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Sir James Paget (1814-1899)

Sir James PagetJames Paget was born in Great Yarmouth on 11th January 1814.  He was one of 18 children but only 8 survived to adulthood.  His father, Samuel Paget ,was a successful businessman as both a shipping merchant and brewer.  This allowed him to privately educate his three eldest sons at Charterhouse School.  Unfortunately, by the time James reached school age his father's financial situation had changed, resulting in him remaining in Great Yarmouth for his early education.  On leaving school, he initially contemplated joining the navy but instead, at the age of sixteen, became apprentice to a local surgeon, Mr Charles Costerton, for a period of five years.  

In 1834, he moved to London to continue his medical training at St. Bartholomew's Hospital and at the age of 22 he passed the MRCS examination.  His path to becoming a surgeon was somewhat unorthodox.  His apprenticeship in Yarmouth left him without the patronage of a great London surgeon and instead he was forced to be essentially self-taught by attending the ward rounds of Dr Peter Latham.  In his spare time he performed as many postmortem examinations as possible and read many anatomy and surgical texts.   In order to improve his knowledge of anatomy, he taught himself German allowing him to study the works of the great German anatomists and surgeons of the time. In 1837, he was appointed curator at St Bartholomew's with a salary of 100 per year.  During the following years he contributed significantly to both the Medical Gazette and Medical Quarterly Review.  Following a postmortem in 1838 he developed typhus and almost died.  In 1836 he had been elected as one of the founding fellows of the Royal College of Surgeons and within a year he became the Aris and Gale Professor of the college.  At the age of 36 he was unusually young to receive this honour.  

In 1843, his fortune changed.  He was appointed as a lecturer in general anatomy and physiology and within months he became the warden at the newly formed St Bartholomew's College.  In 1844, he married his wife Lydia, a marriage that would last 50 years.  His standing at St Bartholomew's rapidly increased and he was finally appointed to the post of assistant surgeon, seeing up to 200 patients in a day.  In 1858 he was appointed Surgeon-in-Ordinary to his Royal Highness the Prince of Wales and in 1871 he was made a Baronet by Queen Victoria.  In 1864 he retired from surgery.  However, the following year, he was elected to the Council of the Royal College of Surgeons and in 1875 he became President of the college.  He died on 30 December 1899.  His son, the then Bishop of Oxford, presided over his funeral at Westminster Abbey.

He published over 20 articles on various aspects of pathology and surgery.  He was one of the first surgeons to correlate patient's symptoms with the clinical examination and as such to develop many of the ideas of clinical surgery.  His name is eponymously associated with several conditions.  In 1874, he reported a series of 15 cases of chronic ulceration of the nipple in association with breast cancer.  He suggested that chronic ulceration induced the cancer but it is now recognised that the nipple changes are part of the neoplastic process.  In 1876, he described five cases of 'osteitis deformans' which be believed to be an inflammatory disease process.  It is now believed to result from an abnormality of bone remodelling due to an increase in osteoclastic activity, possibly as result of a viral infection.

Recent paper

Coppes-Zantinga A R,  Coppes M J.  Sir James Paget (1814-1889):  A great academic Victorian.  J Am Coll Surg 2000;  191:  70-74.

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