Sir James Paget, 1st Baronet
FRS HFRSE (11 January 1814 – 30 December 1899) (, rhymes with "gadget") was an English surgeon and
pathologist
Pathology is the study of the causes and effects of disease or injury. The word ''pathology'' also refers to the study of disease in general, incorporating a wide range of biology research fields and medical practices. However, when used in t ...
who is best remembered for naming
Paget's disease and who is considered, together with
Rudolf Virchow
Rudolf Ludwig Carl Virchow (; or ; 13 October 18215 September 1902) was a German physician, anthropologist, pathologist, prehistorian, biologist, writer, editor, and politician. He is known as "the father of modern pathology" and as the founder ...
, as one of the founders of scientific medical pathology. His famous works included ''Lectures on Tumours'' (1851) and ''Lectures on Surgical Pathology'' (1853). There are several medical conditions which were described by, and later named after, Paget:
*
Paget's disease of bone
Paget's disease of bone (commonly known as Paget's disease or, historically, osteitis deformans) is a condition involving cellular remodeling and deformity of one or more bones. The affected bones show signs of dysregulated bone remodeling at the ...
*
Paget's disease of the nipple
Paget's disease of the breast is a type of cancer that outwardly may have the appearance of eczema, with skin changes involving the nipple of the breast. The condition is an uncommon disease accounting for 1 to 4.3% of all breast cancers and was ...
(a form of intraductal breast cancer spreading into the skin around the nipple)
**
Extramammary Paget's disease
Extramammary Paget's Disease (EMPD) is a rare and slow-growing malignancy which occurs within the epithelium and accounts for 6.5% of all Paget's disease. The clinical presentation of this disease is similar to the characteristics of mammary Pa ...
refers to a group of similar, more rare skin lesions discovered by Radcliffe Crocker in 1889 which affect the male and female genitalia.
*
Paget–Schroetter disease
Paget–Schroetter disease (also known as venous thoracic outlet syndrome) is a form of upper extremity deep vein thrombosis (DVT), a medical condition in which blood clots form in the deep veins of the arms. These DVTs typically occur in the axi ...
*
Paget's abscess
A Paget's abscess, named by eminent British surgeon and pathologist Sir James Paget
Sir James Paget, 1st Baronet FRS HFRSE (11 January 1814 – 30 December 1899) (, rhymes with "gadget") was an English surgeon and pathologist who is best re ...
, an abscess that recurs at the site of a former abscess which had resolved.
Life
Paget was born in
Great Yarmouth,
England
England is a country that is part of the United Kingdom. It shares land borders with Wales to its west and Scotland to its north. The Irish Sea lies northwest and the Celtic Sea to the southwest. It is separated from continental Europe b ...
, on 11 January 1814, the son of Samuel Paget, a brewer and shipowner, and his wife, Sarah Elizabeth Tolver. He was one of a large family, and his brother Sir
George Edward Paget
Sir George Edward Paget, (22 December 1809 – 16 January 1892) was an English physician and academic.
Life
The seventh son of Samuel Paget and his wife, Sarah Elizabeth Tolver, he was born at Great Yarmouth, Norfolk. After schooling there, he ...
(1809–1892), who became
Regius Professor of Physic at the
University of Cambridge
The University of Cambridge is a public collegiate research university in Cambridge, England. Founded in 1209 and granted a royal charter by Henry III in 1231, Cambridge is the world's third oldest surviving university and one of its most pr ...
in 1872, also had a distinguished career in medicine and was made a
K.C.B. James attended a day-school in Yarmouth, and afterwards was intended for the navy; but this plan was given up, and at the age of 16 he was apprenticed to a
general practitioner, for whom he served for four and a half years, during which time he gave his leisure hours to
botanising, and made a great collection of the
flora
Flora is all the plant life present in a particular region or time, generally the naturally occurring (indigenous (ecology), indigenous) native plant, native plants. Sometimes bacteria and fungi are also referred to as flora, as in the terms '' ...
of East
Norfolk
Norfolk () is a ceremonial and non-metropolitan county in East Anglia in England. It borders Lincolnshire to the north-west, Cambridgeshire to the west and south-west, and Suffolk to the south. Its northern and eastern boundaries are the No ...
