James Paget
Encyclopedia
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
surgeon
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
and pathologist who is best remembered for Paget's disease
Paget's disease
Sir James Paget, a surgeon and pathologist, described several diseases, including:* Paget's disease of bone * Paget's disease of the breast* Paget-Schroetter disease* Extramammary Paget's disease...
and who is considered, together with Rudolf Virchow
Rudolf Virchow
Rudolph Carl Virchow was a German doctor, anthropologist, pathologist, prehistorian, biologist and politician, known for his advancement of public health...
, as one of the founders of scientific medical pathology. His famous works included Lectures on Tumours (1851) and Lectures on Surgical Pathology (1853). While most people recall that Paget's disease refers to bone, there were actually three diseases named after him: Paget's disease of bone
Paget's disease of bone
Paget's disease is a chronic disorder that can result in enlarged and misshapen bones. The excessive breakdown and formation of bone tissue causes affected bone to weaken, resulting in pain, misshapen bones, fractures, and arthritis in the joints near the affected bones...
, Paget's disease of the nipple (a form of intraductal breast cancer
Breast cancer
Breast cancer is cancer originating from breast tissue, most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk. Cancers originating from ducts are known as ductal carcinomas; those originating from lobules are known as lobular carcinomas...
spreading into the skin around the nipple), and Extramammary Paget's disease
Extramammary Paget's disease
Extramammary Paget’s disease , also Extramammary Paget disease, is a rare, slow-growing, usually non-invasive intraepithelial adenocarcinoma outside of the mammary gland and includes Paget's disease of the vulva and the extremely rare Paget's disease of the penis...
. Also named for him is Paget's abscess
Paget's abscess
A Paget's Abscess, named by eminent British surgeon and pathologist Sir James Paget, is an abscess that recurs at the site of a former abscess which had resolved.- External links :*...
.
Life
Paget was born in Great YarmouthGreat Yarmouth
Great Yarmouth, often known to locals as Yarmouth, is a coastal town in Norfolk, England. It is at the mouth of the River Yare, east of Norwich.It has been a seaside resort since 1760, and is the gateway from the Norfolk Broads to the sea...
, England
England
England is a country that is part of the United Kingdom. It shares land borders with Scotland to the north and Wales to the west; the Irish Sea is to the north west, the Celtic Sea to the south west, with the North Sea to the east and the English Channel to the south separating it from continental...
on 11 January 1814, the son of a brewer and shipowner. He was one of a large family, and his brother Sir George Paget (1809-1892), who became Regius Professor of Physic
Regius Professor of Physic (Cambridge)
The Regius Professorship of Physic is one of the oldest professorships at the University of Cambridge, founded by Henry VIII in 1540. "Physic" is an old word for medicine, , not physics.-Regius Professors of Physic:...
at the University of Cambridge
University of Cambridge
The University of Cambridge is a public research university located in Cambridge, United Kingdom. It is the second-oldest university in both the United Kingdom and the English-speaking world , and the seventh-oldest globally...
in 1872, also had a distinguished career in medicine
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
and was made a K.C.B.. He attended a day-school in Yarmouth, and afterwards was destined for the navy; but this plan was given up, and at the age of sixteen he was apprenticed to a general practitioner
General practitioner
A general practitioner is a medical practitioner who treats acute and chronic illnesses and provides preventive care and health education for all ages and both sexes. They have particular skills in treating people with multiple health issues and comorbidities...
, whom he served for four and a half years, during which time he gave his leisure hours to botanising
Botany
Botany, plant science, or plant biology is a branch of biology that involves the scientific study of plant life. Traditionally, botany also included the study of fungi, algae and viruses...
, and made a great collection of the flora of East Norfolk
Norfolk
Norfolk is a low-lying county in the East of England. It has borders with Lincolnshire to the west, Cambridgeshire to the west and southwest and Suffolk to the south. Its northern and eastern boundaries are the North Sea coast and to the north-west the county is bordered by The Wash. The county...
. 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
St Bartholomew's Hospital, also known as Barts, is a hospital in Smithfield in the City of London, England.-Early history:It was founded in 1123 by Raherus or Rahere , a favourite courtier of King Henry I...
, in London
London
London is the capital city of :England and the :United Kingdom, the largest metropolitan area in the United Kingdom, and the largest urban zone in the European Union by most measures. Located on the River Thames, London has been a major settlement for two millennia, its history going back to its...
