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March 2018

Sir James Paget—Contributions of a Surgeon and Pathologist

Author Affiliations
  • 1Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
  • 2University of Maryland School of Medicine, Baltimore
  • 3University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
JAMA Dermatol. 2018;154(3):335. doi:10.1001/jamadermatol.2017.6127

Sir James Paget is remembered as one of the greatest English surgeons and fathers of pathology. After passing the College of Surgeon’s Examination in 1836, he struggled to find a job practicing medicine and spent 7 years doing various odd jobs for minimal compensation.1

In 1843, Paget joined St Bartholomew’s Hospital; while working there as a professor and assistant surgeon, he encountered 15 women 40 years or older who presented with “an eruption on the nipple and areola.” In most of these women, the erythematous eruption “had the appearance of a florid, intensely red, raw surface, very finely granular, as if nearly the whole thickness of very acute diffuse eczema, or like that of an acute balanitis.”2(p303) Paget noticed clear, yellowish, and viscid exudation on the nipple and areola of these women that was resistant to local and general treatment. Furthermore, he found that a mammary gland tumor followed in every case within 1 to 2 years. Paget published his findings as On Disease of the Mammary Areola Preceding Cancer of the Mammary Gland in St Bartholomew’s Hospital Reports in 1874, and his discovery was named Paget disease of the breast.2

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