radiation therapist A radiation therapist, therapeutic radiographer or radiotherapist is an allied health professional who works in the field of radiation oncology. Radiation therapists plan and administer radiation treatments to cancer patients in most Western cou ...

laryngeal cancer Laryngeal cancers are mostly squamous-cell carcinomas, reflecting their origin from the epithelium of the larynx. Cancer can develop in any part of the larynx. The prognosis is affected by the location of the tumour. For the purposes of staging, ...

Marolles-les-Braults Marolles-les-Braults () is a commune in the Sarthe department in the region of Pays de la Loire in north-western France. On 1 January 2019, the former commune Dissé-sous-Ballon was merged into Marolles-les-Braults.Sarthe, Coutard attended medical school at University of Paris and graduated in 1902. He served in the French Army and lived for several years in the

Jura Mountains The Jura Mountains ( , , , ; french: Massif du Jura; german: Juragebirge; it, Massiccio del Giura, rm, Montagnas da Jura) are a sub-alpine mountain range a short distance north of the Western Alps and mainly demarcate a long part of the Frenc ...

before returning to Paris to study the medical applications of radium. During World War I, he worked in one of the radiological ambulance units overseen by the Polish-French physicist and chemist Marie Curie. He became the chief of the X-ray department at the Radium Institute of the University of Paris in 1919, working closely with

Claudius Regaud Claudius Regaud (born 30 January 1870 in Lyons, France; died 29 December 1940 in Couzon-au-Mont-d'Or, France) was a French doctor and biologist, one of the pioneers in radiotherapy at the Curie Institute. Scientific work In 1906, Regaud disco ...

and other scientists. Coutard's early work demonstrating the efficacy of radiating patients with laryngeal cancer led to the adoption of radiation therapy as a primary course of cancer treatment. The protracted-fractional method consisted of long durations of radiation applied over several weeks. In the late 1930s, Coutard moved to the United States, first working at the California Institute of Technology and then at the Chicago Tumor Institute. During this time, he accompanied the American entrepreneur Spencer Penrose to Colorado Springs to treat Penrose's

esophageal cancer Esophageal cancer is cancer arising from the esophagus—the food pipe that runs between the throat and the stomach. Symptoms often include difficulty in swallowing and weight loss. Other symptoms may include pain when swallowing, a hoarse voice ...

. After Penrose's death in 1939, his radiotherapy equipment was donated to Penrose Hospital and Coutard became a radiotherapist at the newly-established Penrose Tumor Clinic. In the last decade of his life, Coutard's research became more erratic. He published a

monograph A monograph is a specialist work of writing (in contrast to reference works) or exhibition on a single subject or an aspect of a subject, often by a single author or artist, and usually on a scholarly subject. In library cataloging, ''monograph ...

in 1949 that was largely ignored by reputable journals and his peers. He experienced an

intracerebral hemorrhage Intracerebral hemorrhage (ICH), also known as cerebral bleed, intraparenchymal bleed, and hemorrhagic stroke, or haemorrhagic stroke, is a sudden bleeding into Intraparenchymal hemorrhage, the tissues of the brain, into its Intraventricular hemor ...

in December 1949 and died in

Le Mans Le Mans (, ) is a city in northwestern France on the Sarthe River where it meets the Huisne. Traditionally the capital of the province of Maine, it is now the capital of the Sarthe department and the seat of the Roman Catholic diocese of Le Man ...

a few months later.

Early life and education

Henri Coutard was born on 27 August 1876 in

Marolles-les-Braults Marolles-les-Braults () is a commune in the Sarthe department in the region of Pays de la Loire in north-western France. On 1 January 2019, the former commune Dissé-sous-Ballon was merged into Marolles-les-Braults.Sarthe. His father, Louis Coutard, was a local government official, and his mother, Mélanie Marie Joséphine Coutard ( Ragot), sold novelty items. He had an older brother, Louis, and a younger sister, Helène. In 1887, Coutard enrolled at the , a state

boarding school A boarding school is a school where pupils live within premises while being given formal instruction. The word "boarding" is used in the sense of "room and board", i.e. lodging and meals. As they have existed for many centuries, and now exten ...

in

Le Mans Le Mans (, ) is a city in northwestern France on the Sarthe River where it meets the Huisne. Traditionally the capital of the province of Maine, it is now the capital of the Sarthe department and the seat of the Roman Catholic diocese of Le Man ...

