Doctor's Review: Medicine on the Move

January 19, 2022
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Picture imperfect

Tiny Henri de Toulouse-Lautrec’s talent — and troubles — were larger than life

Perhaps as famous as the iconic Moulin Rouge itself are Henri de Toulouse-Lautrec’s distinctive images of the Parisian nightclub. They’ve been subject to posthumous diagnostic conjecture for decades… but not nearly as much as the eccentric French artist’s strange array of physical and psychological symptoms. To be fair, Toulouse-Lautrec’s short stature and brittle bones are indeed tempting fare for artists and scientists alike, but have medical historians ever really solved the mystery of what ailed the diminutive painter?

Challenging childhood

The cards, it seemed, were stacked against poor Henri from the very moment of his conception, despite — or perhaps because of — his noble birth. Henri Marie Raymond de Toulouse-Lautrec-Monfa was born in the town of Albi in the French region of the Midi-Pyrénées on November 24, 1864. As was common in so many aristocratic French families, his parents, the Count Alphonse and the Countess Adèle de Toulouse-Lautrec, were first cousins... and their consanguinity likely contributed to their young son’s congenital condition.

Henri wasn’t the only one, either. At least three of his cousins — themselves the progeny of kissing cousins — also suffered from dwarfism and other congenital and skeletal defects; one relative was so fragile and tiny that she lived her entire life in a baby carriage. Henri’s parents did have another boy a few years after Henri, but the child died before turning a year old.

Henri was fragile from birth. Short and sickly, he spent much of his childhood indoors watching other kids frolic about his family’s vast country estates. To add insult to injury, he was somewhat unattractive, drooled, had a speech impediment and lifelong sinus troubles. When he was 13, Henri fractured his right femur; when he was 14, he fractured his left. His broken legs never properly healed, nor did they grow beyond that point, and so little Henri walked with a cane and a limp for the rest of his life.

The long months of recovery spent immobilized indoors, however, did contribute to his burgeoning love of art. Under the tutelage of his father, grandfather and uncle, themselves able draftsmen, as well as lessons from professional artists, Henri’s talents emerged.

An artful move

By the time he was a young man, Henri had reached his full height of about one-and-a-half metres tall. Though his torso and arms were average, his legs remained those of a child. His parents spared no expense in treating him, though nothing — not even electroshock therapies — could restore their son to good health or normal size. Henri certainly didn’t let it stop him from pursuing his dreams, though, and with the support of his mother, moved to Paris at the age of 18.

The young Toulouse-Lautrec immersed himself in the vibrant art scene there; a post-impressionist artistic melting pot where he met and was inspired by luminaries like Degas and Van Gogh. Of course, the heart of Belle Époque gaiety that was Paris in the 1880s beat in the simultaneous debauchery and liveliness of Montmartre, where Henri set up his own studio.

Before long, Toulouse-Lautrec’s distinct style — both artistic and personal — earned him a small following. By 1888, he was selling paintings. Early on, he developed his talents through poster ads for local cabarets. In 1891, he did his first Moulin Rouge job, raising his profile tremendously, especially among the average Joes (or rather, average Jacques) of Paris. Fans apparently stalked the poster-hangers around town so that they could steal Toulouse-Lautrec’s cabaret adverts before the paste dried. Unfortunately, the young artist also developed a drinking problem, and as his physical health deteriorated, so did his mental state.

Alcoholic artist

Though somewhat inspirational at first, absinthe and alcohol also dulled the pain of Toulouse-Lautrec’s social anxieties. He made sure he always had a supply of absinthe on hand by storing some in his hollow walking stick. Despite his substance issues, he remained a prolific portraitist, known for chronicling the faces and forms of the Bohemian inhabitants of Montmartre.

It was obvious to most who knew him that his medical situation was more than just a case of short stature. His facial features were quite distinctive, with a large forehead and nose, and a receding chin. He had terrible teeth and constant toothaches, too, and was rarely seen without that famous black hat, which most assumed he wore to add an extra inch or two of height. And, despite his popularity with the local courtesans, rumours swirled about his abnormal genitalia. He admitted to friends that he suffered from syphilis as well, a situation that likely contributed to his declining mental health in later years.

Though he spent his summers in the south, convalescing at his family’s country castles, in the late 1880 and early ’90s, Montmartre was his home. During these years, he was a fixture at the Moulin Rouge and other notorious clubs, and developed his famous friendship with Vincent Van Gogh. Toulouse-Lautrec blossomed into a local celebrity among the eccentric population of Montmartre, which was the centre of the artistic universe at the time — a swirling vortex of writers and painters, sinners and strippers, thinkers and thieves. Toulouse-Lautrec absorbed it all, turning out a vast oeuvre of paintings, lithographs, illustrations and posters that would eventually bring him worldwide recognition.

A deadly stroke

By the late 1890s, he was drinking far more than he was painting. His alcoholism devolved into anxiety, depression, fear and paranoia. Hallucinations often took him over; friends one day found him shooting his pistol at invisible spiders. He believed the police were trying to arrest him and ill-meaning dogs were at every turn. In 1899, after making a very public scene in a brothel and experiencing a breakdown of sorts, Toulouse-Lautrec was dragged by his mother’s goons to a private insane asylum for three months. The scandal was widely broadcast, though his newfound notoriety just increased his fame and fetched higher prices for his paintings.

He continued to take it easy for months after that, resting in the south of France, but he soon resumed his old habits, drinking heavily once again. A series of strokes likely resulting from alcoholism and tertiary syphilis began in March of 1901, resulting in greater paralysis. On September 9, 1901, a final stroke took his life. He died at 36, as famous for the scenes he painted as the scenes he made.

In the century since Toulouse-Lautrec’s death, medical diagnosis has become an art as well, especially with the advent of genetics. Art historians and MDs alike have long been trying to determine exactly what it was that caused the painter’s strange array of symptoms. Posthumous diagnoses have run the gamut from achondroplasia and other forms of dwarfism, to a combination of bad luck and syphilis, to even just a nasty case of rickets.

Too little, too late

During the mid-20th century, the commonly held thought was that Toulouse-Lautrec suffered from an inherited bone disease. At first, osteogenesis imperfecta was believed to be the most likely culprit, since the so-called brittle bone disease would explain why the painter’s bones fractured so easily when he was a young man. Others suggested the cause might be the rarer osteopetrosis, or marble bone disease, in which bones become dense and hard, prone to growth retardation and fracture. But could either of these diseases account for all of Toulouse-Lautrec’s issues? Probably not.

As understanding into another rare genetic disorder has grown, it seems that the debate has finally been settled. Pycnodysostosis seems the most likely culprit. Once the disease was identified by French physicians Pierre Maroteaux and Maurice Lamy in 1962, they declared an official end to the diagnostic debate (though a few others still dispute it).

Pycnodysostosis’s hallmark symptoms — virtually every one of which was displayed by Toulouse-Lautrec — include short stature, fragile bones, large skull, short distal phalanges, dental issues, a distinctive set of facial features including a weak chin and hooked nose, as well as open fontanelles of the sort that might be hidden under a bowler hat. The cherry on top of the diagnostic cake? Parental consanguinity.

In 1996, the gene responsible for pycnodysostosis — now also known as Toulouse-Lautrec Syndrome — was found, making definitive diagnoses possible. Technically, if the remains of the artist were exhumed, a final diagnosis could be made once and for all.

In a bizarre foreshadowing of the debate — and Toulouse-Lautrec’s life in general — one of his final paintings, done shortly before his death, was a dark, thoughtful piece entitled An Examination at the Faculty of Medicine, Paris. If only he knew…

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