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Home , Artists Rights Society, August Macke, Degenerate art, Franz Marc, Marc Chagall, Paul Klee

Paul Klee and his illness, scleroderma

Richard M. Silver, MD

The author (AΩA, Vanderbilt University, 1975) is profes- sor of Medicine and Pediatrics and director of the Division of Rheumatology and Immunology at the Medical University of South Carolina.

t has been said that the viewing and analyzing of fine from a medical perspective increases one’s appreciation of the in- dividual’s suffering and teaches us an important lesson of the humanI aspects of medicine.1 It is likely that few artists suffered as greatly as did , one of the pioneers of . Klee suffered personal loss, intellectual and political persecution, and, finally, a devastat- ing illness, scleroderma. Scleroderma (systemic sclerosis) is characterized by autoimmunity, microvascular injury, and an overproduction of collagen and other extracellular matrix components, often leading to profound changes in personal appearance, significant morbidity, and, in many cases, reduced survival. Despite his fatal illness, Klee’s adaptation and artistic productivity provide a window through which one can appreciate the indomitable spirit of human . Paul Klee was born on December 18, 1879, in the small town of Münchenbuchsee near , .2,3 His mother, Ida Maria Frick, was a trained singer, and his father, Hans Klee, taught music for fifty years at the Cantonal School for Teachers near Bern.4 Both envisioned a musical career for Paul, who indeed was a talented violinist, earning a seat with the Bern City Orchestra. From a very early age, though, it was and art that captured the imagination of Paul Klee, although music accompanied him throughout his life and in his art.

Captive of art, not disease

Fortuitous—Klee encounters Kandinsky

At age eighteen, Klee moved to to study art at the private school of Hermann Knirr, where he soon became one of Knirr’s best pupils. Klee found the atmosphere of Munich stimulating.4 Living a Bohemian life unlike that of his youth in Switzerland, Klee noted his en- joyment of the “free life, the international comradeships and the unusually good musical performances.” 5p5 Two years later, Klee felt compelled to enroll in the Paul Klee, first violin (far right), and friends playing a Schubert Munich Academy of , fearing that to quintet at the Knirr School in Munich, 1900. do otherwise might disappoint his parents, who felt Reproduced with permission of George Braziller, Inc., New York. their son was not studying with sufficient serious- ness. There, he studied under Franz von Stuck. At this formative stage of development, Klee presaged his later fascination with color, complaining that von Stuck, although a good teacher of drawing, was “no good as a teacher of painting, for he never said a thing about color.” 5p5 It was here that Klee first encountered , who would later have a profound influence on Klee’s artistic devel- opment. It was here also that Klee met the girl who was to become his wife—Lily Stumpf, the daughter of a Munich doctor.4 Paul and Lily married when he was ­twenty-­seven over the objection of Lily’s par- ents. Lily was active as a concert pianist and earned a living by giving music lessons, some of which she gave at home while Paul devoted his time to art in his kitchen studio. Between 1906 and 1914, Munich was a center of ­avant-garde­ art, and it was there that Klee joined a community of young artists beginning to explore new ways of artistic expression.1 In 1912, Klee was invited to take part in an exhibition of art by Blaue Reiter, a group that included Kandinsky, , , and Gabriele Münter. The group’s name came from the cover illustration of its exhibi- tion almanac, showing a horse with a rider in , repeating themes from Kandinsky’s earlier painting Southern (Tunisian) Gardens, 1919. Watercolor and india ink on paper. 9½ x 71∕3 inches. Klee was entranced by the sights and colors during a trip to North Africa in 1914, an experience that would have a lasting impact on the artist. © 2007 (ARS), New York/VG Bild-Kunst, . Photo of scleroderma hand courtesy of John Varga, MD, Gallagher Professor of Medicine, Northwestern University Feinberg School of Medicine.