. Here he is noted to have described the first journal club
Journal club
A journal club is a group of individuals who meet regularly to critically evaluate recent articles in scientific literature. Journal clubs are usually organized around a defined subject in basic or applied research. For example, the application of evidence-based medicine to some area of medical...
. Medical students in those days were left very much to themselves; there was no close supervision of their work, but it is probable that Paget gained rather than lost by having to fight his own way. He swept the board of prizes in 1835, and again in 1836; and in his first winter session he discovered the pathogen
Pathogen
A pathogen gignomai "I give birth to") or infectious agent — colloquially, a germ — is a microbe or microorganism such as a virus, bacterium, prion, or fungus that causes disease in its animal or plant host...
for trichinosis
Trichinosis
Trichinosis, also called trichinellosis, or trichiniasis, is a parasitic disease caused by eating raw or undercooked pork or wild game infected with the larvae of a species of roundworm Trichinella spiralis, commonly called the trichina worm. There are eight Trichinella species; five are...
, a parasitic disease
Parasitic disease
A parasitic disease is an infectious disease caused or transmitted by a parasite. Many parasites do not cause diseases. Parasitic diseases can affect practically all living organisms, including plants and mammals...
caused by Trichina spiralis, a minute roundworm that infests the muscle
Muscle
Muscle is a contractile tissue of animals and is derived from the mesodermal layer of embryonic germ cells. Muscle cells contain contractile filaments that move past each other and change the size of the cell. They are classified as skeletal, cardiac, or smooth muscles. Their function is to...
s of the human body, and which is usually acquired by eating infected pork
Pork
Pork is the culinary name for meat from the domestic pig , which is eaten in many countries. It is one of the most commonly consumed meats worldwide, with evidence of pig husbandry dating back to 5000 BC....
. In May 1836 he passed his examination at the Royal College of Surgeons
Royal College of Surgeons of England
The Royal College of Surgeons of England is an independent professional body and registered charity committed to promoting and advancing the highest standards of surgical care for patients, regulating surgery, including dentistry, in England and Wales...
, 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
Hospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....
museum
Museum
A museum is an institution that cares for a collection of artifacts and other objects of scientific, artistic, cultural, or historical importance and makes them available for public viewing through exhibits that may be permanent or temporary. Most large museums are located in major cities...
and of the pathological
Pathology
Pathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....
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
Anatomy is a branch of biology and medicine that is the consideration of the structure of living things. It is a general term that includes human anatomy, animal anatomy , and plant anatomy...
at the hospital; but his advancement there was hindered by the privileges of the hospital apprentices, and by the fact that he had been too poor to afford a house-surgeoncy, or even a dressership.
In 1841 he was made surgeon to the Finsbury Dispensary
Finsbury Dispensary
The Finsbury Dispensary was a charitable dispensary dispensing medical treatment to the poor in Finsbury, London. It was founded in 1780 by a quaker, one George Friend. It operated from various premises during its existence in the 19th century, notably, between 1819 and 1838 it occupied a large,...
; but this appointment did not give him any experience in the graver operations of surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
. In 1843 he was appointed lecturer on general anatomy (microscopic anatomy) and physiology
Physiology
Physiology is the science of the function of living systems. This includes how organisms, organ systems, organs, cells, and bio-molecules carry out the chemical or physical functions that exist in a living system. The highest honor awarded in physiology is the Nobel Prize in Physiology or...
at the hospital, 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 thirty 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, 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
Surgical pathology is the most significant and time-consuming area of practice for most anatomical pathologists. Surgical pathology involves the gross and microscopic examination of surgical specimens, as well as biopsies submitted by non-surgeons such as general internists, medical subspecialists,...
. The first edition of these lectures, which were the chief scientific work of his life, was published in 1853 as Lectures on Surgical Pathology. In 1851 he was elected a Fellow of the Royal Society
Royal Society
The Royal Society of London for Improving Natural Knowledge, known simply as the Royal Society, is a learned society for science, and is possibly the oldest such society in existence. Founded in November 1660, it was granted a Royal Charter by King Charles II as the "Royal Society of London"...
