Sir James Paget, 1st. Baronet

With Rudolf Virchow, Sir James Paget is considered one of the founders of modern pathology. He was born in Great Yarmouth the 8th of 16 siblings. His father was a brewer, shipowner, chandler and sometimes mayor. His elder brother George Edward Paget (1809-1892) became Regius professor at the University of Cambridge.

At 16 Paget was apprenticed to Charles Costerton, a local surgeon and apothecary, and four years later he entered St. Bartholomew's Hospital, London, to which he was associated throughout his life and where he studied or worked from 1834 to 1871. During his first year as a student at St. Bartholomew's, he noted some white specks in the muscle of a cadaver he was dissecting. When examinining them with a microscope he found them to be small, encapsulated worms, later named Trichina spiralis by the British anatomist and palaeontologist Richard Owen (1804-1892). This was the first demonstration of trichinosis in man.

James Paget graduated from the College of Surgeons in 1836, becoming a member of the Royal College of Surgeons the same year. He then gave private tuition, was sub-editor of some medical journals and supplemented his meagre income by translating medical journals and books. During the years 1837 to 1843 he was curator of the College of Surgeons Anatomy Museum, a post in which he was responsible for procuring bodies and performing dissections.

Paget in 1851 commenced private practice and his success was phenomenal, resting on his charming personality as much as his anatomical-pathological knowledge and surgical skill. In 1854 he became surgeon extraordinary to Queen Victoria and, a few years later, surgeon ordinary to the Prince of Wales. He was created a baronet in 1877, the same year he described the bone disorder.

James Paget served as surgeon extraordinary 1858-1877 at Bartholomew's Hospital, sergeant surgeon extraordinary 1867-1877 . He was demonstrator of anatomy and became professor of anatomy and surgery at the Royal College of Surgeons of England (1847-1852) and was elected fellow of the Royal Society in 1851, its vice president 1873-1874 and president in 1875. He was honorary vice chancellor of the University of London, and was named doctor of honour of law at the universities of Oxford, Cambridge and Edinburgh.

Although his practice is alleged to have earned him 10,000 pounds a year Paget continued to make notable scientific contributions as well as to write important books on surgical pathology, tumours and surgery. In 1871, after narrowly escaping death from infection following an accidental cut during a post mortem investigation, Paget resigned from Bartholomew's and restricted himself to consulting practice. His success was phenomenal, resting on his charming personality as much as his anatomical pathological knowledge and surgical skill.

Paget was one of the first to recommend surgical removal of bone marrow tumours (myeloid sarcoma) instead of amputating the limb. If Paget's main field was in surgery, he is now chiefly remembered as an outstanding histologist, one of the first to encourage the study of pathological histology.

His fame rests on his descriptions of several diseases, the most famous of which is osteitis deformans, which he described in 1877. His patient was a man with progressive bone deformity whom he had first seen in 1856. Paget described enlargement of the cranium, anterior curving of the spine, which produced a simian stance, and bowing of the legs. In 1872 vision was compromised by retinal haemorrhages and deafness developed. At autopsy the bone was so soft that it could be cut by a razor, while unusual histological findings were evident. However, the aetiology is still unknown and the genetic basis is uncertain.

To have or have not
Paget was slightly built, of medium weight with a long face and bright eyes. He was a gifted orator and was regarded as the finest lecturer of his area. This brilliant man admired brevity and was famed for it, and equally he disliked smart-Aleck cleverness and held an aversion against epigrams and slogans, even though he used some himself: "To be brief is to be wise".

Gladstone is reputed to have said that he divided people into two classes, "Those who had and those who had not heard James Paget". Paget upheld a close contact with German science and was a life-long friend of Rudolf Virchow. He was an ardent enemy of orthodox influence in medicine, advocating the scientific approach, and fighting the antivivisectionists. It was due to Paget that Virchow came to London to give his famous address on the importance of pathological experiments.

Among his many other friends of various backgrounds were John Ruskin, William Gladstone, cardinal Newman, Alfred Lord Tennyson, Louis Pasteur, Florence Nightingale, Thomas Henry Huxley, and Charles Darwin – indeed, they seem to have made up most of the intelligentsia of their time.

Paget was a noble and sympathetic personality, enjoying the greatest respect and love. His best known work is the catalogue of the pathological museum of the Royal College of Surgeons.