18 The Pharos/Winter 2008 (The Blue Rider, 1903) and Marc’s painting Die the was devoted to uniting the fine and applied arts Grossen Blauen Pferde (The Large , 1911). and in a manner fitting for an industrial age. Klee realized at once that this was an offer he could not refuse.4 At the Bauhaus, Klee taught the principles and practices of art and published one of his most influential works, Pädagogisches Skizzenbuch (Pedagogical Sketchbook, 1925). After five years Learning about color: “I am a painter” of vital and fruitful work in the Bauhaus, this happy time came to a sudden end when the first Nazi parliament of the State of closed the school. The entire Bauhaus A pivotal point in Klee’s career occurred in 1914, when he moved to the up-and-coming­ city of . Soon thereafter, joined his artist friends Louis Moillet and August Macke on a feeling an urge for artistic freedom, Klee accepted an appoint- ­seventeen-day trip to Tunisia. This excursion proved to be an ment at the Art Academy in Düsseldorf. The early 1933 coming unforgettable experience for Klee, who was entranced by the to power of the Nazis soon proved fateful for the German cul- colors and sights of North Africa. Of color he wrote, “It holds ture, but Klee refused to be upset. In February 1933, he wrote me forever—I know that. That is the meaning of this happy to Lily saying, “Not since my return from Venice have I worked hour: color and I are one. I am a painter.” 5p132 He brought the way I have been doing these past two weeks. The number back to Munich the foundations for some of his greatest of alone doesn’t tell the story, but the integrity and works of art. joy in the work that come every day for several hours.” 5p69 The outbreak of put an end to the expression- ist Blaue Reiter group. Kandinsky and others were forced to flee, first to Switzerland and later to their homeland . Klee’s close friends August Macke and Franz Marc were killed in action while serving in the German army. Klee’s father being 1933: a dramatically productive year a German national, Paul was drafted into the German army at the age of ­thirty-five, just one week after learning of the death of Felix Klee, Paul and Lily’s only son, lived in Düsseldorf his friend Marc. Lily argued to army officials that her husband’s at that time, and recorded that from March 1933, when the health was none too good. In his diary, dated July 20, 1916, Klee swastika flag was run up over the Academy, his father stayed commented on his physical weakness from strenuous marches away from his beloved studio.5 Klee withdrew to his home and, and exercises.5 He was never transferred to the front; ironically, as so often the case in difficult times, worked as if obsessed. part of his military service was spent at Schleissheim, where That year saw his greatest productivity to date, comprising 27 his duties included painting aircraft. He was discharged from oil paintings, 119 watercolors and 336 . Paul and Lily military service in February 1919, forever changed. fled to Switzerland in December 1933; shortly thereafter many Klee’s artistic expression changed from mostly draw- ings to the addition of large numbers of oil paintings and watercolors.1,5 An exhibition of over three hundred of his works brought him his first international recognition in 1919. Klee was becoming fa- mous. Then, on November 25, 1920, a telegram arrived from offering Klee an appointment to the Bauhaus in Weimar.4 Not an in the usual sense,

Joseph Goebbels and view exhibit of Entartete Kunst () that included works by Paul Klee and other twentieth century artists.

The Pharos/Winter 2008 19 Paul Klee in his studio in 1938 (left) and 1940 (right). Progression of scleroderma is evident in the later photograph showing taut skin with pigmentary changes, telangiectasiae and loss of the distal portion of two fingers. Reproduced with permission of , Bern, Klee Family Donation (left) and Keystone Switzerland (right).

