The diagnosis of art: Valentin le désossé and Ehlers-Danlos syndrome
Authors: Jeffrey K Aronson, Manoj Ramachandran
Journal: Journal of the Royal Society of Medicine (2007)

Henri de Toulouse-Lautrec was born in Albi in 1864 into a wealthy family, his father a Count. Henri's growth as a child was poor; then when he was 12 he broke his left thigh, followed two years later by his right. The bones failed to heal and his legs stopped growing. It has been suggested that he had pycnodysostosis.1,2 Thus stunted, he found it difficult to enter normal society and took to frequenting low-life haunts in Montmartre. It was at L'Ely, the dance hall L'Elysee-Montmartre, that Lautrec met the two characters that we see in the poster that he later produced to advertise Charles Zidler's Moulin Rouge—La Goulue and Valentin le desosse (Figure 1). Both are described by Pierre la Mure in his fictionalized account of Lautrec's life, Moulin Rouge (1951), which was later made into an Oscar-winning movie by John Huston (1952), starring Jose Ferrer as the artist.



Figure 1

One version of Toulouse-Lautrec's lithographic poster The Moulin Rouge (1891). [In colour online]



La Goulue (‘the Glutton’, Louise Weber, played in the film by Katherine Kath), whom Lautrec also painted in 1892 arriving at the Moulin Rouge, is seen dancing the can-can in the background. La Mure described her as ‘a blonde, eighteen-year-old laundress, broad-faced and stocky, her hair twisted into a high chignon that stuck up like an enormous thumb on top of her head.’ When she danced the can-can, ‘she was a human whirlwind, her skirts flung above her head, her black-stocking legs kicked into the air, her body twisted as if she wanted to shake off her blouse. Sweat streaked her face, her breasts rode high under her clinging blouse, and the muscles bulged in her white thighs.’

The dancer shown posturing in the foreground in silhouette was Jacques Renaudin, nicknamed Valentin le desosse (‘boneless Valentin’) because of his rubbery limbs. He was played in the film by Walter Crisham. La Mure described him as ‘a middle-aged man, fabulously tall and thin, measuring almost eight feet from the crown on his top hat to the tip of his patent-leather shoes. He was a well-to-do bachelor, a soft-spoken, kindly recluse, who had the misfortune to look startlingly like a corpse... a saturnine top-hatted skeleton.’

Lautrec also depicted Valentin in The Dance at the Moulin Rouge (1890) and the Panel for La Goule's Booth: Dance at the Moulin Rouge (1895). In the 1891 poster (Figure 1) he shows Valentin with a flexion deformity of the proximal interphalangeal joint of the little finger of the right hand, which could have been due to an ulnar nerve palsy or Dupuytren's contracture; the latter can occur in alcoholic liver disease,3 and Valentin was a wine merchant by day and a denizen of the Paris nightclubs by night. However, there may also be a deformity of the thumb, perhaps Nalebuff type II combined boutonniere and swan-neck deformity,4 and if this is rheumatoid thumb, the abnormality of the little finger could also be a boutonniere deformity. In the left hand, the proximal interphalangeal joints and perhaps the metacarpophalangeal joints appear to be swollen, which would also be consistent with a rheumatoid arthropathy.

Ehlers-Danlos syndrome is characterized by increased elasticity and fragility of the skin, joint hypermobility, and hyperextensibility. Although at least ten distinct variants have been described, with different abnormalities of collagen, there is a great deal of overlap, and individuals can present with the features of different types, which allows us to hypothesize wildly about Valentin, with his rubbery limbs, arthropathy, and prognathism. The term ‘india-rubber man’ has been used to describe circus contortionists with the syndrome. It can present with polyarthralgia5 and there has even been a report of prognathism,6 albeit in type IV, which is associated with a poor prognosis and short stature.

But whether Valentin le desosse had a rheumatoid arthropathy, Ehlers-Danlos syndrome, or something else entirely, his memory lives on in Lautrec's striking poster.