Art in Science: The Artist and The Disease: The Exemplary Cases of Renoir and Toulouse-Lautrec Art in Science: The Artist and The Disease: The Exemplary Cases of Renoir and Toulouse-Lautrec Berardo Di Matteo MD, Vittorio Tarabella MA, Giuseppe Filardo MD, PhD, Piergiuseppe Tanzi MD, Elizaveta Kon MD, Francesco Iacono MD, Maurilio Marcacci MD From the Column Editors, O ur colleagues in Bologna and Milan, Italy have skillfully illustrated how physical ill- ness shaped the artistry of two French 19 th century icons, Pierre-Auguste Renoir and Henri de Toulouse-Lau- trec. In the case of Renoir, he accommodated for his debilitating deformity and pain from arthritis through the use of technical con- trivances that allowed him to manage canvases, access palettes, and grip brushes. These contraptions helped Renoir continue his prolific and cre- ative career well beyond usual endurance. Renoir persisted in defin- ing through color and brush stroke the inner light of Impressionism. For Toulose-Lautrec, his physical defor- mities drove him to seek asylum and anonymity at the margins of a Bohe- mian lifestyle found in Parisian night clubs. There, he found and painted the vulnerable characters this environ- ment attracted and the theater they represented. For these insights, and for two of many examples of illness influencing art, we are indebted to Dr. Di Matteo and his colleagues. — Gary E. Friedlaender MD, Linda K. Friedlaender BA, MS French painters Pierre-Auguste Renoir and Henri de Toulouse-Lautrec both lived with debilitating muscu- loskeletal diseases. The physical and psychological effects of their ailments shaped both artists’ perceptions of their environments. As Renoir’s health deteriorated due to rheumatoid arthritis, he pivoted away from the expansive freedom of impressionism in favor of studio por- traits capturing the imperial beauty of the human body. Toulose-Lautrec was similarly fascinated with humans, but more their place in the world than A note from the Editor-in-Chief: I am pleased to present the next installment of our ‘‘Art in Science.’’ In this month’s column, Berardo Di Matteo MD and his colleagues from the Humanitas Clinical Institute (Milan, Italy) and the Rizzoli Orthopaedic Institute (Bologna, Italy) profile two French painters who lived with debilitating musculoskeletal diseases: Pierre-Auguste Renoir and Henri de Toulouse-Lautrec. The authors certify that neither they, nor any members of their immediate families, have any commercial associations (such as consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR 1 or The Association of Bone and Joint Surgeons 1 . The institution of one or more of the authors (BDM, VT, GF, AV, PT, MM) has received, during the study period, funding from Italian State through ‘‘5 per mille (year 2011)’’ project. B. Di Matteo MD (&), E. Kon MD, F. Iacono MD, M. Marcacci MD Center for Functional and Biological Reconstruction of the Knee, Humanitas Clinical and Research Center, Rozzano, Milan, Italy e-mail: berardo.dimatteo@gmail.com V. Tarabella MA, P. Tanzi MD Rizzoli Orthopaedic Institute, Bologna, Italy G. Filardo MD, PhD Nano-Biotechnology Lab, Rizzoli Orthopaedic Institute, Bologna, Italy E. Kon MD, M. Marcacci MD Humanitas University, Rozzano, Milan, Italy Art in Science Published online: 7 August 2017 � The Association of Bone and Joint Surgeons1 2017 123 Clin Orthop Relat Res (2017) 475:2376–2381 / DOI 10.1007/s11999-017-5458-7 Clinical Orthopaedics and Related Research® A Publication of The Association of Bone and Joint Surgeons® http://crossmark.crossref.org/dialog/?doi=10.1007/s11999-017-5458-7&domain=pdf http://crossmark.crossref.org/dialog/?doi=10.1007/s11999-017-5458-7&domain=pdf their physical features. Although from an aristocratic family, Toulose-Lau- trec’s physically obvious congenital illness (its exact nature remains obscure, but certainly included short stature) would cast most men of his era to the margins of society, and that is where he felt most comfortable. Toulose-Lautrec found himself regu- larly frequenting boozy nightclubs and brothels, where he often painted sce- nes from middle-class Parisian nightlife [7]. But another common theme emer- ges linking both Renoir and Toulouse- Lautrec beyond their physical disor- ders: An undeniable will to produce art. Perhaps