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Etienne-Jules Marey and Gaston Contremoulins, from Photography to Radiology : a centennial example of Translational Medicine.

Jean-François Moreau, MD, AIHP, FACR.

Emeritus Professor of Radiology, Université Paris Descartes

Consultant geriatric radiologist, Hôpital Corentin Celton, Issy-les-Moulineaux,

France.

Because of characters like Etienne-Jules Marey and his

photographer, Gaston Contremoulins, radiology has been a

science, an art, an industry and a business since its origin providing an

early example of translational technology to medicine and conversely.

Fig. 1. Four main characters (from top to bottom and left to right)

a) Etienne-Jules Marey in 1894 (Courtesy of Académie des sciences-Institut de France);

b) Gaston Contremoulins (Courtesy of Ecole de Radiologie de Saint-Germain-en-Laye);

c) Félix Guyon (Courtesy of Archives de l'AP-HP); d) Charles Rémy (author's collection).

Around the year 2000, meanwhile the

whole World just had concelebrated

the centennial of the discovery of X-rays by

Roentgen in 1895 (1), two new paradigms were

emerging almost simultaneously: «Disruptive

innovation» at the Harvard Business School

(2), and « Translational medicine » whose

most common definition was given by

the Dean of Stanford University, Philip A

Pizzo, in 2002 (3) : « From my perspective,

translational medicine can have both a

narrow as well as a more general definition.

Perhaps the most specific definition is

«bench-to-bedside» research wherein a basic

laboratory discovery becomes applicable

to the diagnosis, treatment or prevention of

a specific disease and is brought forth by

either a physician-scientist who works at the

interface between the research laboratory

and patient care or by a team of basic and

clinical science investigators. » An example

illustrating both of them is the sudden birth

and the quick growth of medical radiology in

Western Europe and the USA before World

War 1. This shows the performances of

humans facing innovations when they have

the power on hands either to develop or to

inhibit their applications to the patient's care

and cure with or without a long-term benefit

for the individuals and/or the populations.

Etienne-Jules Marey (1830-1904) belongs

to a group of French scientific personalities

who made important contributions to the

early growth of the new medical field induced

by the discovery of X-Rays (Fig.1). For the

whole of the twentieth century, their work has

been cast in shadow by the imperial character

of Antoine Béclère (4,5). There is no doubt

Antoine Béclère (1856-1939) is the official

father of French medical radiology since he

was convinced by the first demonstration

of the radiographic effect of X-rays that

Toussaint Barthélémy and Paul Oudin gave

in mid-January 1896 in their private office

close to the Hôpital Saint-Louis in Paris. Like

most of the pioneers, Béclère bought his first

equipment with his own money. He was the

first to teach radiology in the academic unit he

opened in 1899 at the Hôpital Saint-Antoine

in Paris and he wrote most of the medical

volume in the first French treatise dedicated

to radiology edited by Charles Bouchard and

published in 1904 (6). At the famous 1900

Exposition Universelle de Paris, he took the

opportunity to convene a hundred dedicated

individuals from all over the world to

participate at what was named the "Premier

Congrès International d'Electrologie et de

Radiologie Médicales" (7). They agreed

upon the creation of two words still officially

used to define a science, radiology, and

a job, radiographer. The latter split into

two kinds of subspecialists: the medical

doctors had become "radiologists" while

"radiographers" remained linked with the

practice of the technical work. The ubiquitous

corporatist conflict between both radiologists

and radiographers started in France in 1901.

Antoine Béclère was the head of the medical

camp that ultimately won the leadership, but

no earlier than 1935. The strongest resistant

radiographer, Gaston Contremoulins (1867-

1950), who founded the first laboratory

of radiology at the Hôpital Neckerin 1898

retired in 1934. Béclère was the third President

of the International Society of Radiology

(ISR) after the British Thurstan Holland and

Fig. 2. Béclère's stamp

(Courtesy of Centre Antoine Béclère).

the Swedish Gösta Forssell and before the

Swiss Hans Schinz and the American Arthur

Christie. There are a stamp (Fig. 2) and a

Hôpital Antoine Béclère opened in 1969 in

the city of Clamart, on a suburb of Paris. The

biennial Béclère Medal and Béclère Lecture

are the highest ISR awards granted with a

donation of his daughter, Antoinette Beclère,

to the ISR before she died in 1981.

