If the killer had been standing behind the victim when he cut her throat, the reporter explains, and the deepest wounds were on the left side and trailed off to the right, which was the case, then the killer must have held the knife in his right hand. Dr. Llewellyn made a bad deduction. The reporter made an excellent one. Walter Sickert's dominant hand was his right one. In one of his self-portraits he appears to be holding a paintbrush in his left hand, but it is an optical illusion created by his painting his reflection in a mirror.
Dr. Llewellyn might not have been very interested in a reporter's point of view, but perhaps he should have been. If the Dispatch journalist's beat was crime, he had probably seen more cut throats than Dr. Llewellyn had. Cutting a person's throat was not an uncommon way to murder someone, especially in cases of domestic violence. It was not an unusual way to commit suicide, but people who cut their own throats used straight razors, rarely knives, and they almost never sliced their necks all the way through to the vertebra.
The Royal London Hospital still has its admission and discharge record books for the nineteenth century, and a survey of entries shows die illnesses and injuries typical of the 1880s and 1890s. It must be kept in mind that the patients were presumed alive when they arrived at the hospital, which covered only the East End. Most people who cut their throats, assuming they severed a major blood vessel, would never have made it to a hospital but would have gone straight to the mortuary. They would not be listed in the admission and discharge record books.
Only one of the homicides cited during the period of 1884 to 1890 was eventually considered a possible Ripper case, and that is the murder of Emma Smith, forty-five, of Thrawl Street. On April 2, 1888, she was attacked by what she described as a gang of young men who beat her, almost ripped off an ear, and shoved an object, possibly a stick, up her vagina. She was intoxicated at the time, but she managed to walk home, and friends helped her to the London Hospital, where she was admitted and died two days later of peritonitis.
In Ripperology, there is considerable speculation about when Jack the Ripper began killing and when he stopped. Since his favorite killing field seems to have been the East End, the records of the London Hospital are important, not because the Ripper's dead-at-the-scene victims would be listed in the books, but because patterns of how and why people were hurting themselves and others can be instructive. I was worried that "cut throats" might have been miscalled suicides when they were really murders that might be additional ones committed by the Ripper.
Unfortunately, the hospital records don't include much more detail than the patient's name, age, address, in some cases the occupation, the illness or injury, and if and when he or she was discharged. Another one of my purposes in scanning the London Hospital books was to see if there were any statistical changes in the number and types of violent deaths before, during, and after the so-called Ripper rampage of late 1888. The answer is, not really. But the records reveal something about the period, especially the deplorable conditions of the East End and the prevailing misery and hopelessness of those who lived and died there by unnatural causes.
During some years, poisoning was the favored form of taking one's life, and there were plenty of toxic substances to choose from, all of them easily acquired. Substances that East End men and women used to poison themselves from 1884 to 1890 include oxalic acid, laudanum, opium, hydrochloric acid, belladonna, ammonia carbonate, nitric acid, carbolic acid, lead, alcohol, turpentine, camphorated chloroform, zinc, and strychnine. People also tried to kill themselves by drowning, gunshots, hanging, and jumping out of windows. Some leaps out of upper-story windows were actually accidental deaths when fire engulfed a rooming or common lodging house.
It is impossible to know how many deaths or near-deaths were poorly investigated - or not investigated at all. I also suspect that some deaths thought to be suicides might have been homicides. On September 12, 1886, twenty-three-year-old Esther Goldstein of Mulberry Street, White-chapel, was admitted to the London Hospital as a suicide by cut throat. The basis of this determination is unknown, but it is hard to imagine that she cut her neck through her "thyroid cartilage." A slice through a major blood vessel close to the skin surface is quite sufficient to end one's life, and cutting through the muscles and cartilage of the neck is more typical in homicides because more force is required.
If Esther Goldstein was murdered, that doesn't mean she was a victim of Jack the Ripper, and I doubt she was. It is unlikely that he killed an East End woman or two every now and then. When he started, he made a dramatic entrance and continued his performance for many years. He wanted the world to know about his crimes. But I can't say with certainty when he made his first kill.
In the same year that the Ripper crimes began, in 1888, four other East End women died from cut throats - all supposed to be suicides. When I first went through the musty old pages of the Royal London Hospital record books and noticed the numerous women admitted with cut throats, I anticipated that these deaths might have been Ripper murders assumed to be suicides. But more time and research revealed that cut throats were not unusual in a day when most impoverished people did not have access to guns.
Chapter Twelve. The Young And Beautiful
People of the East End were put out of their misery by infections and diseases such as tuberculosis, pleurisy, emphysema, and pneumoconiosis. Men, women, and children were burned and scalded to death by accidents at home and at work.
Starvation killed, as did cholera, whooping cough, and cancer. Parents and their children, weakened by malnutrition and surrounded by filth and vermin, did not have immune systems that could fight off non-lethal illnesses. Colds and flu became bronchitis and pneumonia and death. Many infants weren't long for the world of the East End, and the people who lived and suffered there hated the London Hospital and avoided it if they could. To go there was to get worse. To let a doctor touch them was to die. Often this was true. An abscessed toe requiring amputation could lead to osteomyelitis - a bone infection - and death. A cut requiring sutures could lead to a staph infection - and death.
A sampling of hospital admissions for alleged suicides shows that in 1884, five men tried to kill themselves by cutting their throats, while four women cut their throats and two slit their wrists. In 1885, five women are listed as suicides or attempted suicides by poisoning and one by drowning. Eight men slashed their throats, one used a gun, and another a noose. In 1886, five women attempted suicide by cutting their throats. Twelve women and seven men tried to poison themselves, and another twelve men cut their throats or stabbed or shot themselves.
It simply isn't possible to sort out who really committed suicide and who might have been murdered. If the individual was a person of the dustbin in the East End, and the death or attempted death was witnessed, then police tended to accept what witnesses said. When a woman's abusive, drunk husband hurled two lit oil lamps at her, setting her on fire, she told police in her dying breath that it was entirely her fault. Her husband wasn't charged. Her death was listed as an accident.
Unless a case was obvious, there was no certainty that the manner or even cause of death would be accurate. If a woman's throat was cut indoors and the weapon was nearby, the police assumed she had killed herself. Such assumptions, including those made by the well-meaning Dr. Llewellyn, not only sent police down a false trail - if they bothered following up at all - but bad diagnoses and determinations of injury and death could destroy a case in court. Forensic medicine was not sophisticated in Dr. Llewellyn's day, and this rather than carelessness is the most likely explanation for his hasty, baseless conclusions.