BMJ 1997;315:1704-1708 (20 December)
Education and debate
How Renoir coped with rheumatoid arthritis
Annelies Boonen,
rheumatologist,a
Jan van de Rest,
president, 13th
European congress of rheumatology,b
Jan Dequeker,
rheumatologist,c
Sjef van der Linden,
rheumatologist aa Department of Rheumatology, University Hospital Maastricht, Maastricht, the Netherlands,
b Reumafonds, PO Box 80208, 2508 GE The Hague, the Netherlands,
c Department of Rheumatology, University Hospital of Leuven, Leuven, Belgium
Correspondence to: Dr Boonen aboo@sint.AZMONL
 |
Introduction |
|---|
Out of doom and misery, the most beautiful song may
rise1
Few people know that Pierre-Auguste Renoir, who lived from 1841 to 1919,
suffered from severe rheumatoid arthritis for the last 25 years of his life. At the 13th European
congress of rheumatology in Amsterdam in 1995 Mr Paul Renoir, the artist's 70 year old
grandson, revealed several previously unpublished aspects of his grandfather's
disease.
|
Disease and evolution |
|---|
There is little doubt that Renoir suffered from rheumatoid arthritis, but there is still some
discussion about the precise year the arthritis started.2 It
must have been around 1892, when Renoir was about 50 and in the prime of life. He was married
to Aline Charigot, and two of his three sons had already been born. He was recognised as an
established painter, having had exhibitions not only in Paris and other places in France but also
in Brussels, London, Boston, and New York.
He was active and hardworking, painting and making study tours to Algiers, Italy,
Germany, and Spain. His friends included the painters Manet, Sisley, and Cézanne and
the writers Zola and de Montpassant.
Although no medical records remain, it is possible, thanks to photographs, his personal
letters, and biographical notes by people who knew him well to get a reasonable idea about the
course of his disease. The arthritis started around the age of 50, took on an aggressive form from
1903 onwards, when he was about 60, and made him quite handicapped from the age of 70 for
the last seven years of his life.
In a photograph of 1896, when he was 55, the swelling of the metacarpophalangeal joints
can be clearly seen (fig 1). Five years later, in 1901,
when he was 60, he could still use his hands fully as witnessed in the way he holds his pipe (fig
2). Then the arthritis became more aggressive, and in the
photograph of 1903 (fig 3), at the age of 62, we see the
dramatic change where he tries to hold his inseparable cigarette in his deformed hands. The
aggressive nature of the disease resulted in the destruction and ankylosis of his right shoulder and
ruptures of several extensor tendons of fingers and wrists, leading to poor hand function, as
shown in the picture of his hands of 1912 (fig 4), when
he was 71. Despite these deformed hands, he continued to roll his cigarettes and, according to
his grandson, produced more than 400 paintings.
View larger version (110K):
[in this window]
[in a new window]
|
Fig 1 Renoir during a boat tour on the Seine near Chatou in 1896.
Swelling of the metacarpophalangeal and proximal interphalangeal joints can be
seen.
|
|
View larger version (99K):
[in this window]
[in a new window]
|
Fig 3 This photograph taken in 1903 shows the dramatic progression
of the deformities in Renoir's hands.
|
|
View larger version (99K):
[in this window]
[in a new window]
|
Fig 4 With these deformed hands Renoir continued to roll his own
cigarettes and completed more than 400 works of art. The bandages served to absorb the sweat
to prevent maceration
|
|
A comparable series of pictures illustrates how the disease affected his feet and legs. In
1901, at the age of 60, when his youngest son, Claude ("Coco"), was born, he used
one walking stick (fig 5). In 1908 when it became
difficult to walk with one cane he had to use two (fig 6).
In 1912, at the age of 71, a stroke was reported, which partially paralysed his arms and legs. It
is more likely that the paralysis was due to rheumatoid arthritis, affecting the cervical spine.
From then on he could not walk anymore and he was confined to a wheelchair. A photograph
shows him sitting in his studio next to the canvases and his model, Catherine Hessling
("Dédée"), who lived with the Renoir family and later became his
daughter in law (fig 7).
View larger version (136K):
[in this window]
[in a new window]
|
Fig 6 In 1908 Renoir had to use two walking canes, under which he
had attached rubber stops to prevent them from slipping.
|
|
View larger version (113K):
[in this window]
[in a new window]
|
Fig 7 From 1912 onwards Renoir became wheelchair bound. In this
photograph he is sitting next to his canvasses and his model Dédée (Blonde à la Rose 1915).
|
|
He had to stop travelling abroad, but continued to make frequent trips in France, driven
by his loyal chauffeur, Batistin. However, the deformities of the feet increased and he was soon
unable to wear shoes. His feet had to be wrapped in woollen slippers (fig 8). He developed fixed flexions of his knees two years before his
death. But this did not prevent him from visiting the Louvre in a sedan chair to see a private
exhibition some months before he died (fig 9).
