What research owes to the paget tradition
Professor G. Grey Turner, d.ch. (hon.), m.s., f.r.c.s., f.a.c.s. (Professor of Surgery,UniversityofLondon, at theBritishPostgraduateMedicalSchool.)
(Delivered at the Annual General Meeting of the Research Defence Society, on Tuesday, June 15th, 1937.)
"Magistris meis omnibus
Primo Praesentim omnium et summo
Imo De Pectore
Refero Gratias Libellum Dedico."
Stephen Paget founded the Research Defence Society in 1908. But years before that time Stephen Paget was unknowingly preparing himself to be our guiding star, for as a professional man nurtured in a highly cultivated academic society, he was always in touch with men of science and he knew and highly respected those whose life was devoted to the search for truth by experiment.
His father, Sir James Paget, was always interested in the question of the development of surgery by the experimental method, and in 1881 contributed a very thoughtful article on the subject to the Nineteenth Century. At that time, Stephen was 20 years old and living inLondon, so that he was in close touch with his father's work, and it is almost certain that they talked over the subject together. The article was a clever one and, as illustrating the difficulties of the subject for the humane and educated layman, the author drew attention to the comparison between the pain inflicted in the various types of sport and when animals have to be destroyed for utilitarian purposes with what was sometimes necessary in the course of experiments. He also explained the experimental work that had been done on the ligature of arteries and in many other branches of practical surgery and in a way which could not but appeal to non-professional readers. Sir James summed up the matter very fairly in one sentence when he wrote:
"Speaking generally, it is certain that there are few portions of useful medical knowledge to which experiments on animals have not contributed."
In 1891, the elder Paget was Vice-President and Chairman of the Executive Committee of the Association for the Advancement of Medicine by Research, which did very good advisory work up to the time that its activities were finally merged with those of our own. So that for years Stephen Paget was immersed in affairs of research and came into contact, as Lord Cromer, our first President, put it, with men of "profound learning and lofty aspirations and with a deep sense of the sacredness of the trust which they accepted." Let me say at once that he was the kindest and most humane of men, but with a burning desire to disclose the truth and to relieve suffering, for he loved his fellows. He was intensely sensitive and hated to give pain and these qualities, like many others which he displayed, were inherited. In their early days his parents lived in the Warden's house at St. Bartholomew's Hospital, and it is recorded how terribly his mother was distressed by the sounds of suffering which reached her from the old operating theatre in the pre-anaesthetic days. Then there is the story of his father who spoke of the misery of sitting through a dinner party when he felt that he had done wrong in the management of some case.
It is rather significant that Stephen's very first piece of published writing was "A short account of the Act for the better prevention of Cruelty to Animals," which was published in 1891. In 1899 came his book "Experiments on Animals with an Introduction by Lord Lister," and this went through at least three editions. Then followed "The Case against Anti-vivisection" and "What we owe to Experiments on Animals," both published in 1904. Clearly, when the question of a Society for the Defence of Research came up here was the man and it was generally felt that there was no other person for well suited to be its guardian angel. After nearly 30 years of usefulness, it seems a very proper thing review the history of the formation of the Society and to ask ourselves why it was founded. The answer to the latter question was very well put by a writer in the Observer at the time of the formation of the Society, who wrote: "... when it is one man's business to propagate a delusion and nobody's business to destroy it, Truth is apt to find herself more than usually hampered.''