And what about Etienne-Jules Marey?

Marey was elected in 1878 to the

Académie des Sciences, as the successor

of Claude Bernard (1813-1878). Both of

them were brillant medical doctors trained

at the Hospitals of L'Assistance publique à

Parisand are both sacred monsters of the

French physiology of the nineteenth century.

Bernard was mostly a chemist, Marey was

a physicist and an artist. Marey soon had a

passionate interest in the physiology of the

movement of the fluids and of living beings

(8). He was professor of physiology at the

Collège de France where he developed

chronophotography and pioneered the future

of cinematography with his assistant Georges

Demenÿ (9,10). Parallel work was undertaken

by Eadweard Muybridge, the photographer

of Leland Stanford, governor of the state of

California, USA, and founder of Stanford

University in Palo Alto (11). Both of them

worked together fruitfully when Muybridge

visited Marey's Station physiologique during

several months in 1881 (12). Marey was a

so prestigious scientist that he presided over

the centennial of the creation of the Institut

de France, encompassing the five greatest

National Academies including the Académie

des Sciences; that event was celebrated

during the notable year 1895, marked by the

foundation created by Alfred Nobel in Paris

and the discovery of X-rays. Marey used his

speech on 23 December 1895 at the end of his

mandate to express his sorrow over the recent

death of Louis Pasteur (13). He could not cite

the discovery of X-rays because Wilhelm

Roentgen did not disseminate the information

worldwide before 5 January 1896. Before

then only Roentgen's wife, whose hands

were imaged twice on the 9 November

and 22 December 1895, was aware of it ;

Roentgen informed the Wurzburg Physico-

Medical Society on 28 December 1895. The

mathematician Henri Poincaré was the only

Frenchman among the illustrious scientists

who received the personal letter and the

reprint Roentgen mailed on 2 January 1896

(1,4,7).

Poincaré and the medical membership

of the Académie des Sciences received

the news in January: Etienne-Jules Marey,

Charles Bouchard, Félix Guyon, Pierre-Carl

Potain, Arsène d'Arsonval, Odilon-Marc

Lannelongue and Paul Brouardel who was

the Dean of the Faculté de médecine de Paris

(14). All of them save Brouardel were early

supporters of radiology. On 20 January 1896

the Académie des Sciences was told about

the first French radiographic trial by Oudin

and Barthélémy (15) and their paper was

published by Lannelongue (16), a surgeon

who produced his own ones later (17,18). Dr.

Toussaint Barthélémy was Poincaré's nephew

but, as a subscriber, he learnt the news when

he red the famous Frankfurter Zeitung issue

dated on 7 January 1896 announcing the

sensational discovery: he spoke a fluent

German because he was born in Lorraine, a

province he quited in 1870 after the French

defeat versus the Prussian army; he informed

immediately his friend Oudin who was a

famous biophysicist; both of them repeated

Roentgen's experiments radiographing hands

successfully (4).

Auguste and Louis Lumière (19,20), Henri

Becquerel (21,22), Arsène d'Arsonval

(23) published their own observations on the

"photography through the opaque bodies".

The physicist Marie-Alfred Cornu was the

next president of the Académie des Sciences;

in his last speech on 21 November 1896

he put a great emphasis on the discovery

of X-rays and their medical applications as

the most important scientific event of the

year 1896 (24). One hundred and sixty-one

papers on Roentgen-rays or X-rays were

presented at the Académie des Sciences

during 1896 (25). Their number was meager

at the Académie Nationale de Médecine :

25 papers, all of them reporting medical

findings only (26). Ten out of these were

presented by Oudin and Barthélémy, most

of them illustrating the hand disease (27); all

of them were introduced by the professor of

dermatology and syphiligraphy at the hôpital

Saint-Louis, Alfred Fournier, who expressed

both his admiration for the procedure used

by the authors starting with the description

of the normal radioanatomy before they

described more and more radioclinical

patterns, and for the earnest improvement

of the quality of their images. Apart from a

few surgeons and the physicist d'Arsonval,

the earliest supportive medical academicians

were the bacteriologists; Béclère pionnered

virology and immunology before he became

a radiologist (5).

