As the crazed surgeon made his incisions

At the same time, his murders were becoming more and more cruel. Ten years before, Chikatilo had found merely molesting children was not enough for him and, almost by accident, had killed for the first time. But now, simply killing did not do much for him. He had to intensify the suffering of his victims, by performing more and more horrible operations on them - many of which were carried out while they were still alive. Photographs in the files of the investigators show the state of the corpses after they were found. Even those that were fresh were virtually unrecognizable, as a result not just of stabbing and slashing but of deep wounds in the belly through which he extract their internal organs. By now his knowledge of human anatomy was such that he knew what they were, which he wanted, and exactly where to cut in order to get at them most easily. The agony for his victims must have been incredible. Many must have died literally of shock as the crazed surgeon made his incisions.

Pg 150