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September 23, 2017
X-Ray Francis Henry Williams

Francis Henry Williams (1852-1936)

A method for more fully determining the outline of the heart by means of the flourescope together with other uses of this instrument in medicine. Boston Med Surg J 1896. 135 :335-7

Francis Henry Williams
Portrait of Francis Henry Williams
Portrait of Francis Henry Williams


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Francis Henry Williams was an American physician and used the fluoroscopy for the examination of the heart in 1896. In the introduction of his article, he wrote:

"The picture which presents itself to the eye when the body is examined with the fluorescope is full of interest. The trunk appears lighter above than below the diaphragm and the rise and fall of the muscle are distinctly seen; the chest is divided vertically by an ill-defined dark band which includes the backbone; and each side is crossed by the dark outline of the ribs, the spaces between which, are the brighest portion of the picture. One also sees the pulsating heart, especially the ventricles, and under favorable conditions the right auricle and left auricle, but it is difficult to separate the latter from pulmonary artery; a small portion of one side of the arch of the aorta may be seen in the first intercostals space to the left of the sternum..."

He then continued:

"In examining the heart by means of percussion, we can usually determine its left border, but we cannot find its lower border. Now let us see what can be done in this direction by means of the x-rays. The constant motion of the heart and diaphragm interfere with the use of radiography but  renders fluorescopy all the more valuable."

He described four cases in this article and one patient presented with enlarged heart. He also compared his findings on fluoroscopy with those observed on percussion which he was using to delineate the left border of the heart and concluded "they correspond in a general way." He also made the diagnosis of aortic aneurysms using fluoroscopy. Williams examined forty patients with tuberculosis and wrote: "...not only that the fluoroscope is of value in determining the extent of the disease, but also sometimes reveals its location, where and when it would otherwise have been unsuspected." Williams mentioned that the presence of advanced lung disease had little impact on his observations of the heart.

In the conclusion of his article, Williams remarked:

"... I have found them [X-rays] especially useful in diseases of the heart and lungs. We may now look where we have previously only been able to listen, and sometimes to hear but imperfectly. The advance consists not alone in what we can now see that we could not see before, but also in that we can by hand and ear and eye together strengthen and confirm these separate observations beyond their respective limitations; singly they are beams, together an arch which justifies a heavier weight of inference."

Fluoroscopic examination of the heart gained increasing popularity during the first two decades of the 20th century and was used routinely as a diagnostic tool until late 1960's.

Link to the journal: NEJM


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