View larger version (144K):
[in this window]
[in a new window]
|
Fig 9 Renoir was carried in his sedan chair by his friends or staff to
places that were difficult to reach in a wheelchair (garden in Cagnes-sur-Mer,
1917).
|
|
There is evidence that the rheumatoid arthritis affected not only his joints. At the
beginning of the disease a pleuritis is reported and later a facial palsy, which was treated with
electrotherapy. From 1904 onwards, at the age of 63, he began to lose weight because of
rheumatoid cachexia (fig 10). He reports this quite
cynically in a letter: "I can't stay seated because I'm so thin. Forty six
kilos, that can't be called fat. My bones are sticking through my skin and this despite a
good appetite." 3 Renoir's rheumatoid
arthritis was nodulous and the nodules on his back became particularly troublesome after 1912,
the year he became wheelchair bound. These nodules were removed by Dr Prat, a surgeon at the
Belvédère Hospital in Nice. In 1918 gangrene of his foot was described. Despite
good care, he also developed bedsores. Finally, in 1919, on his return from Paris to his house in
the south of France, he caught pneumonia and died on 3 December, having spent several hours
painting that evening on a still life of apples in a basket that his youngest son, Coco, had brought
him.
|
Treatment |
|---|
In the early years of the disease Renoir was treated by his two family doctors—Dr
Baudot at Essoye in the Aube region, where he had a studio, and Dr Journeac, his doctor in
Montmartre. They prescribed purges and antipyrine. He followed their advice but limited the use
of antipyrine because he was frightened that it would influence his artistic creativity. He relied
more on physical exercise to remain in good condition and to keep the optimal use of his hands
and arms. A quotation from the bibliography written by Renoir's second son, Jean (the
film director), illustrates this: "He had no great faith in the benefit of walking which
brought into play only certain muscles. He believed much more in ball-games and began
juggling every morning 10 minutes before going to his studio." 4
His grandson told us that the wooden sticks he used for juggling were made according to
the master's instructions by his Paris coal merchant. He also liked playing billiards
because this obliged him to adopt all sorts of awkward postures. He used to play it with his wife,
Aline, who became the better player and beat him repeatedly. Another game to exercise his arms
was bilbouquet. This difficult French ball game involves a wooden ball with a hole in it,
weighing between 500 g and 3 kg. The player has to throw the ball and then to try to catch it on
a wooden stick via the hole.
To experience the benefits of warmth and physical exercise he visited French spas such
as Vichy, Bourbonne-les-Bains, and Aix-les-Bains four or five times
between 1899 and 1914. He used to move there for several months along with his entire family,
his staff, and even his piano and parrot. His hope for some cure is expressed in a letter of 1903
to one of his friends: "I've the impression I have come to the right place, a lot of
people here seem well satisfied with the waters." 3
When the disease deteriorated he agreed that warmth was beneficial and gave some pain
relief. For that reason he spent more and more time in the south of France. At first there were
family holidays with the Manets and Cézannes. Later, he and his wife bought a big estate
in Cagnes-sur-Mer, near Nice. One of his reasons for buying the estate was to save
several 1000 year old olive trees that were threatened with being cut down. He built a house,
"Les Colettes," and a studio, and in 1908 the family moved to
Cagnes-sur-Mer.
But even in the hot Mediterranean climate, Renoir wanted to be dressed warmly (fig
8). This is described by one of his best friends:
"He wears no special painter's garb. He sits in his armchair, his spindly legs
crossed, his poor feet wrapped in woollen slippers, his body covered in shawls and his pale fine
head muffled to the ears in a cap or white linen hat according to the season." 5 Also, to share their warmth, he often nursed one of the many cats
that lived around the house. Occasionally, the Institut Pasteur in Paris, checking the authenticity
of Renoir's paintings, has found cats' hairs in the paint. This helps to date the
paintings. His family doctor at this time was Dr Gachet. He was an art connoisseur and is well
known from the portrait by Van Gogh, who was also one of his patients.
|
Influence on style and technique of painting |
|---|
There has been discussion among experts about whether the disease had an influence on
Renoir's painting.6 There is certainly a change in
style around 1880. That year Renoir travelled to Italy and, influenced by the classic Italian
Renaissance painters, he had a so called artistic crisis. For a time his style became more harsh
and the colours he used were more vivid. However, this was several years before his arthritis
started.