It is only necessary to remind my hearers that the Society really arose out of the work done by a Committee, over which that distinguished physiologist, Professor E. H. Starling, presided, in preparation for the Royal Commission on Vivisection of 1906. In order that the case for research workers should be properly put, it was necessary that the aspect of men of science should be presented thoroughly and conscientiously and with as little overlapping as possible, and for that purpose the ground had to be thoroughly prepared and it was to get up their case so to speak that Professor Starling's committee was formed. This was really a big under-taking for the Commission sat for no less than 18 months, the number of questions put and answered was 21,701 and there was a delay of four years before the report was published. Having done its work so thoroughly, it was felt to be a very great pity that this authoritative body should be allowed to dissemble without establishing some machinery to carry on its useful watchful labours and to interest the public, both lay and professional, in its work. At a meeting held at the house of Stephen Paget, 70,Harley Street, on January 27th, 1908, it was therefore agreed to form the Research Defence Society. That meeting was attended by several leaders in the profession, including among others, Professor Cushny (in the chair), Dr. Beevor, Dr. Henry Head, Sir Victor Horsley, Sidney Holland and Stephen Paget. The body was later enlarged and became the first Committee of the new Society, with Lord Cromer as President and Stephen Paget as Secretary. From that time up till his death in 1926, Paget devoted a large part of his time and tremendous activity to its affairs. In 1913, the Journal of the Society, The Fight Against Disease, was established and has been carried on up to the present time. Until his death, Paget was the Editor, and under his guidance its motto might have been "Ring out the false, ring in the true" (Tennyson), for he never missed an opportunity of contradicting any false statement made by those opposed to research. It is fascinating to look back through its pages and to trace the activities of our Society through the intervening years. Doubtless many others gave notable service but it is universally admitted that no one played so prominent and exacting a part, and to no single person has the Society ever been so much indebted.
Quite naturally, many may ask who was this Paget whose name is evidently so well worth keeping before us? The main facts of his life are easily told. He was the youngest of the four sons of Sir James Paget and was born in 1855, during the years that his distinguished father was struggling for recognition in the surgical world ofLondon. Stephen was educated at a private school, the St. Marylebone and All Souls' Grammar School, situated in Regent's Park just at the top of Baker Street, and later at Shrewsbury, where he stayed four years, acquiring a sound knowledge of Latin and Greek and general literary culture. Afterwards he went up toChristChurchatOxford, where he took his degree in 1878 with a second class in Greats. His brother, the late Bishop Luke Paget, told me that Stephen loved every minute of his life atOxford. He was one of a small set of very pleasant men, literary, artistic and musical but in full contact with the life of the College.
Stephen was the only one of the family to follow his father's profession and duly qualified in Medicine and became a Fellow of theCollegeofSurgeonsin 1885. For the customary period he acted as House Surgeon to Sir Thomas Smith at St. Bartholomew's Hospital. Bart's never had a more devoted son and many of Stephen's essays deal with the fullness and happiness of his life there. He was later Assistant Surgeon at theMetropolitanHospitaland Surgeon to theWestLondonHospitalfrom 1888 to 1908, and from 1896 he was also in charge of the Ear, Nose and Throat Department at theMiddlesexHospital. In 1910 he resigned his hospital appointments and largely gave up private practice. During most of this time he lived inHarley Street, where he practically kept open house for his students and other young people, for he was most hospitable. These various capacities bring us up to the beginning of the War.
In October of 1914, Paget wrote that in all probability the Society would for a long time be almost out of work, whereas events proved that the officers of the Society were to be more hard worked than ever. Soon it was suggested that lectures dealing with pioneers in the profession, like Ambroise Pare, Pasteur, Lister and Miss Nightingale, might be of great value and might be a set off to the more serious occupation of the times. The Secretary was most active in this way and delivered a large number of such lectures. But something more important was to come, and when later on there was an intensive campaign led by misguided persons against anti-typhoid and other methods of inoculation for our soldiers, the Society felt that it was time to act. A short leaflet was issued explaining the nature of the protective treatment and giving instances of its value. This leaflet was largely distributed to those who were likely to be involved in the War and it was considered of such outstanding merit that no less than 316,000 copies were distributed throughout the various commands. Later it was translated into French and issued to those Belgians who were temporary refugees in this country. With the approval of the War Office, the Honorary Secretary delivered very numerous lantern lectures to troops in training. Sometimes there was such great demand that the lecture had to be repeated twice on the same occasion and at one camp no less than three times. Between January 5th and March 31st, 1915, Paget delivered no less than 38 of these lectures at places as for apart asOxford, theChannel Islandsand Harwich. This was very hard work and eventually resulted in a breakdown of health, which necessitated him taking a period of comparative quiet for purposes of recuperation.
During 1916 and 1917 he went to Petrograd in charge of theAnglo-RussianHospital, but there his health seriously failed and he was reluctantly compelled to give in, though he struggled on with his work at home until 1918 when he went down to live in the country at Limpsfield, inSurrey. From then, for another eight years, he worked hard for the Society, attending to every detail of its organisation and affairs. He also did a great deal of literary work and in this way kept up the unequal struggle against ill-health, until release came on May 8th, 1926. He was ideally happy with his wife and was the father of two daughters, and as Nature said when he died:
"To her and their two daughters medicine owes a debt of gratitude. Their loving care enabled him to devote all his time and energies to the great object of his life—the freedom of research."
