HX34 Rash assumptions; how syphilitic gossip blighted Oscar Wilde’s legacy

Abstract ‘My wallpaper and I are fighting a duel to the death. One or the other of us must go.’ These are the famed last words of one of Ireland’s most renowned novelists, playwrights and humourists, Oscar Wilde, who passed away aged 46 years on 30 November 1900 in the Hôtel d’Alsace in Saint-Germain-des-Prés, Paris. With his final years being ones of imprisonment and persecution for the crime of homosexuality, Wilde’s cause of death being a ‘cerebral meningitis’ led biographers to speculate that the poet’s demise was due to neurosyphilis. Although not an opinion held by his doctors, it became the accepted, presumed cause of his demise by the public for much of the following century. Indeed, the most famous biographies of Wilde, including the Pulitzer Prize-winning account by Professor Richard Ellmann published in 1986, laid the diagnosis of syphilis at Wilde’s door. Yet the evidence for syphilis in Oscar Wilde’s case is limited, even negligible, and is born from the suggestion he kept company with a prostitute named ‘Old Jess’ – a student in Oxford who was suspected to have syphilis. The remainder of this posthumous diagnosis appears to have been decided based on a constellation of symptoms, readily explained by other pathologies. Most significantly, his cause of death has been postulated to have been secondary to either a malignant cholesteatoma or uncontrolled otitis media. Wilde had undergone surgery for this condition, having been blighted by ear issues, and was noted to have become deaf in one ear during his imprisonment in 1895 with frequent bouts of blood-stained discharge – though which ear is not stated. Associated fevers and headaches lent to the assumption of neurosyphilis. Compounding this was an erythematous, pruritic, waxing and waning eruption across his face, arms, back and chest that plagued him during his final years. Wilde himself believed this to be related to mussels, although, again, it fits neatly into a syphilitic narrative. However, an alternative, and potentially more fitting proposed explanation, is one of a para-phenylenediamine (PPD) contact dermatitis from hair dye (Nater JP. Oscar Wilde’s skin disease: allergic contact dermatitis? Contact Dermatitis 1992; 27: 47–9). Wilde was noted to have greying hair from a young age, and both he and his contemporaries have documented his use of hair dyes, which may have resulted in development of an allergic contact dermatitis. While the cause of Oscar Wilde’s death will likely never be definitively concluded, it is just that the long-presumed diagnosis of syphilis, attributed largely due to his sexuality and resultant stigmatization, is being challenged, including efforts to elucidate his skin pathology.