as a highly educated, purpose-driven individual, who accepts the position offered for higher reasons than his own personal gain. Whilst this could be read as the hyperbole of a university-educated physician over and against a surgical practitioner, his wife had in fact written to the king appealing for the return of her husband due to the total lack of financial support or communication she had received from him since February 1789. 63 José Tuells has also highlighted the problematic relationship between Balmis and his wife that substantiates  O'Sullivan's portrayal. 64 Tuells also indicates that Balmis had a penchant for actresses, in particular one Antonia San Martín, who it would seem was treated by O'Sullivan for venereal disease, and warned by him to stay clear of charlatan cures. 65 The questionable aspects of Balmis's character are further undermined by the suggestion that he had directly attempted to discredit O'Sullivan's abilities to treat venereal disease in order to place in post an individual who had agreed to pay him, Balmis, a percentage of his salary whilst in absentia. 66 O'Sullivan thus singles him out as disreputable, lacking in trustworthiness, seeking financial gain at the cost of the medical community, and of questionable moral standards.
This early attempt to discredit the Spaniard is important as it sets the scene for O'Sullivan's later vitriolic criticism that centred on Balmis's unexpected and complete reversal of opinion, moving from outright vocal opponent of the Beato method to primary supporter and eventual ambassador of the cure, a move, we are told, that was driven by Balmis's desire to protect his career interests. O'Sullivan claims that Balmis had been under the continuous scrutiny of both the Viceroy and the Protomedicato since his arrival in Mexico, that he had failed to provide proof of the authenticity of his medical training and avoided tribunals to which he had been summoned. When proof of his training was finally produced, these merely licensed Balmis as a romance surgeon limiting his practice to such an extent that he could not even let blood until he had gained further accreditation. 67 In light of these facts the Viceroy gave Balmis an official warning against making further false assertions. On his return to Mexico in 1791, without the protection of his patrons in the Gálvez family and with little to no credibility within the medical community or among the public, the Spaniard was desperate to find a means to secure his career. 68 For the purposes of O'Sullivan's narrative, the argument is clearly that Balmis had falsely inflated his standing in the medical and surgical communities. O'Sullivan, moreover, argues that not only had Balmis never 'warmed the seats of the universities of Paris and Montpellier for even half an hour', as he had claimed, but his entire knowledge of that country was based solely on his friendship with a French hairdresser. 69 The narrator thus lays bare layer upon layer of deception, persistently attempting to undermine any claims to credibility by Balmis, both in his private life and in the public sphere.
There can be little doubt that through these techniques he was aiming to raise questions regarding the suitability of Balmis, setting him on the side of unreason and even deception and, by contrast, promoting his own position as potential arbitrator for the truth. O'Sullivan's criticism may have been aimed at discrediting Balmis in Spanish medical circles, however, I would suggest that the word of an Irish physician in distant Mexico may have proven ineffective in light of Balmis's powerful patron. Further documentation is necessary to ascertain the validity of many of O'Sullivan's arguments, yet he offers a fascinating insight into the complexity and the drive for ambition of these early medical practitioners and the need to understand the role of the patronage system within which they worked.
Balmis was not, of course, the only powerful figure to receive O'Sullivan's ire. As his account moves from the initial introduction of the character of Viana as a curandero, through to processes followed by his supporters in the hospital, we find continuous analogies between dramatic performance and puppetry as a symbols of deceit and manipulation. 70 In his description of the early meeting to assess the extent to which patients had been cured, O'Sullivan records the following: All the patients entered singing and dancing, pouring blessings over the Lord Archbishop and Don Nicolas (for the Beato had now reached such levels of respect as to deserve this form of address), proclaiming in loud voices that they were cured and well. This farce was much applauded by the Beato's supporters but any philanthropist taking the opportunity to peek behind that curtain to see the means by which they moved the puppets in this pantomime could not help but be filled with indignation … each one had been given a role to play in this farce. The performance could not have been better designed to convince the Lord Archbishop, body and soul, in defence of this cause, and to instil fear in those practitioners who may have spoken out against the cure and whose silence is now assured. 71 Further allusions to spectacle and disguise become evident in the discussions that follow amongst the hospital staff: The role played by Dr Jove in this meeting was very strange. Throughout the entire discussion he remained completely silent, as if he were adopting a stance of complete neutrality. Whenever his opponents directed their arguments to him, he pretended not to hear and left the task of responding to the Archbishop, only encouraging him now and then with a little comment or other, or with some sign of approval to show that he had referenced some term of medical authority well. … No doubt they had adopted a strategy of putting Dr Jove's words in the Archbishop's mouth in the hope of giving them more authority and opening them up to fewer responses; but whatever their intention, it could only have been laughable to see a Master and Doctor, a University Professor and Protomédico remain silent in a meeting with medical staff that dealt with trials in which he himself had been named observer, and an exalted Prince of the church debating these questions with the same zeal and ardour he might have used to defend the consubstantiation of the Divine Word in an argument with an Arian. 72 70 The term curandero can be used to refer to a folk healer but within the context of O'Sullivan's report he clearly adopts it to mean charlatan. There is little doubt that García Jove, President of the Protomedicato, features heavily as one of the main 'anti-heroes' and a subtle manipulator on many occasions in this account. 