. He received a in literature in 1893 and another in mathematics the following year. During this time, he also received an award for excellence in his school's military and gymnastics programs. After secondary school, he entered medical school at the University of Paris, training in Parisian hospitals and completing an internship in

Nantes Nantes (, , ; Gallo: or ; ) is a city in Loire-Atlantique on the Loire, from the Atlantic coast. The city is the sixth largest in France, with a population of 314,138 in Nantes proper and a metropolitan area of nearly 1 million inhabita ...

. His doctoral thesis was titled ("Extraperitoneal lesions of the bladder and rectum observed in cases of pelvic fracture"). It summarised eight cases from the literature and one from his previous patients. He defended his thesis on 17 July 1902.

Career

Military service and interest in radium

After medical school, Coutard enrolled as a medical officer and captain in the , the elite mountain infantry force of the French Army. After contracting pulmonary tuberculosis he moved to the

Jura Mountains The Jura Mountains ( , , , ; french: Massif du Jura; german: Juragebirge; it, Massiccio del Giura, rm, Montagnas da Jura) are a sub-alpine mountain range a short distance north of the Western Alps and mainly demarcate a long part of the Frenc ...

to recover, and during that time practiced general medicine. In 1912, he returned to Paris after becoming interested in the potential medical applications of radioactivity. Radioactivity had first been discovered in the element uranium by the physicist Henri Becquerel in 1896, and over the next several years, the French researchers Marie and Pierre Curie discovered the radioactivity of additional elements: thorium, polonium, and radium. Coutard began studying the properties of radium at an experimental laboratory co-founded by the physicist . His research centred on therapeutic applications of radium in animals, and he presented his work at the 1912 meeting of the . Coutard was drafted during World War I and worked as a

radiation therapist A radiation therapist, therapeutic radiographer or radiotherapist is an allied health professional who works in the field of radiation oncology. Radiation therapists plan and administer radiation treatments to cancer patients in most Western cou ...

in a military hospital near

Baccarat, Meurthe-et-Moselle Baccarat (; german: Burgambach) is a commune in the Meurthe-et-Moselle department in the Grand Est region of north-eastern France. The inhabitants of the commune are known as ''Bachâmois'' or ''Bachâmoises''. The commune has been awarded thre ...

, on the Eastern Front. There, he met

Claudius Regaud Claudius Regaud (born 30 January 1870 in Lyons, France; died 29 December 1940 in Couzon-au-Mont-d'Or, France) was a French doctor and biologist, one of the pioneers in radiotherapy at the Curie Institute. Scientific work In 1906, Regaud disco ...

, a

radiobiologist Radiobiology (also known as radiation biology, and uncommonly as actinobiology) is a field of clinical and basic medical sciences that involves the study of the action of ionizing radiation on living things, especially health effects of radiation. ...

with whom he later collaborated. Coutard also worked in one of the radiological ambulance units overseen by Marie Curie. He attained the rank of

major Major (commandant in certain jurisdictions) is a military rank of commissioned officer status, with corresponding ranks existing in many military forces throughout the world. When used unhyphenated and in conjunction with no other indicators ...

by the end of the war.

Radium Institute

In 1919, Coutard became the chief of the X-ray department at the Radium Institute of the University of Paris, working with other scientists including Regaud and Antoine Lacassagne. Using a single X-ray unit in the basement of the institute, he conducted experiments on animals, administered radiation therapy to patients, and performed diagnostic imaging of the pharynx and

larynx The larynx (), commonly called the voice box, is an organ in the top of the neck involved in breathing, producing sound and protecting the trachea against food aspiration. The opening of larynx into pharynx known as the laryngeal inlet is about ...