. 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 Virchow
Rudolph Carl Virchow was a German doctor, anthropologist, pathologist, prehistorian, biologist and politician, known for his advancement of public health...
had done in Germany
Germany
Germany , officially the Federal Republic of Germany , is a federal parliamentary republic in Europe. The country consists of 16 states while the capital and largest city is Berlin. Germany covers an area of 357,021 km2 and has a largely temperate seasonal climate...
; but he had hardly begun to get into practice, and he had kept himself poor that he might pay his share of his fathers debts- a task that took him fourteen years to fulfill.
Paget was the father of Sir John Paget (2nd Baronet); the Rt Revd Dr Francis Paget
Francis Paget
The Right Reverend Francis Paget was the 33rd Bishop of Oxford from 1901 until his death. He was the second son of the noted surgeon Sir James Paget, 1st Baronet, and brother of Luke Paget, Bishop of Chester. He was educated at St Marylebone Grammar School,Shrewsbury and Christ Church, Oxford...
, Lord Bishop of Oxford
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 Rt Revd Dr Luke Paget, Lord Bishop of Chester
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 expands across most of the historic county boundaries of Cheshire, including the Wirral Peninsula and has its see in the City of Chester where the seat is located at the Cathedral...
; and Stephen Paget
Stephen Paget
Stephen Paget was an English surgeon, the son of the distinguished surgeon and pathologist Sir James Paget. Stephen Paget has been long credited with proposing the "seed and soil" theory of metastasis, even though in his paper “The Distribution Of Secondary Growths In Cancer Of The Breast”, The...
, an English surgeon who first proposed the "seed and soil" theory of metastasis
Metastasis
Metastasis, or metastatic disease , is the spread of a disease from one organ or part to another non-adjacent organ or part. It was previously thought that only malignant tumor cells and infections have the capacity to metastasize; however, this is being reconsidered due to new research...
.
Paget was friends with Charles Darwin
Charles Darwin
Charles Robert Darwin FRS was an English naturalist. He established that all species of life have descended over time from common ancestry, and proposed the scientific theory that this branching pattern of evolution resulted from a process that he called natural selection.He published his theory...
and Thomas Henry Huxley. He was a committed Christian
Christian
A Christian is a person who adheres to Christianity, an Abrahamic, monotheistic religion based on the life and teachings of Jesus of Nazareth as recorded in the Canonical gospels and the letters of the New Testament...
and maintained that there was no conflict between religion and science.
Works
It is probable that no famous surgeon, not even John HunterJohn Hunter (surgeon)
John Hunter FRS was a Scottish surgeon regarded as one of the most distinguished scientists and surgeons of his day. He was an early advocate of careful observation and scientific method in medicine. The Hunterian Society of London was named in his honour...
(1728-1793), ever 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
English language
English is a West Germanic language that arose in the Anglo-Saxon kingdoms of England and spread into what was to become south-east Scotland under the influence of the Anglian medieval kingdom of Northumbria...
, French
French language
French is a Romance language spoken as a first language in France, the Romandy region in Switzerland, Wallonia and Brussels in Belgium, Monaco, the regions of Quebec and Acadia in Canada, and by various communities elsewhere. Second-language speakers of French are distributed throughout many parts...
, German
German language
German is a West Germanic language, related to and classified alongside English and Dutch. With an estimated 90 – 98 million native speakers, German is one of the world's major languages and is the most widely-spoken first language in the European Union....
, Dutch
Dutch language
Dutch is a West Germanic language and the native language of the majority of the population of the Netherlands, Belgium, and Suriname, the three member states of the Dutch Language Union. Most speakers live in the European Union, where it is a first language for about 23 million and a second...
and Italian
Italian language
Italian is a Romance language spoken mainly in Europe: Italy, Switzerland, San Marino, Vatican City, by minorities in Malta, Monaco, Croatia, Slovenia, France, Libya, Eritrea, and Somalia, and by immigrant communities in the Americas and Australia...
literature of the subject, and by incessant study and microscope
Microscope
A microscope is an instrument used to see objects that are too small for the naked eye. The science of investigating small objects using such an instrument is called microscopy...
work had put himself level with the most advanced knowledge of his time; so that it was said of him by Robert Owen
Robert Owen
Robert Owen was a Welsh social reformer and one of the founders of utopian socialism and the cooperative movement.Owen's philosophy was based on three intellectual pillars:...
, 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.