years later, much of the “degenerate art” was burned in the courtyard of a fire Die Zwitscher-Maschine (), 1922. Watercolor, and pen and ink on oil station, while other works were sold by the transfer drawing on cardboard. 25¼ x 19 inches. Painted during his Bauhaus years, Nazis at auction,6 including Klee’s emblem- Klee blends nature with the industrial world. atic Die ­Zwitscher-Maschine­ (Twittering © 2007 Artists Rights Society (ARS), New York/VG Bild-Kunst, Bonn. Digital image © The /Licensed by SCALA/Art Resource, NY. Machine, 1922). After returning to Switzerland, Klee worked in an improvised studio in a small of his colleagues were forbidden to paint, while exit from apartment in Bern. His colors blossomed out and became became more difficult. On the eve of his departure, stronger. A new emerged that was different from the Klee wrote to Felix, “I have grown somewhat older these past rigidity of the Bauhaus period and different, too, from the few weeks. But I won’t let my gall rise, or at any rate I’ll spike relaxed and delicate Düsseldorf period.5 Exhibitions of his the gall with humor. That’s easy for men. In such cases women work in Bern and Basel were met, however, with restraint; the usually resort to tears.” 5p70 conservative Swiss were suspicious of modern art and perhaps Hundreds of Klee’s works were confiscated by the Nazis, also politically doubtful. and seventeen were later shown in ’ infamous Although his mother was Swiss and Klee had been born exhibition, Entartete Kunst (Degenerate Art). Premiering in and reared near Bern, he lived in Switzerland as a resident Munich in 1937, and then traveling to eleven other cities in alien. The Swiss sergeant interviewing Klee at the time of Germany and , the exhibition also included works by his citizenship application questioned the artist’s sanity, be- Picasso, , , and others. Modern traying perhaps the official’s political leanings (vide supra). art was banned by the Nazis in favor of the Heroic art that Klee’s Swiss citizenship was refused because it was feared exemplified the German race. Klee’s work was characterized that if his art should take root in Switzerland, it would in- as “confusion of a psychological instable character” and com- sult real art and cause good to deteriorate.5 By the pared to works produced by schizophrenic patients.1p1516 Two time Klee was finally called to sign the necessary citizenship

20 The Pharos/Winter 2008 such pain in my fingers during such hot weather.” 2p320 Klee rarely spoke directly of his illness, nor did he dwell upon it in his correspondence, but additional manifestations of scleroderma can be surmised from some of his letters. While walking at higher elevations, Klee complained of recur- ring cold sensitivity and dyspnea: “I inhale as deep as possibly. My dyspnea depends on the trail, whether going up or going down. It also depends upon the weather . . . and it also depends on how much food I have in my stomach.” 2p321 Klee suffered from the first symptoms of digestive problems and a feeling of fullness after any meal. Later, he experienced severe dysphagia and became able to take only liquid nutrition. Symptoms of Raynaud’s phenomenon, followed by his skin manifestations, ultimately led to the diagnosis of scleroderma in December 1936. It seems likely that the dyspnea and dysphagia were also manifestations of scleroderma. Klee was denied two of his pleasures by his physicians, who forbade him to smoke or play the violin.5 These prohibitions may have been a reflection of a profound degree of vasospasm, digital ulcers, or the arthritis that so frequently affects sclero- derma patients. In correspondence, Klee described arthritic pains in his hands. His arthritis or joint contractures may papers, he was too ill to travel to Bern. Swiss citizenship was have made painting difficult; like Renoir, who suffered from granted only posthumously. rheumatoid arthritis, Klee required the use of a larger paint- brush, while his style changed from intricate lines to broad brush strokes. Klee’s letters reflect a sense of isolation, not just geographic Raynaud’s, dyspnea, dysphagia, but physical as well: “a feeling of being on the outside as an in- and skin thickening curable patient; an immigrant and an incurable patient is dou- bly isolated.” 2p321 Isolation was later expressed in his art (vide infra). Near the end of 1938, Klee’s health deteriorated when In the summer of 1935 Paul Klee fell ill. The precise na- he suffered a bout of “vasomotor neurosis.” 2p322 Photographs ture of his initial illness is unclear now as it was then, but he of Klee in his Bern studio in 1938 and 1940 show strong evi- complained of continuous fatigue and was bedridden for long dence of the progressive nature of his disease. In the later pho- periods of time. His attending physician, Dr. Schorer, and the tograph, Klee’s nose is pinched by taut skin. Elsewhere the skin consulting dermatologist, Prof. Dr. Nägell, diagnosed “bron- is either ­hyper- or hypopigmented. Telangiectasiae are present chitis with complications of the lungs and heart as a result of on the face and hand. The photograph appears to reveal the measles.” 2,4p92 In December 1936, Lily noted that, “Because loss of the distal portions of Klee’s fourth and fifth digits of of problems with his skin, blood tests are done for calcium, the left hand (Klee was left-handed),­ although the fingers may phosphorous and metabolic activity. The physicians insist now simply be flexed or fixed in flexion contractures. In that same that it could not be measles. What is it then? In any case, it is year, Klee became tired to the degree that even talking became a miracle that he is alive.” 2p321 arduous. The small incline to his house was difficult for him to Although he had been generally healthy except for a bout traverse: “This is now my Matterhorn,” he joked.2p323 of diphtheria in childhood, Klee had symptoms that foreshad- Klee continued to work until the spring of 1940. By May, owed the onset of his scleroderma. During the time in Dessau however, he was gravely weakened and entered a sanatorium and Düsseldorf, Klee complained of the bitter cold. His trips in Orselina-Locarno. In his last postcard to his wife, Klee southward became a geographical destination for his be- wrote, “The diet, I imagine, is going to do me some good; the cause the northern climate had become unbearable.2 As early difficulty is more one of the mechanism of swallowing, and as the winter of 1930, Klee spoke for the first time of suffering what will suit me is discussed before every meal, day after from the symptoms of Raynaud’s phenomenon that, as for day. . . . The doctor drops in every so often and prescribes most scleroderma patients, may have been the initial mani- some new routines.” 5p78 Klee’s dyspnea worsened, and he was festation of his disease. Klee wrote, “There is nothing more transferred to the hospital Sant’ Agnes in Locarno-Muralto. hostile than water turning into ice; never before had I endured On the morning of June 29, 1940, Paul Klee died peacefully in

