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Sir James Paget and Paget's Disease

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Sir James Paget and Paget's Disease Zbe ÜBoston flfoebícal anb Suroícal Journal (¡table aï ÜJiutíruh-. February 10,1916 ADDRESS Students' Text Book of Hygiène. By W. James Wilson, M.D.. 208 D. M.D. 209 Paokt and Elliott C. Oxford Medical Publications. By M. Macdonald, Sir James Paoet's Disease. By Cutler, Albert P. Mathews. 209 M.D., Boston. 187 Physiological Chemistry. By ORIGINAL ARTICLES EDITORIALS for State Legislation. 210 A Sketch of the Organization for the Care and National Suggestions Traits* Statistics. 211 PORTAT10N OF THE SlCK AND WOUNDED IN THE BRITISH EX- University Registration Psychological Study of Criminalb at the Massachusetts PEDITIONARY Forces in France. By Itogcr I. Lee, M.D*, 211 Boston. 192 State Prison. Massachusetts Milk Legislation. 212 The Occurrence op the Wabsermann Reaction among Hos- 212 pital 1'atiknth. By Albert A. Hornor, M.D., Boato». 104 Medical Notes. Treatment of Central Nervous System Syphilis. By I. OBITUARY Boston. 195 Chandler Walker, M.D., GeoHoe Howard Malcolm Howe, M.D. 217 THERAPEUTIC AND PREVENTIVE MEDICINE CORRESPONDENCE The Treatment op Syphilis. By C. Morton Smith, M.D., Thomas F. M.D. 221 108 Surgeon of the "Mayflower." Harrington, Boston. op Influenza. D. Spear, M.D. 221 The Source Edmund 222 MEDICAL PROGRESS A Reminiscencp. of Dr. White. liobcrt A. tides. M.D. Acknowledgment From the Front. Allan Récent PnociiiEss in NEunoi.ociY. By John Jcnks Thomas, A Gracious 222 M.D., Boston (Continued). 203 Perry, IA. Col. BOOK REVIEWS MISCELLANY for Dr. Cheever. 217 as a William Allen M.D. 207 Memorial Resolutions Syphilis Modern Problem. By Puscy, in the United States. 218 Mothcrcraft. By Sanili Cornstock. 207 Improvino Cancer Statistics 210 The Practical Series. 208 United States Death Rates in 1014.,. Medicine Examinationb. 220 Sixteenth Annual Report of the State Board of Insanity of Benefit of Physical 222 the Commonwealth of Massachusetts. 208 Notices, Recent Deaths, Etc. care to students and a fine example to any who model their lives thereafter. To clear up what may confuse some of you, I will merely recall that there are two diseases SIR JAMES PAGET AND PAGET'S called Paget's disease. In 1874 Paget read a ' ' Areo- DISEASE.* short report on Disease of the Mammary la Preceding Cancer of the Mammary Gland." BY Elliott C. Cutler, M.D., Boston. At the present time, cancer of the breast, begin- ning about the areola, usually as an intensely I. PAGET'S DISEASE. is known red, raw, finely granular skin lesion, as Paeet's disease. My claim to talk on os- Paget's disease of bone, In disease of bone, called by mm does not rest with interest I Paget's it any exceptional may teitis deformans, we are more interested, and as a medical in this for liave, man, affection, is in relation to this disease that Paget's name it does not seem to within the realms be of pos- is most often recalled. His original communica- that the treatment this dis- sibility successful of tion I have here; it came out in 1876, when he ease shall come through surgical efforts. But, ' ' A Form was years old, and is entitled as to all students of with suffi- sixty-two medicine imbued of Chronic Inflammation of the Bones." Now cient and the values of a historical in curiosity this disease forms a definite clinical picture diseases which are named background, appeal its outward and it occurs to me that, so in aspects after their discoverers, this instance, be- like Addison's disease, Parkinson's disease and the I was led to a the cause of name, study of disease, it was the external manifes- man and times. The was a Hodgkin's his effort thousand tations of the disorder that attracted Paget's times repaid, for James Paget is one of the curiosity and observation and made him study men in modern medicine. I great say modern, further a group of cases so evidently unusual. for he lived the years when anesthesia through Even now there must be many unrecognized dis- was discovered and had as Pas- see contemporaries ease entities amongst us which we may even teur and Lister. but doubtless their outward mani- And to talk on I have full because frequently, Paget right, festations are obscure and vary so greatly that lie was, a much of first, great surgeon, though even our best observers fail to detect them. his greatness was obtained because of his scien- himself called this bony disorder a rare tific and his Paget efforts, his teaching, literary gifts. disease of bone and it still remains such, though I found his life stimulating and in the tremendously some 200 cases have been reported litera- and it constitutes an ideal interesting, indeed