Sir James Paget (1814-1894)

Sir James Paget (Fig. 1) formed with William Fergusson (1808–1862) and Sir Benjamin Brodie (1783–1762) a triumvirate of surgical ‘greats' in England in the nineteenth century [1]. Paget was born in Great Yarmouth, Norfolk, England, and until 20 yr of age had not ventured further than a few miles from his birthplace. His father, Samuel, was a prosperous businessman who unfortunately went bankrupt, so that James after his elementary school education in Great Yarmouth was unable to follow his elder brothers to the famous Charterhouse School, then in London, and following this to be an undergraduate at Cambridge University. However, remaining in Great Yarmouth gave him the opportunity of studying botany in the surrounding countryside, and at age 20 with his elder brother to publish a book on the Natural history of Yarmouth. Not having had the dubious advantage of a public school and Cambridge University education, Paget was not proficient in either Latin or Greek, the hallmarks of the times of an educated person, and he retained his regional accent all his life, never acquiring the artificial public school pronunciation, which came into prominence after the Education Act of 1870. Paget began an apprenticeship as a surgeon–apothecary in 1830 at the age of 16. Four years later he began medical studies at St. Bartholomew's Hospital in London. He proved to be a hard worker and won prizes in medicine, surgery, chemistry and, not surprisingly, botany. Paget's greatest success as a medical student came in 1835 when he described Trichina spiralis, commenting that, ‘All the men in the dissecting rooms, teachers included, “saw” the little white specks in the muscles: but I believe that I alone “looked at” them and “observed” them’. In 1836 Paget passed the College of Surgeons examination, but despite having a distinguished undergraduate career, he was unable to obtain a surgical training post, as he was not a ‘University man’. Instead the following year he became curator of the pathological museum at St. Bartholomew's Hospital where he published a 487‐page Catalogue of the pathological specimens of St. Bartholomew's Hospital. Subsequently he was appointed by the Royal College of Surgeons of England to compile a descriptive catalogue of specimens of John Hunter (1728–1793). In 1841 he was appointed dispensary surgeon at St. Bartholomew's Hospital, and subsequently in 1861 full surgeon—despite having had no formal training in surgery. Sir James Paget received numerous awards, including his knighthood in 1871, and was called upon to give numerous addresses and prestigious lectures, including the Hunterian Oration in 1877. After this oration, William Gladstone (1809–1898) the future prime minister remarked, ‘Demosthenes could not have done it better’. Sir James Paget today is remembered for his description of osteitis deformans [2, 3]. All the clinical features were described, save the most common, namely fractures. Two patients developed bone tumours: one in the humerus, now recognized as one of the most common sites, and the other in the radius. Although sarcomas develop only in a focus of Paget's disease, in both cases the bones appeared on gross appearances to be free of the disease. Unfortunately, the drawings of the histological appearances of the tumour of the radius are uninterpretable. Although Paget believed that osteitis deformans was a new disease, there is abundant evidence of its existence in ancient skeletal remains, confirmed both by histology and radiology, and there is a painting of a grotesque old woman by Quinter Metsys (Massys) (1465–1530) in the National Gallery in London, England, which might be interpreted as Paget's disease of the skull. Today osteitis deformans is known as Paget's disease of bone, perhaps the one example of the preferable use of an eponym to describe a disease. Sir James Paget was also the first to describe osteochondritis dessicans, and also what is known today as Osgood–Schlatter disease [4]. Paget was the first to recognize that the median nerve could be compressed at the wrist, which was only confirmed in the early part of the twentieth century. Sir James Paget was also the first to describe several non‐rheumatological conditions, including: Paget's disease of the nipple, extramammary Paget's skin neoplasm usually involving the anogenital area, axillary vein thrombosis, fibrosarcoma of the abdominal muscles especially rectus abdominis (Paget's recurrent fibroid) and recurrent abscesses (Paget's residual abscesses). Sir James Paget is remembered in St. Bartholomew's Hospital with a ward named after him. A hospital bearing his name, but not his title, was opened in his home town of Great Yarmouth in 1996. Lithograph of Sir James Paget at age 35.

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