There is no doubt Marey was the catalyst

in promoting radiology through his

photographer, Gaston Contremoulins. In the

early 1890ies, the latter was appointed at

the laboratory of microphotography headed

by a trio made of Félix Guyon, professor of

urology at the Hôpital Necker, Mathias Duval,

professor of anatomy at the Ecole des Beaux-

Arts de Paris and of pathology at the Faculté

de médecine de Paris, and Yvon (4,10). More

precisely Contremoulins worked with Duval's

associate professor, Charles Rémy, who was

also both a surgeon at the hospital of the city of

Nanterre and a histologist at thehôpital de la

Charité(28). Who did inform Contremoulins

that Marey was developing microscopic

chronophotography? Guyon who was

Marey's close friend? More likely Georges

Demenÿ. In the fall 1892, Contremoulins

mailed a letter to Marey expressing his desire

to be his experimenter (10) (Fig. 3 ). After he

appointed Contremoulins under an unknown

agreement, Marey oversaw his experiments

on the microvasculature of small animals.

Marey and Demenÿ broke their long-term

worthwhile relationship in 1894 because of

a financial dispute dealing with the creation

the lucrative Société du Phonoscope by

the latter; Contremoulins did not take

over his position but he provided a strong

contribution to Delanglade's medical thesis

on chronophotography (29).

Like many photographers in the early

years of radiology (4), Contremoulins

rapidly became interested in the applications

of X-rays to medicine and biology. Félix

Guyon reported the first description of biliary

and renal calculi on 21 April 1896, at the

Académie Nationale de Médecine (30); the

experiment was done by James Chappuis,

professor of physics at the Ecole centrale des

Arts & Manufactures and a resident in urology,

Fernand-Joseph Chauvel, whom both were

also associated with the first radiography of

a fetus a few weeks earlier. Guyon quickly

bought X-ray equipment with his own money

and installed it in the Clinique Urologique

at the Hôpital Necker of Paris (31) where

he invited Contremopulins to perform his

radiographies (32). During the second half

of 1896, Marey presented two radiological

papers by Rémy and Contremoulins (33,34).

Marey persuaded them to study the vessels of

the hand with a radiopaque compound made of

metallic powders, generically termed bronze,

embedded in sealing wax then dissolved

in alcohol (Fig. 4). In 1897, both of them

published a method of radiophotography of

the soft tissues inspired by the histological

Fig. 4. Excerpt of Rémy and Contremoulins' first communication at the Académie des Sciences evidencing

the interest of Marey in the early development of radiology in 1896. (Facsimile by courtesy of Académie

des Sciences-Institut de France)

Fig. 3. Excerpt of Marey's letter dated on 14 December 1892 and mailed from Napoli, Italy, recommending

Contremoulins to his assistant Georges Demenÿ (Courtesy of Cinémathèque Française) : «Mr.

Contremoulins writes to me that he is highly motivated to working with you in photography. Before I'm back

[to Paris] then I show him what I'm doing in microscopic photography, let you do for him what you feel it is

convenient.» (Author's translation)

preparations by silver chromate (35).

Influenced by a report by Bouchard,

Dr. Georges Clemenceau, Ministre de

l'Intérieurwho also covered health affairs,

decided in 1898 to create four laboratories of

radiology in Paris (4). One of these, actually

dated on 1896, was already functioning under

the direction of Albert Londe, photographer of

the famous neurologist Charcot at the Hospice

de la Salpêtrière. According to a Wikipedia

anonymous resource (36), Albert Londe

with Marey performed many photographic

experiments concerning movement, and the

layout of his laboratory at the Salpêtrièrewas

similar to Marey's Station Physiologique.

In 1893, Londe published the first book on

medical photography, titled « La photographie

médicale: Application aux sciences

médicales et physiologiques ». In 1898, he

published « Traité pratique de radiographie

et de radioscopie: technique et applications

médicales» that is likely the first of the

discipline. Another laboratory was created

at the Hôpital Necker under the exclusive

Fig. 5. Contremoulins' compass (Courtesy of Ecole

de radiologie, Saint-Germain-en-Laye).