Although he gave up operating when 64, he continued to see patients in consultations, and, as late as 1891 he travelled to Rome as an advisor. When he died in London in 1899 at the age of 85, his burial service was conducted by his son, who was bishop of Oxford. An other son, Stephen Paget (1855-1926), was well known for his efforts in experimental medicine, and in 1908 founded the Research Defence Society.

James Paget married Lydia North in 1844; they had six children.

"We sat for eight days, and on six of them decided to do nothing."
Quoted by W. K. Pyke-Lees in Medical Ethics, Chapter II."

"As no two persons are exactly alike in health so neither are any two alike in disease; and no diagnosis is complete or exact which does not include an estimate of the personal character, or the constitution of a patient.
There used to be a French saying that “French physicians treat the disease, English the patient.” So far as this is true it is to the honour of the English, for to treat a sick man rightly requires the diagnosis not only of the disease but of all the manner and degrees in which its supposed essential characters are modified by his personal qualities, by the mingled inheritances wrought in him by the conditions of his past life, and by many things besides."
Address to Abernethian Society, 1885. Quoted by Sir James Patterson Ross in St. Bartholomew’s Hospital Journal, 1950, 54: 50.

"Let me suggest that the instances of recovery from disease and injury seem to be only examples of a law yet larger than that within the terms of which they may be comprised; a law wider than the grasp of science; the law that expresses our Creator’s will for the recovery of all lost perfection. To this strain of thought we are guided by the remembrance that the healing of the body, was ever chosen as the fittest emblem in His work."
Lectures on Surgical Pathology, Lecture 7.

"Your responsibilities are as various as are the ills that flesh is heir to¸ they are as deep as the earnestness with which men long to be delivered from suffering, or from the grasp of death. Why, we sometimes see the beam of life and death so nearly balanced, that it turns this way or that, according to the more or less skill that may be cast into the scale of life."
Memoirs and Letters, “On the Motives to Industry in the Study of Medicine”

"In remembering those with whom I was year after year associated, and whom it was my duty to study, nothing appears more certain than that the personal character, the very nature, the will, of each student had far greater force in determining his career than any helps or hindrances whatever. All my recollections would lead me to tell that every student may draw from his daily life a very likely forecast of his own life in practice, for it will depend on himself a hundredfold more than on circumstances. The time and the place, the work to be done, and its responsibilities, will change; but the man will be the same, except in so far as he may change himself."
St. Bartholomew’s Hospital Reports, London, 1869, 5: 238.

"In May 1844, I married, and began to enjoy that happiness of domestic life which has already lasted without a break, without a cloud, for 39 years. From this time, the “being alone” was the being alone with one who never failed in love, in wise counsel, in prudence and in gentle care of me. With her it was easy to work and be undisturbed by anything going-on around med; a habit I can advise everyone to learn . . . she wrote for me, copying for the press my roughly written manuscripts, sitting with med till midnight or far into the morning."
Memoirs and Letters, Part 1, Chapter VII.

• Lectures on Tumours, etc. 1851.
• Lectures on Surgical Pathology, Delivered at the R. C. S. England. 1863. 3rd editon by Will. Turner, 1870. American edition, Philadelphia, 1865.
• On gouty and some other forms of phlebitis.
  St. Bartholomew’s Hospital Reports, London, 1866, 2: 82-92. Paget-Schrötter.
• Pathological catalogue of the Museum of the Royal College of Surgeons.
• On diseases of the mammary areola preceding cancer of the mammary gland.
  St. Bartholomew's Hospital Report, 1874, 10: 87-89.
• Clinical Lectures and Essays. 1875.
• On a form of chronic inflammation of bones (osteitis deformans).
  Medico-Chirurgical Transactions, London, 1877, 60: 37-63.
• Additional cases of osteitis deformans.
  Medico-Chirurgical Transactions, London, 1882, 65: 225-236. Also several works in the Transactions and Proceedings of the Royal Society; Medico-Chirurgical Transactions, London; St. Bartholomew Hospital Report; Lancet; Medical Times and Gazette, London; British Medical Journal, London.
• Stephen Paget, editor:
  Memoirs and letters of Sir James Paget.
  London, Longmans, Green and Co., 1901.
• G. Turner:
  The Paget tradition.
  New England Journal of Medicine, Boston, 1931, 205: 622–629.
• K. Reed, T. B. Grage:
  The Paget tradition revisited.
  American Journal of Surgery, Newton, MA, 1982, 144: 498–503.
• B. V. Shenoy, B. W. Scheithauer:
  Sir James Paget.F. R. S.
  Mayo Clinic Proceedings, Rochester, 1983, 58: 51–55.