Henri Coutard

After medical school, Coutard enrolled as a medical officer and captain in the Chasseurs Alpins, the elite mountain infantry force of the French Army.[6] After contracting pulmonary tuberculosis he moved to the Jura Mountains to recover, and during that time practiced general medicine.[4] In 1912, he returned to Paris after becoming interested in the potential medical applications of radioactivity.[3][4] 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.[7] He began studying the properties of radium at an experimental laboratory co-founded by the physicist Jacques Danne.[3][4] Coutard's research centred on therapeutic applications of radium in animals, and he presented his work at the 1912 meeting of the French Association for the Advancement of Science.[3]

Coutard was drafted during World War I and worked as a radiation therapist in a military hospital near Baccarat, Meurthe-et-Moselle, on the Eastern Front.[3][8] There, he met Claudius Regaud, a radiobiologist with whom he later collaborated.[3] Coutard also worked in one of the radiological ambulance units overseen by Marie Curie. He attained the rank of major by the end of the war.[6][9]

Ève Curie, Coutard, Queen Mary of Teck, and the Viscountess Runciman in 1937

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.[4][9] 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.[9][10] 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.[11] At the 1921 International Congress of Oto-Rhino-Laryngology in Paris, Coutard presented data from six patients with laryngeal cancer 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.[4]

Scientists had differing opinions on the optimal timing of radiation doses.[12] 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.[13][12] He presented his method at the 1928 International Congress of Radiology, and it became known as "Coutard's method" or the "protracted-fractional method".[12][14] 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.[15][16] Though he never published rigid standards for radiation doses, he meticulously recorded the treatments that he administered to each patient, using a radiometer that he constructed.[10][17] Over the next decade, he continued experimenting with different therapy regimens, including short, intensive doses and interrupted regimens.[10] Radiotherapists from other countries visited the Radium Institute to meet Coutard and train with him,[9] including Simeon T. Cantril, who later became the first president of the American Society for Radiation Oncology.[18][19]

Coutard (pictured far right) in 1937 with other leading cancer researchers

Coutard grew interested in United States radiotherapy research, where supervoltage units (X-ray generators with a peak kilovoltage of several hundred kilovolts) were being produced.[20] The physicist Charles Christian Lauritsen, on behalf of his mentor Robert Andrews Millikan, 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.[21] He resigned his position at the Radium Institute and was succeeded by François Baclesse.[22] At Caltech, he studied high-voltage therapy and worked closely with Millikan and the physicist Seeley G. Mudd.[13][21]

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.[13] Cutler's ambitions for the institute were curtailed as a result of the Great Depression.[21] He was unable to secure a supervoltage unit for Coutard, and the institute did not receive many patients.[23] During this time, he treated the American entrepreneur and philanthropist Spencer Penrose for esophageal cancer, having previously treated Penrose for laryngopharyngeal cancer in Paris in 1932. Penrose bought a radiotherapy unit for his home in Colorado Springs, Colorado, and Coutard accompanied him there to continue his treatment.[24]

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.[25] He accepted, and moved to Colorado Springs in 1941.[13]

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 particles, and stopped publishing papers in scientific journals.[13] His ideas were criticised by his peers and he became increasingly isolated.[25]

Coutard published a monograph in 1949, reporting on his findings from Colorado Springs.[25] 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.[13]