. In his early work during this period, he observed the recurrence of cancer when tumours were insufficiently irradiated and the need to avoid excessive irradiation of the eyes. He believed that the dose of radiation needed to be high enough to cause an observable reaction in the mucous membrane, and coined the term ''radioepithelitis'' to describe this reaction. At the 1921 International Congress of Oto-Rhino-Laryngology in Paris, Coutard presented data from six patients with

laryngeal cancer Laryngeal cancers are mostly squamous-cell carcinomas, reflecting their origin from the epithelium of the larynx. Cancer can develop in any part of the larynx. The prognosis is affected by the location of the tumour. For the purposes of staging, ...

who he had treated with radiation. His work was well received, and physicians began adopting radiation therapy as a primary course of treatment for cancer. Scientists had differing opinions on the optimal timing of radiation doses. Coutard believed that long durations of radiation, applied over several weeks, produced the best results and theorised that this technique allowed tissue to recover between sessions. He presented his method at the 1928 International Congress of Radiology, and it became known as "Coutard's method" or the "protracted-fractional method". Using this technique, Coutard achieved the first reported cures of laryngeal cancer using radiation, and by about 1930 he had obtained data on the five-year survival rate of his technique. Though he never published rigid standards for radiation doses, he meticulously recorded the treatments that he administered to each patient, using a

radiometer A radiometer or roentgenometer is a device for measuring the radiant flux (power) of electromagnetic radiation. Generally, a radiometer is an infrared radiation detector or an ultraviolet detector. Microwave radiometers operate in the microwave w ...

that he constructed. Over the next decade, he continued experimenting with different therapy regimens, including short, intensive doses and interrupted regimens. Radiotherapists from other countries visited the Radium Institute to meet Coutard and train with him, including Simeon T. Cantril, who later became the first president of the

American Society for Radiation Oncology ASTRO (the American Society for Radiation Oncology) is a professional association in radiation oncology that is dedicated to improving patient care through professional education and training, support for clinical practice and health policy standar ...

.

Caltech and the Chicago Tumor Institute

Coutard grew interested in United States radiotherapy research, where supervoltage units ( X-ray generators with a

peak kilovoltage Peak kilovoltage (kVp) refers to the maximum high voltage applied across an X-ray tube to produce the X-rays. During X-ray generation, surface electrons are released from a heated cathode by thermionic emission. The applied voltage (kV) acceler ...

of several hundred kilovolts) were being produced. The physicist

Charles Christian Lauritsen Charles Christian Lauritsen (April 4, 1892 – April 13, 1968) was a Danish/American physicist. Early life and career Lauritsen was born in Holstebro, Denmark and studied architecture at the Odense Tekniske Skole, graduating in 1911. In 191 ...

, on behalf of his mentor

Robert Andrews Millikan Robert Andrews Millikan (March 22, 1868 – December 19, 1953) was an American experimental physicist honored with the Nobel Prize for Physics in 1923 for the measurement of the elementary electric charge and for his work on the photoelectric e ...

, invited Coutard to work at the Kellogg Research Laboratory at the California Institute of Technology. At the same time, Max Cutler of the Chicago Tumor Institute offered Coutard a leading position there. Coutard accepted both offers in late 1937. He resigned his position at the Radium Institute and was succeeded by . At Caltech, he studied high-voltage therapy and worked closely with Millikan and the physicist

Seeley G. Mudd Seeley Greenleaf Mudd, M.D. (April 18, 1895 – March 10, 1968) was an American physician, professor, and major philanthropist to academic institutions. Early life Mudd was born in Denver, Colorado in 1895, and was the son of noted mining engine ...

. After working at Caltech for six months, Coutard moved to Chicago and studied the use of short, concentrated doses of radiation for treating laryngeal cancer at the Chicago Tumor Institute, while teaching graduate courses there. Cutler's ambitions for the institute were curtailed as a result of the

Great Depression The Great Depression (19291939) was an economic shock that impacted most countries across the world. It was a period of economic depression that became evident after a major fall in stock prices in the United States. The economic contagio ...

. He was unable to secure a supervoltage unit for Coutard, and the institute did not receive many patients. During this time, Coutard treated the American entrepreneur and

philanthropist Philanthropy is a form of altruism that consists of "private initiatives, for the Public good (economics), public good, focusing on quality of life". Philanthropy contrasts with business initiatives, which are private initiatives for private goo ...