painting was a coping mechanism for both artists or maybe the freedom of expression can simply exceed the limits imposed by disease. Renoir and Rheumatoid Arthritis In 1892, at the age of 50, French impressionist Pierre-Auguste Renoir developed rheumatoid arthritis, which limited his mobility and affected his ability to paint [4]. But paint he did. Despite battling his condition for nearly three decades, Renoir produced an estimated 4000 paintings [3] in his career—many coming after the age of 50. Only his extreme perseverance made it possible for him to produce so prolifically. Renoir started his formal training as a painter at the age of 21 under Charles Glyere, a Swiss-born painter and art teacher. There, he befriended French painters Claude Monet, Alfred Sisley, and Frédéric Bazille. Brought together by their dismissal and rejection of exhibition and studio art, this group of modern artists, along with Édouard Manet and Edgar Degas, spearheaded the Impressionist period [9]. In the 1870s, these painters left the confines of their studios to paint en plein air (outdoors). Their landscapes and sce- nes of middle-class Parisian life were at first satirized by critics using a then- derogatory adjective—impressionis- tic—that eventually came to define the movement, since their work was characterized by brushstrokes that captured the artists’ perceptions of light and motion, rather than previous artistic styles that valued precision [8]. The Luncheon of the Boating Party Renoir’s The Luncheon of the Boating Party (Fig. 1), is a vibrant example of Impressionism. The work depicts the gathering of some of the artist’s closest friends (including his future wife) as they share food, wine, and conversa- tion on the balcony of a restaurant overlooking the Seine River. One of his most famous ‘‘early’’ paintings, Renoir captures a moment where the attitudes of the crowd are both lively and relaxed. The Luncheon of the Boating Party won the favor of the critics at the 7th Impressionism Exhi- bition in 1882 and cemented Renoir’s status as an emerging star in the Impressionism period. But unlike his impressionist col- leagues, Renoir never fully withdrew from studio art, and through the years he would find himself moving back toward the traditional portraits from the 18th century French artists he grew up admiring [9]. Slow sales of his impressionist work with a wife and three children, as well as deteriorating health may have influenced his deci- sion to pursue studio art. Painting Through Pain Renoir’s rheumatoid arthritis deeply influenced his daily activities and lim- ited his artistic choices. He became more focused on depicting the human body, rather than landscapes. Nude bodies and domestic scenes became the main subjects of his late period, often represented in statuary and plastic poses like in The Judgment of Paris (Fig. 2). Using soft and fluid colors, this change of subject was interpreted by critics as a personal attempt to celebrate and remember his past health. His short and rapid brushstrokes, particularly emphasized in his last works, were 123 Volume 475, Number 10, October 2017 Art in Science 2377 Art in Science likely the result of the deforming arthritis in his fingers and hands. ‘‘His hands were terribly deformed,’’ his son Jean wrote. ‘‘His rheumatism had made the joints stiff and caused the thumbs to turn inward towards the palms, and his fingers to bend towards the wrists. Visitors who were unprepared for this could not take their eyes off his deformity’’ [6]. In 1903, the disease became even more aggressive, triggering ankylosis of the wrists, phalangeal joints, right shoulder, and both knees. With no effective cure or ability to manage his symptoms at the time, Renoir also man- ifested facial palsy, nodules in the back, pleural effusion, and weight loss [4]. In 1908, Renoir moved to the Mediterranean coast in the hope that a warmer climate could provide him symptomatic relief and better working conditions. He never abandoned his art, as it represented the best strategy to cope with the disease—a sort of modern occupational therapy. Renoir’s youngest son, Claude, became his personal assistant, preparing his palette and even placing the brush in the artist’s deformed hands [1, 3, 10]. Renoir used a special easel allowing him to reach