Fig. 6. Spectro-trigono-métro-radiographeused for

the localisation of intracranial foreign body. Drawing

published in L'Illustration, 22 November 1897

(Courtesy of L'Illustration).

Fig. 7. Monthyon-awarded Contremoulins' letter

acknowledging the Académie des Sciences written

on Station Physiologique stationery. (Courtesy

of Académie des sciences-Institut de France).

executive direction of Gaston Contremoulins

(4). From 1898 to 1901, Contremoulins built

an outstanding laboratory subsidized by the

city of Paris which became the reference for

the further projects in radiological wards.

He was not medically qualified but soon he

developed excellent relationships with the

surgeons who appreciated his meticulous

performance and his inventive abilities shown

in the idea of "métroradiologie" (Fig. 5).

With Rémy he had become famous in 1897

with a description of some sophisticated

and precise equipment for the detection of

foreign bodies they called "spectro-trigonométro-

radiographe" (37) ; they received

the Prix Monthyon a high medical award

delivered annually by the Académie des

Sciencesto compensate the expansive cost

of the tool (2500francs to be compared with

the 2000francs of Demenÿ's annual salary).

Contremoulins soon became a contributor to

journals and newspapers. The popular weekly

magazine, L'Illustration, dedicated the cover

page of the 22 November 1897 issue to that

innovative tool (Fig. 6 and 7). Another Prix

Monthyonwas awarded for his paper on the

technique of plain film used for the detection

of urolithiasis in humans published in 1899

with the urologist Albarran (38). Marey

presented several Contremoulins' papers

when he was the president of the Académie

Nationale de Médecine during the year 1900.

Contremoulins no longer communicated

with the Académie de Médecine afterwards,

because in 1901 he had become Béclère's

toughest enemy in a severe corporatist

conflict (4,5,32).

Antoine Béclère had to face opposition

both from a medical and a radiographic

lobby over four decades:

1) Béclère could not get the Ministère de

l'Educationto create an academic chair of

radiology before he died in 1939 (5). Many

medical academic colleagues were angry with

him because they believed he was perverting

the art of medicine, even though he respected

Laennec's anatomoclinical principles

and method (39). Still in the 1930ies,

they regarded radiology, a photographic

technology, with contempt. They disliked the

facts that radiology could rapidly provide a

precise diagnosis which might contradict

their intellectual arguments and that autopsy

was no longer the only means to make a

diagnosis anatomically. These disagreements

were topics for caricaturists until medicine

became truly scientific in the second half of

the 20th century.

2) Béclère also came into conflict with the

non medical radiographers, even when they

were respected, like Contremoulins, because

of the many scandals relating to incompetent

or dishonest practitioners. When a new deal

emerged in 1908 still under Dr. Georges

Clemenceau's Ministership, Béclère could

not obtain the chairmanship of the radiology

department exclusively for medical doctors

although this was recommended by the

Académie Nationale de Médecine (4,5).

Thirty-nine members of the Académie

des Sciences, headed by Paul Villard who

discovered the gamma-rays, signed a letter

supporting Contremoulins after they visited

his laboratory (4). However, neither Bouchard

nor Becquerel, who were respectively

Présidentand Secrétaire perpétuel of the

Académie des Sciences in 1909, nor the

medical membership with the exception of

the bacteriologist Emile Roux, co-signed the

letter. Contremoulins at the Hôpital Necker

and Puthomme, his former assistant, at the

Salpêtrière, kept their positions as the heads of

those two out of the eight official laboratories

of the hospitals of the Assistance publique à

Pariscreated by Clemenceau. Béclère was in

charge of the radiological service of the city of

Paris during World War1 (4,5). Contremoulins

refused to be under the hierarchy of a doctor

and resigned, in spite of his recognized

competence in the military aspects of the

work. Looking for foreign bodies was a

common radiological investigation. An

ad hoc committee was nominated in 1917

at the Académie de Médecine to evaluate

Contremoulins' method since it appeared that

the radiographer might have been unfairly

denigrated or ignored; Edouard Kirmisson

and three other academicians recalled the

interest in Contremoulins' metroradiological

tool in surgery (40).