Spencer Penrose for

esophageal cancer Esophageal cancer is cancer arising from the esophagus—the food pipe that runs between the throat and the stomach. Symptoms often include difficulty in swallowing and weight loss. Other symptoms may include pain when swallowing, a hoarse voice ...

, having previously treated Penrose for laryngopharyngeal cancer in Paris in 1932. Penrose bought a radiotherapy unit for his home in

Colorado Springs, Colorado Colorado Springs is a home rule municipality in, and the county seat of, El Paso County, Colorado, United States. It is the largest city in El Paso County, with a population of 478,961 at the 2020 United States Census, a 15.02% increase since ...

, and Coutard accompanied him there to continue his treatment.

Penrose Tumor Clinic and decline

Penrose died in 1939, and stipulated that his radiotherapy equipment be donated to the local Glockner Hospital (now Penrose Hospital). His wife, Julie Penrose, used funds from their El Pomar Foundation to establish the Penrose Tumor Clinic at the hospital and invited Coutard to practice radiotherapy at the new clinic. He accepted, and moved to Colorado Springs in 1941. In the last decade of his life, Coutard's research became more erratic. He began to conduct unorthodox experiments, including the use of blocks of gold as X-ray filters and homeopathic theories of

beta particle A beta particle, also called beta ray or beta radiation (symbol β), is a high-energy, high-speed electron or positron emitted by the radioactive decay of an atomic nucleus during the process of beta decay. There are two forms of beta decay, β� ...

s, and stopped publishing papers in scientific journals. His ideas were criticised by his peers and he became increasingly isolated. Coutard published a

monograph A monograph is a specialist work of writing (in contrast to reference works) or exhibition on a single subject or an aspect of a subject, often by a single author or artist, and usually on a scholarly subject. In library cataloging, ''monograph ...

in 1949, reporting on his findings from Colorado Springs. According to the radiologist and historian E. R. N. Grigg, the monograph was a "rambling mixture of clinical observations, working hypotheses, and fantastic assumptions"; it was largely ignored by reputable journals as well as his peers.

Personal life

Coutard married Anne-Marie Adèle Rougier in Paris on 25 March 1919, at the end of World War I. During his time at the Radium Institute, they lived on the outskirts of Paris. Anne-Marie remained in Paris when Henri worked in the United States, and she died of leukemia there in 1940. After her death, Coutard married Suzanne Rosalie Jourgeon (née Mathot), the widow of one of his former patients in France. She moved to Colorado Springs and they lived within walking distance of the Penrose Tumor Clinic. When Suzanne's health deteriorated in 1949, she moved back to Paris to live with her children from her first marriage; she died there later that year.

Death and legacy

In late 1949 Coutard traveled to the Radium Station of Copenhagen, where the director, Jens Nielsen, was one of his few remaining followers. He experienced an

intracerebral hemorrhage Intracerebral hemorrhage (ICH), also known as cerebral bleed, intraparenchymal bleed, and hemorrhagic stroke, or haemorrhagic stroke, is a sudden bleeding into Intraparenchymal hemorrhage, the tissues of the brain, into its Intraventricular hemor ...

on a trip to France to visit his sister's family in December 1949. After several months of illness, Coutard died at his sister's home in Le Mans on 16 March 1950. While Coutard's experiments in final years were considered unorthodox by his peers, his earlier contributions helped radiation therapy become an established treatment for people with cancer. Grigg described Coutard's most important contribution as "teaching a generation of radiologists to observe their patients carefully and to record painstakingly the clinical course of treatment". Coutard's protracted-fractional method laid the groundwork for modern dose fractionation methods, and he is also remembered for being the first to present results on X-ray imaging of the larynx. During his lifetime, he published about 35 papers in addition to his 1949 monograph. His hometown, Marolles-les-Braults, later named a square near the center of the town after him.

Notes

References

Sources

* * * * * * * * * * * * * {{DEFAULTSORT:Coutard, Henri 1876 births 1950 deaths 20th-century French physicians California Institute of Technology people French Army officers French military personnel of World War I People from Sarthe Radiation therapy University of Paris alumni