But these few facts convey an insufficient idea of the manner of the man. Stephen Paget was beloved by his colleagues and was always most helpful and courteous to everyone with whom he had dealings. He loved the truth and anything unrighteous gave him pain. He was artistic and intensely musical, and it is said that he wept for joy when he first listened to a full orchestra. Music meant a great deal to him. He was almost untaught and did not play from notes, but his playing by ear was wonderful, strong and faultless. Loud, bad noises or music out of tune made him sad. In many-ways he was an idealist and some actions which he took, and which many looked upon as thoroughly unpractical, were really prompted by this side of his personality. It is recorded for instance that at the time he was House Surgeon at Bart's he sat up all night with a little girl dying from hopeless peritonitis. Nothing could be done for her, but he just felt it to be his duty to be by her side. During the same period, he sucked out the mucus from a blocked tracheotomy tube in a case of diphtheria and it was only by a merciful chance that he escaped the infection. He was entirely unselfish and was always ready to take the blame that more properly belonged to others. Although the verdict was a complete vindication for him there can be no doubt that he was terribly distressed about the legal action in which he was involved while surgeon at theWestLondonHospital. Nevertheless, he bore no malice against the relative of the patient who brought the action, and probably comforted himself by remembering what his father said about the undeserved blame meted out to members of the profession being much more than counter-balanced by the undeserved praise.
Stephen was a beautiful writer, a first-rate organiser and a very good speaker, though too impulsive and eager to be a polished orator. I can remember so well when I first heard him lecture atNewcastle-on-Tyneas long ago as 1909. Then he was slight and rather thin, with sharp features and an intensive style. As he talked about his beloved Pasteur he warmed to the task and was obviously putting his whole soul into the effort to bring the many facts of the life of that great scientist before his audience. He was burning with the desire to unveil the truth and to lay bare the achievements of the pioneer, who through his researches had brought medicine to a state in which it could offer enormous benefits to the community. Paget's object was always to see fair play, to put the real facts squarely before his hearers and to inform them of what was often unknown and ill-understood. In every way he was not only a born teacher, but was fired with enthusiasm for his task and had something of the zealous driving force of a Savonarola.
As an operating surgeon he was not especially gifted and he was certainly much too sensitive and much too delicate in constitution for the stern wear and tear of the rough and tumble of a surgeon's life. But in spite of this he was somewhat of a pioneer, for the work that he did on the strictly professional side broke new ground and his book on "The Surgery of the Chest," published in 1896, was one of the earliest to deal with that subject. It is an octavo volume of 440 pages with two appendices and 12 plates, and with a very beautiful dedication, which I have put as a heading to this lecture. "A Collection of Essays for Students," published in 1896, presents sound teaching, and is written in a delightful style strangely like his father's similar contributions. It was just the same with his papers on "Tumours of the Palate" and on "Parotitis." After he had given up general surgical work he took up the treatment of deformities, especially about the face, by the then novel method of the subcutaneous injection of paraffin, and with great enthusiasm. But it is no secret that he disliked much of the operative work and that he was temperamentally ill-suited for those sudden emergencies with which any surgeon may be called upon to deal.
It will never be known how much else Stephen Paget contributed to magazines and the Press, but there can be no doubt that his output over many years was large and important. A list of his published works shows his great industry and may well be put here:—
The Published Writings of Stephen Paget, 1855-1926.
A Short Account of the Act for the Better Prevention of Cruelty to Animals. 1891.
The Surgery of the Chest. 1896.
John Hunter—Man of Science and Surgeon. 1897.
Ambroise Pare and His Times. 1897 (and later reprinted).
Essays for Students. 1899.
The Memoirs and Letters of Sir James Paget. 1901.
Selected Essays and Addresses of Sir James Paget. (Edited) 1902.
The Young People by One of the Old People. 1906. Confessio Medici. 1908.
The Faith and Works of Christian Science. 1909.
I Wonder, or Essays for Young People. 1911.
Another Device : the Faith and Works of Christian Science. 1912.
