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 we? 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. It is clear from Sickert’s letters that throughout his life he was prone to urinary tract infections, which would have been consistent with strictures caused by repeated surgeries. In fact, when Sickert died on January 22, 1942, his cause of death was recorded as uremia (kidney failure) due to chronic nephritis (recurring urinary tract infections), with a contributing factor of myocardial degeneration, or heart disease that can accompany kidney disease.
There is no indication that Sickert ever suffered from infections or other complications of his bowels, rectum, or anus, and in a letter he wrote to artist Sir William Eden (circa 1901), Sickert mentions how much he wanted “a sound cock again . . .” In a preface written to an exhibition catalog of Eden’s pictures (not dated but probably 1890s), Sickert is discussing art and states that it is not possible to change an “organic living thing,” and uses the example of the impossibility of improving the “shape of a baby’s nose once it is born.” Typically, Sickert is enigmatic, his literary transitions opaque and his explanations few. I cannot say with certainty whether, when mentioning his unsound penis, he was referring to a temporary disability due to another urinary tract infection or to a permanent deformity. Nor can I say with certainty that his allusion to the inability of one to change a physical feature after birth is a veiled reference to his own birth defect.
One of the most distinctive features of the Ripper letters is that so many of them were written with drawing pens and daubed or smeared with bright inks and paints. They show the skilled hand of a highly trained or professional artist. More than a dozen include phallic drawings of knives—all long, daggerlike instruments—except for two strange, short, truncated blades in brazenly taunting letters. One of the stubby-knife letters, mailed on July 22, 1889, was penned in black ink on two pages of cheap paper that bear no watermarks.
London West
Dear Boss
Back again & up to the old tricks. Would you like to catch me? I guess you would well look here—I leave my diggings—close to Conduit St to night at about 10:30 watch Conduit St & close round there—Ha—Har I dare you 4 more lives four more cunts to add to my little collection & I shall rest content Do what you will you will never nap . . . Not a very big blade but sharp [Jack the Ripper jotted beside his drawing of the knife]
Following the signature is a postscript that trails off in the very clear letters “R. St. w.” At first glance this abbreviation might appear to be an address, especially since “St.” is used twice in the letter to indicate Street, and “W” might mean West. There is no such London address as R Street West, but I suppose one might interpret the “R. St.” as an odd abbreviation of Regent Street, which runs into Conduit Street. It is possible, however, that the cryptic initials are a double entendre—another “catch me if you can.” They could hint of the killer’s identity and where he spent some of his time.
On a number of Sickert’s paintings, etchings, and sketches, he abbreviates Sickert as St. In later years he puzzled the art world by deciding that he was no longer Walter but Richard Sickert, and signed his work R.S. or R. St. In another letter the Ripper wrote to the police on September 30, 1889—only two months after the one I just described—there is another similarly drawn truncated knife blade and what appears to be a scalpel or straight razor with the initials R (possibly W) S faintly scratched on the blade. I’m not aware that the elusive initials on these 1889 letters have ever been noticed, and Sickert might have been amused by that. He did not want to be caught, but he must have found it exhilarating when the police missed his cryptic clues entirely.
Regent Street and New Bond Street would have been familiar to
Walter Sickert. In 1881, he tagged along with Ellen Terry as she hit the shops of Regent Street in search of gowns for her role as Ophelia at the Lyceum. At 148 New Bond Street was the Fine Art Society, where James McNeill Whistler’s paintings were exhibited and sold. In the July 1889 letter, the Ripper uses the word “diggings,” which is American slang for a house or residence, and can also refer to a person’s office. Sickert’s professional business would have included the Fine Art Society, which was “close round” Conduit Street.
Speculations about what the Ripper meant in this letter are enticing. However, they are by no means a reliable account of what was going through Sickert’s mind. But there are many reasons to think that Sickert would have read Robert Louis Stevenson’s The Strange Case of Dr. Jekyll and Mr. Hyde, which was published in 1885. Sickert wouldn’t have missed its theatrical performances that began in the summer of 1888. Stevenson’s work might have helped Sickert to define his own duality.