. At the end of his apprenticeship, he published with one of his brothers a very careful ''Sketch of the Natural History of Yarmouth and its Neighbourhood''.
In October 1834, he entered as a student at
St Bartholomew's Hospital
St Bartholomew's Hospital, commonly known as Barts, is a teaching hospital located in the City of London. It was founded in 1123 and is currently run by Barts Health NHS Trust.
History
Early history
Barts was founded in 1123 by Rahere (die ...
, in London. Here he is noted to have described the first
journal club
A journal club is a group of individuals who meet regularly to critically evaluate recent articles in the academic literature, such as the scientific literature, medical literature, or philosophy literature. Journal clubs are usually organized ar ...
. Medical students in those days were left very much to themselves; there was no close supervision of their work, but Paget probably gained rather than lost by having to fight his own way. He swept the board of prizes in 1835, and again in 1836; in his first winter session, he discovered the
pathogen
In biology, a pathogen ( el, πάθος, "suffering", "passion" and , "producer of") in the oldest and broadest sense, is any organism or agent that can produce disease. A pathogen may also be referred to as an infectious agent, or simply a germ ...
for
trichinosis
Trichinosis, also known as trichinellosis, is a parasitic disease caused by roundworms of the '' Trichinella'' type. During the initial infection, invasion of the intestines can result in diarrhea, abdominal pain, and vomiting. Migration of ...
, a
parasitic disease
A parasitic disease, also known as parasitosis, is an infectious disease caused by parasites. Parasites are organisms which derive sustenance from its host while causing it harm. The study of parasites and parasitic diseases is known as parasitolo ...
caused by ''Trichinella spiralis'', a minute
roundworm
The nematodes ( or grc-gre, Νηματώδη; la, Nematoda) or roundworms constitute the phylum Nematoda (also called Nemathelminthes), with plant-parasitic nematodes also known as eelworms. They are a diverse animal phylum inhabiting a bro ...
that infests the
muscles of the human body, and which is usually acquired by eating infected pork. In May 1836, he passed his examination at the
Royal College of Surgeons
The Royal College of Surgeons is an ancient college (a form of corporation) established in England to regulate the activity of surgeons. Derivative organisations survive in many present and former members of the Commonwealth. These organisations a ...
, and became qualified to practice. The next seven years (1836–1843) were spent in London lodgings, and were a time of poverty, for he made only 15 pounds a year by practice, and his father, having failed in business, could not give him any help. He managed to keep himself by writing for the medical journals, and preparing the catalogues of the hospital museum and of the
pathological
Pathology is the study of the causes and effects of disease or injury. The word ''pathology'' also refers to the study of disease in general, incorporating a wide range of biology research fields and medical practices. However, when used in th ...
museum of the Royal College of Surgeons. In 1836, he had been made curator of the hospital museum, and in 1838, demonstrator of morbid
anatomy
Anatomy () is the branch of biology concerned with the study of the structure of organisms and their parts. Anatomy is a branch of natural science that deals with the structural organization of living things. It is an old science, having it ...
at the hospital, but his advancement there was hindered by the privileges of the hospital apprentices, and because he had been too poor to afford a house-surgeoncy, or even a dressership.
In 1841, he was made surgeon to the
Finsbury Dispensary, but this appointment did not give him any experience in the graver operations of surgery. He was appointed lecturer on general anatomy (microscopic anatomy) and
physiology
Physiology (; ) is the scientific study of functions and mechanisms in a living system. As a sub-discipline of biology, physiology focuses on how organisms, organ systems, individual organs, cells, and biomolecules carry out the chemical ...
at the hospital in 1843, and warden of the hospital college then founded. For the next eight years, he lived within the walls of the hospital, in charge of about 30 students resident in the little college. Besides his lectures and his superintendence of the resident students, he had to enter all new students, to advise them how to work, and to manage the finances and the general affairs of the school. Thus, he was constantly occupied with the business of the school, and often passed a week, or more, without going outside the hospital gates.