The New Parents' Assistant. 1914. "
Essays for Boys and Girls: a First Guide towards the Study of the War. 1915.
I Sometimes Think: Essays for Young People. 1916.
Life and Work of Sir Victor Horsley. 1919.
Henry Scott Holland : Memoir and Letters. 1921.
Anti-Vivisection Refutations :Experiments on Animals, with Introduction by Lister. 1899. (3rd Edition 1906). The Case Against Anti-Vivisection. 1904.
What we owe to Experiments on Animals. 1904.
For and Against Experiments on Animals 1912.
Pasteur, and After Pasteur. 1914.
I Have Reason to Believe. 1921.
With J. M. C. Crum : Francis Paget, Bishop ofOxford. 1902.
With Sir N. Moore : History of the Royal Medico-Chirurgical Society. 1905.
With C. Thompson : A Memoir of Henry Lewis Thompson.1905. (Published in H. L. Thompson's "Four Biographical Memoirs on Wesley and Others.")
Also several papers in the Medical Journals, very many pamphlets and articles for the Research Defence Society and numerous communications published anonymously in magazines and in the Press.
In everything that Stephen Paget did we find some evidence of the influence of the family tradition with which he was peculiarly and intimately associated throughout his life. Stephen was immensely influenced by the example of his parents with whom he was privileged to remain in close association for over forty years. He was also House Surgeon to Sir Thomas Smith, who had been his father's last apprentice and favourite pupil, and was known for his humble-mindedness and devotion to duty. His wife was the daughter of one of his father's best pupils, Dr. Edward Burd, ofShrewsbury, to whom his son-in-law charmingly dedicated his life of John Hunter. Stephen was also closely associated with his brothers, who were all gifted men devoted to the same tradition. To get an idea of what this tradition meant, we must review the main facts of his father's career.
James Paget was one of the best known of theLondonsurgeons of the mid-Victorian era and one of the best beloved of all time. He was the youngest of the nine surviving children of the seventeen which were born to his parents. His own father had been a brewer atYarmouth, a good business man, prosperous, hospitable and so much held in esteem that it followed him into adversity. But his mother was the crowning glory of his parenthood for she was a woman of iron will and grim determination, who lived for her family, but withal artistic and musical. As a boy, James Paget had a hankering for a life at sea, but he was finally apprenticed to a local surgeon and thus began his great career in the profession. The picture, which he has left us of his apprenticeship days gives a good insight into that sort of life for he did the dispensing, kept the books, and attended to the country folk who dropped in to be bled, usually on market days. But it gave him the opportunity of getting familiar with the surrounding country and of acquiring a sound knowledge of botany and natural history, which proved a good training in accurate observation.
When his indentures were completed, he came to London to " walk the hospitals," as was the custom of those days, and he records how he spent fifteen starving hours on the outside of the coach on the journey. He was entered at St. Bartholomew's Hospital, but as he was not able to afford the 500 guineas, which was usually-paid by the articled pupils and as he had not been up at the University, he was rather alone and might have carried on in obscurity had he not attracted attention by winning all the prizes during his first year. Even in those early days he showed his intuition for research for he not only saw, but observed and examined some curious little specks occurring in the muscles of one of the subjects in the dissecting room, and thus was the first to describe the entozoon now known as the Trichina spiralis. It is true that Richard Owen, of the Royal College of Surgeons, supplied the name, read a paper on the subject and took the credit for the discovery.
After obtaining a qualification he was very doubtful as to what his future course should be, but he decided to stay on inLondonin the hope that he might make a success and there the grim determination of his mother came to his aid, for his position could not have been more unfavourable. Things were bad at home, his father could ill-afford to help, and very soon it was necessary for the young surgeon to go round to City friends to borrow money to help pay his father's debts. Eventually these debts were settled by Paget and his elder brother, and as showing their character, it is on record that when all were satisfied they hunted up two who had not pressed their claims and saw to it that they were paid in full. At that time he lived in lodgings in Serle Street, Lincoln's Inn Fields, and supported himself on what he earned from a small post in the medical school and by writing, but his life was so lonely that he records how much he was startled if he heard a strange step on the stairs when he was burning the midnight oil. In spite of his impecunious position, he had the audacity to become engaged though it was eight long years before he was able to marry. During this waiting time he worked at theCollegeofSurgeons, and by his study of theHunterianMuseumhe laid the basis of that knowledge of pathology which was to make him famous.