There are many parallels between Jack the Ripper and Mr. Hyde: inexplicable disappearances; different styles of handwriting; fog; disguises; secret dwellings where changes of clothing were kept; disguised build, height, and walk. Through the symbolism in his novel, Stevenson gives us a remarkable description of psychopathy. Dr. Jekyll, the good man, is in “bondage” to the mysterious Mr. Hyde, who is “a spirit of enduring evil.” After Hyde commits murder, he escapes through the dark streets, euphoric from his bloody deed. He is already fantasizing about the next one.
Dr. Jekyll’s evil side is the “animal” that lives within him and feels no fear and relishes danger. It is in the “second character” of Hyde that Dr. Jekyll’s mind becomes most nimble, his faculties “sharpened to a point.” When the beloved doctor transforms himself into Hyde, he is overwhelmed by rage and a lust to torture and murder whoever he comes upon and can overpower. “That child of hell had nothing human,” Stevenson wrote. Neither did Sickert when his “From Hell,” to borrow a phrase from the Ripper letters, other self replaced his ruined manhood with a blade.
As if Sickert’s childhood surgeries and subsequent dysfunctions weren’t misfortune enough, he suffered from what in the nineteenth century was called “depraved conditions of the blood.” Letters written by Sickert in later life indicate that he periodically suffered from abscesses and boils that would send him to bed. He would refuse to seek out a doctor. An exact diagnosis of Sickert’s congenital deformity and any other health problems associated with it may always remain elusive, although in 1899, he refers to his “organs of generation” having “suffered all his life,” and to his “Physical misery.” St. Mark’s patient records do not exist prior to 1900, nor does it appear that Sir Alfred Duff Cooper kept any papers that might reveal information about Sickert’s surgery in 1865. Cooper’s records were not passed down in the family, according to his grandson, the historian and author John Julius Norwich.
Surgery in the early to mid-1800s was not a pleasant experience, especially surgery to the penis. The anesthetics ether, nitrous oxide (laughing gas), and chloroform had been discovered some thirty years earlier, but it wasn’t until 1847 that Great Britain began using chloroform, which may not have helped young Walter much. Dr. Salmon, the head of St. Mark’s, did not believe in anesthesia and did not allow the use of chloroform in his hospital because it was prone to cause death if the dose wasn’t just right.
Whether Walter was chloroformed during his two surgeries in Germany is not known, although he mentions in a letter to Jacques-Emile Blanche that he remembered being chloroformed while his father, Oswald Sickert, looked on. It is hard to know exactly what Sickert was referring to or when or how many times—or even if he was telling the truth. Sickert may or may not have been given anesthesia in London when Dr. Cooper operated on him in 1865. What is most amazing is that the little boy did not die.
Only a year earlier, in 1864, Louis Pasteur had concluded that germs cause disease. Three years later, in 1867, Joseph Lister would argue that germs could be combated by using carbolic acid as an antiseptic. Infection was such a common cause of hospital deaths that many people refused to be operated on, preferring to take their chances with cancer, gangrene, fulminating infections caused by injuries such as burns and fractures, or other potentially fatal maladies. Walter survived, but it is unlikely that he relished recollecting his hospital experience.
One can only imagine his terror when at the age of five he was whisked away by his father to the foreign city of London. The boy left behind mother and siblings and was in the care of a parent not known for compassion or warmth. Oswald Sickert wasn’t the sort to hold little Walter’s hand and offer words of love and comfort when he helped his son into the horse-drawn taxi that would take them to St. Mark’s Hospital. The father may have said nothing at all.
At the hospital, Walter and his small bag of belongings were left with the matron, most likely Mrs. Elizabeth Wilson, a seventy-two-year-old widow who believed in cleanliness and discipline. She would have assigned him a bed, placed his belongings in a locker, deloused and bathed him, then read him the hospital rules. At this time, Mrs. Wilson had one assistant nurse, and there was no nurse on duty at night.
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 & 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 ensure 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 the 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.