Paget , Sir , James , 1814-1899 , 1st Baronet , surgeon

Sir James Paget was born on 11 January 1814 at Great Yarmouth, the son of Samuel Paget, brewer and ship owner, and one time mayor of Great Yarmouth. Paget was the eighth of seventeenth children, nine of which survived childhood, and brother of the eminent physician Sir George Paget. His early education was at a local private school. However his father ran into financial difficulties after the short boom of the post-Napoleonic War years, and Paget could not follow his elder brothers' route through Charterhouse and on to university. In 1830 he was instead apprenticed for five years to Charles Costerton, surgeon in Great Yarmouth. During his apprenticeship Paget wrote and published with one of his brothers a book on the natural history of the town.

In 1834 Paget became a student at St Bartholomew's Hospital (St Bart's), London, and took lodgings in the capital. The following year, whilst undertaking some dissection work, he noticed white specks in the muscles of his subject. On inspection through a microscope he found them to be cysts containing worms. Professor Richard Owen later confirmed his observations, and the parasite became known as Trichina spiralis. From 1835-36 Paget was appointed clinical clerk, under the physician Peter Mere Latham, because he could not afford the fee demanded by the surgeons of the hospital for the office of "dresser". Consequently he did not become a house surgeon. In 1836, at the age of twenty-two, Paget became a member of the Royal College of Surgeons of England.

He made a short study tour to Paris before settling in London, where he supported himself by teaching and writing. From 1837-42 he was sub-editor of the Medical Gazette, and also wrote for the Medical Quarterly Review. In 1837 he was also appointed curator of St Bart's Museum, and in 1839 was made demonstrator of morbid anatomy. In 1841 he was elected surgeon to the Finsbury Dispensary. At St Bart's he was promoted to the position of lecturer on general anatomy and physiology in 1843, and in the same year became one of the original fellows of the Royal College of Surgeons. Also in 1843 he was elected warden of St Bart's new college for students, which in addition to a salary included accommodation within the college. In 1844 he finally married his fiancé Lydia North, after an eight-year engagement.

In 1846 Paget compiled a catalogue of St Bart's Museum, the style and content of which laid the foundation of his reputation. He also prepared a catalogue of the pathological specimens housed in the Hunterian Museum, which appeared between 1846 and 1849. In 1847 he was appointed an assistant surgeon at St Bart's, after a severe contest. There was some opposition to his appointment on the grounds that he had not been a dresser or a house surgeon, and so did not hold the qualifications traditionally thought necessary for the post. From 1847-52 he was Arris and Gale Professor of Anatomy and Surgery at the Royal College of Surgeons. The subsequent publication of these lectures, in his Lectures on Surgical Pathology (1853), gave a great impulse to the study of pathology, which had been waning for some time. In 1851 he was elected fellow of the Royal Society. In the same year he resigned from his post as warden at St Bart's, although he remained assistant surgeon and lecturer. Consequently he found he had the time to set up a consultant practice. He moved to Henrietta Street, to a house large enough to accommodate his growing family and practice.

In 1858, whilst still only an assistant surgeon, he was appointed surgeon-extraordinary to the Queen. He was surgeon to the Prince of Wales, later King Edward VII, and attended the Princess of Wales, later Queen Alexandra, during a long illness. Also in 1858 Paget moved to a larger property in Harewood Place, just off Oxford Street. In 1859 he resigned from his appointment as lecturer in physiology at St Bart's, owing to his burgeoning private practice. At the time his was the largest surgical practice in London. In 1860 he was appointed a member of the Senate of the University of London. He became full surgeon at St Bart's in 1861, and from 1865-69 lectured on surgery at the medical school. From 1865-89 he was a member of the council of the Royal College of Surgeons. From 1867-77 he held the post of Serjeant-Surgeon-Extraordinary. In 1869 he was made president of the Clinical Society.

Paget held great authority amongst his contemporaries, and it has been said that he was a surgeon who

`advanced his art by showing how pathology might be applied successfully to elucidate clinical problems, when as yet there was no science of bacteriology' (DNB, 1901, p.241).

He made great use of the microscope to determine the true nature of morbid growths. He was widely respected as a teacher, due to his eloquence and his ability to grasp the principles of his subject, and to discuss them briefly and clearly. His name is ultimately associated with a chronic eczematous condition of the nipple, which related to breast cancer, and with a chronic inflammation of bones, which was named Osteitis deformans.

Paget resigned as surgeon at St Bart's in 1871 and was immediately appointed a consulting surgeon of the hospital. In the same year he was created a baronet. He was vice president of the Royal College of Surgeons in 1873 and 1874, and president in 1875. In the same year he was elected president of the Royal Medical and Chirurgical Society. He had made numerous contributions to medical literature throughout his career and this continued after his retirement from the hospital. He wrote articles on various topics, including cancer, syphilis and typhoid, as well as surgical conditions. In 1875 he published a collection of his papers entitled Clinical Lectures and Essays. He was the Royal College of Surgeons representative at the General Medical Council from 1876-81, and was the Hunterian orator at the college in 1877. In 1877 he was also made Serjeant-Surgeon to Queen Victoria.

In 1881 Paget was president of the International Congress of Medicine at the meeting held in London. In 1883 he became Vice-Chancellor of the University of London, a post he retained until 1895. In 1887 he was president of the Pathological Society of London. Amongst his many distinctions he was awarded honorary degrees from the universities of Oxford, Cambridge, Dublin, Bonn and Wurzberg.

Lady Paget died in 1895. Paget began to deteriorate soon afterwards, never really recovering from the blow caused by his wife's death. He died at his house in Regent's Park, where he had moved on his retirement, on 30 December 1899. He was buried at Finchley cemetery, after a funeral service at Westminster Abbey. The Pagets' four sons and two daughters survived both parents, their son Francis became Bishop of Oxford, whilst Stephen followed in his father's path and became himself a distinguished surgeon.

Publications:
A Sketch of the Natural History of Great Yarmouth and its Neighbourhood, containing Catalogues of the Species of Animals, Birds, Reptiles, Fish, Insects and Plants, at present known, James & Charles Paget (Yarmouth, 1834)
A Descriptive Catalogue of the Pathological Specimens contained in the Museum of the Royal College of Surgeons (Vol. I 1846; Vol. II 1847; Vol. III 1848; Vols. IV & V 1849; 2nd ed. 1882-85)
A Descriptive Catalogue of the Anatomical Museum of St Bartholomew's Hospital (Vol. I 1847; Vol. II, 1852)
Handbook of Physiology: assisted by J. Paget, William Senhouse, Sir James Paget (London, 1848)
Lectures on Surgical Pathology (London, 1853; 2nd ed. 1863; 3rd ed. 1870; 4th ed. 1876)
Clinical Lectures and Essays, Howard Marsh (ed.) (London, 1875, transl. into French, 1877)
The Hunterian Oration (London, 1877)
On Some Rare and New Diseases (London, 1883)
Studies of Old Case Books (London, 1891)
John Hunter, Man of Science and Surgeon, 1728-93; with an Introduction by Sir James Paget, Stephen Paget (London, 1897)
Memoirs and Letters of Sir James Paget, ed. by Stephen Paget (London, 1901) Posthumously published
Selected Essays and Addresses, edited by S. Paget, Sir James Paget, Stephen Paget (ed.) (London, 1902)

Publications by others about Paget:
Sir James Paget: The Rise of Clinical Surgery, Shirley Roberts (London, 1989)