​PAGET, SIR JAMES,Bart. (1814–1899), British surgeon, born at Yarmouth on the 11th of January 1814, was 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 at Cambridge in 1872, also had a distinguished career in medicine 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, whom he served for four and a half years, during which time he gave his leisure hours to botanizing, and made a great collection of the flora of East Norfolk. At the end of his apprenticeship he published with one of his brothers a very carefulSketch of the Natural History of Yarmouth and its Neighbourhood. In October 1834 he entered as a student at St Bartholomew’s Hospital. 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 detected the presence of theTrichina spiralis, a minute parasite that infests the muscles of the human body.^[1] In May 1836 he passed his examination at the RoyalCollege of Surgeons, and became qualified to practise. Thenext seven years (1836–1843) were spent in London lodgings,and were a time of poverty, for he made only £15 a year bypractice, and his father, having failed in business, could notgive him any help. He managed to keep himself by writing forthe medical journals, and preparing the catalogues of the hospitalmuseum and of the pathological museum of the Royal Collegeof Surgeons. In 1836 he had been made curator of the hospitalmuseum, and in 1838 demonstrator of morbid anatomy atthe hospital; but his advancement there was hindered by theprivileges of the hospital apprentices, and by the fact that hehad been too poor to afford a house-surgeoncy, or even a dressership.In 1841 he was made surgeon to the Finsbury Dispensary;but this appointment did not give him any experience in thegraver operations of surgery. In 1843 he was appointed lectureron general anatomy (microscopic anatomy) and physiologyat 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 residentstudents, he had to enter all new students, to advise them howto work, and to manage the finances and the general affairsof the school. Thus he was constantly occupied with thebusiness of the school, and often passed a week, or more, withoutgoing outside the hospital gates. In 1844 he married Lydia,youngest daughter of the Rev. Henry North. In 1847 he wasappointed an assistant-surgeon to the hospital, and Arris andGale professor at the College of Surgeons. He held this professorshipfor six years and each year gave six lectures in surgicalpathology. (The first edition of these lectures, which werethe chief scientific work of his life, was published in 1853 asLectures on Surgical Pathology.) In 1851 he was elected aFellow of the Royal Society. In October 1851 he resigned thewardenship of the hospital. He had now become known as agreat physiologist and pathologist: he had done for pathologyin England what R. Virchow had done in Germany; but he hadhardly begun to get into practice, and he had kept himself poorthat he might pay his share of his father’s debts—a task that it took him fourteen years to fulfil.

It is probable that no famous surgeon, not even John Hunter, 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, French, German, Dutch and Italian literature of the subject, and by incessant study and microscope work had put himself level with the most advanced knowledge of his time; so that it was said of him by R. Owen, 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 modernmicroscope, to the pathology and bacteriology of the present day.It is Paget’s greatest achievement that he made pathologydependent, in everything, on the use of the microscope—especiallythe pathology of tumours. He and Virchow may truly be calledthe founders of modern pathology; they stand together, Paget’sLectures on Surgical Pathology and Virchow’sCellular-Pathologie.When Paget, in 1851, began practice near Cavendish Square,he had still to wait a few years more for success in professionallife. The “turn of the tide” came about 1854 or 1855; andin 1858 he was appointed surgeon extraordinary to QueenVictoria, and in 1863 surgeon in ordinary to the prince ofWales. He had for many years the largest and most arduoussurgical practice in London. His day’s work was seldom lessthan sixteen or seventeen hours. Cases sent to him for finaljudgment, with especial frequency, were those of tumours, andof all kinds of disease of the bones and joints, and all “neurotic”cases having symptoms of surgical disease. His supremacylay rather in the science than in the art of surgery, but his nameis associated also with certain great practical advances. Hediscovered the disease of the breast and the disease of the bones(osteitis deformans) which are called after his name; and hewas the first at the hospital to urge enucleation of the tumour,instead of amputation of the limb, in cases of myeloid sarcoma.

In 1871 he nearly died from infection at a post mortemexamination, and, to lighten the weight of his work, was obligedto resign his surgeoncy to the hospital. In this same yearhe received the honour of a baronetcy. In 1875 he waspresident of the Royal College of Surgeons, and in 1877Hunterian orator. In 1878 he gave up operating, but foreight or ten years longer he still had a very heavy consultingpractice. In 1881 he was president of the InternationalMedical Congress held in London; in 1880 he gave,at Cambridge, a memorable address on “Elemental Pathology,”setting forth the likeness of certain diseases of plants and treesto those of the human body. Besides shorter writings he alsopublishedClinical Lectures and Essays (1st ed. 1875) andStudiesof Old Case-books (1891). In 1883, on the death of Sir GeorgeJessel, he was appointed vice-chancellor of the university ofLondon. In 1889 he was appointed a member of the royalcommission on vaccination. He died in London on the 30thof December 1899, in his eighty-fifth year. Sir James Pagethad the gift of eloquence, and was one of the most careful andmost delightful speakers of his time. He had a natural andunaffected pleasure in society, and he loved music. He possessedthe rare gift of ability to turn swiftly from work to play; enjoyinghis holidays like a schoolboy, easily moved to laughter, keento get themaximum of happiness out of very ordinary amusements,emotional in spite of incessant self-restraint, vigorousin spite of constant overwork. In him a certain light-heartedenjoyment was combined with the utmost reserve, unfailingreligious faith, and the most scrupulous honour. He was allhis life profoundly indifferent toward politics, both nationaland medical; his ideal was the unity of science and practice inthe professional life. (S. P.)