At the age of twenty-eight he became the first Warden of theNewResidentialCollegeat St. Bartholomew's. He married a year later and for seven further years presided over the collegiate establishment, and at the end of his Warden-ship he was able to state that "the students have lived as their fathers would have wished them to live." Eighteen years later, with the assistance of two of his friends, he studied the after-career of one thousand of his old pupils, and this research showed that a man in after-life is pretty much what he finds himself as a student and that character counts for more than all else in his career. About this time he was appointed lecturer in Physiology, largely because no one else in the school was competent to deal with this new science. This meant a great deal of work, not only in studying foreign literature, but in actual research with the microscope. It led to the publication of a book on Physiology by one of his pupils, called Kirkes, and this book, under a new name, is still a popular handbook to this day, the 35th edition having been issued this year.
At the age of 33 he was appointed Assistant Surgeon to the Hospital, though at that time he had never done an operation in private practice. Soon afterwards he became Hunterian Lecturer at theCollegeofSurgeonsand there he was able to use the information which he had garnered from the study of the collection while preparing the catalogue. About this time the necessities of his increasing family meant that he had to seek a wider field of private practice and he took the momentous step of moving westward toHenrietta Street, and shortly afterwards to the house in Hare-wood place, which was to become his domicile during all the busiest years of his very full life. He has left on record what it all meant in the way of incessant toil. As he said, his day's work was seldom shorter than sixteen hours and it usually commenced at seven in the morning with operations in some distant part of the town, for nursing homes and private clinics were unknown at that time. After a long morning spent in his consulting room, he would do hospital practice in the afternoon, then more visit to patients in their own homes, and perhaps committee work before returning home to a simple dinner. His evenings were spent with his family around him while he worked at a corner of the table conducting a voluminous correspondence without the aid of a typewriter, making notes of cases, preparing lectures or articles for journals and doing such professional reading as was necessary, and all with punctillious care, and carried on into the small hours of next morning. As he often stated in after-life, he worked to within an inch of his life, and never knew what it was to consider his own comfort or convenience. For a time Stephen became his assistant and secretary, and doubtless imbibed in that way the habits of careful accuracy, which so richly endowed his father. In his memoirs, Paget gives a delightful picture of these evenings, which is well worth quoting:
"In May, 1844, I married and began to enjoy that happiness of domestic life which has already lasted without a break, without a cloud, for 89 years. From this time the ' being alone ' was the being alone with one who never failed in love, in wise counsel, in prudence, and in gentle care of me. With her it was easy to work and be undisturbed by anything going on around me; a habit which I can advise everyone to learn. Her admirable music and her singing, with a matchless gentle voice, and a pure cultivated style, were a refreshing accompaniment to my evening reading and writing, and when these were over she wrote for mc, copying for the Press my roughly written manuscripts, sitting with me till midnight or far into the morning, all alone, or, after a time, with the baby brought down in its cradle and watched and fed.
"I can recommend the plan to all young married people. It is an intensely happy one and may teach them to work in the midst of what are commonly called interruptions. I owe to it that I have never once needed to leave my family in order to work alone or undisturbed ; whether for writing, reading or any similar work, no kind of good music or talking has ever interrupted me. I have thoroughly enjoyed them even while at work."
There is at least one amusing story concerning his nightly secretarial task. He was accustomed to sign his letters " truly yours," but one evening while busy at his desk his daughter sang to his wife's accompaniment. For once his attention was led astray and he became absorbed in the music, for to his dismay he discovered that he had been signing his letters "truly, truly, thine"!
