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 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.