SIR JAMES PAGET'S NOTES ON HIS STUDENTS by John L. Thornton, A.L.A. Librarian, St. Bartholomew's Hospital Medical College

THE LIBRARY OF the Royal College of Surgeons of houses a notebook in the handwriting of Sir James Paget (1814-1899) which records the names of students who attended his Demonstrations on Morbid between 1839 and 1843, and his Lectures on General Anatomy and between 1843 and 1859. These were given at St. Bartholomew's Hospital. The notebook is interleaved, and Paget used the blank pages for annotations which are brief, sometimes pungent, but, judging by the upright character of their writer, always strictly fair. The notebook was presented to the Royal College of Surgeons in 1910 by , Sir James' son, but Sir James had used the list in the compilation of his paper " What becomes of medical students" published in 1869. In this he recorded the success or otherwise of one thousand of his students, and presented the following facts. In one category he noted that twenty-three achieved distinguished success; sixty-six considerable success; 507 fair success ; and 124 very limited success. A total of fifty-six failed entirely; ninety-six left the profession; eighty-seven died within twelve years of commencing practice; and forty-one died during their pupilage, seventeen of " phthisis." Of the failures, fifteen did not pass the examinations ; five failed through scandalous misconduct; ten through ill-health or ill-luck; and ten through intemperance or dissipation. Those who left the profession retired on private means, became actors, soldiers, entered the Church, took up farming, [etc.], and " three became homoeopathic practitioners, but took to that class no repute for either wisdom or working power." Of those who died, nearly 13 per cent. were dead within fifteen years, but Paget commented that this was about the general average mortality, and suggested that there was no higher mortality among medical students at that period. Five committed suicide, and one was hung. This was the notorious William Palmer, of whom Paget wrote: " Idle, dissolute, extravagant, vulgar and stupid. He scarcely practised and was chiefly engaged on the turf. He was hung for the murder of a friend Wm. Cook in [1886]." Some of Paget's comments are very interesting, and throw light on the social conditions of the period, particularly as regards medical students. For example, of one person Paget wrote: "An exceedingly idle student, dull, and drunken. He married an innkeeper's daughter in his pupilage and she reclaimed him, and he got into practice at Abingdon and lived respectfully even after her death." George King was "A working student, of fair ability and a good anatomist. Directly after passing the College he turned farmer, and in 1860 was a ' highly respected parishioner' near Newmarket, fat and with many children." A tragic incident is recorded in the following: "A very hardworking, earnest, student, with considerable power of learning; a scholar. Soon after passing, he had acute mania, and during partial recovery committed suicide in an Asylum." W. S. Robins was " a vulgar, noisy, dissipated man, who in his first session spent too much money and was taken away and left the profession." A promising student was Joseph Eld, " one of the most laborious, clear-headed, and capacious students I ever knew. He could learn everything without a fault. Besides he was eminently industrious and gentle. So beautiful a mind, surely never occupied so grotesque and strange a body : and this inferior part of him died after his second year of study." 199 SIR JAMES PAGET'S NOTES ON HIS STUDENTS George F. Dansey was " a well-meaning, weak-minded man. He married a prostitute during his pupilage, and went into a very small practice among the poor at Somers Town. But his wife 'turned to,' dispensed for him, took in Invalids, and kept his house well: and in 1860 he was well afloat." A less happy ending is suggested for James S. Webb, " a vulgar low fellow, practising illegally. Was convicted of an indecent assault on some female patient and was ' recom- mended to leave,' and did so in 1855-6." It is of interest to read through the names in Paget's notebook, picking out those who later achieved success. Among those that will readily be recognised are the following: Sir William Scovell Savory (1826-1895), who became Surgeon to St. Bartholomew's Hospital, President of the Royal College of Surgeons, and Surgeon Extraordinary to , but on whom Paget fails to comment. John Abernethy Kingdom (a godson of John Abernethy), of whom Paget states he was " amiable and industrious but of small ability, [etc.]." Henry Power (1829-191 1), Ophthalmic Surgeon to St. Bartholomew's Hospital, and father of Sir D'Arcy Power (1855-1941). John A. Warburton, "Abernethy's grandson. He inherited large property in Lunatic Asylums but died in his pupilage." George W. Callendar (1830-1879), Surgeon to Bart's Hospital from 1871 until his premature death in 1879, of whom Paget wrote: " Steady in work, clear- headed, able to learn and a singularly clear writer [etc.]." Sir Thomas Smith (1833-1909), the last of Paget's apprentices, who became distinguished as a surgeon and as a teacher, but on whom Paget fails to comment, probably because it was unnecessary. Sir William Turner (1832-1916), Professor of Anatomy at Edinburgh, and later Principal of the University. Daniel Hack Tuke (1827- 1895), who became eminent as a psychiatrist and the author of several books on the subject, who Paget described as " a very steady, working and well-informed man. He went into Lunacy-practice." Sir (1828-1913), who failed to be elected to the staff at Bart's, but achieved distinction as a surgeon and author. As a student he was " One of the most industrious observers of cases that I ever knew. I recommended him for the work of reporting for the Medical Gazette, and he did excellently in it and rose well." The first woman doctor who had taken a medical degree in America was admitted to Bart's as a student by Paget. She was , and Paget passed the following comments on her: " The celebrated Dr. Elizabeth Blackwell-a sensible, quiet, discreet lady-she gained a fair knowledge (not more) of medicine; practised in New York: then tried to promote female doctordom in England." This was the first woman student at Bart's, and the experiment was not tried again for many years, despite the apparent success of the venture. George Rolleston (1829-1881) became Linacre Professor of Anatomy and Physiology at Oxford, and Sir George Murray Humphry (1820-1896), Professor of Anatomy (later of Surgery) at Cambridge, making at least three of Paget's pupils who became professors of anatomy. Howard Marsh (1839-1915) was also to become Surgeon at St. Bartholomew's Hospital, and later went as Professor of Surgery to Cambridge. W. Morrant Baker (1839-1896) and William Senhouse Kirkes (1823-1864) are among other famous names that might be mentioned Paget also had as a pupil the son of Charles Costerton of Yarmouth, to whom he himself had been apprenticed. Against the name of Horace Costerton a line is drawn through the column normally devoted to fees, and Paget must have written with sorrow the words " Silly, idle, dull, but the least vicious of my old Master's four sons. He was for a year or two an assistant, but then died of fever in the hospital." The above gives some idea of the fascinating information to be gleaned from a perusal of Sir James Paget's Notebook, and tends to emphasize the importance of the words with which Paget ended his paper: " The time and place, the work to be done, and its responsibilities, will change; but the man will be the same, except in so far as he may change himself." 200 SIR JAMES PAGET'S NOTES ON HIS STUDENTS ACKNOWLEDGMENT My special thanks are due to Mr. W. R. LeFanu, M.A., Librarian, the Royal College of Surgeons of England, for permission to have Paget's Notebook photographed so that a copy might be deposited in the College Archives of St. Bartholomew's Hospital.