73 O'Sullivan's attitude to the Archbishop, however, is much more ambiguous. The descriptions vary from direct attacks on his tactics of bullying and intimidation of hospital staff to excusing him on the basis of naiveté and a blindness caused by his desire to promote the public good. Conscious, perhaps, that a critical appraisal of an Archbishop would not sit quite so well with his readers in the Spanish Academy as that of a mere physician, he is quick to temper his language in his conclusion and explain Haro y Peralta's angry outbursts as resulting from an overdeveloped sense of concern for the patients and his hospital. The Protomédicos, however, receive no such recommendation. They are described variously in terms of physical, intellectual, and moral grotesque highlighting directly their perceived limited or lack of ability to practise enlightened medicine, especially within the context of the trials, Dr Giral, President of the Protomedicato, an octogenarian in whom it is not surprising to note the same weakness of spirit as of body; Dr Rada, docile by nature, lacking in decision, one of those men who prefer to be led rather than be concerned with forming their own opinions, a characteristic that is common in the people of this land; and Dr Jove, a subtle and active personality who, as Protomédico de Merced, is recognised as the mind and soul that directs and encourages all the activities of that triumvirate. 74 The lack of proper care by the Tribunal is emphasised by the further references to García Jove asserting that he was consistently working to fulfil his own particular ends by whatever strategy necessary, largely absenting himself from the ward rounds in the hospital. Giral is described as quite literally blind and too heavy to be able to stand for any length of time, and as such incapable of performing the ward rounds required of him in the trials. 75 The metaphorical notion of blindness within this comment is also quite clear. Rada, in the meantime, who was acting on behalf of all three, examines the patients declaring that 'some still had a wee fever, another a wee cold, this one a wee nothing, and that one some other wee symptom'. 76 These expressions depict either a lack of knowledge or proper care in assessing the true condition of the patients and underline the more satirical elements in O'Sullivan's criticism of the lack of acceptable medical procedures in place. We should also note among the scathing descriptions of the Protomédicos, a singular example of O'Sullivan's opinion of the people of New Spain as weak-willed, or lacking in decisiveness, and easily  76 Ibid., fol. 37. I have chosen to use the more colloquial expression 'wee' in this translation as a means of expressing the Spanish apocopation 'ito' or 'ita' at the end of the terms a childishness of approach and minimisation of the importance of the proper terms. In 1792 José Francisco Rada held the Chair of Mathematics in the Royal Pontifical University, Calendario manual y guía de forasteros (1792), 104. led, that seems to tie directly to generalised ideas of degeneracy and the inferiority of the Americas. 77 This attitude tallies with his overall approach that sides more on his perception of European superiority in education and character over that of his New World contemporaries. A strong explanation, we could conclude, as to why he failed so significantly to adapt himself into the local structures.
In sharp contrast to these morally and professionally questionable supporters of the Beato method, we find the few who openly opposed the decisions taken during the trials; most notably, Alejo Ramón Sánchez. 78 O'Sullivan depicts Sánchez very much as a martyr in the pursuit of medical truth as well as an homme ilustré. Victim of yet one more act of deceit on the part of the Beatistas, Sánchez is blamed for the death of a soldier who had presented with severe symptoms, particularly tumours in the parotid glands, but whose condition had been ignored in the previous meeting to assess the status of the venereal patients. According to O'Sullivan the ineffective cure allowed the tumours to increase resulting in the suffocation of the patient, yet the Beatistas were quick to cast the 'venom of this catastrophe against the opponents of the method.' 79 Sánchez, then, became their scapegoat. O'Sullivan's depiction of a man of sense of honour and faith embodies an enlightened ideal both in character and professional commitment: Sánchez was 'an excellent teacher, a man of talent, intellect, and commitment, an adornment to his profession, the delight of society', of 'virtuous conduct', a 'constant friend', 'excellent husband' and 'loving father' who refused to be cowed and, instead, remained to stand against the false testimony of his aggressors. In the event, he died from a severe case of colic before his case could ever be brought to trial. 80 Two other colleagues receive similar if briefer praise wherein the moral character of the individual is closely tied to their enlightened approach to medicine: Mariano Aznares is described as working with 'method and energy' and Josef Ferrer as a man of 'no self-interest but of modesty and moderation'. 81 O'Sullivan places himself alongside Sánchez claiming the medical and moral high ground, and arguing that had he been in a similar position: he would not have become demoralised, rather solus contra omnes, he would have appealed to the higher court of the republic of letters, and confidently awaited the decision, declaring in the interim, vertute mea me involvo. 82 Where Sánchez quite literally has become a martyr to the truth, O'Sullivan depicts himself in similar light as a stoic and a martyr in terms of the negative impact on his career and his eventual dismissal from the hospital. 83 inclusion as a corresponding member of the Academy in 1793 and their agreement with his analysis, it is unclear why little or no action was taken in regard to the continued promotion of the cure. These issues form part of further investigation necessary into the systems of patronage in the practice of medicine in the early modern world. And if, as Daston has argued, recognition, once given within the illustrious network of the republic of letters, did not remain at an individual level, but reflected on the nation, how does this relate to the space occupied by migrant physicians such as O'Sullivan and their survival strategies? 89