James Paget

Biography

• Born 11 January 1814, Great Yarmouth, United Kingdom
• 1834-1836 Medical school, St Bartholomew’s Hospital, London
• 1838 – Contracted Typhoid after conducting a post-mortem
• 1846 – Elected fellow of the Royal College of Surgeons
• 1847 – Appointed the Aris and Gale Professor of the Royal College  where he gave lectures on nutrition, blood, repair and reproduction following injury, inflammation and tumours. These lectures formed the basis for his classical text Lectures on Surgical Pathology.
• 1858 – Royal Surgeon Extraordinary
• 1863 – Surgeon-in-Ordinary to His Royal Highness, the Prince of Wales
• 1867 – Sergeant-Surgeon Extraordinary
• 1871 – Awarded a Baronet by Queen Victoria, pronouncing him Sir James Paget
• 1877 – Sergeant-Surgeon to Queen Victoria during her reign
• Died 30 December 1899, London, United Kingdom

Medical Eponyms

Paget-Schroetter Syndrome: Axillo-subclavian vein thrombosis due to endothelial trauma, as a result of repetitive activity of the upper limbs. [Paget 1858; 1875 and Schrötter 1884. Attribution by ESR Hughes 1948]

1858 – Paget described ‘some affections of voluntary muscles as a consequence of excessive exercise’ with reference to four cases of enlargement of the upper limb appearing to be associated with ‘dilated or varicose state of the veins’

In another case, in a soldier 27 years old, there was great enlargement of all the muscles of the right arm and shoulder, and such fulness of all its subcutaneous veins, and such a feeling of weight and tightness when it hung down, that I supposed the axillary vein must be obstructed. However, with rest in the Hospital, and the occasional application of leeches, the muscles gradually diminished, and the veins be came less filled; and finally, during an attack of scarlatina, they returned to nearly their natural state.

Paget, Medical Times and Gazette. March 1858

1875 – Paget described in greater detail two of these cases in the chapter “gouty phlebitis” in his collection of Clinical lectures and essays. This is generally taken as the first description of effort thrombosis, despite a clear reference to the original publication of the cases from March 1858.

In strong contrast with cases of widely diffused phlebitis, are those in which a single small portion of a great vein becomes obstructed…

A man about 50 years old, thin, and moderately muscular, and usually healthy, observed, during a September, that his right arm was growing larger, and, as he thought, stronger, and fitter for work…I found the upper arm two inches more in circumference than the left, and the whole limb enlarged in the same proportion.

With the help of the hot douche, warmth, and friction, the swelling of the arm very gradually subsided; and, as it did so, the cord-like feeling of the obliterated axillary vein became more distinct. A year elapsed before the vein regained its completely natural condition.

Paget, ‘Gouty Phlebitis’ 1875

Paget’s disease of the nipple. (1874)

Paget’s disease of bone (1877) [aka Paget’s disease; osteitis deformans]

Paget’s Sign: A test eliciting a fluid filled mass. Two fingers are placed either side of the lump / mass in question, and when a third finger pressed on top, the two fingers move apart.

Paget’s Recurrent Fibroid (AKA Desmoid tumour) (1853): A fibroid-like tumour, that despite surgical removal reoccurred at the same site. His attention was drawn to this condition following repeated removal of fibroid like masses from the same site. His case series, which documents distributions all over the body described his attempts to diagnose and understand the reoccurrence.

Paget’s residual abscess (1869): Paget described the formation of abscesses at the site of prior inflammation and suppuration. He published a series of case reports in 1869, detailing recurrent abscesses distributed across numerous anatomical sites and age groups.

All abscesses formed in or about the residues of former inflammations

Key Medical Attributions

Osgood-Schlatter disease (1891)

Carpal Tunnel syndrome (1854:42-44)

1869 Introduced many of the approaches that underpin the foundations of the empirical study of medical education as a scientific discipline. Paget’s article initiated research in medical education, and, despite being neglected, anticipated much that eventually followed. He singularly anticipated the questions, the methods, and the approaches of future empirical research in medical education, and which deserves proper recognition. [Lancet. 2005]

Controversies

Trichinella spiralis

Whilst a first year medical student, he isolated, prepared and documented samples of Trichinella spiralis, a parasite he observed in dissection studies. However, it was his supervisor, Richard Owen who named the species and presented it to the Zoological society, taking credit for the discovery. On the discovery of the parasites in cadaver specimens, Paget stated:

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

Osteitis deformans

In Paget’s second paper on osteitis deformans (later termed Paget’s disease of the bone), he admits that he was not the first to use the term. He grants credit to a German physician, Professor Czerny. Paget writes:

After the publication of the paper I found that the name ostitis deformans had been given by Prof. Czerny, of Freiburg, to a disease described by him in the ‘Wiener medizinische Wochenschrift,’ September 27th, 1873. It Is mainly, as he says, “Eine locale Malacie des Unterschenkels,” a rather acute inflammation of the lower part of the tibia and fibula, inducing softening and angular bending, and then followed by hardening.

Major Publications

• Paget J. Account of a dislocation, in consequence of disease of the first and second cervical vertebrae. Medico-Chirurgical Transactions 1848; 31: 285-95.
• Paget J. Lectures on surgical pathology: Delivered at the Royal College of Surgeons of England.1853 [Carpal Tunnel]
• Paget J. On some affections of voluntary muscles III. Medical Times and Gazette. 1858; 260-261[Paget-Schroetter syndrome]
• Paget J. What becomes of medical students. St Bartholomew’s Hospital Reports 1869; 5: 238–242.
• Paget J. On diseases of the mammary areola preceding cancer of the mammary gland. St. Bartholomew Hospital Reports, London, 1874, 10: 87-89. [Paget’s disease of the nipple]
• Paget J. Gouty Phlebitis. In: Clinical lectures and essays. 1875 [Paget-Schroetter syndrome p305-308]
• Paget J. On a Form of Chronic Inflammation of Bones (Osteitis Deformans). Medico-Chirurgical Transactions 1877;60:37-64 [Paget’s disease of bone]
• Paget J. The Hunterian oration. 1877
• Paget J. Additional cases of osteitis deformans, notes on seven cases. Medico-Chirurgical Transactions 1882; 65: 225-36 [Paget’s disease of bone]
• Paget J. The Hunterian oration. 1877
• Paget J. An address on the utility of scientific work in practice. Br Med J 1887;2: 811-814
• Paget J. Lectures in Surgical Pathology, Vol 2. Royal College of Surgeons England, 1853. p155-166.
• Paget, J. On Residual Abscesses. Saint Bartholomew’s Hospital reports, Volume 5. 1968. p73 – 79.

References

• Turner G. The Paget tradition. New England Journal of Medicine, 1931;205: 622-629
• Buchanan W. The contribution of Sir James Paget (1814-1894) to the study of rheumatic disease. Clin Rheumatol. 1996 Sep;15(5):461-72. [PMID 8894359]
• Buchanan W. Sir James Paget (1814-99): surgical Osler? Proc R Coll Physicians Edinb. 1996 Jan;26(1):91-114. [PMID 11614125]
• Colman E. Sir James Paget: the man and the eponym. Calcif Tissue Int. 2002 May;70(5):430-1. [PMID 11960206]
• McManus IC. Sir James Paget’s research into medical education. Lancet. 2005 Aug 6-12;366(9484):506-13.
• Paget J. The first description of carpal tunnel syndrome. J Hand Surg Eur Vol. 2007 [PMID 17296253]
• Top 100 Ultrasound – Ultrasound Case 085