REFERENCE PAGET, J. (1869) St. Bart's Hosp. Rep. 5, 238 ; also in Selected essays and addresses by Sir James Paget, London, Longmans, Green, 1902, p. 27.

ANNALS EDITORIAL OFFICE AS FROM THE end of this month the Annals Editorial Office will be situated on the first floor of the main College building, a short way down the corridor past the Library, in the direction of the gallery of the Great Hall.

DIARY FOR SEPTEMBER (18th-30th) Wed. 18 D.C.H. Examination begins. Thur. 19 First Membership Examination begins. Tues. 24 Final Membership Examination begins. 5.00 PROF. G. WALD-Edridge-Green Lecture-The molecular basis of vision. * Wed. 25 D.Orth. Examination begins. Thur. 26 5.00 PROF. J. F. SILVA-Hunterian Lecture-Old dislocations of the elbow.* Mon. 30 Surgery Lectures and Clinical Conferences begin. 5.15 MR. N. R. BARRETT-Hiatus hernia. 6.30 MR. G. F. ROWBOTHAM-Head injuries and their surgical indications. DIARY FOR OCTOBER Tues. 1 5.15 MR. C. W. FLEMMING-Some fractures of the humerus. Wed. 2 5.15 PROF. LAMBERT ROGERS-Spinal cord tumours. 6.30 MR. HAROLD BURGE-Problems in breast cancer. Thur. 3 5.15 DR. C. F. SCURR-Anaesthesia in thoracic and cardiac surgery. 6.30 MR. PATRICK CLARKSON-The management of burns. Fri. 4 5.15 SIR REGINALD WATSON-JONEs-Fractures and allied disorders of the spine. Mon. 7 5.15 MR. W. M. CAPPER-The surgery of peptic ulceration. 6.30 MR. A. W. L. KESSEL-Surgery of the osteo-arthritic hip-joint. Tues. 8 5.00 DR. B. C. MORSON-Erasmus Wilson Demonstration.* Wed. 9 Final L.D.S. Examination (Part I) begins. 5.15 MR. W. J. LYTLE-Inguinal hernia-history and recent advances. 6.30 PROF. R. MILNES WALKER-Portal hypertension. 7.30 Monthly Dinner. Thur. 10 D.M.R.T. Examination (Part I) begins. 2.00 Quarterly Council. 5.00 PROF. P. R. ALLISON-Cecil Joll Lecture.* Fri. 11 5.00 Board of Faculty of Dental Surgery. 5.15 MR. A. L. D'ABREU-Surgery of pulmonary tuberculosis. 6.30 MR. D. INNES WILLIAMs-Neoplasms of the urinary tract in child- hood. 201