a surgery done in the 19th century, lots of blood in the room, high quality, black and white

(nsfw:1.5),(worst quality, low quality:1.4) ,lowres,bad anatomy,bad hands, text, error, missing fingers,extra digit, fewer digits, cropped, worstquality, low quality, normal quality,jpegartifacts,signature, watermark, username,blurry,bad feet,cropped,poorly drawn hands,poorly drawn face,mutation,deformed,worst quality,low quality,normal quality,jpeg artifacts,signature,watermark,extra fingers,fewer digits,extra limbs,extra arms,extra legs,malformed limbs,fused fingers,too many fingers,long neck,mutated hands,polar lowres,bad body,bad proportions,gross proportions,text,error,missing fingers,missing arms,missing legs,extra digit, ((Intricate clothes, too much lace, too much dacoration on clothes,bad face