The Pharos/Winter 2008 21 Captive of art, not disease

his sleep. What regimen or medication was prescribed is not Klee did not fear death. He said, “Death is nothing bad; known, for all of the records of Klee’s final stay were later lost I long ago reconciled myself to it. How do we know what is in a fire. No postmortem examination was performed, and the more important, our present life or what comes after? I won’t death certificate reads simply “coronary disease.” 2 Given the mind dying if I have done a few more good paintings.” 5p90 Klee nature of his disease, it is possible that Klee died from heart created more than nine thousand works of art in his lifetime. failure, which, in turn, may have been due to primary sclero- During the year of the diagnosis of scleroderma, 1936, Klee derma heart disease, cor pulmonale secondary to pulmonary created a mere ­twenty-five works, the nadir of his produc- fibrosis or pulmonary hypertension, renovascular hyperten- tivity. Sensing his mortality, Klee’s artistic output increased sion, or a combination of one or more of these well-known dramatically, peaking in 1939, the last full year of his life. complications of scleroderma. That year Klee produced an astonishing 1253 works. Later it The precipitating cause of Klee’s scleroderma, as in most would be said of him, “It had been a life of incomparably rich cases, will never be known. Some have speculated that a viral harvests, but during this very past year a harvest matured illness such as measles triggered an autoimmune process later which seemed to add something entirely new to all that he had manifesting as scleroderma.1 Others, including his son Felix, already reaped.” 5p89 have speculated that exposure to toxic heavy metals present in It would be unreasonable to attribute all of the changes seen paint pigments may have played a role in the development of in Klee’s later works solely to his illness, scleroderma. Surely the disease,5,7 although little evidence exists that heavy metals Klee was affected profoundly not only by his disease, but also have an etiologic role in scleroderma. Evidence is accumulat- by the loss of close friends and colleagues, the political up- ing, however, that organic solvents can trigger scleroderma heaval that forced his departure from Germany to Switzerland, in susceptible individuals.8,9 Judging from the large number where his art was less appreciated, and the knowledge that of oil paintings (over 730) produced in his lifetime, and Klee’s a second world war was looming. Lightheartedness and wit meticulously maintained studios, it is possible that Klee had gave way to introspection and despair.6 Intricate, small-scale substantial exposure to white spirits and other solvents used compositions gave way to larger and coarser pieces. The more to thin or clean paint from his brushes. Thus, the high inten- vigorous tone of his later works was seen as a triumph of the sity and long duration of Klee’s solvent exposure may have creative will over the physical being. Changes in physiognomy been a factor in the development of his scleroderma. and then death, took center stage.