As far as possible, he always had his family about him and he records how on Sunday afternoons they would all walk down to the Hospital where he took the elder children into the wards while the younger ones remained in the Square. Thus from the earliest days, Stephen absorbed the atmosphere in which he was destined to live. At 57 Sir James retired from St. Bartholomew's Hospital for health reasons. He afterwards stated that if he had died before sixty, his wife and family would have been very poor. But he continued to work right on into old age, and at 73 he was made President of the Pathological Society of London, and in his address to that body he urged that practice is full of opportunities for science. For him science meant measurement, careful accurate observation and the collection of facts. At 76 he attended the International Medical Congress atBerlin, at 77 he travelled toRometo see a patient, and at 79 he attended as a delegate the tercentenary festival of theUniversityofDublin. When 80 years of age he delivered an address to the students of his old hospital before the Abernethian Society, where 60 years previously, as a student, he had read his paper on the Trichina spiralis. One extract from that address will illustrate his mature judgment on the opportunities and duties of our work and how much he continued to think of their scientific aspects and importance:
"It is often said or implied that in our profession a man cannot be both practical and scientific; science and practice seem to some people to be incompatible. Each man, they say, must devote himself to the one or the other. The like of this has long been said and it is sheer nonsense."
The next few years brought a gradual diminution of activities, but he continued to do what lay nearest to his hand with all his might and only yielded step by step to advancing years and feebleness. Finally, in 1899, the long struggle came to an end and he passed away in his 85th year, honoured and respected by all. His main characteristics were his capacity and love of work and his vehement and unflagging determination, which gave him no pause and was like one of the forces of nature. He never left off a task until finished and his motto might have been that which Sir Spencer Wells had engraved over the portal of his country house at Golders Green: "Do to-day's work to-day." His indomitable will carried him through six attacks of pneumonia and it often seemed to those about him that he simply would not die. He was punctilious to a fault and as careful of the time of others as he would expect them to be of his own. Hating quarrels, he was conciliatory and whenever possible appealed to the method of arbitration, but when the occasion demanded he would take a stand from which he would not move.
As a medical writer he was without a rival and used the most perfect English with the most beautiful style. He was the best medical orator of his generation, and his Hunterian Oration, delivered sixty years ago, is still looked upon as a masterpiece. Gladstone, himself a great orator, was accustomed to divide mankind into two sorts—those who had heard Paget and those who had been denied the good fortune. But of all his addresses none was more replete with wisdom or more conducive to high ideals than that which he delivered in 1863 at the opening of the winter session of St. Bartholomew's, when he was 49 years of age. It was in praise of the motives of industry and in it occur these striking passages:
"And there is yet another temptation against which I venture to warn you. That which will most harass you in your practice will be the apparent success of dishonesty. You must be prepared for it, for it will not cease in your time, if indeed it ever does."
Then followed these priceless sentences with which he concludes his address:
"The burden of my address is work, lifelong work. And so it is and so it must be; there is no success without it. A kind of success indeed there is without it—the getting of money without honour, and to that there are many ways, but vie do not teach them here."
In his professional work he proved himself a keen observer and his name is associated with at least two diseases, which he first recognised and described, and it is no small testimony to his ability that the clinical descriptions which he wrote of those conditions all those years ago have scarcely been added to since his time. He knew all the important people of his day and frequently entertained distinguished men of all walks of life at his own house. His relations with his fellows were absolutely correct and ideal and he was looked upon as a great leader in his profession and his word was accepted in all matters of difficulty without question.
It is easy to recognise from this brief review of his life what an example he must have been to his children and we can see in him those very characteristics which were so notable in his father and which must have impressed themselves on him from his earliest days. No one recognised this more than Stephen Paget, as is shown by his frequent references to the subject and as witnessed by the dedication which I have used as a heading for this lecture.
But in addition to the association with his father he was in close touch with other distinguished people as well as the members of his family, and it is fair to say that he learned a great deal from these associations. It was at his father's house that he first met Pasteur, at a time when the International Medical Congress met inLondonin 1881. That Congress itself deserves a passing note for it was an outstanding success, largely due to the unremitting work of Sir James, who enjoyed his highest honour as its President. During the long period of preparation, extending over two years, Sir James never missed a single committee meeting. He it was who set a high standard for the Congress when he insisted that first and foremost it should be for the purpose of true scientific work and the advancement of the profession, and that this object should be the watchword. The Congress was attended by many notabilities and in addition to Pasteur there were Lister, Virchow, Koch, Langenbeck, Charcot, Yolkman and numerous others. The President's address on that occasion was remarkable and set a very high and noble standard when he said:
"We had better not compete where wealth is the highest evidence of success; we can compete with the world in the nobler ambition of being counted among the learned and the good who strive to make the future better and happier than the past."
