From the Column Editors,
Our colleagues in Bologna and Milan, Italy have skillfully illustrated how physical illness shaped the artistry of two French 19 th century icons, Pierre-Auguste Renoir and Henri de Toulouse-Lautrec. In the case of Renoir, he accommodated for his debilitating deformity and pain from arthritis through the use of technical contrivances that allowed him to manage canvases, access palettes, and grip brushes. These contraptions helped Renoir continue his prolific and creative career well beyond usual endurance. Renoir persisted in defining through color and brush stroke the inner light of Impressionism. For Toulose-Lautrec, his physical deformities drove him to seek asylum and anonymity at the margins of a Bohemian lifestyle found in Parisian night clubs. There, he found and painted the vulnerable characters this environment 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 musculoskeletal 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 portraits capturing the imperial beauty of the human body. Toulose-Lautrec was similarly fascinated with humans, but more their place in the world than their physical features. Although from an aristocratic family, Toulose-Lautrec’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 regularly frequenting boozy nightclubs and brothels, where he often painted scenes from middle-class Parisian nightlife .
But another common theme emerges linking both Renoir and Toulouse-Lautrec beyond their physical disorders: 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 . But paint he did. Despite battling his condition for nearly three decades, Renoir produced an estimated 4000 paintings  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 . In the 1870s, these painters left the confines of their studios to paint en plein air (outdoors). Their landscapes and scenes of middle-class Parisian life were at first satirized by critics using a then-derogatory adjective—impressionistic—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 .
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 conversation 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 Exhibition in 1882 and cemented Renoir’s status as an emerging star in the Impressionism period.
But unlike his impressionist colleagues, 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 . Slow sales of his impressionist work with a wife and three children, as well as deteriorating health may have influenced his decision to pursue studio art.
Painting Through Pain
Renoir’s rheumatoid arthritis deeply influenced his daily activities and limited 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 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” .
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 manifested facial palsy, nodules in the back, pleural effusion, and weight loss .
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 limited motion of his right shoulder. Although the pain was nearly unbearable, 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 replied: “The pain passes, but the beauty remains” .
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  (sometimes known as Toulouse-Lautrec Syndrome); alternative explanations might include achondroplasia or osteogenesis imperfecta, all of which can explain some of his difficulties, though not all of them.
Toulouse-Lautrec’s physical appearance 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 him. With its bright colors and short and fast brushstrokes, Toulouse-Lautrec 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 handicapped, 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 “Bohemian” 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 Toulouse-Lautrec later revealed that the well-dressed man is instructing the woman on the “can-can”, a popular French cabaret dance featuring high kicks, splits, or even cartwheels . Toulouse-Lautrec’s use of contrasting colors shifts our eyes beyond the dancers 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 , 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 advertisements 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 .
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 outcast. 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 complications 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.
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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 ® 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 ® or The Association of Bone and Joint Surgeons®.
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.
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Di Matteo, B., Tarabella, V., Filardo, G. et al. Art in Science: The Artist and The Disease: The Exemplary Cases of Renoir and Toulouse-Lautrec. Clin Orthop Relat Res 475, 2376–2381 (2017). https://doi.org/10.1007/s11999-017-5458-7