Death and dying in Klee’s work Faces—Klee’s obsession

All his life, Klee was interested in people’s faces. In count- less drawings and paintings he sought to capture the human- ness and inhumanness of facial expression.5 Scleroderma wrought changes in Klee’s own bodily features that are re- 1200 flected in his later works. As scleroderma progresses, the fa- 1000 cial skin becomes taut and assumes a mask-like character. One

orks of Klee’s last works is indeed entitled Maske (The Mask, 1940). 800 Numerous drawings such as Ein Kranker macht Pläne (A Sick Man Making Plans, 1939), and Der Kranke im Boot (Sick Man 600 in a Boat, 1940), depict the artist’s illness and imminent death. otal Number of W T Another famous work from his final year is Gefangen (Captive, 400 1940). Felt by many to depict the artist’s imprisonment from 200 his progressive scleroderma, a weeping face painted with heavy brush strokes is surrounded by bars.1,6 0 Death is also the theme of what may be considered Klee’s 1925 1927 1929 1931 1933 1935 1937 1939 last self-­portrait, Tod und Feuer (, 1940). Here Year is the stark image of a white death mask whose mouth and A graph depicting the artistic productivity of Klee. In 1936, the eyes are formed by the German word for death, tod. The pig- year his scleroderma was diagnosed, there was a marked drop ment seems to be only barely brushed onto the burlap canvas in productivity followed in his final years by a prodigious output. and the thick black line seems to be wavering in its density. Data from reference 5. Perhaps this is a reflection of Klee’s physical weakness, but,

22 The Pharos/Winter 2008 Der Kranke im Boot (Sick Man in a Boat), 1940. This drawing and another work entitled Charon were drawn in the final year of Klee’s life; each signifies crossing the river into the realm of the dead. © 2007 Artists Rights Society (ARS), New York/VG Bild-Kunst, Bonn.

regardless, it conveys the impression of bodily fading and withdrawal from life.10 In the upper left of the painting, the sun is seen resting on the hand of death. A featureless man with a body of no substance walks towards death and fire. Klee seems to be accepting of death, walking without hesitation, and happy in a life’s work that brought him nearer to an understanding of creation. The proximity of personal death has become ines- capable. Some months prior to his death, Klee confided to his friend, , “Naturally I have not struck the tragic vein without some preparation. Several pictures have pointed the way with their message: The time has come.” 4p92 Unsigned and unnamed, Klee’s last , found on the easel of his Bern studio, is a large that implies no slackening of the artist’s creative mastery.4 Klee’s body was cremated in Lugano. Speaking at his memorial service, a childhood friend, Dr. Hans Bloesch, said, “Paul Klee gave much to many human beings, and gratitude for all he gave ac- companies him to the grave. So many and various were the contributions he made to art that we to- day cannot yet begin to estimate their importance and ultimate effects.” 5p88 Indeed, Klee’s manifold contributions would not be fully ­appreciated

Gefangen (Captive), 1940. Painted in the last months of his life, the artist’s rendering of a weep- ing face surrounded by bars is symbolic of Klee’s physical entrapment by scleroderma. © 2007 Artists Rights Society (ARS), New York/VG Bild-Kunst, Bonn. Image courtesy of Fondation Beyeler.

