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Sir James Paget: 1814-1899
Considered one of the greatest English surgeons, Paget’s wide knowledge of medicine made him an outstanding diagnostician, physiologist and one of the fathers of pathology.
At the peak of his success, Sir James Paget was earning an annual income greater than £10,000. However, his success as a physician and a surgeon was hard-earned. After passing his surgeon’s exam, Paget worked 10 years, from 1836 to 1846, at multiple posts before he was elected an assistant surgeon at St Bartholomew’s Hospital.
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Source: National Library of Medicine |
His earnings during this time were often meager for a physician, averaging between £100 and £200 per year. He worked as the curator of the Museum at St Bartholomew’s Hospital; as a subeditor for the Medical Gazette; and as a staff member of the Quarterly Review, translating French, German, Italian and Dutch journals into English. Although it completely cut him off from clinical surgery, this work allowed Paget to acquire a wide knowledge of medical science.
Paget may have spent the first 30 years of his life relatively unknown, but the second half of his life would be drastically different. A revered physician and surgeon, Paget would eventually have the largest surgical practice in London and become surgeon to Queen Victoria of England.
A slow start
Paget was born on Jan. 11, 1814, in Yarmouth, England. He was the 12th child of 17 born to Samuel and Elizabeth Paget. At the age of 16, Paget started a four-and-a-half–year apprenticeship under Charles Costerton, a medical practitioner in town. As a student of both painting and botany, Paget became skilled in sketching objects in nature and pathological specimens. In 1834, he and Costerton published Natural History of Great Yarmouth, which described the flora and fauna of the area.
Shortly after, Paget enrolled in St Bartholomew’s Hospital. While a student, he discovered a new pork parasite, the Trichina spiralis. Generations of dissectors had seen them and dismissed them as calcified tissue, but Paget, accustomed to having his curiosity aroused by natural phenomena, collected some of the tiny bodies for closer examination. The tiny calcified body was actually a worm in its capsule. Within 18 months of enrollment, Paget successfully passed the College of Surgeons’ exam.
Unfortunately, due to a change in family fortune, Paget’s father was unable to raise the money to secure an apprenticeship for his son with a hospital surgeon. Paget would spend the next seven years working low-paying jobs.
In 1843, he obtained a position as a lecturer in general anatomy and physiology at St Bartholomew’s and became warden of the newly formed St Bartholomew’s Hospital College. These last two appointments improved his financial earnings enough to marry. On May 23, 1844, he married Lydia North, after an eight-year engagement.
Successful years
In 1846, Paget was named the Aris and Gale Professor of the Royal College, and in 1847 was finally elected an assistant surgeon at St Bartholomew’s.
As the Aris and Gale Professor, he was required to deliver six lectures during a two-week period. He was reelected five times. The topics of his lectures were nutrition, the life of blood, the processes of repair and reproduction after injuries, inflammation, tumors and malignant tumors. These lectures were later compiled and published in two volumes and are considered to be among the classics of surgery.
In 1851, Paget gave up the lecture position to open a private practice. His practice would grow gradually until it became the largest in London. In the following years, Paget was named the Surgeon Extraordinary to Her Majesty Queen Victoria of England, Surgeon at St Bartholomew’s and later Lecturer in Surgery at St Bartholomew’s.
Paget’s surgical class grew to be the most widely attended in London. At almost 60 years old, he was working harder than ever. In 1871, he had an attack of blood poisoning during a post-mortem examination. This illness forced him to reduce his workload and resign from the active staff of St Bartholomew’s. Later that year Paget was bestowed a Baronetcy by the Queen.
Although his active duties at the hospital were finished, Paget would make many of his great medical discoveries after his “retirement.” He was also bestowed many honors, including president of the Royal College of Surgeons; Hunterian Orator and vice-chancellor of the University of London; and president of the International Congress of Medicine, held in London in 1881.
Multiple eponyms
Although he is most recognized for Paget’s disease of the nipple and Paget’s disease of the bone, Paget was the first to describe a wide variety of diseases including osteochondritis dessicans, Osgood-Schlatter disease, axillary vein thrombosis, Paget’s skin neoplasm, Paget’s recurrent fibroid and Paget’s residual abscesses.
An avid student of tumors, Paget devoted a large part of his lecture series at St Bartholomew’s to tumors and even tried to determine the role of heredity in cancer. In 1874, he published “On disease of the mammary areola preceding cancer of the mammary gland” in St Bartholomew’s Hospital Reports.
This short paper described 15 women who presented with “an eruption on the nipple and areola” that appeared “florid, intensely red, raw surface, very finely granular, as in nearly the whole thickness of the epidermis were removed.” Paget found that within two years, in all of the cases, cancer of the mammary gland followed these symptoms. This condition was later called Paget’s disease of the nipple.
In 1876, he wrote his most famous work, “On a form of chronic inflammation of bones (osteoitis deformans),” which was read in front of the Royal Medical and Chirurgical Society of London. In it he described the 20-year evolution of a disease of the bone from its early manifestation to its termination by sarcoma of the radius. Paget’s disease of the bone is now described as a “localized disorder of bone remodeling characterized by an increased number of larger-than-normal osteoclasts.” He suggested that it be called Osteitis deformans until more was known about the disease. However, the cause of the disease is still unproven and a cure is unknown.
He retired fully from practice in 1893. During this time, he and his son, Stephen Paget, began compiling and writing his memoirs Sir James Paget: Memoirs and Letters, which was published posthumously. Paget died on Dec. 30, 1899, one day short of witnessing a new century, at 85 years old. – by Leah Lawrence
For more information:
- Buchanen WW. Sir James Paget (1814-1894). Rheumatology. 2003;42:1107-1108.
- Coppes-Zantinga AR, Coppes MJ. Sir James Paget (1814-1889): a great academic Victorian. J Am Coll Surg. 2000;191:70-74.
- Jay V. Sir James Paget. Surgeon to Queen Victoria. Arch Pathol Lab Med. 2007;123:995.
- Jones AR. Sir James Paget. J Bone Joint Surg Br. 1951;33:446-451.
- McManus IC. Sir James Paget’s research into medical education. Lancet. 2005;366:506-513.
- Pearce JMS. Sir James Paget: a biographical note. Q J Med. 1997;90:235-237.
- Sir James Paget (1814-1899). CA Cancer J Clin. 1971;21:302.