In pathology his work was even more important. He fills the place in pathology that had been left empty by Hunter's death in 1793; 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
Bacteriology is the study of bacteria. This subdivision of microbiology involves the identification, classification, and characterization of bacterial species...
of the present day. It is Paget's greatest achievement that he made pathology dependent, in everything, on the use of the microscope, especially the pathology of tumors. 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
Cavendish Square is a public square in the West End of London, very close to Oxford Circus, where the two main shopping thoroughfares of Oxford Street and Regent Street meet. It is located at the eastern end of Wigmore Street, which connects it to Portman Square, part of the Portman Estate, to its...
, 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, and in 1863 surgeon in ordinary to Albert Edward, Prince of Wales
Edward VII of the United Kingdom
Edward VII was King of the United Kingdom and the British Dominions and Emperor of India from 22 January 1901 until his death in 1910...
. He had for many years the largest and most arduous surgical practice in London. His days work was seldom less than sixteen or seventeen 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; and he was the first to urge removal of the tumour, instead of amputation
Amputation
Amputation is the removal of a body extremity by trauma, prolonged constriction, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on individuals as a preventative surgery for...
of the limb, in cases of myeloid sarcoma. In 1870, he was elected a foreign member of the Royal Swedish Academy of Sciences
Royal Swedish Academy of Sciences
The Royal Swedish Academy of Sciences or Kungliga Vetenskapsakademien is one of the Royal Academies of Sweden. The Academy is an independent, non-governmental scientific organization which acts to promote the sciences, primarily the natural sciences and mathematics.The Academy was founded on 2...
.
In 1871 he nearly died from infection
Infection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...
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 baronetcy of Harewood Place (Middlesex). In 1874 he received an honorary degree from the University of Cambridge
University of Cambridge
The University of Cambridge is a public research university located in Cambridge, United Kingdom. It is the second-oldest university in both the United Kingdom and the English-speaking world , and the seventh-oldest globally...
. In 1875 he was president of the Royal College of Surgeons, and in 1877 delivered the Hunterian oration. In 1875 he was also elected as president of the Medical and Chirurgical Society of London
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 because of disagreement with the autocratic style of its president, James Sims...
. In 1878 he gave up operating, but for eight or ten years longer he still had a very heavy consulting practice. In 1881 he was president of the International Medical Congress held in London; in 1880 he gave, at Cambridge, a memorable address on Elemental Pathology, setting forth the likeness of certain diseases of plant
Plant
Plants are living organisms belonging to the kingdom Plantae. Precise definitions of the kingdom vary, but as the term is used here, plants include familiar organisms such as trees, flowers, herbs, bushes, grasses, vines, ferns, mosses, and green algae. The group is also called green plants or...
s and trees to those of the human body.
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
University of London
-20th century:Shortly after 6 Burlington Gardens was vacated, the University went through a period of rapid expansion. Bedford College, Royal Holloway and the London School of Economics all joined in 1900, Regent's Park College, which had affiliated in 1841 became an official divinity school of the...
. 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
Aleister Crowley , born Edward Alexander Crowley, and also known as both Frater Perdurabo and The Great Beast, was an influential English occultist, astrologer, mystic and ceremonial magician, responsible for founding the religious philosophy of Thelema. He was also successful in various other...
for tongue cancer. An operation was advised but Crowley declined and died the following year.
He died in London on 30 December 1899, at the age of 85.
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
Music
Music is an art form whose medium is sound and silence. Its common elements are pitch , rhythm , dynamics, and the sonic qualities of timbre and texture...
. He possessed the rare gift of 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, 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
Politics
Politics is a process by which groups of people make collective decisions. The term is generally applied to the art or science of running governmental or state affairs, including behavior within civil governments, but also applies to institutions, fields, and special interest groups such as the...
, 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 poisoning trial of Adelaide Bartlett for the murder of her husband Edwin. After a spirited defense by
Sir Edward Clarke
Edward George Clarke
Sir Edward George Clarke QC QC was a British barrister and politician, considered one of the leading advocates of the late Victorian era and serving as Solicitor-General in the Conservative government of 1886–1892...
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 he is best remembered for: "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!" Paget's interests in crime were shared by his son John Paget, who wrote a book Puzzles and Paradoxes about several famous historical mysteries.
External links
- Sir James Paget History of Surgeons - surgeons.org.uk
- Lectures on Surgical Pathology (New York, 1860)