There are many ways to upset the balance between growth and destruction that is found in every bone. An excess of bone may be due to an excess of osteoblasts, but it can also be caused by a want of osteoclasts. Osteopetrosis, literally bones-like-rock, is an osteoclast disorder, the opposite of the far more familiar osteoporosis that is the bane of post-menopausal women. Having bones-like-rock can be lethal. There is a particularly harsh variety of the disorder that affects children and usually kills them before they turn twenty. Often they die of infections because bone accretes in the cavities where marrow is manufactured, marrow being one of the main sources of immune-system cells. Somewhat paradoxically, the bones of people with osteopetrosis also tend to fracture rather easily, the probable consequence of an architecture that has gone awry. And when fractures do occur they are not easily repaired, for among the things that osteoclasts do is to smooth away the jagged edges of our bones should we break them.
Osteopetrosis, albeit of a fairly mild variety, is thought by some to be responsible for the shortness of Henri de Toulouse-Lautrec. This is just one of several retrospective diagnoses – achondroplasia and osteogenesis imperfecta among them – that have been attempted of the French painter. None is particularly convincing, but then bone disorders are so many, and their symptoms so various and subtle, that they are easily mistaken for one another, particularly when all we know of the patient comes from biography, a handful of photographs, and a selection of self-portraits, mostly caricatures. Yet the search for ‘Lautrec’s disease’ goes on. Part of his fascination, particularly for French physicians, comes from the fact that he was a scion of one of France’s most noble houses, the Comtes de Toulouse-Lautrec, a dynasty of rambunctious southern noblemen who had, at one time or another, ruled much of Rouergue, Provence and the Languedoc, sacked Jerusalem, dabbled in heresy, been excommunicated by the Pope (on ten separate occasions) and, in the thirteenth century, felt the military wrath of the French Crown. But more than this, the impulse to diagnose Henri Toulouse-Lautrec comes from the belief that this gifted painter made his deformity part of his art.
There may be something to this. As one walks through the Musée d’Orsay in Paris or else the museum at Albi, not too far from Toulouse itself, which is dedicated to his work, what strikes you are the nostrils. In painting after painting – of the dancer La Goulue, the actress Yvette Guilbert, the socialite May Milton, or the many other anonymous Parisian demi-mondaines who inhabit Lautrec’s art – what we see are nostrils, gaping, dark and cavernous. It is hardly a flattering view, but perhaps it is one that would have come quite naturally to the artist, for he was rather short. By the time he was full grown, Lautrec was only 150 centimetres (four feet eleven inches) tall. Critics have also argued that Lautrec’s disorder had a more subtle effect on his art: a tendency after 1893 to truncate the limbs of his models so that only the heads and torsos remain in the frame, a device for excluding that part of his own anatomy that he would much rather forget: his legs.
Lautrec’s legs caused him much grief. He seems to have had a fairly healthy childhood, but by the time he was seven his mother had taken him to Lourdes, where she hoped to find a cure for some vaguely described limb problem. He was stiff and clumsy and prone to falls, and only went to school for one year, leaving when he proved too delicate for schoolyard roughhousing. By the age of ten he was complaining of constant severe pains in his legs and thighs, and at thirteen minor falls caused fractures in both femurs which, to judge from the length of time during which he supported himself with canes, took about six months to heal. He would use a cane nearly all his adult life; indeed, friends believed that he walked any distance only with reluctance and difficulty.
As he grew, Lautrec also underwent some unusual facial changes. A pretty infant, and a handsome boy, he later developed a pendulous lower lip, a tendency to drool, and a speech impediment rather like a growling lisp, and his teeth rotted while he was still in his teens – traits which his parents, who were notably good-looking, did not share. He was self-conscious about his looks, wore a beard all his adult life, and never smiled for a camera. Many critics have argued that it was a sort of physical self-loathing that caused him to seek and portray all that was most vicious and harsh in his milieu. But then, fin-de-siècle Paris could be a vicious and harsh place. One night at Maxim’s, when Lautrec had sketched some lightning caricatures of his neighbours, one of them called to him as he hobbled away. ‘Monsieur,’ he said, gesturing to a pencil stub left on the table, ‘you have forgotten your cane.’ On another occasion, looking at one of the many portraits he had done of her, Yvette Guilbert remarked, ‘Really, Lautrec, you are a genius at deformity.’ He replied, ‘Why, of course I am.’
Lautrec is thought to have been afflicted by a variety of osteopetrosis called pycnodysostosis. It is caused by a deficiency in the enzyme that osteoclasts use to dissolve the protein matrix of bones. During adulthood the activity of this enzyme is partially repressed by hormones, and it is the declining levels of estrogen in post-menopausal women – and hence the unwarranted activity of the enzyme – that causes osteoporosis. Lautrec was diagnosed with pycnodysostosis in 1962 by two French physicians, Pierre Maroteaux and Maurice Lamy, but their claim has not gone unchallenged. Lautrec’s most recent biographer, Julia Frey, concedes that at least some of his symptoms are consistent with the disorder, but points out that others are not. Where pycnodysostosis patients typically have soft heads – rather in the manner of the boneless Cape Malays – there does not seem to be any evidence that Lautrec’s head was anything but solid.
Whatever his disorder, it seems that he shared it with several other members of his family. By the time Henri Marie Raymond, Comte de Toulouse-Lautrec-Montfa, was born in 1864 his family, though still rich, was quite inbred. The Napoleonic abolition of primogeniture had prompted an already much-reduced French nobility to keep what wealth remained in their families by the simple expedient of not marrying out of them. Henri’s parents were first cousins, as were his aunt and uncle: between them they produced sixteen children, of whom four including Henri were dwarfed, the other three far more severely than he. Indeed, it is likely that at least some surviving members of that noble house still carry the mutation, though it is not likely to be expressed if they have discontinued their consanguineous habits.
Lautrec himself had no doubts about the ultimate cause of his malady. One night, in one of his favourite haunts, Montmartre’s Irish and American Bar, two women were arguing about a pitiful dog whose legs shook from hip dysplasia. The dog’s owner conceded that the animal wasn’t handsome, but insisted nevertheless that it was pure-bred. ‘Are you kidding, that dog has a pedigree? Have you taken a look at his ugly fur and his twisted feet?’ laughed her friend. ‘He makes you feel sorry for him.’ ‘You obviously don’t know anything about it,’ said the dog’s owner, and turned to Henri who was sitting next to her. ‘Tell her, Monsieur, that my dog can perfectly well be ugly and still be pedigreed.’ Henri, getting down from his high barstool and standing up to his full four feet eleven inches, saluted her with a charcoal-stained hand and murmured, ‘You’re telling me.’