In 1844, he married Lydia North (d.1895), youngest daughter of the Rev. Henry North. In 1847, he was appointed an assistant-surgeon to the hospital, and Arris and Gale professor at the Royal College of Surgeons. He held this professorship for six years and each year gave six lectures in
surgical pathology
Surgical pathology is the most significant and time-consuming area of practice for most anatomical pathologists. Surgical pathology involves gross and microscopic examination of surgical specimens, as well as biopsies submitted by surgeons and ...
. The first edition of these lectures, which were the chief scientific work of his life, was published in 1853 as ''Lectures on Surgical Pathology''. He was elected a Fellow of the
Royal Society
The Royal Society, formally The Royal Society of London for Improving Natural Knowledge, is a learned society and the United Kingdom's national academy of sciences. The society fulfils a number of roles: promoting science and its benefits, re ...
in 1851. In October 1851, he resigned the wardenship of the hospital. He had now become known as a great physiologist and pathologist; he had done for pathology in England what
Rudolf Virchow
Rudolf Ludwig Carl Virchow (; or ; 13 October 18215 September 1902) was a German physician, anthropologist, pathologist, prehistorian, biologist, writer, editor, and politician. He is known as "the father of modern pathology" and as the founder ...
had done in Germany, but he had hardly begun to get into practice, and he had kept himself poor so he might pay his share of his father's debts, a task that took him 14 years to fulfill.
Paget was the father of Sir John Paget (2nd Baronet); the Rt Revd Dr
Francis Paget, Lord
Bishop of Oxford
The Bishop of Oxford is the diocesan bishop of the Church of England Diocese of Oxford in the Province of Canterbury; his seat is at Christ Church Cathedral, Oxford. The current bishop is Steven Croft, following the confirmation of his elect ...
; the Rt Revd Dr
Luke Paget, Lord
Bishop of Chester
The Bishop of Chester is the Ordinary of the Church of England Diocese of Chester in the Province of York.
The diocese extends across most of the historic county boundaries of Cheshire, including the Wirral Peninsula and has its see in the ...
; and
Stephen Paget, an English surgeon who first proposed the "seed and soil" theory of
metastasis
Metastasis is a pathogenic agent's spread from an initial or primary site to a different or secondary site within the host's body; the term is typically used when referring to metastasis by a cancerous tumor. The newly pathological sites, then ...
.
Paget was friends with
Charles Darwin
Charles Robert Darwin ( ; 12 February 1809 – 19 April 1882) was an English naturalist, geologist, and biologist, widely known for his contributions to evolutionary biology. His proposition that all species of life have descended ...
and
Thomas Henry Huxley
Thomas Henry Huxley (4 May 1825 – 29 June 1895) was an English biologist and anthropologist specialising in comparative anatomy. He has become known as "Darwin's Bulldog" for his advocacy of Charles Darwin's theory of evolution.
The stori ...
. He was a committed Christian and maintained there was no conflict between religion and science.
He was elected as a member of the
American Philosophical Society
The American Philosophical Society (APS), founded in 1743 in Philadelphia, is a scholarly organization that promotes knowledge in the sciences and humanities through research, professional meetings, publications, library resources, and communit ...
in 1854.
Works
No famous surgeon, not even
John Hunter (1728–1793), was likely to have founded his practice deeper in science than Paget did, or waited longer for his work to come back to him. In physiology, he had mastered the chief English, French, German,
Dutch
Dutch commonly refers to:
* Something of, from, or related to the Netherlands
* Dutch people ()
* Dutch language ()
Dutch may also refer to:
Places
* Dutch, West Virginia, a community in the United States
* Pennsylvania Dutch Country
People E ...
and Italian literature of the subject, and by incessant study and
microscope
A microscope () is a laboratory instrument used to examine objects that are too small to be seen by the naked eye. Microscopy is the science of investigating small objects and structures using a microscope. Microscopic means being invisi ...
work had put himself level with the most advanced knowledge of his time, so that it was said of him by
Robert Owen, in 1851, that he had his choice, either to be the first physiologist in Europe, or to have the first surgical practice in London, with a baronetcy. His physiological lectures at St Bartholomew's Hospital were the chief cause of the rise in the fortunes of its school, which in 1843 had gone down to a low point.