a large canvas despite the lim- ited motion of his right shoulder. Although the pain was nearly unbear- able, Renoir never stopped painting. Henri Matisse, a renowned French artist and an admirer of Renoir’s work, once asked Renoir why he carried on painting while in such agony. He Fig. 1 In The Luncheon of the Boating Party, Renoir captures a moment where the attitudes of the crowd are both lively and relaxed. Pierre-Auguste Renoir, Luncheon of the Boating Party, 1880–81. Oil on canvas, 51 1/4 9 69 1/8 in. The Phillips Collection, Washington, DC, Acquired 1923. Any reproduction of this digitized image shall not be made without the written consent of The Phillips Collection, Washington, DC. 123 2378 Di Matteo et al. Clinical Orthopaedics and Related Research 1 Art in Science replied: ‘‘The pain passes, but the beauty remains’’ [6]. Overcoming Limitations Through Art Henri de Toulouse-Lautrec was born in France in 1864 to an upper-class family in which his parents were first cousins; Toulouse-Lautrec’s growth was delayed, and it was evident that he had short stature compared to his peers. During his childhood, he experienced fractures in both legs from minor trauma. Persistent leg pain made it impossible for Toulouse-Lautrec to walk without the aid of canes. He also experienced recurrent sinusitis, headaches, and impaired vision and hearing. Modern physicians attribute this constellation of symptoms to a genetic disorder, likely pycnodysostosis [2] (sometimes known as Toulouse-Lautrec Syndrome); alternative explanations might include achondroplasia or osteogenesis imper- fecta, all of which can explain some of his difficulties, though not all of them. Toulouse-Lautrec’s physical appear- ance and limitations deeply influenced his artwork. Unable to take part in ‘‘traditional’’ aristocratic occupations, used art as a way to fully express his repressed energy. His sinuous lines and dynamic dance scenes represented a physical athleticism that always eluded Fig. 2 The Judgment of Paris is an example of Renoir focusing on the human body, perhaps as an attempt to celebrate and remember his past health. Pierre-Auguste Renoir, The Judgement of Paris, ca. 1908. Black, red and white chalk on off-white, medium-weight, medium-texture paper, 19 1/4 9 24 1/2 in.; 48.895 9 62.23 cm. The Phillips Collection, Washington, DC, Acquired 1940. Any reproduction of this digitized image shall not be made without the written consent of The Phillips Collection, Washington, DC. 123 Volume 475, Number 10, October 2017 Art in Science 2379 Art in Science him. With its bright colors and short and fast brushstrokes, Toulouse-Lau- trec was intrigued by Impressionism early in his artistic career, but he later developed a post-impressionist style similar to Paul Cézanne and Vincent Van Gogh. Visibly deformed, physically hand- icapped, and ostracized from the luxurious upper-class existence, the artist hid among the outsiders of Paris to observe the gritty nightlife of the city. He regularly visited bistros where he met and painted society’s down- and-outs, and depicted the ‘‘Bo- hemian’’ lifestyle. At the Moulin Rouge, The Dance One of Toulouse-Lautrec’s most famous paintings, ‘‘At the Moulin Rouge, The Dance’’ (Fig. 3) captures the energy inside the famous dance hall in Montmartre, Paris. The work’s colors are striking; in the foreground, our eyes immediately land on the woman in the pink dress possibly gazing at the well-dressed man and woman in red socks dancing in the center of the nightclub. An inscription on the back of the painting by Tou- louse-Lautrec later revealed that the well-dressed man is instructing the woman on the ‘‘can-can’’, a popular French cabaret dance featuring high Fig. 3 At the Moulin Rouge, the Dance (1890) captures the energy inside the famous dance hall. The Henry P. McIlhenny Collection in memory of Frances P. McIlhenny, 1986. 