ture. Since out the characteris- whose will be of vast benefit to all medical Paget pointed study tics wbich we shall discuss, studies of the past *Read at the meeting of the historical section of the Harvard have re- Medical Society on Jan. 4, 1916. literature and old museum specimens The Boston Medical and Surgical Journal as published by The New England Journal of Medicine. Downloaded from nejm.org at SAN DIEGO (UCSD) on July 8, 2016. For personal use only. No other uses without permission. From the NEJM Archive. Copyright © 2010 Massachusetts Medical Society. vealed many unrecognized cases. Jonathan row cavity, in the new spaces left by the de- Hutchinsoii himself claimed to have found a struction of the old cortex and also on the sur- typical example in a mummy's skull from face of the bones. The new bone at first is Egypt. Yet, that it is still a rare disease is lacking in bone salts, and Paget himself found shown by the fact that of 285,000 out-patient (hat phosporus, calcium and magnesium were cases at the Massachusetts General Hospital, in less than normal in affected areas. Thus the the years 1903 to 1915, only 7 cases are recorded structure, though thickened up and larger, is as definite examples of this disorder. less strong and gives way before the weight of Now, as I have suggested, the clinical picture the body, producing in the spine and lower ex- is pretty definite except in the cases where a tremities the characteristic deformities. single bone is affected. These cases are ex- (Lantern slides were then shown, illustrat- tremely rare and the diagnosis rests entirely ing by photographs of patients and x-rays of with the x-ray findings. It is essentially a separate bones from different localities, all the chronic disease of bone occurring in middle Ol- typical characteristics of the disease. In addi- íate life and usually unattended by any symp- tion the plates from Paget's original case were tom other than those of skeletal changes, except reproduced and finally two portraits of Paget for grumbling rheumatic pains in the parts af- and an engraving of St. Bartholomew's Hos- fected. Paget himself paints the picture pital, made in 1844, were shown.) clearly as follows: "The disease begins in middle age or later, is very slow in progress, II. SIR JAMES PAGET. may continue for many years without influence James was born in on the and other Paget Yarmouth, Eng- general health, may give no in 1814 and died in London in 1899. trouble than those which are due to the land, changes These 85 were filled to of shape, size and direction of the diseased bones. years overflowing always with incessant and it seems Even when the skull is and activities, indeed, hugely thickened, to that a man could work so all its bones altered in remarkable, me, exceedingly structure, and so hard and survive to such the mind remains unaffected. The disease af- continuously yet a old It is for those of fects most the bones of the lower ripe age. interesting frequently long who are connected with the medicine of extremities and the and is you skull, usually symmet- Boston to recall that it was in 1810 rical. The bones that Warren enlarge and soften, and those and Jackson started the foundation of the Massa- bearing weight yield and become unnaturally curved chusetts General Hospital, which received its and misshapen. The spine, whether by first in 1821. to the weight of the skull, patient yielding overgrown Stephen the was a brewer and or by change in its own sink Paget, father, structures, may ship owner, refined, and seem to shorten with increased dor- prosperous, temperate, pub- greatly and generous. The mother was a sal and lumbar the become lie-spirited curves; pelvis may splendid woman of better social Paget wide ; the neck of the femora become position. may nearly of lier father as a real who left but the however speaks gentleman horizontal, limbs, misshapen, as a only the gout, of which he himself remain and fit to the legacy strong support trunk." inherited a most troublesome share. She was a in his first he em- Further, describing case, handsome, strong-willed woman, best remem- phasizes strongly the postural defects. "The bered for her intense love of her children, but shape and habitual posture of the patient were also for her great industry and skill in writing, thus made strange and His head was peculiar. needlework, and painting. Such then were his advanced and lowered so that the neck was parents and boasts he. was well born ! very and the when he held his Paget short, chin, head It was a large family, 17 children in all, nine at ease, was more than an inch lower than the growing to full age, of whom James was the top of the sternum.
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