His work in pathology was even more important. He filled the place in pathology left empty by Hunter's death in 1793; this was the time of transition from Hunter's teaching, which for all its greatness was hindered by want of the modern microscope, to the pathology and
bacteriology Bacteriology is the branch and specialty of biology that studies the morphology, ecology, genetics and biochemistry of bacteria as well as many other aspects related to them. This subdivision of microbiology involves the identification, classificat ...
of the present day. Paget's greatest achievement was that he made pathology dependent, in everything, on the use of the microscope, especially the pathology of
tumours
A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...
. He and Virchow may truly be called the founders of modern pathology; they stand together, Paget's ''Lectures on Surgical Pathology'' and Virchow's ''Cellulär-Pathologie''.
When Paget, in 1851, began practice near
Cavendish Square
Cavendish Square is a public garden square in Marylebone in the West End of London. It has a double-helix underground commercial car park. Its northern road forms ends of four streets: of Wigmore Street that runs to Portman Square in the much la ...
, he had still to wait a few years more for success in professional life. The turn of the tide came about 1854 or 1855; and in 1858 he was appointed surgeon extraordinary to
Queen Victoria
Victoria (Alexandrina Victoria; 24 May 1819 – 22 January 1901) was Queen of the United Kingdom of Great Britain and Ireland from 20 June 1837 until her death in 1901. Her reign of 63 years and 216 days was longer than that of any previo ...
, and in 1863 surgeon in ordinary to
Albert Edward, Prince of Wales. He had for many years the largest and most arduous surgical practice in London. His day's work was seldom less than 16 or 17 hours. Cases sent to him for final judgment, with especial frequency, were those of tumours, and of all kinds of disease of the bones and joints, and all neurotic cases having symptoms of surgical disease. His supremacy lay rather in the science than in the art of surgery, but his name is also associated with certain great practical advances. He discovered the Paget's disease of the breast and the Paget's disease of the bones (''osteitis deformans''), which are named after him; he was the first to urge removal of the tumour, instead of
amputation of the limb, in cases of
myeloid sarcoma
A myeloid sarcoma (chloroma, granulocytic sarcoma, extramedullary myeloid tumor) is a solid tumor composed of immature white blood cells called myeloblasts. A chloroma is an extramedullary manifestation of acute myeloid leukemia; in other words, ...
. In 1869 he was elected President of the
Clinical Society of London The Clinical Society of London was founded in London in 1868 and merged in 1907 with the Royal Society of Medicine.
The founding of the Clinical Society was mainly due to Drs. Edward Headlam Greenhow and John Burdon Sanderson who convened a meeting ...
.
In 1870, he was elected a foreign member of the
Royal Swedish Academy of Sciences.
In 1871, he nearly died from infection at a ''post mortem'' examination, and, to lighten the weight of his work, was obliged to resign his surgeoncy to the hospital. In this same year, he received the honour of the
baronet
A baronet ( or ; abbreviated Bart or Bt) or the female equivalent, a baronetess (, , or ; abbreviation Btss), is the holder of a baronetcy, a hereditary title awarded by the British Crown. The title of baronet is mentioned as early as the 14t ...
cy of Harewood Place in the
County of Middlesex
Middlesex (; abbreviation: Middx) is a historic county in southeast England. Its area is almost entirely within the wider urbanised area of London and mostly within the ceremonial county of Greater London, with small sections in neighbouring ...
. He received an honorary degree from the
University of Cambridge
The University of Cambridge is a public collegiate research university in Cambridge, England. Founded in 1209 and granted a royal charter by Henry III in 1231, Cambridge is the world's third oldest surviving university and one of its most pr ...
in 1874. In 1875, he was president of the Royal College of Surgeons, and delivered the
Hunterian oration
The Hunterian Oration is a lecture of the Royal College of Surgeons of England. The oration was founded in 1813 by the executors of the will of pioneering surgeon John Hunter, his nephew Dr Matthew Baillie and his brother-in-law Sir Everard Hom ...
in 1877. Also in 1875, he was elected as president of the
Medical and Chirurgical Society of London
The Medical and Chirurgical Society of London was a learned society of physicians and surgeons which was founded in 1805 by 26 personalities in these fields who had left the Medical Society of London (founded 1773) because of disagreement with th ...