The Pharos/Winter 2008 23 the development of the artificial hip, and who has long been fascinated by Klee’s extraordinary creativity in the face of major physical impairments. Klee considered the universe to be a balance between opposing forces, and he often represented opposites or extreme incongruities in his art. It is inspiring that after a brief period of reduced productivity, Klee painted prodi- giously after the disease and its prognosis were known to him. Such an indomitable spirit is characteristic of many scleroderma patients and an inspiration to those of us privileged to participate in some small way in their care.

Acknowledgments This article is dedicated to the late Professor E. Carwile LeRoy (AΩA, University of North Carolina at Chapel Hill, 1959) who inspired my interest in scleroderma and in the artist Paul Klee, and to Helen S. Silver who instilled my love of art. Thanks to Anette Hebebrand-Verner for her assistance with translation and Jim Nicholson for his enthusiastic and expert assistance with illustrations.

Tod und Feuer (Death and Fire), 1940. Considered by some to be Klee’s References last self-portrait, in this painting the unity of life and death is attained at 1. Wolf G. Endure! how Paul Klee’s illness influenced his last.4 © 2007 Artist Rights Society (ARS), New York/VG Bild-Kunst, Bonn. art. Lancet 1999; 353: 1516–18. 2. Ostendorf B, Maiburg B, Schneider M. Sklerodermie for many years to come. Following the death of his wife Lily und Paul Klee: Metamorphose von leben und kunst. English in 1946, Paul Klee’s ashes were buried in the Schosshalde translation by Hebebrand-Verner A, June 2006. Z Rheumatol 2004; Cemetery in Bern. Klee’s gravestone bears the following well- 63: 318–25. known epigram from his diary: 3. LeRoy EC, Silver RM. Paul Klee and scleroderma. Bull Rheum Dis 1996; 45: 4–6. In the here I am utterly incomprehensible 4. Grohmann W. Paul Klee. New York: Harry N. Abrams; For I dwell just as well with the dead 1955. As with the unborn 5. Klee F. Paul Klee. New York: George Braziller; 1962. Somewhat closer to creation than most 6. Varga J. Illness and art: the legacy of Paul Klee. Curr Opin But far from close enough.5p90 Rheumatol 2004; 16: 714–17. 7. Pedersen LM, Permin H. Rheumatic disease, heavy-metal Sixty-five years after his death, the Swiss and of pigments, and the great masters. Lancet 1988 Jun 4: 1267–69. Bern fulfilled a belated recon- 8. Nietert PJ, Silver RM. Systemic sclerosis: environmental and ciliation with their native son. occupational risk factors. Curr Opin Rheumatol 2000; 12: 520–26. Zentrum Paul Klee opened 9. Magnant J, de Monte M, Guilmot J-L, et al. Relationship in 2005 adjacent to the cem- between occupational risk factors and severity markers of systemic etery where Klee is buried. sclerosis. J Rheumatol 2005; 32: 1713–18. The museum houses more 10. Hall D. Klee. : Limited; 1977. than four thousand of Klee’s 11. Geelhaar C. Paul Klee: Life and Work. Jaffe WW, translator. creations and pays tribute to New York: Barron’s; 1982. Klee’s contributions as a mu- Special stamp of the Swiss sician, a poet, and a teacher. The author’s address is: Post Office for the inauguration The center was made possible Division of Rheumatology and Immunology of Zentrum Paul Klee, which Medical University of South Carolina opened in 2005 near Bern. by Klee’s descendants, who donated many of his works, Suite 912 and also by a magnanimous 96 Jonathan Lucas Street gift from the family of Prof. Dr. Med. Maurice E. Müller, the Charleston, SC 29425 internationally renowned orthopaedic surgeon who pioneered E-mail: [email protected]

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