Of course, the progressive deformities of his hands and the ankylosis of his shoulder
obliged him to adapt his painting technique continuously. Photographs and testimonies help us
to reconstitute how he painted. When it became difficult to hold his palette in his hand he first
let it balance on his knees and the edge of the easel. Later, he asked for it to be fixed, like a
rotating table on the arm of his wheelchair (fig 11).
View larger version (146K):
[in this window]
[in a new window]
|
Fig 11 Renoir had to adapt his painting technique continuously; the
brushes had to be fixed in his hands by his wife or model and he couldn't hold his palette,
so he let it balance on his knees and the edge of the easel. His wheelchair was already of modern
design, and he filled the back with cushions to prevent the development of
bedsores.
|
|
As time passed, he found it increasingly difficult to pick up and hold the brushes. His
wife, son, or model had to fix the brush in his deformed hands. In figure 12 his grandson shows how he finally held the brush, wedged in
the first metacarpal space. The bandages did not serve to fix the brush but to absorb the sweat
of the palms of his hands to prevent maceration and possible infection. He obviously changed
his brush less often than before and became slower in painting. This might also explain why he
used a progressively shorter brushstroke and started to paint dry on dry instead of wet on wet.
Still, he always continued to paint starting with a touch of white, then adding and mixing the
other colours afterwards. Throughout his life he used the same 11 colours, only later adding
black.
View larger version (53K):
[in this window]
[in a new window]
|
Fig 12 Renoir's grandson Paul shows how Renoir held his
brush when his hands were severely deformed by arthritis.
|
|
The ankylosis of his right shoulder limited him to painting only small areas of about 30
cm by 30 cm. To reach a bigger area he moved his whole body, and with some imagination this
can be seen in figure 13. Renoir was ambidextrous and
twice, after breaking his arm, he made use of this ability. Even art specialists cannot notice the
difference in his paintings.
View larger version (105K):
[in this window]
[in a new window]
|
Fig 13 With some imagination you can see the master moving his
whole body to overcome the limited movement of his arm due to ankylosis of his
shoulder.
|
|
View larger version (125K):
[in this window]
[in a new window]
|
On the Terrace 1878. Renoir revealed the happy side of life in his
images. "For me a picture must be an amiable thing, joyous and pretty—yes,
pretty! There are enough troublesome things in life without inventing others." Marcel
Proust said: "Women who go by in the streets are different from their
predecessors—now they are Renoirs" ART INSTITUTE OF
CHICAGO/BRIDGEMAN ART LIBRARY
|
|
Renoir's invention of the moving canvas or picture roll was important for his
painting technique; it replaced his easel. The linen was fixed on wooden slats, which could turn
around two spindles linked by the chain of his old bicycle and driven by a crank to move the
canvas up and down. Unfortunately, no pictures exist of this special easel. The picture roll
allowed him to continue to paint large works and Les Grandes
Baigneuses is one of the works painted in this way (fig 14). It measures 160 cm by 110 cm and was painted in 1918 and
1919, when his hands were severely deformed and the mobility of his right shoulder was
restricted. On some paintings of this period the traces of the bars can be seen.
View larger version (126K):
[in this window]
[in a new window]
|
Fig 14 Les Grandes
Baigneuses. This painting, measuring 160 cm by 110 cm, was painted in 1918 and
1919 on the picture roll.
|
|
It might seem surprising that Renoir started sculpting during the last 12 years of his life.
He was inspired by the sculptor Maillol, who at that time made a bust of Renoir because the
painter was appointed chevalier d'honneur. Renoir
made a bust and later a medallion (fig 15) of the head
of his youngest son, Coco. The medallion served as a decoration for the fireplace in their new
house "Les Collettes." A reproduction of the medallion is available from the
Renoir family, who are pleased to give information about it. He made other bronzes in
cooperation with Guino, Maillol's pupil, who served as the executor of Renoir's
ideas.
