For over a century the sudden death of Constance Wilde, wife of the famous author and playwright Oscar Wilde, has remained a mystery. Now, thanks to medical sleuthing by retired UCT academic and psychiatrist Dr Ashley Robins and Wilde's grandson, Merlin Holland, the cause of Constance's death may finally have been determined.

Constance and her son, Cyril Wilde.

Constance Wilde died suddenly in Genoa, Italy on 7 April 1898, from complications following surgery for the removal of a uterine fibroid. She was 40 years old. These facts, however, describe only a small part of the circumstances that surrounded her death.

Constance had fled to Genoa to escape the scandal and spectacular fall from grace of her husband, who in 1895 had been found guilty of the crime of being homosexual. She found herself in a foreign city, with two young sons, having abandoned her career as a children's author and her role as a suffragette.

'Pelvic madness'

The Wilde family: Oscar, Cyril and Constance Wilde

In addition, she was plagued by mysterious physical symptoms such as facial paralysis, exhaustion, pain and an inability to walk – symptoms that many doctors had tried unsuccessfully to treat.

Enter the urbane and seemingly knowledgeable high-society Italian gynaecologist, Luigi Maria Bossi, who claimed he had a cure.

Dr Ashley Robins, a retired UCT academic and psychiatrist who spent time reviewing old correspondence and documentation together with the Wilde's grandson, Merlin Holland, posits that Constance consented to undergo surgery with Bossi, believing a cure was possible. "Bossi was fond of diagnosing his patients with conditions such as 'pelvic madness', believing that all neurological illness in women stemmed from their reproductive organs, even though at the time such diagnoses were already discredited," says Robins. "It is likely that Constance died of blood poisoning or an obstructed intestine, either of which could have been brought about by the operation."

Although at the time Bossi did not suffer any consequences for the botched surgery, he was later penalised for his archaic medical beliefs with a two-year suspension from his professorship at Genoa University, before being fatally shot by one of his patients' husbands.

Nine-year illness

According to Robins' and Holland's re-examination of the correspondence between Constance and her brother, she first started displaying symptoms almost a decade before her death.

Their recently published Lancet study states: "Her nine-year illness was characterised by widespread pains, right-leg weakness, tremor of the right arm, profound fatigue, and a left facial paralysis ... For the first seven years the clinical picture was dominated by intermittent acute episodes, followed by extended periods of recovery; in the last two years her disability became permanent, with gradual deterioration. A likely diagnosis is multiple sclerosis of the relapsing-remitting type, which subsequently developed into secondary progressive multiple sclerosis."

This debilitating neurological condition is thought to be triggered by the degeneration of myelin, a substance that protects nerve fibres from damage. Although the illness was first described by Jean-Martin Charcot in 1868, physicians may not have associated Constance's symptoms with the then relatively recently identified disease.

What prompted Robins and Holland to re-examine the 117-year-old letters?

For Robins, it comes down to a lifelong fascination with Oscar Wilde. "My mother would read me Wilde's fairytales as a child, but she would never explain how he died. I became fascinated by him, his wit, and his larger-than-life personality."

In 2000, the centenary of Oscar Wilde's death, Robins played a part in the discovery that he had died from meningitis brought on by ear surgery, rather than from syphilis, as had been speculated. In 2011 Robins also published a book analysing Wilde's personality and retrospectively diagnosing him with hysterical personality disorder.

Premature deaths

Merlin Holland had a more personal reason to investigate the cause of his grandmother's death. While his mother was alive, she had worried that revealing the contents of the letters would encourage people to sensationalise Constance's life and death. With this new discovery, however, previous ideas that her death had been caused by a fall, poisoning, or syphilis contracted from Oscar have all been proven untrue.

"I rather feel this will put Constance to rest, poor thing," he says.

Almost 120 years after their deaths, we now know that Oscar and Constance died from completely unrelated medical conditions. Nonetheless their deaths share common, tragic elements.

They both died young, and from possibly avoidable medical conditions that today might be treated successfully. In both their cases, the more indirect causes of their premature deaths can be related to the prevailing social attitudes of the day.

For Oscar, prejudice against homosexuality led to his incarceration and physical decline, while Constance suffered the consequences of being a woman at a time when the medical fraternity tended to blame neurological conditions on female physiology.

"Tragically, if Constance had been alive today, there would have been every chance that her condition, while incurable, could have been diagnosed and treated," says Robins. "I would like to believe that medicine, the very discipline that failed her then, has also played a part in uncovering the truth behind both their deaths."

Story by Ambre Nicolson. Image of the Wilde family courtesy of imgarcade.com. Images of Constance and Cyril Wilde and Oscar Wilde courtesy of Wikimedia Commons.