. In 1878, he gave up operating, but for eight or 10 years longer, he still had a very heavy consulting practice. In 1880, he gave, at Cambridge, a memorable address on Elemental Pathology, setting forth the likeness of certain diseases of plants and trees to those of the human body. The next year, he was president of the
International Medical Congress
The International Medical Congress (french: Congrès International de Médecine) was a series of international scientific conferences on medicine that took place, periodically, from 1867 until 1913.
The idea of such a congress came in 1865, dur ...
held in London. In 1887 he was elected President of the
Pathological Society of London
The Pathological Society of London was founded in 1846 for the "cultivation and promotion of Pathology by the exhibition and description of specimens, drawings, microscopic preparations, casts or models of morbid parts."
Its first meeting was he ...
Besides shorter writings, he also published ''Clinical Lectures and Essays'' (1st ed. 1875) and ''Studies of Old Case-books'' (1891). In 1883, on the death of
Sir George Jessel, he was appointed vice-chancellor of the
University of London
The University of London (UoL; abbreviated as Lond or more rarely Londin in post-nominals) is a federal public research university located in London, England, United Kingdom. The university was established by royal charter in 1836 as a degree ...
. In 1889, he was appointed a member of the Royal Commission on Vaccination.
In May 1886, he treated Edward Crowley, father of
Aleister Crowley
Aleister Crowley (; born Edward Alexander Crowley; 12 October 1875 – 1 December 1947) was an English occultist, ceremonial magician, poet, painter, novelist, and mountaineer. He founded the religion of Thelema, identifying himself as the pr ...
for tongue cancer. An operation was advised, but Crowley declined and died the following year.
He died at home, 5 Park Square West in
Regent's Park
Regent's Park (officially The Regent's Park) is one of the Royal Parks of London. It occupies of high ground in north-west Inner London, administratively split between the City of Westminster and the Borough of Camden (and historically betwee ...
, London, on 30 December 1899, at the age of 85. The ''Memoirs and Letters of Sir James Paget'', edited by Stephen Paget, was published in 1901.
Sir James Paget had the gift of eloquence, and was one of the most careful and most delightful speakers of his time. He had a natural and unaffected pleasure in society, and he loved music. He possessed the rare gift of the ability to turn swiftly from work to play, enjoying his holidays like a schoolboy, easily moved to laughter, keen to get the maximum of happiness out of very ordinary amusements, emotional in spite of incessant self-restraint, and vigorous in spite of constant overwork. In him a certain light-hearted enjoyment was combined with the utmost reserve, unfailing religious faith, and the most scrupulous honour. He was all his life profoundly indifferent toward politics, both national and medical; his ideal was the unity of science and practice in the professional life.
Sir James's reputation remains high due to his work as a surgeon and medical research and work, but he also had an apparent interest in criminal matters. In 1886, he followed the
Pimlico Mystery, the poisoning trial of Adelaide Bartlett for the murder of her husband Edwin. After a spirited defence by
Sir Edward Clarke, Bartlett was acquitted. The key problem of the trial was that Edwin was poisoned by liquid chloroform, which was found in his stomach, but liquid chloroform burns the throat if swallowed, and the drinker would be screaming. Edwin Bartlett never screamed the night he died. As a result, an alternative theory of suicide was considered and helped get the acquittal, but it left the public unsatisfied. Paget, upon hearing the result, made the comment for which he is best remembered: "Now that she has been acquitted for murder and cannot be tried again, she should tell us in the interest of science how she did it!"
See also
*
James Paget University Hospital
James Paget University Hospital is at Gorleston-on-Sea, Great Yarmouth, Norfolk, England, on the A47 Lowestoft Road. It is managed by the James Paget University Hospitals NHS Foundation Trust.
History
The hospital, which replaced Great Yarmout ...
References
Sources
*
*
*
External links
Sir James PagetHistory of Surgeons – surgeons.org.uk
''Lectures on Surgical Pathology'' (New York, 1860)
{{DEFAULTSORT:Paget, James
19th-century English medical doctors
English scientists
British pathologists
Fellows of the Royal Society
People from Great Yarmouth
Alumni of the Medical College of St Bartholomew's Hospital
Baronets in the Baronetage of the United Kingdom
Members of the Royal Swedish Academy of Sciences
1814 births
1899 deaths
Vice-Chancellors of the University of London