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

How long Walter was in the hospital before Dr. Cooper performed the surgical procedure, I don't know, and I can't state as fact whether chloroform or an injection of a 5% solution of cocaine or any other type of anesthesia or pain reliever was used. Since it didn't become standard practice at St. Mark's to anesthetize patients until 1882, one might suspect the worst.

Inside the operating theater, an open coal fire blazed to warm the room and heat the irons used to cauterize bleeding. Only steel instruments were sterilized. Dressing gowns and towels were not. Most surgeons wore black frock coats not unlike the ones butchers wore in slaughterhouses. The stiffer and filthier with blood, the more the coat boasted of a surgeon's experience and rank. Cleanliness was considered to be finicking and affected, and a London Hospital surgeon of that time compared washing a frock coat to an executioner manicuring his nails before chopping off a person's head.

St. Mark's operating table was a bedstead - most certainly an iron one - with head- and footboards removed. What a ghastly impression a little boy must have had of an iron bedstead. On his ward he was confined to an iron bedstead, and he had an operation on one. It would be understandable if he associated an iron bedstead with bloody, painful terror - and rage. Walter was alone. His father may not have been very reassuring and might have viewed his son's disfigurement with shame or disgust. Walter was German. This was his first time in London. He was abandoned and powerless in an English-speaking prison where he was surrounded by suffering and subjected to the orders, probing, scrubbings, and bitter medicines of an old, no-nonsense nurse.

Mrs. Wilson - assuming she was on duty at the time of Walter's surgery - would have assisted in the procedure by placing Walter on his back and separating his thighs. Typically, in operations on the rectum or the genitals, the patient was virtually hog-tied, with arms straightened, legs arched, wrists bound to ankles. Walter may have been restrained with cloth ligatures, and as an extra precaution, the nurse may have firmly held his legs in place while Dr. Cooper took a scalpel and cut along the fistula's entire track, according to the hospital's standard procedure.

If Walter was a lucky little boy, his ordeal began by his feeling suffocated as his nose and mouth were covered with a chloroform-soaked rag that was guaranteed to make him violently nauseated later. If he was an unlucky little fellow, he was wide awake and experienced every horror happening to him. It is no wonder Sickert would go through life with no love for "those terrible hospital nurses, their cuffs, their enemas amp; their razors," as he wrote more than fifty years later.

Dr. Cooper may have used a blunt knife for separating tissue, or a "curved director" (steel probe) to pass through the opening in the penis, or a trocar to puncture tender flesh. He may have passed a section of "stout thread" through the track of the new opening and tied a "firm knot" at the end, to strangulate the tissue over time in much the same way a thread or post keeps the hole in a newly pierced ear from closing. It all depends on what was really wrong with Walter's penis, but Dr. Cooper's corrective procedures would by necessity have been made only more extensive and painful after Walter's two earlier surgeries in Germany. There would have been scar tissue. There could have been other disastrous sequelae, such as strictures and partial - or almost complete - amputation.

Dr. Cooper's published medical procedures do not mention fistulas of the penis - or hypospadias - but his method when performing typical fistula operations on a child was to operate as quickly as possible to prevent shock and insure that the "little patient," Dr. Cooper wrote, wasn't "exposed" or left with open wounds "more than absolutely necessary." At the end of this ordeal, Dr. Cooper would close any incisions with silk sutures called "ligatures" and pack cotton wool into the wounds. While Walter was going through all this and who knows what else, the elderly Mrs. Wilson in her starchy uniform would have assisted as needed, doing her best to quiet straining limbs and screams if Walter had not been anesthetized. Or if he had, her face may have been the last one he saw as the sickly-sweet chloroform knocked him out. She may have been the first person he saw when he woke up throbbing with pain and retching.

In 1841, Charles Dickens was operated on without anesthesia. "I suffered agonies, as they related all to me, and did violence to myself in keeping to my seat," Dickens wrote in a letter to a friend. "I could scarcely bear it." Surgery on the penis must have been more painful than any rectal or anal procedure, especially when a patient was a five-year-old foreigner who could not have possessed the coping skills, the insight, or perhaps fluency enough in English to understand what was happening to him when Mrs. Wilson changed his dressings, administered his medicines, or appeared at his bedside with a supply of leeches if he had an inflammation believed to be due to an excess of blood.

Mrs. Wilson may have had a sweet bedside manner. Or she may have been strict and humorless. A typical requirement of a nurse in those days was that she be single or widowed so that all her time could be devoted to the hospital. Nurses were underpaid, worked long, grueling hours, and were exposed to extraordinarily unpleasant conditions and risks. It was not uncommon for nurses to "get into drink" a bit too much, to run home for a nip, to show up at work a bit mellow. I don't know about Mrs. Wilson. She could have been a teetotaler.

Walter's hospital stay must have seemed to him an endless stretch of bleak, scary days, with breakfast at eight, followed by milk and soup at 11:30, then a late-afternoon meal and lights out at 9:30 P.M. There he lay, day in and day out, in pain, no one on duty at night to hear him cry or comfort him in his native tongue or hold his hand. Had he secretly hated Nurse Wilson, no one could really blame him. Had he imagined she was the one who destroyed his penis and caused him so much anguish, that would be understandable. Had he hated his mother, who was far away from him during his ordeal, that would come as no surprise.

In the nineteenth century, to be born illegitimate or to be the child of an illegitimate parent was a terrible stigma. When Sickert's maternal grandmother had sex out of wedlock, according to Victorian standards, she enjoyed it, which implied that she suffered from the same genetic disorder that prostitutes did. The common belief was that this congenital defect was passed down the bloodline and was a "contagious blood poison" routinely described in the newspapers as a "disease that has been the curse of mankind from an early period in the history of the race, leaving its baneful effects on posterity to the third and fourth generations."

Sickert might have blamed his boyhood agonies, his humiliations, and his maimed masculinity on a genetic defect or "blood poison" that he inherited from his immoral dance-hall grandmother and his illegitimate mother. The psychological overlays to young Walter's physical curse are tragic to contemplate. He was damaged, and his language as an adult reveals a significant preoccupation with "things medical" when he was writing about things that were not.

Throughout his letters and art reviews there are metaphors such as operating table, operation, diagnosis, dissection, laying bare, surgeon, doctors, fateful theater, castrated, eviscerated, all your organs taken out, anesthetized, anatomy, ossify, deformation, inoculated, vaccinating. Some of these images are quite shocking, even revolting, when they suddenly uncoil and strike in the middle of a paragraph about art or daily life, just as Sickert's use of violent metaphors strikes unexpectedly, too. When he is discussing art, one doesn't expect to run into morbid horror, horrors, deadly, dead, death, dead ladies' hearts, hacking himself to pieces, terrify, fear, violent, violence, prey, cannibalism, nightmare, stillborn, dead work, dead drawings, blood, putting a razor to his throat, nailing up coffins, putrefied, razor, knife, cutting.