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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" 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.