View larger version (149K):
[in this window]
[in a new window]
|
Fig 15 Inspired by the sculptor Maillol, Renoir made some bronzes,
such as this medallion of his youngest son, Coco, dated 1908 BRIDGEMAN ART
LIBRARY
|
|
|
Other devices |
|---|
View larger version (149K):
[in this window]
[in a new window]
|
Blonde à la Rose 1915. Andrée Madelaine
Heuschling (also called Catherine Hessling or Dédée), an actress from Alsace,
was Renoir's model for more than 100 paintings (see also fig 7). She was found by Aline, Renoir's wife, in a
photographer's shop in Nice after they had been searching for several years for a model
with such beauty. Dédée married Renoir's son Jean, the film director, in
1920 GIRAUDON/BRIDGEMAN ART LIBRARY
|
|
Renoir used his creativity not only to be able to continue painting but also to let him
function as normally as possible in his personal life. In his daily life he adapted other
tools—for example, his walking sticks. He started using them in 1901, when he had
difficulty walking. He attached rubbers under them to prevent him from slipping. In 1912, the
year he became paralysed, he bought a wheelchair in Nice and later on two others to use in Paris.
They were modern in design (fig 11). He filled them
with cushions to protect his bones and to prevent the development of more bedsores. He also had
a sedan chair, in which he was carried in places inaccessible to wheelchairs (fig 9).
|
Coping |
|---|
When looking at Renoir's paintings it is easy to forget that he suffered a great deal.
Not only did he have to put up with the pain, progressive disability, and periods of depression
but his two eldest sons were injured in the first world war, and his wife, Aline, died in
1915.
Painting was almost a physical need and sometimes a cure, as if Renoir wanted to create
on the canvas those things which he had to miss in real life because of his disability. Even when
he woke at night crying in pain, he asked for some painting material and started to make small
paintings on wood (fig 16). The beauty of nature and
women constantly inspired him, and music played an important part in his life. As a small boy,
in his Paris school, he had singing and piano classes from Charles Gounod, who suggested that
he should follow a musical career. But even at the age of 12 the young Renoir had developed an
interest in painting and turned down the offer, though he kept his love for music. He was always
singing or humming tunes from operas while painting, and his piano always moved with him.
The Renoirs moved 53 times in Paris alone.
View larger version (100K):
[in this window]
[in a new window]
|
Fig 16 When Renoir woke at night because of pain, he asked for
painting materials and made small paintings on wood. Painting helped him to endure and forget
his pain.
|
|
His happy and fruitful life would have been impossible without the continuous support
and motivation of his friends, the models, his staff, and his family. His most dedicated friends
were the Cézannes, Albert André, and some of the art dealers of the time. They
visited him frequently and brought interesting people with them such as Rodin and Matisse, who
visited Cagnes-sur-Mer a couple of times (fig 17). His cook and his chauffeur were devoted to him. The cook
carried him in her arms around the house or garden, and his chauffeur drove him everywhere
until the last months of his life, stopping at all the places that Renoir wanted to admire and
paint.
View larger version (121K):
[in this window]
[in a new window]
|
Fig 17 Henri Matisse, Albert André, Pierre Renoir (the eldest
son), and Malec André around Renoir at New Year 1919.
|
|
Without doubt Aline, his wife, was the most important person in his life (fig 18). She devoted her life to him, making sure that he had no
worries about the household and that he was always surrounded by friends. The visitors and
models were welcomed with open arms, and Aline's excellent cooking and choice of
good wine were well known. Her death in 1915 was a great loss to him. From that time on, his
youngest son, Coco, who was only 14, took over his father's care in the evening after the
staff had left (fig 18). Renoir was completely dependent
on him and made sure a teacher came to the house so that he could see his son as much as
possible. He took great pleasure in teaching him ceramics in a specially built studio.
View larger version (133K):
[in this window]
[in a new window]
|
Fig 18 Aline was more than a wife: she devoted her life to him. After
her death, Coco, their youngest son, took her place as much as possible
|
|
|
Acknowledgements |
|---|
We acknowledge the help from Paul Renoir and his wife,
Marie-Paul Renoir, who spent many hours talking with AB and lent us the family's
photograph albums.
|
References |
|---|
- Van Duinkerken A. De mensen
hebben hun gebreken. Utrecht: Spectrum, 1958.
- Saudan Y. Did Renoir's arthritis have a repercussion
on his work? In: Appelboom T, ed. Art, history and antiquity of rheumatic diseases. Brussels: Elsevier,
1987:46-8.
- White BE. Renoir, his life, art and
letters. New York: Abrams, 1984.
- Renoir J. Pierre-Auguste
Renoir: mon père. Paris: Gallimard, 1981.
- Riviere G. Renoir et ses
amis. Paris: Flouru, 1921.
- Louie JS. Renoir, his art and his arthritis. In: Appelboom
T, ed. Art, history and antiquity of rheumatic diseases. Brussels: Elsevier, 1987:43-4.
Top
Introduction
Disease and evolution