He kept open house all the week and thrice daily entertained a large party of members of the Congress. It was in this atmosphere and in these circumstances that Stephen Paget moved in his own home. Just fancy, what an experience for a young man of 26 and what an opportunity! Of all the guests on that occasion Pasteur was the universal favourite.
But Stephen must have been familiar with Pasteur's work for long before and it is quite plain that this great scientist was one of his lifelong heroes, and a series of letters from Pasteur to his father, who was addressed as Cher et Vénéré maître, were among his treasured possessions. In 1914 he published a little monograph entitled "Pasteur and after Pasteur," and in that he pays a warm tribute to Vallery Radot's life of the master, which, he says, is one of the best of all books and ought to be in every public library. Paget's own book shows his capacity for getting at the heart of a matter, and the reader must be struck with the evident influence of his own early life from the way he picks out the homely touches that enlighten its pages. His reference to the young Pasteur's journey to Paris, forty-eight hours on the outside of the coach in bitter weather, recalls his father's first journey to London, and then the boy's loneliness in Paris and his yearning for his home in the country beside the tanner's burn, as shown by his remark to his companion, " I should get all right if only I could smell the tanyard." And the references to young Pasteur's home life and the family precepts " Work hard, honour your country, put spiritual things above material and other people before yourself, have courage, have patience," are so reminiscent of his own father's example, and there is much else in the same strain. Stephen knew how to pick out the essentials and his epitome of Pasteur's work on fermentation, which you will recall so much impressed Lister and was the basis of his work on wound infection, is very well done.
Incidents which have now become historic in Pasteur's life work were vividly portrayed and the author especially fastened on that famous occasion when at the Academy of Medicine in Paris, one of Pasteur's most weighty colleagues was eloquently enlarging on the causes of epidemics in lying-in hospitals. But Pasteur, who had experimentally investigated the problem, could stand it no longer and interrupted the speaker, declaring from his place, "None of those things cause the epidemic; it is the nursing and medical staff who carry the microbe from an infected woman to a healthy one." As the orator replied that he feared that microbe would never be found, Pasteur went to the blackboard and drew a diagram of the chain-like organism, which we now know as the streptococcus, declaring " There, that's what it's like " (Tenez, voici sa figure). In the words Paget employs one can picture the whole memorable scene when probably for the first time the cause of child-bed fever, which in the world's history has been the cause of such poignant misery, was publicly demonstrated.
But the whole book shows his familiarity with the notable achievements of that outstanding man and is a fine introduction to the great chapter on the progress of science, which will always be associated with Pasteur's name. Stephen shows that he realised the wickedness of the opposition to Pasteur's work and there is little doubt that this knowledge encouraged him in his work for the defence of research in our own country. At the end of the chapter on rabies there is a beautiful description of the memorial to Pasteur in the institute which bears his name inParis. This is quoted from an article in the Spectator in 1910 by an anonymous writer, but it is clearly from Paget's own pen and is a very fine tribute to the master. In many ways this little book is a very revealing exposition of Pasteur's life and times, but it also reflects the influence of James Paget on his son.
As a writer he had a place and a style all his own and for the whole of his life his contributions were numerous and well known. His life of his father, entitled "Memoirs and Letters of Sir James Paget," is a great book which has proved an enormous comfort to medical men the world over. I have heard it described by a most distinguished member of my profession as the surgeon's Bible and I consider it to be so useful and helpful that I always feel it should be by the bedside of every doctor. In its pages will be found, not only the example of a great life beautifully unfolded, but a complete guide to the understanding of the many complicated ethical problems, which are apt to beset us all. This book involved an enormous amount of work for the author, but it was clearly a labour of love. It must always remain one of the classics of biography and proves an exception to the rule that a biography should not be written by a near relative. Stephen's modesty and his affectionate admiration of his father are alike brought out in the preface, when he writes: "But for all the good help that has been given, the book is not worthy of his memory." Three years after his father's death Stephen republished a collection of his essays and addresses, and in a short preface he shows the affection and regard, not only which he himself felt for his distinguished parent, but which he expected others would naturally feel about him:
"... There is indeed nothing more here than such a selection of Sir James Paget's writings as any one of his pupils might wish to have made in honour of him and for love of him."
