Patricia Cornwell - Portrait Of A Killer - Jack The Ripper - Case Closed

I have avoided the recycled inaccuracies that have metastasized from one book to another. I have concluded that information cited since Sickert's death consistently says nothing intentionally damning or humiliating about his life or character. The fistula was not considered important because apparently those who have mentioned it did not fully realize what it was or that it could have caused devastating repercussions in Sickert's psyche. I must admit I was shocked when I asked John Lessore about his uncle's fistula and he told me - as if it were common knowledge - that the fistula was a "hole in [Sickert's] penis."

I don't think Lessore had a clue as to the significance of what he was saying, and I would be surprised if Denys Sutton knew much about Sickert's fistula, either. Sutton's reference to the problem says no more than that Sickert underwent two failed surgeries "for fistula in Munich," and in 1865, while the Sickert family was in Dieppe, his great-aunt Anne Sheepshanks suggested a third attempt by a prominent London surgeon.

Helena does not mention her elder brother's medical problem in her memoirs, but one wonders how much she knew. It's unlikely that her eldest brother's genitalia were a topic of family conversation. Helena was an infant when Sickert suffered through his surgeries, and chances are that by the time she was old enough to give much thought to the organs of reproduction, Sickert was not inclined to run around naked in front of her - or anyone else. He obliquely alluded to his fistula when he used to joke that he came to London to be "circumcised."

In the nineteenth century, fistulas of the anus, rectum, and vagina were so common that St. Mark's Hospital in London was dedicated to treating them. There are no references to fistulas of the penis in the medical literature I consulted, but the term may have been loosely used to describe penile anomalies such as the one Sickert suffered from. The word "fistula" - Latin for reed or pipe - is generally used to describe an abnormal opening or sinus that can cause such atrocities as a rectum connected to the bladder or to the urethra or to the vagina.

A fistula can be congenital but is often caused by an abscess that takes the path of least resistance, and burrows through tissue or the skin surface, forming a new opening for urine, feces, and pus to escape. Fistulas could be extremely uncomfortable, embarrassing, and even fatal. Early medical journals cite harrowing cases such as miserably painful ulcers, bowels emptying into bladders, bowels or bladders emptying into vaginas or uteri, and menstruation through the rectum.

During the mid-1800s, doctors attributed the cause of fistulas to all sorts of things: sitting on damp seats, sitting outside on omnibuses after physical exertion, swallowing small bones or pins, the "wrong" food, alcohol, improper clothing, the "luxurious" use of cushions, or sedentary habits associated with certain professions. Dr. Frederick Salmon, the founder of St. Mark's Hospital, treated Charles Dickens for a fistula caused by, he said, the great writer's sitting at his desk too much.

St. Mark's was established in 1835 to relieve the poor of rectal diseases and their "baneful varieties" and in 1864 moved to City Road in Islington. In 1865, it suffered financial devastation when the hospital secretary fled from London after embezzling?400, or one quarter of the hospital's annual income. A fund-raising dinner to be hosted by the fistula-free Dickens was proposed, but he declined the honor. In the same year, Walter Sickert arrived at St. Mark's in the fall to be "cured" by its recently appointed surgeon, Dr. Alfred Duff Cooper, who later married the daughter of the Duke of Fife and was knighted by King Edward VII.

Dr. Cooper was a twenty-seven-year-old medical star rapidly on the rise in his profession. His specialties were the treatment of rectal and venereal diseases, but no search of his published writings or other literature unearthed any mention of his treating so-called fistulas of the penis. Explanations of Sickert's fistula range from fair to awful. Nature may have slighted him with a genetically inherited malformation of the genitals called hypospadias, in which the urethra terminates just below the tip of the penis. German medical literature published at the time of Sickert's birth indicates that a case of simple hypospadias was "trifling" and more common than generally known. A "trifling" case meant the fistula would not interfere with procreation and was not worth the risk of a surgical procedure that could cause infection and death.

Since Sickert's malformation required three surgeries, his problem must not have been "trifling." In 1864, Dr. Johann Ludwig Casper, professor of forensic medicine at the University of Berlin, published a description of a more serious form of hypospadias: In this malformation, there is an opening in the urethra at the "root" or base of the penis. Even worse is epispadias, which occurs when the urethra is divided and runs like a "shallow gutter" along the back of a rudimentary or incompletely developed penis. In mid-nineteenth century Germany, such cases were considered a type of hermaphroditism or "doubtful sex."

When Sickert was born, his gender may have been ambiguous, meaning his penis was small, possibly misshapen, and imperforate (lacking a urethra). The bladder would have been connected to a canal that opened at the base of the penis - or near the anus - and there may have been a cleft in the scrotum that resembled the female clitoris, vagina, and labia. It is possible that Sickert's gender wasn't clearly established until his testicles were discovered in the folds of the so-called labia and it was determined that he had no uterus. In cases of ambiguous genitalia, if the afflicted child's gender turns out to be male, he is usually masculine and healthy in all respects as he matures except for his penis, which may be acceptably functional but is certainly not normal. In the early days of surgery, attempts to repair seriously deformed genitalia generally resulted in mutilation.

Without medical records, I can't say exactly what Sickert's penile anomaly was, but if his problem was only "trifling" hypospadias, why did his parents resort to risky surgery? Why did his mother and father wait so long before attempting to correct what must have been a very unpleasant affliction? Sickert was five when he underwent surgery the third time, and one wonders how soon this occurred following the first two operations. We know that his great-aunt interceded to bring him to London, suggesting that his disability was acute and that possibly the two previous operations had been recent and may have resulted in complications. If indeed he was three or four when this nightmarish medical ordeal began, it could be that his parents delayed corrective procedures until they were certain of his gender. I do not know when Sickert was named Walter Richard. To date, no birth certificate or record of a christening has turned up.

In Helena's memoirs she writes that when she was a child "we" always referred to Walter and his brothers as "Walter and the boys." Who are ire? I doubt his brothers referred to themselves as Walter and the boys, nor would I imagine that little Helena came up with the phrase on her own. I am inclined to suspect that the reference to Walter and the boys came from one or both parents.

Given Helena's picture of a young Walter who was precocious and dominant, such a law unto himself that he wasn't placed in the same category as the other sons, it may be that the phrase Walter and the boys was a way of acknowledging his precocity. It may also be that he was physically different from his brothers - or maybe from all boys. If the latter is the explanation, the repeated use of the phrase could have been humiliating and emasculating for the young Walter.

Sickert's early boyhood was traumatized by medical violence. When corrective surgery for hypospadias occurs after the age of eighteen months, it can create fears of castration. Sickert's operations would have resulted in strictures and scarring that could have made erections painful or impossible. He may have suffered partial amputation. His art does not include nude males, with the exception of two sketches I found that appear to have been done when he was in his teens or in art school. In each, the nude male figure has a vague stub of a penis that looks anything but normal.