123 2380 Di Matteo et al. Clinical Orthopaedics and Related Research 1 Art in Science kicks, splits, or even cartwheels [5]. Toulouse-Lautrec’s use of contrasting colors shifts our eyes beyond the dan- cers and further into the crowd to the man in the red jacket in the upper left of the painting. Known for observing and depicting brief moments inside the working class Parisian nightclubs he often frequented, Toulouse-Lautrec uses bright color to offer multiple perspectives from the scene [7], taking us from the pretty onlooker in the pink dress, to the easy-going dancers in the center of the crowd, to the man in the red jacket surrounded by patrons at the bar. In addition to depicting moments inside the Moulin Rouge, Toulouse- Lautrec designed poster-sized adver- tisements for the nightclub as well. Although considered low-brow artistry not on par with studio painting or sculptures, Toulouse-Lautrec’s posters transcended all artistic boundaries and contributed to a period of high art and cultural development in Paris known as Belle Epoque [5, 11]. Toulouse- Lautrec had a keen sense of celebrity, and his posters would often turn local Parisian dancers like Jane Avril into full-fledged stars. Considered the father of ‘‘pop art’’, he laid the groundwork for modern commercial artists like Andy Warhol [7]. But for all of his artistic triumphs, Toulouse-Lautrec could never escape his physical deformities, nor the bars and brothels that accepted him when most of society treated him as an out- cast. Although his art was a way to cope with the sense of exclusion, Toulouse-Lautrec ultimately died in 1901, at the age of 36, from compli- cations related to alcoholism and syphilis. Renoir and Toulouse-Lautrec could not be healed in life, but they both left remarkable legacies of beauty and creativity despite the cruelties of fate. References 1. Boonen A, van de Rest J, Dequeker J, van der Linden S. How Renoir coped with rheumatoid arthritis. BMJ. 1997;7123:1704–8. 2. Hodder A, Huntley C, Aronson JK, Ramachandran M. Pycnodysostosis and the making of an artist. Gene. 2015;555:59–62. 3. Kowalski E, Chung KC. Impairment and disability: Renoir’s adaptive coping strategies against rheumatoid arthritis. Hand. 2012;7:357–63. 4. Mota LMH, Neubarth F, Diniz LR, Freire de Carvalho J, Santos Neto LL. Pierre-Auguste Renoir (1841- 1919) and Rheumatoid Arthritis. J Med Biogr. 2012;20:91–92. 5. Renoir J. Renoir, My Father. Boston, MA: Little Brown; 1962. 6. Rishel JJ. Philadelphia Museum of Art: Handbook of the Collections. Philadelphia, PA: Philadelphia Museum of Art; 1995:206. 7. The Art Story. Henri de Toulouse- Lautrec. Available at: http://www. theartstory.org/artist-toulouse-lautrec- henri.htm. Accessed June 26, 2017. 8. The Art Story. Impressionism. Available at: http://www.theartstory. org/movement-impressionism.htm. Accessed June 26, 2017. 9. The Art Story. Pierre-August Renoir. Available at: http://www.theartstory. org/artist-renoir-pierre-auguste.htm# important_art_header. Accessed June 26, 2017. 10. Tonelli F. Painting and sculpturing with ‘‘broken’’ hands: The victory of Renoir. Clinical Cases in Min- eral and Bone Metabolism. 2012;9: 59. 11. Trachtman P. Toulouse-Lautrec. The fin de siä̀cle artist who captured Paris’ cabarets and dance halls is drawing crowds to a new exhibition at Wash- ington, D.C.’s National Gallery of Art. Available at: http://www.smith- sonianmag.com/arts-culture/toulouse- lautrec-78257137/#ySisHjiVvkmz- ibBz.99. Accessed July 6, 2017. 123 Volume 475, Number 10, October 2017 Art in Science 2381 Art in Science http://www.theartstory.org/artist-toulouse-lautrec-henri.htm http://www.theartstory.org/artist-toulouse-lautrec-henri.htm http://www.theartstory.org/artist-toulouse-lautrec-henri.htm http://www.theartstory.org/movement-impressionism.htm http://www.theartstory.org/movement-impressionism.htm http://www.theartstory.org/artist-renoir-pierre-auguste.htm%23important_art_header http://www.theartstory.org/artist-renoir-pierre-auguste.htm%23important_art_header http://www.theartstory.org/artist-renoir-pierre-auguste.htm%23important_art_header http://www.smithsonianmag.com/arts-culture/toulouse-lautrec-78257137/%23ySisHjiVvkmzibBz.99 http://www.smithsonianmag.com/arts-culture/toulouse-lautrec-78257137/%23ySisHjiVvkmzibBz.99 http://www.smithsonianmag.com/arts-culture/toulouse-lautrec-78257137/%23ySisHjiVvkmzibBz.99 http://www.smithsonianmag.com/arts-culture/toulouse-lautrec-78257137/%23ySisHjiVvkmzibBz.99 Art in Science: The Artist and The Disease: The Exemplary Cases of Renoir and Toulouse-Lautrec Renoir and Rheumatoid Arthritis The Luncheon of the Boating Party Painting Through Pain Overcoming Limitations Through Art At the Moulin Rouge, The Dance References