ARTICLE IN PRESS

Historical Article
THE FIRST DESCRIPTION OF CARPAL
TUNNEL SYNDROME
JAMES PAGET, FRS
Lately Professor of Anatomy and Surgery to the College:
Assistant Surgeon and Lecturer in Physiology at St Bartholomew’s Hospital, London
First published: Lectures in Surgical Pathology delivered at the Royal College of Surgeons of England, Vol. 1. London:
Longman, Brown, Green & Longmans (1853)

Conditions Necessary to Healthy Nutrition

Researched by ANDREAS GOHRITZ and PETER M. VOGT

Klinik für Plastiche-, Hand- and Wiederherstellungschirurgie, Medizinische Hochschule, Hannover, Germany

Pages 42–43 (A description of two cases of median nerve
injury, the second of which involved compression of the
nerve at the level of the wrist)
In the College-Museum (No. 2177) is the hand of a
man, whose case is related by Mr Swan, the donor of the
preparation. The median nerve, where it passes under
the annular ligament, is enlarged, with adhesion to all
the adjacent tissues, and induration of both it and them.
A cord had been drawn very tight round this man’s wrist
seven years before the amputation of the arm. At this
time, it is probable, the median and other nerves
suffered injury; for he had constant pain in the hand
after the accident, impairment of touch, contraction of
the fingers, and (which bears most on the present
question) constantly repeated ulcerations at the back of
the hand.
again, in 1836. His name first appeared in the medical
literature as a student in 1835, when he described
Trichina Spiralis, a minute roundworm that infests
human muscles, usually acquired by eating infected
pork: ‘All the men in the dissecting rooms, teachers
included, ‘‘saw’’ the little white specks in the muscles:
but I believe that I alone ‘‘looked at’’ them and
‘‘observed’’ them’.
In May 1836, he passed the examination of the Royal
College of Surgeons, so qualifying to practice. Paget’s
path towards an academic career in surgery was
unorthodox, as he was not a ‘University man’ and, so,
was unable to obtain a training post. The years between
1836 and 1843 were spent in London lodgings in poverty
on a salary of only 15 pounds per year. His father,
having failed in business, could not give him any help.

Mr Hilton has told me this case: A man was at Guy’s

Hospital, who, in consequence of a fracture at the lower
end of the radius, repaired by an excessive quantity of
new bone, suffered compression of the median nerve. He
had ulceration of the thumb, and fore and middle
fingers, which resisted various treatment, and was cured
only by so binding the wrist that, the parts on the
palmar aspect being relaxed, the pressure on the nerve
was removed. So long as this was done, the ulcers
became and remained well; but as soon as the man was
allowed to use his hand, the pressure on the nerves was
renewed, and the ulceration of the parts supplied by
them returned.

SIR JAMES PAGET (1814–1899) (Plates 1, 2)

James Paget was born in Great Yarmouth, Norfolk,
England. He was one of 16 children of a brewer,
shipowner and chandler. After being apprenticed for
four years to a local apothecary-surgeon, he entered St
Bartholomew’s Hospital, London as a student at the age
of 20 years. He swept the board of prizes in 1835 and, Plate 1 James Paget as a young man.

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