The memoir of his father placed medical biography on such a high plane that it must have been difficult even for Stephen to follow, but nevertheless his "Life of Sir Victor Horsley" is a most successful account of another great exponent of research and all that it means. This was a difficult task, for Horsley was a man of very strong views with which Paget was often not in agreement. This book especially appealed to me for I had known Sir Victor for a good many years. He was extremely kind to me when I first paid a visit toLondonas a mere lad, and I was fortunate enough to see him at work in his laboratory, in the wards of his hospital, and in the operating theatre. When later on the War took us both overseas he most kindly looked me up inEgyptand we were associated inMesopotamia, where it was my sad privilege to follow his cortege to the grave one terribly hot evening in July of 1916. He was a remarkable personality, one of our great men and with the warmest and kindest heart imaginable.
There are many other works which, were remarkable in various ways. His life of John Hunter in the Masters of Medicine series, published in 1897, is also a perfect piece of biography. It was dedicated to his father-in-law and has an introduction by his father, then eighty-three years old, in which he praises the Hunterian method of careful observation and the correlation of observation and experiment. It is a most admirable book, complete, accurate and fully documented, but withal charmingly written and delightful to read. His "Confessio Medici" is one of the most remarkable books that have ever been written by a doctor. It was published in 1908, the year of the foundation of our Society. Paget was then fifty-three and had eighteen more years to live, but though written at a comparatively early age, it expresses the wisdom garnered from his most active professional years. There is little doubt that this series of essays was a self-revelation, many are introspective and not a little sad, but they are nearly all crammed with wisdom presented in a most attractive style. The very titles of the chapters are most suggestive—" The Discipline of Practice," "The Spirit of Practice," "Wreaths and Crosses of Practice "—and are the expression of his own experiences in the most exacting of professions. In one chapter of just 14 pages, entitled "A Good Example," he gives a wonderful account of one of his heroes, the French surgeon, Ambroise Pare, and it might be read and reread with ever increased profit by all doctors and nurses. But the influence of his father runs through the whole book and the story of his last days in a chapter entitled "The Very End” is a fine piece of writing. Many of our profession have derived great comfort from the Confessio and I range myself with those who will always be grateful to its author. His "Ambroise Pare and His Times" was an early and not quite so successful effort, published in 1897, but it shows his admiration for the great sixteenth century surgeon of war and peace. It must also have pleased Paget in that it gave him an opportunity of dedicating the book to his old chief and father's friend and pupil, Sir Thomas Smith. Through the written word Paget was a great general educationalist, and between1906 and 1917 he published half a dozen works for the guidance of young folks through their parents. These books, entitled " I Sometimes Think," " I Wonder," " The Young People," " The New Parents' Assistant" and some others, deserve to be better known and I predict that they will be rediscovered and more appreciated in the future than they have been hitherto.
I have acknowledgments to make to several friends who have supplied me with material for this lecture. To all I am much indebted, but especially to the late Bishop Luke Paget, our founder's elder brother, who died only a few weeks ago. In his own chosen sphere Luke Paget worthily upheld the family tradition and he was intensely devoted to the memory of his brother with whom he shared the greatest veneration for his father. I have the most vivid recollection of an occasion when Bishop Paget, then 81 years of age, came down to the Children's Hospital at Shadwell in his old diocese at 9 o'clock one winter night to deliver an address to nurses and doctors on " Sir James Paget at Home."
In reviewing the long history of scientific research one is struck by the fact that it has often sadly lacked protectors, for the workers have been so intent on their tasks that only very few have bestirred themselves either in their own defence or that of their fellow labourers. It is a very fine thing when someone, not actively engaged in research, puts on the armour and, like the knights of old, acts as champion for his maligned fellows. Such a one was Stephen Paget and research in its widest sense has every reason to be grateful to his memory. His own fine attributes were largely derived from his notable lineage. His father was constantly engaged in some sort of scientific enquiry and was steeped in the history of surgery and knew what the experimental method had done for the art, which he so much adorned. Furthermore, he was so trusted and respected that his statements on these matters, as on any professional subject, were taken as authoritative. During his lifetime he did much for the promotion of research, but nothing more valuable than the stimulus which he gave to his son, for his example fired the young man with his own indomitable ardour from which our Society has so greatly profited.
In conclusion, may I commend to you what the Pagets have done for research in their own time and for posterity.