Radiology would not have developed

without the convergence of three major

preliminary inventions : the Crookes' tube,

electrical power and photography. In 1901,

Roentgen was the first Nobel Prize winner

in physics, an honor that his compatriot

Phillipp Lenart did not obtain because, unlike

Röntgen, he was not a photographer then

could not evidence his own but controversial

discoveries (1,7). Contremoulins had all three

inventions at hand: he was able to make his own

Crookes'tubes, he knew electrical technology,

and he was an expert in photography. At the

Ecole des Beaux-Arts in Rouen, he learnt

the basics of multimodality imaging from

drawing to architecture. Working with Marey,

who was also a painter and a sculptor, he

became an inventive master of mechanics and

microscopic chronophotography. Working

with Rémy at the histology laboratory,

he learnt gross pathology in humans and

animals. Those who have had the chance to

look at his radiographs admire their superb

quality. His papers show his outstanding

mastery of both technology and diagnosis.

He had the privilege of radiographing the first

opacification of the subarachnoidal space with

Lipiodol by Forestier and Sicard in 1921 (41)

(Fig. 8). Contremoulins soon carefully studied

dosimetry and radioprotection (42,43,44). He

fought against the abusive use of fluoroscopy

and radiography. Many radiologists died

from radiation exposure or suffered terrible

radionecroses. Their names are listed in

a memorial in Hamburg, Germany, in the

hospital where Albers-Schoenberg practiced

radiology, but then died prematurely of

cancer (7). Many pioneers, like his colleague

Charles Infroit, successor of Albert Londe

who resigned in 1900, died prematurely

because they submitted themselves to

careless irradiations by the "invisible light"

before its harmful effects were clearly shown

at the 1910 Exposition Universelle of Liège,

Belgium that hosted the second «Congrès

International d'Electrologie et de Radiologie

Médicales». Neither Contremoulins nor his

staff members suffered any radionecrosis,

cancer or leukaemia; however they never

practiced radiation therapy. In the 1920s,

he wrote about the necessity to protect the

environment of the radiological wards, in

hospitals as well as in private offices (45,46).

In 1929, Maurice de Broglie, physicist and

expert in X-rays at the Académie des Sciences,

was in charge of an official report which

supported the validity of Contremoulins'

ideas about radioprotection in the structure of

radiographic rooms (47).

Marey as well as Roentgen were idealist

scientist contempting financial business.

Marey, who owned personal wealth, and

Demenÿ patented many inventions but they

were poor businessmen (10). Under the

auspices of the Collège de France, Marey

built and managed his Station physiologique

mostly with governmental subventions and

his own money, unlike the modern joint

ventures between research centers and

bankable start-ups. He invested 6000 francs

in six chronophotographs but he sold only one

specimen. In their correspondence exchanged

when Marey was used to spend the fall and

the winter seasons in Napoli, Italy, Demenÿ

always complains of financial problems

that his boss never tried to solve actually.

In spite of Demenÿ's pressure, Marey was

Fig. 8. First case of opaque myelography

after injection of Lipiodol in the subarachnoidal

space in 1921. Dr. Jacques Forestier

handwrote comments. Contremoulins

signed the radiography (arrow). (Courtesy

of Dr Michel Guerbet).

fully reluctant to involve his genious talent

in the development of cinematographic

entertainment programs that would have

subsidized their undertakings. Meanwhile

Demenÿ and his Société du Phonoscope fell

into bankruptcy in 1895, those programs

enriched talented "plagiarists" like Gaumont

and Lumière Brothers in France (48). Roentgen

Fig. 9 a, b, c. Metroradiological table and devices for radiopelvimetry detecting dystocies.

(Courtesy of Ecole de radiologie, Saint-Germain-en-Laye).

was even stricter since he refused to patent

the discovery of X-rays and to enter any

further business ventures. At an economical

viewpoint, radiology had been a disruptive

innovation that could develop free of charge

to all inventors of the equipments enabling a

new highly lucrative process of translational

technology to medicine. Contremoulins

who patented his invents as well as charged

the radiographies to the patients was wiser

at the Hôpital Necker where his laboratory

management never sounded to be negative

financially during his 35-year mandate.

Was Contremoulins an extraordinary

character? Studying his life and work,

the author's answer is : yes, indeed! Looking

at his radiopelvimetric method and tools

(Fig. 9 a, b, c), why not to evoke his inventive

potentials if he had lived when computed

imaging emerged from the 1960ies? His

expertise overwhelmed the strict boundaries

of radiology. With the surgeons Delbet,

then Schwartz and Robineau, he invented

the bone prostheses applied to numerous

wounded soldiers after World War 1 (49,50).

He invented many tools for orthopaedic

surgery (Fig. 10 and 11 ), which were usually

presented by Robineau at both Académies des

Sciences and Académie de Chirurgie (51,52).

Maurice Robineau (Fig.12) took advantage of

Fig. 10. Metroradiological device for osteosynthesis

of the knee. (Courtesy of Ecole de radiologie, Saint-

Germain-en-Laye).

Fig. 11. Prothesis of the cubitus made of aluminium

covered by latex. (Courtesy of Ecole de radiologie,

Saint-Germain-en-Laye).

Fig. 12. Dr Maurice Robineau. (Author's collection).

Contremoulins's inventiveness to propose the

first treatment (osteosynthesis) for fractures

of the neck of the femur by bone pinning in

France (53). In 1935, Contremoulins settled

in the city of Saint-Germain-en-Laye where

he continued to practice metroradiology at

the hospital. He founded a school there where

he taught future radiographers and this school

is still in operation. He committed suicide in

1950 because he had become blind (32).

In conclusion, because Etienne-Jules

Marey was in charge of eminent academic

positions while radiology was starting, he

had been immediately supportive of the

investment of his assistant photographer,

Gaston Contremoulins, in the promising

radiological specialty. He practiced at the

Hôpital Necker of Paris then at the Hôpital

de Saint-Germain-en-Laye during 54 years

of his life without any radio-induced damage.

Contremoulins was the radiographers' most

brilliant godfather. While he was in conflict

as early as 1901with the medical concept

of radiology headed by Antoine Béclère,

Contremoulins always found a strong group

of supporters at the Académie des Sciences

who would be active and faithful until he

retired in 1934 from the Hôpital Necker.

Both Marey and Contremoulins belongs to

the group of the ancestors of translational

medicine. Because Contremoumlins was

banned off the medical decision makers

before World War 2, the University of Paris

missed its chance to consolidate the core of

a future radiological institute of technology

where computed tomography programs could

have been conceived. His laboratory was

destroyed after he retired. The author was the

chairman of the Necker's new department of

radiology in 1988-99. He rebuilt it without any

knowledge of that prestigious but forgotten

story. Should he had known it, instead of

the destruction of a joint space unusable for

clinical radiology, he would have featured

the department differently with a prospective

vision of a technological laboratory to the

21st century when molecular radiology has

become the must of medical imaging.

Acknowledgement.

The author is highly indebted to Professor

Marta Braun, Ryerson University, Toronto,

Ontario, Canada, and to Dr. Judith A. W.

Webb, F.R.C.P., F.R.C.R., London, UK, for

their help in the edition of the manuscript.

The author thanks gratefully M.J.

Watremez and J.C. Stoleric who accepted

to communicate their unpublished memoir

written in 1983: «Gaston Contremoulins:

un pionnier de la Radiologie.» available at

the Ecole de Radiologie, Saint-Germain-en-

Laye, only.

The author gratefully acknowledges Mrs.

Claire Guttinger of the Department of

Archives of the Collège de France of Paris,

Mrs. Florence Greffe of the Department of

Archives of the Académie des Sciences, Mr.

Jean-François Vincent of the Bibliothèque

InterUniversitaire de Médecine (BIUM),

Mr. Valdo Kneubühler of the Cinémathèque

Française, and Mr. Laurent Provost of www.

Historix.fr website for their fruitful help in

the bibliographic research.

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